Banner

06
Apr

Statins and Alzheimer’s

Statins have been in the news again, with banner headlines in the Daily Express proclaiming “Statins halt Alzheimer’s”.  This is extremely misleading, but may have given false hope to patients and their families.

A small research project on mice bred to produce excess levels of amyloid protein, a symptom of Alzheimer’s disease in humans, suggested that simvastatin could help to control the disease.  However the treatment only worked on young mice which means that it might only be effective in the early stages of the disease, if it worked in humans at all.  Two recent peer-reviews of other research into the effects of statins on Alzheimer’s in humans have discovered no improvement in patients.  Much more research will be needed to prove whether statins could really help in the early stages of the disease.

Dr Simon Ridley, head of research at Alzheimer’s Research UK, put the study into context in a statement for the NHS Behind the Headlines site. He said: “People should view the results with caution until further research has teased out how simvastatin might be working in these mice, and more importantly, until there is any significant new clinical trial data in humans.”

As a Locum GP, sadly, you may have to explain to your patients and their families that the papers have got it seriously wrong and that statins are unlikely to be of any benefit to humans suffering from Alzheimer’s.



Read More...

Published Date: 6th April 2012
 Category: health care, health news
Tags: , , , , , , |
22
Mar

Pain relief during labour

Recent reports in the Daily Express and Daily Mail announced that a study had proved natural pain-relief methods were useless during labour, but they somewhat over-simplified the findings of the study.

The report, by the Cochrane Collaboration, drew together the results of several previously published studies of pain-relief during labour.  The report said that some methods had been proven effective, some might be effective but needed more research to give true results, and that other methods had not been studied sufficiently to say whether they were effective or not.

There is enough evidence on CSEs and epidurals to say that they definitely work and that CSEs work faster than epidurals.  Entonox and other inhaled analgesics also come into this category, although fewer studies have been done on their effectiveness.  However all of these methods have their drawbacks, including vomiting from gas and the increased use of forceps and ventouse interventions to facilitate birth following epidurals.

Under the “might be effective” heading come water births, relaxation techniques, acupuncture, massage, non-opioid drugs such as NSAIDs and local anaesthetic nerve blocks.  New mothers have reported good results from all of them, with massage apparently the least effective. These methods reduced the need for forceps or ventouse interventions, while acupuncture also reduces the number of caesarean sections.  They also cause fewer problems than Entonox and epidurals.  However there has not been much research into the more natural methods and the advice has to be “they work for some people”.

In the third category, where insufficient study has been done to reach an informed conclusion, come hypnosis, bio-feedback, aromatherapy, intramuscular opioid injections and TENs machines.  Much more research is needed on all of these before patients can definitely be told that they are effective.

As a locum GP, the report leaves your options open when giving advice to expectant mothers.  If total pain relief is required CSEs are the most effective method, despite their drawbacks; if a more natural birth is what the parents want then acupuncture, relaxation and birthing pools all seem to work well.  It should go without saying that even if a woman starts labour with a more natural form of pain relief, the option to move on to stronger methods will always be there if necessary.



Read More...

Published Date: 22nd March 2012
 Category: health care, medical locum agency
Tags: , , , |
07
Mar

The NHS Bill: the story so far.

The NHS Bill which is currently going through Parliament is causing considerable discussion, not to say alarm, among GPs and other medical professionals in England and Wales.  Most branches of the NHS seem to be against the proposals.

It is undoubtedly the case that the NHS could run more efficiently and that cost savings could be made.  The problem is to achieve the changes without adversely affecting patient care, both in hospitals and in the community.

Proposals to pass elements of the healthcare budget to local councils are causing the most alarm. The newspapers are full of stories that the money will be used to pay for such things as damp-proofing the homes of the elderly to prevent cold-related illnesses, or filling in pot-holes in the road to prevent accidents that would have to be treated by the NHS.  How true that is is anybody’s guess.  What is true is that local authorities will have less intimate knowledge of the health service than GPs and local hospitals.

