Common painkillers 'pose heart risk'

29 May 2013 Last updated at 19:40 ET

By James Gallagher Health and science reporter, BBC News

Pills

Two common painkillers, ibuprofen and diclofenac, can slightly increase the risk of heart problems if taken in high doses for a long time, data suggests.

People with severe arthritis often take the drugs, which also calm inflammation, to go about daily life.

The researchers said some patients would deem the risk acceptable, but they should be given the choice.

A study, published in the Lancet, showed the drugs posed even greater risks for smokers and the overweight.

The risks have been reported before, but a team of researchers at the University of Oxford analysed the issue in unprecedented detail in order to help patients make an informed choice.

The group investigated more than 353,000 patient records from 639 separate clinical trials to assess the impact of non-steroidal anti-inflammatory drugs.

They looked at high-dose prescriptions levels, rather than over-the-counter pain relief, of 150mg diclofenac or 2,400mg ibuprofen each day.

They showed that for every 1,000 people taking the drugs there would be three additional heart attacks, four more cases of heart failure and one death as well cases of stomach bleeding – every year as a result of taking the drugs.

So the number of heart attacks would increase from eight per 1,000 people per year normally, to 11 per 1,000 people per year with the drugs.

“Three per thousand per year sounds like it is quite a low risk, but the judgement has to be made by patients,” said lead researcher Prof Colin Baigent.

He added: “So if you’re a patient and you go and sit in front of your doctor and discuss it, you are the one who should be making the judgement about whether three per thousand per year is worth it to allow you, potentially, to go about your daily life.”

He said this should not concern people taking a short course of these drugs, for example for headaches.

However, he did warn that those already at risk of heart problems would be at even greater risk as a result of the high-dose drugs.

High blood pressure, cholesterol and smoking all increase the risk of heart problems.

Prof Baigent said: “The higher your risk of heart disease, the higher your risk of a complication. Roughly speaking, if you’ve got double the risk of heart disease, then the risk of having a heart attack is roughly doubled.”

He said patients should consider ways to reduce their risk, which could include statins for some patients.

Alternative

A similar drug called rofecoxib (known as Vioxx), was voluntarily taken off the market by its manufacturer in 2004 after similar concerns were raised.

There are more than 17 million prescriptions of non-steroidal anti-inflammatory drugs in the UK each year. Two thirds are either ibuprofen or diclofenac.

A third drug, naproxen, had lower risks of heart complications in the study and some doctors are prescribing this to higher-risk patients.

The drug does a similar job to aspirin by stopping the blood from clotting although this also increases the odds of a stomach bleed.

Prof Alan Silman, medical director of Arthritis Research UK, said the drugs were a “lifeline” for millions of people with arthritis and were “extremely effective in relieving pain”.

He added: “However, because of their potential side-effects, in particular the increased risk of cardiovascular complications which has been known for a number of years, there is an urgent need to find alternatives that are as effective, but safer.”

Prof Donald Singer, member of the British Pharmacological Society and from the University of Warwick, said: “The findings underscore a key point for patients and prescribers – powerful drugs may have serious harmful effects.

“It is therefore important for prescribers to take into account these risks and ensure patients are fully informed about the medicines they are taking.”

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Common painkillers ‘pose heart risk’

29 May 2013 Last updated at 19:40 ET

By James Gallagher Health and science reporter, BBC News

Pills

Two common painkillers, ibuprofen and diclofenac, can slightly increase the risk of heart problems if taken in high doses for a long time, data suggests.

People with severe arthritis often take the drugs, which also calm inflammation, to go about daily life.

The researchers said some patients would deem the risk acceptable, but they should be given the choice.

A study, published in the Lancet, showed the drugs posed even greater risks for smokers and the overweight.

The risks have been reported before, but a team of researchers at the University of Oxford analysed the issue in unprecedented detail in order to help patients make an informed choice.

