First batch of surgeon data revealed

27 June 2013 Last updated at 21:46 ET

By Nick Triggle Health correspondent, BBC News

Surgeons operatingOnly heart surgeons have published individual performance data so far

The first wave of new performance data for individual surgeons in England is being published in what is being hailed as a historic moment for the NHS.

Vascular surgeons have become the first of a new group of nine specialities to publish the information, including death rates.

It will appear on the NHS Choices website later. The other groups will follow in the coming weeks.

But the move has been overshadowed by some surgeons refusing to take part.

They were able to do this because of data protection laws, although earlier this month Health Secretary Jeremy Hunt warned that those refusing to take part would be publicly named.

Just six out of nearly 500 vascular surgeons, who specialise in procedures on the arteries and veins, including stents, have opted out.

Nonetheless, the move to publish this data is being viewed as a significant milestone.

To date, individual performance data has only been published for heart surgeons.

But for years there has been debate about whether other areas of medicine should follow.

The publication of surgery-specific data was first called for in 2001 by Prof Sir Ian Kennedy, who chaired the inquiry into the excessive number of deaths of babies undergoing heart surgery in Bristol.

‘Difficult and complex’

But some doctors have been resistant to widening publication of data for eight surgical specialties and cardiology, as there is a fear that it may give a misleading impression.

Those doctors who take on the most difficult and complex cases may appear to be performing badly, when in fact they could be the leading specialists in their field.

The specialities taking part account for about 4,000 surgeons, more than half the workforce.

Alongside mortality rates, the data includes information on other aspects such as length of stay in hospital after a procedure.

Prof Norman Williams, president of the Royal College of Surgeons, said: “This is an historic moment for surgery, and I’m enormously proud of what surgeons up and down the country have achieved.

“It has been a difficult and complex undertaking carried out in a short timescale but we see this as the beginning of a new era for openness in medicine.

“It is early days, but it will change for the better the nature of the bond between patient and surgeon, which is based on both openness and trust.”

The college said that overall it looked as if more than 99% of doctors had agreed to the release of the data this summer with fewer than 30 expected to resist.

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Hormone therapy, calcium may lower fracture risk

By Genevra Pittman

NEW YORK | Fri Jun 28, 2013 2:30pm EDT

NEW YORK (Reuters Health) – Women taking a combination of hormone therapy and calcium and vitamin D tablets after menopause were less likely to fracture their hip than those not taking hormones or supplements, in a new study.

“We always tell women to take calcium and vitamin D,” said Dr. Michele Curtis, a women’s health researcher from the University of Texas Health Science Center at Houston.

“At the end of the day what this study really says is, what you thought was a good thing to do really is a good thing to do.”

Because of the known risks of hormone therapy, one of the study’s authors said women should not take it solely to ward off fractures – but if they’re taking hormones for other reasons, it might be a good idea to add calcium.

Although many women take calcium and vitamin D for bone health, evidence has been mixed on how much supplements really help over and above what women get through their diets.

In February, the government-backed U.S. Preventive Services Task Force said there were no benefits but some risk for post-menopausal women taking low-dose vitamin D and calcium. The group recommended against supplement use to prevent broken bones.

For the new study, Jean Wactawski-Wende from the University at Buffalo and her colleagues compared seven years’ worth of fracture data for women in their 50s, 60s and 70s participating in the Women’s Health Initiative (WHI) study.

In one arm of the trial, participants were randomly assigned to take either hormone therapy or a drug-free placebo. In another, they took 1,000 milligrams of calcium and 400 IU of vitamin D or placebo tablets each day.

About 16,000 women were part of both the hormone and vitamin trials, including 4,000 randomized to both hormone therapy – either estrogen alone or estrogen and progesterone – and calcium and vitamin D.

In total, 214 women had a hip fracture during the study.

The researchers found that women assigned to both the hormone therapy and vitamin groups were about half as likely to have a fracture as those in the placebo groups.

During an average one-year period, they calculated that 11 out of 10,000 women taking both hormones and calcium and vitamin D would suffer a hip fracture, compared to 22 per 10,000 using neither.

However, the combination treatment had no effect on women’s bone mineral density – a reflection of osteoporosis and fracture risk, Wactawski-Wende and her team reported in the journal Menopause.

Some previous studies have suggested that vitamin D may protect against fractures less by strengthening bones than by improving muscle strength and thereby reducing falls, but others have not found the same effect.

Hormone therapy has become less common since WHI data linked hormone use to heart disease, stroke and breast cancer, though it’s still considered the most effective treatment for some symptoms of menopause, such as hot flashes.

Curtis, who wasn’t involved in the new research, said she thinks the pendulum initially swung too far away from hormone therapy, and that doctors are coming to realize it may still help some women.

“I think ultimately people have become aware that maybe it’s not the placebo for getting older that some may have perceived it was being marketed as, but that maybe there are benefits for it,” she told Reuters Health.

Because of the risks, women shouldn’t take hormone therapy just to prevent fractures, Wactawski-Wende said.

“The major indication for taking hormone therapy is for management of moderate to severe menopausal symptoms,” she told Reuters Health.

However, “those women who are on hormone therapy for vasomotor symptoms, who may also get the benefit of prevention of fractures, should consider supplementing with calcium at the same time to get the best benefit,” she said.

SOURCE: Menopause, online June 24, 2013.

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New labels tied to fewer child poisonings by OTC meds

By Kathryn Doyle

NEW YORK | Fri Jun 28, 2013 1:19pm EDT

NEW YORK (Reuters Health) – Fewer small children have been sickened or died from accidentally taking cough and cold medicines meant only for older ages, according to a new study of the effects of recent label changes on these over the counter products.