The current Bill, it is generally agreed, is a mess.  It has been amended so much that – like so many bad laws before it – it will probably make the situation worse if it is ever passed.  Healthcare professionals and many MPs, even in the Coalition parties, recognise this and are calling on the Government to withdraw the Bill.  However David Cameron sees the Bill as a vital step in his drive to lower Government spending, and it is unlikely that he will do a U-turn at this stage.

The story isn’t over yet.  Discussions and arguments continue.  All that GPs, locums and other healthcare staff can do is watch and hope that sense will prevail.  We will be posting further comment as the news unfolds; watch this space.



Read More...

Published Date: 7th March 2012
 Category: health care, health news
Tags: , , , |
20
Feb

Can chemotherapy be used safely during pregnancy?

Cancer during pregnancy means compromising the health of either the mother or the foetus – or so we used to be told.  Now it appears that treatment during pregnancy may be safe for both parties, as long as it is not undertaken during the first 12 weeks of pregnancy.

A recent cohort study on subjects in cancer referral clinics in Belgium, The Netherlands, Canada and the Czech Republic followed children born to mothers who had had chemotherapy during pregnancy.  The study considered both pregnant women undergoing chemotherapy at the time of the study and children born before the study commenced, so the children ranged in age from 18 months to 18 years. None of the treatments had started during the 1st trimester.  The 70 children were initially followed for 22 months and will be re-assessed later.

All the mothers had been treated using various forms of chemotherapy; some had also had radiotherapy and/or surgery.

The children were examined on their general health, brain and heart function, hearing and cognitive development and compared to national norms for children of similar ages.  Most of those assessed were born prematurely (average 35.7 weeks) and received lower than normal IQ scores, which suggested to the researchers that planned premature delivery was unhelpful to the babies’ development.

Some of the children showed higher than average behavioural problems, which could point to subtle effects of chemotherapy on neurodevelopment.  Other health scores were within national norms, suggesting that cancer treatment is on the whole safe during 2nd and 3rd trimester pregnancy and need not be delayed, risking the mother’s health in an attempt to protect the unborn child.

Clearly a study group of just 70 children does not give a conclusive result, and the study is continuing with a wider sample which will also consider the longer-term effects of maternal cancer treatment on the health of the children.  However the results from this limited study seem largely positive for both mother and child.



Read More...

Published Date: 20th February 2012
 Category: medical locum agency
Tags: , , |
07
Feb

Vitamin D – Nature’s cure-all?

Vitamin D has been in the news recently. In one report it was touted as the “cure” for infertility, while another announced that a quarter of UK toddlers were in danger of developing rickets due to a lack of Vitamin D. Is there any truth in either allegation?

Researchers in Austria considered all the published studies on the effect of Vitamin D in both male and female fertility and concluded that the vitamin does play a part in biological processes involved in sperm and ovary cells and that it could affect levels of sex hormones.

However the Daily Mail’s assertion that the cure for infertility is a holiday in the sun is overstating the case: the best conclusion is that there may be some connection between human fertility and Vitamin D levels. Many of the studies considered by the Austrian team used animals, not humans, and several studies contradicted each other, so the picture is far from clear.

One area where Vitamin D has been proven as beneficial is bone health, and a lack of the vitamin is definitely prejudicial. Without an adequate supply bones become thin and misshapen. Rickets is a condition involving softening of the bones in children, leading to deformity (typically bow-legs); in adults, bone softening is known as osteomalacia and causes pain and muscle weakness. Rickets is on the rise in the UK, but is still rare and certainly not at epidemic level as suggested by some newspaper reports.

Vitamin D also helps regulate levels of calcium and phosphate in the body, cell growth, inflammation, neuromuscular and immune function… the list goes on. Research is still being carried out into the – possibly many – other functions Vitamin D may be responsible for controlling. It is recognised as vital to general health.