The group investigated more than 353,000 patient records from 639 separate clinical trials to assess the impact of non-steroidal anti-inflammatory drugs.

They looked at high-dose prescriptions levels, rather than over-the-counter pain relief, of 150mg diclofenac or 2,400mg ibuprofen each day.

They showed that for every 1,000 people taking the drugs there would be three additional heart attacks, four more cases of heart failure and one death as well cases of stomach bleeding – every year as a result of taking the drugs.

So the number of heart attacks would increase from eight per 1,000 people per year normally, to 11 per 1,000 people per year with the drugs.

“Three per thousand per year sounds like it is quite a low risk, but the judgement has to be made by patients,” said lead researcher Prof Colin Baigent.

He added: “So if you’re a patient and you go and sit in front of your doctor and discuss it, you are the one who should be making the judgement about whether three per thousand per year is worth it to allow you, potentially, to go about your daily life.”

He said this should not concern people taking a short course of these drugs, for example for headaches.

However, he did warn that those already at risk of heart problems would be at even greater risk as a result of the high-dose drugs.

High blood pressure, cholesterol and smoking all increase the risk of heart problems.

Prof Baigent said: “The higher your risk of heart disease, the higher your risk of a complication. Roughly speaking, if you’ve got double the risk of heart disease, then the risk of having a heart attack is roughly doubled.”

He said patients should consider ways to reduce their risk, which could include statins for some patients.

Alternative

A similar drug called rofecoxib (known as Vioxx), was voluntarily taken off the market by its manufacturer in 2004 after similar concerns were raised.

There are more than 17 million prescriptions of non-steroidal anti-inflammatory drugs in the UK each year. Two thirds are either ibuprofen or diclofenac.

A third drug, naproxen, had lower risks of heart complications in the study and some doctors are prescribing this to higher-risk patients.

The drug does a similar job to aspirin by stopping the blood from clotting although this also increases the odds of a stomach bleed.

Prof Alan Silman, medical director of Arthritis Research UK, said the drugs were a “lifeline” for millions of people with arthritis and were “extremely effective in relieving pain”.

He added: “However, because of their potential side-effects, in particular the increased risk of cardiovascular complications which has been known for a number of years, there is an urgent need to find alternatives that are as effective, but safer.”

Prof Donald Singer, member of the British Pharmacological Society and from the University of Warwick, said: “The findings underscore a key point for patients and prescribers – powerful drugs may have serious harmful effects.

“It is therefore important for prescribers to take into account these risks and ensure patients are fully informed about the medicines they are taking.”


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'First' dementia assisted suicide

30 May 2013 Last updated at 11:25 ET

Dementia brain scanThe brain shrinks in dementia patients

The first reported case of a British person choosing to end their own life at a centre in Switzerland because they had dementia has taken place.

The 83-year-old was thought to be in the early stages of the neurodegenerative disease.

A psychiatric assessment found that he was mentally competent to make the decision.

He travelled to the Dignitas facility in Zurich and reportedly made the choice with the support of his family.

Dementia is the gradual loss of brain function leading to loss of memory and the inability for patients to understand what is happening around them. It affects 800,000 people in the UK.

Further details of the case have not been released, but the family did receive guidance over the telephone from Dr Michael Irwin, a retired GP known as Dr Death for his views on assisted suicide.

Dr Irwin said the man was in the early stages of dementia during which time someone’s “mental competence is still fairly normal”.

He told the BBC: “He knew how the dementia was likely to develop and he did not want to suffer that process himself and also he wanted to make certain that his family did not see him suffer.”

This is not definitively the first case of a dementia patient going down this route, but it is the first time the details have come to light.

Dr Irwin said there was a stronger case for assisted suicide in these patients than those with terminal illnesses. “When you have a chronic debilitating condition like dementia then to me that is a much more serious medical problem, a much greater degree of suffering than someone who has been given a diagnosis of a terminal illness when they’re going to die in a couple of months.”