The best source of the vitamin is through the skin from UVB rays in sunlight, as long as care is taken to avoid sunburn. It is hard to obtain enough Vitamin D purely from the diet (the best sources are oily fish, eggs and cheese), but it is added to many foods including baby-milk formulas, some breakfast cereals and soy milk.

Supplements are recommended for nursing mothers, small children, and those who cannot absorb the vitamin through their skin, such as the house-bound and people who cover their skin for cultural reasons.

Health professionals are being encouraged to offer advice on Vitamin D supplementation to those at risk, to avoid the largely preventable health problems associated with lack of the nutrient. Doctors should also be encouraging their patients to spend time out of doors, absorbing the vitamin naturally and effectively through their skin whenever possible.



Read More...

Published Date: 7th February 2012
 Category: health care, health news
Tags: , , , , , |
31
Jan

Could statins help breast cancer patients?

You may have seen reports in some newspapers recently that researchers have discovered a possible link between statins and cancer treatment. The Daily Express, for example, reported that statins had “been shown to block the growth and spread of tumours” and that they “could be the key to beating cancer”. Your patients may want to know how soon they can start being treated with statins for their cancer.

However, the answer is not quite so straightforward. The research, which was carried out by scientists at Columbia University and other centres throughout the USA, Japan and Norway, concentrated on a very distinct form of breast cancer.

The researchers found that a mutated form of the p53 gene produces an abnormal form of protein which encourages the development of tumours, whereas the healthy gene prevents them. They investigated altering the mutated form of the gene so that it no longer promoted the growth of tumours, and also using the mutated form in healthy cells to see whether it would encourage the development of cancer in them.

They discovered that the same biochemical sequence that led to cells becoming cancerous was also involved in the creation of cholesterol, which suggested that statins could be useful in preventing the development of the cancer. According to NHS sources (www.nhs.uk/news/) the researchers discovered that simvastatin “reduced cancer cell growth and increased cancer cell death to an even greater extent than interfering with the gene mutation alone”.

The research was all laboratory-based, using cultures generated from breast cancer tumours containing the mutant p53 gene. Tests were also performed on mice, but no human testing has yet been undertaken. This research was just an early step in the process of investigating the link between statins and the treatment of a specific type of breast cancer. Further studies and clinical testing will be required both on breast cancer and on the possibility of using statins to treat other forms of cancer, and it will take several years before statins could be licensed for use in cancer treatment.

There is no evidence so far that the use of statins by patients with high cholesterol will reduce their risk of developing cancer.

The NHS says, “This study provides exciting, if early, evidence of a potential role for a widely available drug in the treatment of cancer. … However, many questions remain unanswered, and it is not possible to say as yet whether statins or related drugs will ultimately be useful as cancer treatments”.

Sadly, your patients have a long wait ahead of them.



Read More...

Published Date: 31st January 2012
 Category: health care
Tags: , , |
17
Jan

Could processed meat cause pancreatic cancer?

Researchers from the Karolinska Institute of Sweden have posited the theory that eating processed meat could cause pancreatic cancer. They considered the results of 11 studies in reaching this conclusion. Their findings were published in the peer-reviewed British Journal of cancer and, with varying degrees of accuracy, in the Press, including the Guardian, the Daily Mail, the Daily Express and BBC News. Are the researchers right and, if so, what does it mean for your patients?

The research was carried out with funding from the Swedish Cancer Foundation, and investigated earlier studies that included 2,307,787 people in the USA, Europe and Japan, of whom 6,643 (

The studies considered by the researchers variably measured other possible factors in the development of pancreatic cancer, such as smoking, physical activity, age, BMI, a family history of cancer, other health problems such as diabetes, or other dietary considerations, making a true relationship between these factors and pancreatic cancer hard to discover.