Dr Peter Saunders, director of Care Not Killing Alliance, said, “This case is hugely alarming and shows that if we were to change the law to allow assisted suicide in this country there would inevitably be further pressure for incremental extension to include dementia patients as is already happening in the Netherlands.

“Vulnerable people would feel constrained to end their lives for fear of being a burden upon loved ones and this pressure would be particularly intensely felt at this time of economic recession when many families are struggling to make ends meet.”

The Alzheimer’s Society said: “No-one with the condition should have to accept a poor quality of life. Instead we need to be driving up standards to ensure everyone can enjoy a good quality of life today.

“And when the time comes, people with dementia deserve a dignified death and good quality end of life care – no less than everyone else.”

Visit the Source Site

‘First’ dementia assisted suicide

30 May 2013 Last updated at 11:25 ET

Dementia brain scanThe brain shrinks in dementia patients

The first reported case of a British person choosing to end their own life at a centre in Switzerland because they had dementia has taken place.

The 83-year-old was thought to be in the early stages of the neurodegenerative disease.

A psychiatric assessment found that he was mentally competent to make the decision.

He travelled to the Dignitas facility in Zurich and reportedly made the choice with the support of his family.

Dementia is the gradual loss of brain function leading to loss of memory and the inability for patients to understand what is happening around them. It affects 800,000 people in the UK.

Further details of the case have not been released, but the family did receive guidance over the telephone from Dr Michael Irwin, a retired GP known as Dr Death for his views on assisted suicide.

Dr Irwin said the man was in the early stages of dementia during which time someone’s “mental competence is still fairly normal”.

He told the BBC: “He knew how the dementia was likely to develop and he did not want to suffer that process himself and also he wanted to make certain that his family did not see him suffer.”

This is not definitively the first case of a dementia patient going down this route, but it is the first time the details have come to light.

Dr Irwin said there was a stronger case for assisted suicide in these patients than those with terminal illnesses. “When you have a chronic debilitating condition like dementia then to me that is a much more serious medical problem, a much greater degree of suffering than someone who has been given a diagnosis of a terminal illness when they’re going to die in a couple of months.”

Dr Peter Saunders, director of Care Not Killing Alliance, said, “This case is hugely alarming and shows that if we were to change the law to allow assisted suicide in this country there would inevitably be further pressure for incremental extension to include dementia patients as is already happening in the Netherlands.

“Vulnerable people would feel constrained to end their lives for fear of being a burden upon loved ones and this pressure would be particularly intensely felt at this time of economic recession when many families are struggling to make ends meet.”

The Alzheimer’s Society said: “No-one with the condition should have to accept a poor quality of life. Instead we need to be driving up standards to ensure everyone can enjoy a good quality of life today.

“And when the time comes, people with dementia deserve a dignified death and good quality end of life care – no less than everyone else.”


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IV Levosimendan Mixed Blessing for Outpatients

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By Todd Neale, Senior Staff Writer, MedPage Today

Published: May 30, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
  • Outpatient IV levosimendan for end-stage heart failure failed to improve functional capacity or quality of life, despite some positive outcomes.
  • Note that levosimendan is an inodilator that, unlike other inotropic agents, does not increase intracellular calcium, and is approved for use in Europe but not the U.S.

LISBON — Outpatient IV levosimendan for end-stage heart failure failed to improve functional capacity or quality of life, despite some positive outcomes, a placebo-controlled trial showed.

The percentage of patients who had at least a 20% improvement on their 6-minute walk test and at least a 15% improvement in scores on the Kansas City Cardiomyopathy Questionnaire — the primary endpoint — was not significantly different between the two groups at either 8 weeks (P=0.82) or 24 weeks (P=0.81), according to Gerhard Poelzl, MD, of Innsbruck Medical Center in Austria.

There was, however, a significant reduction in the secondary composite endpoint of death, heart transplant/ventricular assist device implantation, or acute heart failure after 24 weeks (17.4% versus 35.1%, P=0.037), he reported at the Heart Failure Congress here.

But Aldo Maggioni, MD, spokesperson for the Heart Failure Association of the European Society of Cardiology, which organizes the meeting, cautioned against reading too much into that finding, saying that it could be the play of chance. The trial was not big enough, he said, to definitively assess any effects on clinical events.

But, considering that the trial missed its primary endpoint, “it’s not encouraging,” said Maggioni, who is director of the research center of the Italian Association of Hospital Cardiologists (ANMCO) in Florence.

The prevalence of end-stage heart failure is increasing, Poelzl said, and the costs associated with rehospitalizations are high. It has been thought that repeat, outpatient therapy with inotropic agents could prevent some of the readmissions, but the strategy — when tried with drugs like dopamine and dobutamine — has been associated with excess mortality.

Levosimendan — which is approved for use in Europe but not the U.S. — is an inodilator that, unlike other inotropic agents, does not increase intracellular calcium, according to Poelzl. Previous studies have suggested that it might reduce mortality, although the trial evidence is mixed in terms of survival.

The LevoRep study, which was conducted at 11 centers in Austria, Greece, and Germany, tested whether four 6-hour infusions of levosimendan (0.2 mcg/kg/min) given 2 weeks apart were safe and effective in outpatients with advanced heart failure.

It included 120 patients with New York Heart Association class III or IV heart failure that had been stable for more than 3 months on optimal background therapy. The mean age of the patients was 70 and one-fifth were female. The average left ventricular ejection fraction was 24%.

At both 8 and 24 weeks after the first infusion was given, the percentage of patients who met the thresholds for improvement in the 6-minute walk test and quality of life did not differ between the levosimendan and placebo groups, translating into a missed primary endpoint.

The reduction in clinical events seen at 24 weeks was not seen at 8 weeks.

At the earlier follow-up, the patients receiving levosimendan were significantly more likely to have a drop in N-terminal pro-brain natriuretic peptide (45.5% versus 23.3%, P=0.006), although the benefit disappeared by the later follow-up.

The treatment appeared to be safe, as there was no significant difference between the groups in the overall rate of adverse events (25% with levosimendan versus 16% with placebo, P=0.26). However, hypotension tended to be more common in the levosimendan group (24% versus 14%, P=0.25).

Commenting after Poelzl’s presentation, John Teerlink, MD, of the University of California San Francisco, commended the researchers for a trial that had appropriate enrollment criteria and a well-treated patient population.

One criticism he had, however, was that the infusions were not performed for longer than 6 weeks.

In addition, he said, because the trial missed its primary endpoint — possibly because of small patient numbers — it is unclear how to interpret the finding on the secondary endpoint.

“It was a well-designed and conducted trial. It investigates a very important indication of repeated dosing in outpatients with a precedent of neutral or poor clinical outcomes in prior studies,” Teerlink said. “It raises the intriguing possibility of a clinical benefit of levosimendan and I’m really looking forward to a larger, properly powered, placebo-controlled, randomized clinical trial to further investigate these results.”

The trial was sponsored by Innsbruck Medical University in Austria and funded by an unrestricted grant from Orion Pharma.

Poelzl and two of his co-authors have received lecture fees from Orion Pharma.

Teerlink reported receiving consulting fees and research grants from Amgen, BioVentrix, Cytokinetics, Novartis, and Trevena.

Primary source: Heart Failure Congress
Source reference:
Poelzl G, et al “Efficacy and safety of intermittent ambulatory infusions of levosimendan in end-stage heart failure” HFC 2013; Abstract 287.

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Stroke Network Leads to Better Outcomes

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By Salynn Boyles, Contributing Writer, MedPage Today

Published: May 29, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

  • Stroke care networks save lives and reduce the need for long-term care, a study of one of the largest and longest operating networks confirmed.
  • Note that the implementation of the stroke system was associated with increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit, and antithrombotic therapy.