There were also discrepancies between the studies in how they measured meat consumption: some lumped all red and processed meat together, others divided the two, while yet others had individual figures for beef, lamb, pork etc., so again the correlation is hard to prove. Amounts eaten were taken from participants, who may well have estimated rather than measured the amounts consumed, so the figures may not be 100% accurate.

The Karolinska Institute researchers did not feel that their results were conclusive, and suggested that further studies were necessary to establish without doubt a link between processed meat consumption and pancreatic cancer in both sexes, and between red-meat eating and pancreatic cancer in men.

,p>The NHS (www.nhs.uk/news) says: “There was no overall association between red meat and pancreatic cancer, and the researchers only found a risk for men. There was an overall association between processed meat and cancer, but no separate risk for men and women. Therefore, interpreting whether there is a true risk – and with what food in particular – is difficult”. They pointed out that the absolute risk of developing pancreatic cancer is in any case limited, so “even if the figure of 19% is accurate it is a 19% increase on a small risk of this cancer”.

The best advice for your patients is that the link with pancreatic cancer is not conclusive but that they would be safer eating a balanced, healthy diet. The Department of Health recommends that people who eat more than 90 gr per day of either red or processed meat should reduce their intake to 70 gr at most, as these foods are often high in saturated fat and salt.

Locum jobs for GPs and Hospital doctors



Read More...

Published Date: 17th January 2012
 Category: health news, medical locum agency
Tags: , , , |
14
Dec

NHS Direct App a big hit with Users

NHS Direct’s mobile phone app has become a big hit with users, providing health advice to over one million patients in its first six months.

The app was released for smartphones at the end of May 2011. It immediately flew to Number One spot on the iTunes list of top free apps. Demand was so great to begin with that the download service had trouble coping.

Chief operating officer Ronnette Lucraft said: “More people now access NHS Direct’s services online than they do over the phone and it is our aim to continue to provide our services in places that patients and the public will find useful and convenient.

“The mobile app is a more discreet and less embarrassing way of seeking health advice for sensitive issues in public or crowded places. We know that people also value the ability to request a call-back from a nurse if it is required, which is why the app is fully integrated with our phone service.”

The app includes access to 40 health and symptom checkers covering a wide range of problems including dental pain, diarrhoea and vomiting, abdominal pain, rashes, back pain and burns. Patients can also get advice about how to relieve symptoms associated with specific conditions such as flu and hay fever. There’s also the opportunity to get more specialist advice on issues such as mental health, contraception, sexual health matters and pregnancy problems.

Users have praised the free app. Vicky Wood from Milton Keynes commented:

“Having a young family, it’s really helpful to be able to access health advice quickly. I’ve used the NHS Direct telephone service before, and I regularly use the online tools when I’m at home, so it was great to be able to access their advice away from home through my mobile. I found the explanations of why I was being asked certain questions really useful, and the function to expand information on certain symptoms meant that I could quickly understand anything I’d not come across before.

“I have found that rashes on the kids can look very different when they first appear to a day or so later, so being able to save the self-care advice onto my phone to refer back to on another day would give me additional reassurance and prevent me needing to seek a second opinion from my GP or walk-in centre.”

Outcomes from the mobile app can include instant on-screen self-care advice or advice on the most appropriate course of action. Patients can save any self-care advice they receive back to the app or email it to themselves so that they can access it easily at a later date. The app is linked to NHS Direct’s telephone service and, if a further assessment is recommended, users will be able to submit their contact details so that an NHS Direct nurse advisor can call them back.

The NHS Direct app is available to download free of charge. The health and symptom checkers that are available through the app are also available online on the NHS Direct website.



Read More...

Published Date: 14th December 2011
 Category: nhs direct
Tags: , , , |
30
Nov

INDEPENDENT ASSESSMENT PANELS

Family GPs could soon be stripped of their powers to write sick notes for long term absentees from work if recommendations in a new government report are adopted.