Stroke care networks save lives and reduce the need for long-term care, a study of one of the largest and longest operating networks confirmed.

In an integrated system of stroke care delivery in Ontario mortality rates 30 days after hemorrhagic stroke decreased from 38.3% to 34.4% after the networks were fully implemented (P<0.001) and discharge to a long-term care or chronic care facility dropped from 16.9% to 14.8% (P<0.001), reported Moira Kapral, MD, of the University of Toronto Institute for Clinical Evaluative Sciences, and colleagues in CMAJ.

The 10-year study included data on 243,287 patient visits to emergency departments (ED) and 163,198 hospital admissions for acute stroke or transient ischemic attack before and after 2005, when the stroke care network became fully operational in Ontario.

The networks are designed to integrate the delivery of stroke treatment across regions to optimize the chances that patients will receive timely, evidence-based therapies even if they don’t live near a designated stroke center.

“After the stroke network was introduced there were clear improvements in the quality of stroke care,” Kapral told MedPage Today. “More patients were treated with optimal stroke care interventions, such as thrombolysis, including clot-busting drugs, and stroke-unit care.”

Kapral’s group used population-based provincial administrative databases to identify all ED visits and hospital admissions for acute stroke and transient ischemic attack from 2001 to 2010.

They assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centers, and on rates of discharge to long-term care facilities and 30-day mortality after stroke.

The proportion of patients who received care at either a regional or district stroke center increased from 40% before 2005 to 46.5% after full implementation of the system (P<0.001). The median time from stroke presentation to carotid revascularization decreased from 50 to 22 days (P<0.001).

Piecewise regression analysis showed a gradual increase in the rate of care at stroke centers before 2005, followed by a significant upward shift in rates in 2005.

And significant increases were seen between 2002 and 2009 in rates for the following (P<0.001 for all):

  • Thrombolytic therapy use: 10% to 27%
  • Neuroimaging: 77% to 93%
  • Carotid imaging: 44% to 68%
  • Care in a stroke unit: 3% to 24%
  • Dysphagia screening: 47% to 57%
  • Antithrombotic therapy: 80% to 94%

By far the biggest improvements were seen at regional and district stroke centers, with little or no change evident at nondesignated centers, the authors reported.

The authors cautioned that “although we observed an increase in the proportion of patients seen at designated stroke centers over the study period, the absolute magnitude of the increase was modest, with more than half of the population receiving care at nondesignated centers even 5 years following the full implementation of the stroke system.”

They suggested that this was the result of the system being designed mostly to facilitate the transfer, or bypass, of those patients most likely to be good candidates for thrombolytic therapy or neurosurgical interventions.

Nonetheless, the decreases would be expected to result in about 200 fewer stroke-related deaths and 300 fewer patients requiring long-term care or chronic care annually, they pointed out.

The researchers conceded that significant regional variations in care persist, and they acknowledged that Ontario’s large and geographically diverse territory has made the implementation of an integrated stroke care network a challenge.

Kapral said increased utilization of telemedicine and other efforts to provide evidence-based therapies to patients not treated at designated stroke centers should improve patient outcomes.

The Ontario Telestroke Program has provided neurologist consultations for stroke patients treated at regional hospitals without stroke centers over the last decade and 30% received thrombolytic treatments.

“Despite our best efforts, there will always be patients who just don’t live close enough to a stroke center to be treated at one,” she said. “That is why networks are especially important in rural and remote areas.”

The study had some limitations. The authors focused on hospital-based processes of care and outcomes and did not have data on longer-term outcomes such as functional status, quality of life, or after-stroke care. Also, the piecewise regression analyses did not account for the potential effects of concurrent interventions.

Still, they concluded that the findings provide stroke support for the ongoing development and implementation of networks to coordinate the delivery of stroke care, and that “future research should focus on identifying the specific components of such systems that are most likely to account for improvements in outcomes.”

The Ontario Stroke Registry is funded by the Canadian Stroke Network and the Ontario Ministry of Health and Long-Term Care.

Kapral reported no conflicts of interest. One co-author reported receiving payments for board membership, lectures, or travel expenses from Boehringer Ingelheim Canada, Bristol-Myers Squibb, Sanofi Canada and Bayer Canada.

From the American Heart Association:

  • Optimize Interdisciplinary Rehabilitation in Stroke

Primary source: CMAJ
Source reference:
Kapral MK, et al “Effect of a provincial system of stroke care delivery on stroke care and outcomes” CMAJ 2013; DOI: 10:1503/cmaj.121418.

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Alzheimer’s Patients Mimic Emotions of Those Around Them: Study

News Picture: Alzheimer's Patients Mimic Emotions of Those Around Them: StudyBy Steven Reinberg
HealthDay Reporter

Latest Alzheimers News

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TUESDAY, May 28 (HealthDay News) — People with Alzheimer’s disease or early thinking and memory problems tend to mirror the emotions of those around them, researchers find.

This transfer of emotions, known as emotional contagion, appears heightened in people with Alzheimer’s and related mental decline, according to the University of California, San Francisco (UCSF) team. And it can be important in the management of these patients, they added.

“Calm begets calm,” said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer’s Disease Research Center in New York City, who was not involved in the study.

Emotional contagion is a rudimentary form of empathy, enabling people to share and experience other people’s emotions, said lead researcher Virginia Sturm, an assistant professor in the UCSF department of neurology.

“It’s a way by which emotions travel across people quickly and even without awareness,” explained Sturm. This process can shape behaviors and cause changes in the brain, she added.

In the early stages of Alzheimer’s disease and in people with mild thinking and memory problems, emotional contagion increases, the researchers found. It is even more apparent in people with dementia, they noted.

“In Alzheimer’s disease and other dementia we think some people may have an increased sensitivity to other people’s emotions,” Sturm said.

“As their memory and thinking abilities decline, it seems this is accompanied by the enhancement of other emotional processes,” she said.

This means that if caregivers are anxious or angry, their patients will pick up and copy these emotions.

On the other hand, if the caregiver is calm and happy, patients will emulate these positive emotions, Sturm said.

“This is a way Alzheimer’s patients connect with others, even though they don’t have an understanding of the social situation,” she said. “In order to manage patients, it might be that the caregivers being calm and happy would go a long way in keeping their patient calm and happy.”

Alzheimer’s disease is an age-related brain disorder that begins slowly and gradually robs people of their ability to lead their everyday lives. In the United States, one-third of the nation’s seniors die with Alzheimer’s or another type of dementia, according to the Alzheimer’s Association.

The study, published online May 27 in the Proceedings of the National Academy of Sciences, involved 237 adults. Sixty-two patients had mild memory and thinking problems and 64 had Alzheimer’s disease. The others were mentally healthy.

Participants took tests to identify depression and other mental health problems and also underwent MRI scans to identify changes in the brain related to emotional contagion.

The researchers found higher emotional contagion in those with mild mental impairment and Alzheimer’s disease, compared with those who did not have these conditions.

This growth of emotional contagion paralleled the increase in damage to the right temporal lobe of the brain, reflecting biological changes in the neural system, the study found.

“The right temporal lobe is important for different aspects of emotion and social behavior,” Sturm said.

Depression was also greater among those with mild mental impairment and Alzheimer’s disease, the study found.

From a neurologist’s perspective, “it is extraordinary that something so complex as emotional perception can be controlled by such a localized part of the brain,” Gandy said.

“Also, classically it has been the frontal lobe damage that leads to emotional disturbance,” Gandy added. “Now we know the temporal lobes can play similar roles.”

MedicalNews
Copyright © 2013 HealthDay. All rights reserved.