The government’s ‘Independent Review of Sickness Absence’ report is expected to make a number of far-reaching recommendations to challenge what they describe as “Sick Note Britain.”

It is estimated that 140 million working days are lost to sickness absenteeism each year. 300,000 people leave work each year to claim sickness-related benefits.

Lord Freud, the minister for Welfare Reform, explained the thinking behind the controversial reforms: “The economy loses £15 billion in lost economic output each year due to sickness absence and we cannot continue to foot this bill.”

One of the proposed changes seeks to abolish the powers of family GPs to write long term sick notes and transfer them instead to an Independent Assessment Panel staffed by qualified health professionals.

According to the thinking behind the report family GPs are not best qualified to judge what work people with long term illnesses are capable of doing, and have little incentive to refuse to sign sick notes to patients in their practice.

Instead GPs would be expected to refer patients to a new Independent Assessment Panel when a patient had been off work for four weeks. The state-funded body would then concentrate on assessing whether an employee was capable of work as well as developing strategies to reintroduce those on long-term sick leave back into employment.
The British Medical Association welcomed the proposals: “GPs have a long-term relationship with their patients and it puts them in a difficult situation if they are being asked to tell a patient that they’re wrong and are fit to work,” it said. “GPs are often not best placed to assess what someone can and cannot do. It is far better if a trained occupational health doctor does that.”
Workers leaders were more critical. TUC General Secretary Brendan Barber said: “Unions are concerned that however well-intended this report, there is a danger it will be seized upon by some rogue employers as an excuse to force people back to work before they are good and ready.
“The report also fails to address the huge issue of “presenteeism” where workers come in to work when they should be off sick, despite evidence that this is a major and growing problem in the workplace.”
Dame Carol Black, national director for Health and Work, said: “Sickness absence from work can be unavoidable, but when unduly prolonged it is wasteful and damaging. We believe we have presented an urgent and compelling case to change the current system so that it unashamedly promotes work for those that can.
“If implemented, these recommendations will ensure many more people with health conditions are able to enjoy the benefit of work; far fewer will needlessly lose work and fall into long-term benefit dependency.”

Updated by MP Locums, a Medical Recruitment Agency



Read More...

Published Date: 30th November 2011
 Category: doctor jobs
Tags: , , , |
28
Oct

Renewed Emphasis on Young People and Mental Health

The government’s Chief Medical Officer and the NHS Medical Director are to write to UK   clinicians to remind them of the NICE guidelines which are available to help deal with a range of mental health problems which are affecting children and teenagers.

This follows the recent announcement that the UK government is investing £32 million in psychological therapies, including talking therapies, for children and young people with mental health problems.

One in ten children aged 5-16 years has a clinically diagnosable mental health problem. At any one time, more than a million children will have a diagnosable mental health disorder and mental illness in childhood and adolescence costs between £11,000 and £59,000 per child every year.

Deputy Prime Minister Nick Clegg said: “This investment in children’s mental health is vital. Talking therapies are proven to work, and so we are expanding services to treat children and young people with the tailored care that they need.”

“Mental health must have the same priority as physical health. Giving children the treatment they need as soon as they need it will help ensure that millions of children suffering from a mental health problem will have a fairer opportunity to succeed in life.”

Chief Executive of Young Minds, Sara Brennan, welcomed the announcement: “Children and young people tell us they want increased access to talking therapies, to be centrally involved in decisions about their care and for clinicians to be trained to make these possible. The Children and Young People’s IAPT programme is unique in achieving all the above in one initiative.”

The first phase of the training is expected to focus on cognitive behavioural therapy and parenting therapy.

Earlier this year the Government published its mental health strategy – No Health Without Mental Health – which takes a life course approach, with a focus on early and effective intervention, alongside extending psychological therapies to children and young people.



Read More...

Published Date: 28th October 2011
 Category: doctor jobs, health news, medical locum agency
Tags: , , , |