SOURCES: Virginia Sturm, Ph.D., assistant professor, department of neurology, University of California, San Francisco; Sam Gandy, M.D., associate director, Mount Sinai Alzheimer’s Disease Research Center, New York City; May 27, 2013, Proceedings of the National Academy of Sciences, online



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Surgery at end of week 'more risky'

28 May 2013 Last updated at 19:10 ET

Doctors during surgeryResearchers looked at all types of non-emergency surgery, from hip operations to heart bypasses

People who have surgery towards the end of the week are more likely to die than those who have procedures earlier on, researchers say.

A British Medical Journal report into non-emergency operations in England, suggests the overall risk of death from such planned procedures remains low.

But it shows “unacceptable” variation in survival rates through the week, a leading body of UK surgeons says.

The government says it is committed to safe care for patients at all times.

Researchers from Imperial College London gathered data from all non-emergency surgery undertaken by the NHS in England in 2008-11.

Looking at some 4 million operations they found more than 27,000 deaths within a month of surgery, putting the average risk of death at 0.67%.

Appropriate aftercare

The researchers say they are concerned about the significant variation over the week, with the risk lowest for surgery carried out on Monday and then increasing with each subsequent day to peak at the weekend.

The paper shows people who have their operations on Friday are 44% more likely to die than those who have a procedure on Monday.

Professor Antony Narula, of the Royal College of Surgeons, who was not involved in the research, said: “It is not acceptable that there should be such a wide variation in the mortality rates following elective surgery, according to the day of the week the operation takes place.”

The researchers say the findings may be due to a poorer quality of aftercare at the weekend, when people who have their surgery later in the week need it most.

‘Critical period’

Dr Paul Aylin, lead author of the study said: “The first 48 hours following a procedure is most critical and when things can go wrong, such as bleeding and infections. If you don’t have the right staff, this is likely to contribute to things being missed.

“If I were a patient I would take comfort from the fact the overall death rate is low, but if I were to have an operation towards the end of the week I would be interested in whether the hospital had the appropriate services to look after me throughout my recovery, including at the weekend.”

He says the higher risk of death could be due to fewer doctors, nurses and many non-clinical staff being available on Saturdays and Sundays.

And the study suggests the risk of dying was higher still for surgery conducted over the weekend – 82% greater than on Monday – though the researchers caution only a minority of planned operations currently take place on Saturdays and Sundays.

Previous research looking at emergency procedures shows people are at greater risk of death if admitted during the weekend.

‘Weekend malaise’

But this is the first large study to look at planned operations, ranging from high-risk procedures such as heart bypass grafts to routine hernia repairs.

Katherine Murphy, chief executive of the Patients Association, said: “Whilst this research once again highlights the NHS’s weekend malaise and makes for concerning reading, it unfortunately doesn’t identify a new problem, but rather a failure to address an issue that has repeatedly been highlighted in the past…

“It is a shame that, despite the publication of hundreds of pages worth of reports and recommendations, so little action has been taken to actually address the problems identified.”

Sir Bruce Keogh, medical director of NHS England, said: “We have established a forum to develop viable financial and clinical options to help our NHS provide more comprehensive services seven days a week.”

Visit the Source Site

Surgery at end of week ‘more risky’

28 May 2013 Last updated at 19:10 ET

Doctors during surgeryResearchers looked at all types of non-emergency surgery, from hip operations to heart bypasses

People who have surgery towards the end of the week are more likely to die than those who have procedures earlier on, researchers say.

A British Medical Journal report into non-emergency operations in England, suggests the overall risk of death from such planned procedures remains low.

But it shows “unacceptable” variation in survival rates through the week, a leading body of UK surgeons says.

The government says it is committed to safe care for patients at all times.

Researchers from Imperial College London gathered data from all non-emergency surgery undertaken by the NHS in England in 2008-11.

Looking at some 4 million operations they found more than 27,000 deaths within a month of surgery, putting the average risk of death at 0.67%.

Appropriate aftercare

The researchers say they are concerned about the significant variation over the week, with the risk lowest for surgery carried out on Monday and then increasing with each subsequent day to peak at the weekend.

The paper shows people who have their operations on Friday are 44% more likely to die than those who have a procedure on Monday.

Professor Antony Narula, of the Royal College of Surgeons, who was not involved in the research, said: “It is not acceptable that there should be such a wide variation in the mortality rates following elective surgery, according to the day of the week the operation takes place.”

The researchers say the findings may be due to a poorer quality of aftercare at the weekend, when people who have their surgery later in the week need it most.

‘Critical period’

Dr Paul Aylin, lead author of the study said: “The first 48 hours following a procedure is most critical and when things can go wrong, such as bleeding and infections. If you don’t have the right staff, this is likely to contribute to things being missed.

“If I were a patient I would take comfort from the fact the overall death rate is low, but if I were to have an operation towards the end of the week I would be interested in whether the hospital had the appropriate services to look after me throughout my recovery, including at the weekend.”

He says the higher risk of death could be due to fewer doctors, nurses and many non-clinical staff being available on Saturdays and Sundays.

And the study suggests the risk of dying was higher still for surgery conducted over the weekend – 82% greater than on Monday – though the researchers caution only a minority of planned operations currently take place on Saturdays and Sundays.

Previous research looking at emergency procedures shows people are at greater risk of death if admitted during the weekend.

‘Weekend malaise’

But this is the first large study to look at planned operations, ranging from high-risk procedures such as heart bypass grafts to routine hernia repairs.

Katherine Murphy, chief executive of the Patients Association, said: “Whilst this research once again highlights the NHS’s weekend malaise and makes for concerning reading, it unfortunately doesn’t identify a new problem, but rather a failure to address an issue that has repeatedly been highlighted in the past…

“It is a shame that, despite the publication of hundreds of pages worth of reports and recommendations, so little action has been taken to actually address the problems identified.”

Sir Bruce Keogh, medical director of NHS England, said: “We have established a forum to develop viable financial and clinical options to help our NHS provide more comprehensive services seven days a week.”


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Avatar therapy for schizophrenia

29 May 2013 Last updated at 10:13 ET

By Lorna Stewart BBC Health Check

Three avatars created by patientsAvatars created by patients

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Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests.

The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.

Using customised computer software, the patients created avatars to match the voices they had been hearing.

After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.

The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.

“I encourage the patient saying, ‘you mustn’t put up with this, you must tell the avatar that what he or she is saying is nonsense, you don’t believe these things, he or she must go away, leave you alone, you don’t need this kind of torment’,” said Prof Leff.

“The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”

By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.

Treatment as usual

The trial, conducted by Prof Leff and his team from University College London, compared 14 patients who underwent avatar therapy with 12 patients receiving standard antipsychotic medication and occasional visits to professionals.

Later the patients in the second group were also offered avatar therapy.

Only 16 of the 26 patients completed the therapy. Researchers attributed the high drop-out rate to fear instilled in patients by their voices, some of which “threatened” or “bullied” them into withdrawing from the study.

New treatment options have been welcomed for the one in four patients with schizophrenia who does not respond to medication. Cognitive behaviour therapy can help them to cope but does not usually ease the voices.

Paul Jenkins, of the charity Rethink Mental Illness, said: “We welcome any research which could improve the lives of people living with psychosis.

“As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available.

“While antipsychotic medication is crucial for many people, it comes with some very severe side effects. Our members would be extremely interested in the development of any alternative treatments.”

Next phase

A larger trial featuring 142 patients is planned to start next month in collaboration with the King’s College London Institute of Psychiatry.

Prof Thomas Craig, who will lead the larger study, said: “The beauty of the therapy is its simplicity and brevity. Most other therapies for these conditions are costly and take many months to deliver.

“If we show that this treatment is effective, we expect it would be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.”

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