High doses of antihistamines can cause coma, seizure and abnormal heart rhythms in kids, and an overdose of the pain reliever acetaminophen can cause liver failure, according to the study’s lead author Dr. Maryann Mazer-Amirshahi of the department of emergency medicine at The George Washington University in Washington, D.C.

“Also, consider that there is not a lot of evidence that these medications are effective in young children, so the benefit of using them does not outweigh the risks,” Mazer-Amirshahi told Reuters Health.

In 2007, the U.S. Food and Drug Administration and the Consumer Healthcare Products Association took such products made specifically for children off the market, and in 2008 they added warnings to adult medications cautioning not to give the drugs to kids under four years old, according to Dr. Dan Budnitz, director of the Centers for Disease Control and Prevention Medication Safety Program.

He was not surprised to see a study indicating that those measures were effective, Budnitz told Reuters Health.

Based on reports to poison control centers in the U.S., the study found that unintentional ingestions of over the counter cough and cold medicines among kids decreased by a third between 2005 and 2010.

The number of children under 12 who had taken the medicines accidentally decreased by 33 percent; those given the medications by their parents in error decreased by 46 percent, according to the results published in The Journal of Pediatrics.

There were also 59 percent fewer calls to poison control centers for infants under two years old given the medicine incorrectly by a parent.

“We were expecting to see a decrease but the magnitude of it took us by surprise,” Mazer-Amirshahi said.

“The changes had a major effect but at the same time, although there were profound decreases, there remains a significant number of ingestions,” she said.

“I can tell you from my own practice experience I frequently encounter parents who give these medications even though they aren’t recommended,” she said.

Kids can also still get into medicine bottles on their own and take some, which won’t be solved by label changes, Budnitz said.

There were 54,000 unintentional ingestions of cough and cold medicines in 2010, down from 80,000 in 2005, according to the study. The way to get those numbers down further is by changing safety features of the bottles, Budnitz said.

“There are opportunities to build in safety to products,” such as including “flow restrictors” in the nozzles, he said. Features like those can “keep a child puzzled long enough for an adult to notice” that they’ve gotten into the medicine cabinet, he said.

Educating parents is another important prevention technique, he said.

Mazer-Amirshahi hoped the results of the study would prompt doctors to have a conversation with patients about these common medications.

Understandably, parents want to act when their child is sick, but they need to carefully read labels and talk to their pediatrician before giving any medications to young children, she said.

“In addition, be sure to safely store any medications in the home out of the reach of children,” she said.

SOURCE: The Journal of Pediatrics, online June 14, 2013.

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New Therapy Helps Restore Speech After Stroke


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The Gupta Guide

Published: Jun 27, 2013

By Charlene Laino, Senior Writer, Gupta Guide
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

  • Adding inhibitory repetitive transcranial magnetic stimulation (rTMS) to traditional speech and language therapy significantly improved language recovery in stroke survivors with aphasia.
  • Note that increases were largest for subtest naming and tended to be higher for comprehension, token test, and writing.

Adding inhibitory repetitive transcranial magnetic stimulation (rTMS) to traditional speech and language therapy significantly improved language recovery in stroke survivors with aphasia, a small study showed.

Researchers randomized 24 patients with subacute poststroke aphasia to a 10-day protocol of 20-minute inhibitory 1 Hz rTMS over the right triangular part of the posterior inferior frontal gyrus or sham stimulation, followed by 45 minutes of speech and language therapy.

The change in global Aachen Aphasia Test score, the primary outcome measure, was significantly higher in the rTMS group than in the sham arm (t test, P=0.003), Alexander Thiel, MD, of McGill University in Montreal, and colleagues reported online in Stroke.

The TMS group’s improvements were on average three times greater than the non-TMS group, the researchers said.

Increases were largest for subtest naming (P=0.002) and tended to be higher for comprehension, token test, and writing (P<0.1).

“A combination of repetitive TMS and standard treatment led to improved outcomes, particularly in word finding and naming,” said Bruce Dobkin, MD, a professor of neurology at UCLA Geffen School of Medicine who was not involved with the study.

Importantly, while rTMS was applied over the right frontal cortex, PET scans showed patients in the rTMS group activated proportionally more voxels in the left hemisphere after treatment than before compared with sham-treated patients (t test, P=0.002).

“The increased activation in the left side of the brain that had the lesion suggests that inhibiting the homologous cortex on the right of the brain led to reorganization of left speech areas,” Dobkin explained.

There were no adverse effects related to the treatment.

Aphasia affects more than a third of all stroke victims, and early and intensive speech and language therapy is the only effective treatment to date, but usually is limited in duration and intensity.

With this sham-controlled, blinded, and randomized study, we present the first evidence that inhibitory rTMS over the right posterior inferior frontal gyrus can easily be applied in a clinical rehabilitation setting, is safe, and improves the effectiveness of conventional speech and language therapy by fostering the left-hemispheric language networks,” the researchers wrote.

“The results are modest,” Dobkin said. But they open the door to larger, multicenter trials, he said, which is just what the researchers plan. The NORTHSTAR study has been funded by the Canadian Institutes of Health Research and will be launched at four Canadian sites and one German site later in 2013.

Please share your thoughts on the new treatment. Add your Knowledge below. — Sanjay Gupta, MD

The Walter and Marga Boll and Wolf-Dieter-Heiss Foundations funded the study.

The researchers reported no financial disclosures.

Dobkin reported no relevant conflicts of interest.

Primary source: Stroke
Source reference:
Theil, A et al “Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia” Stroke 2013; DOI: 10.1161/STROKEAHA.111.000574/-/DC1.

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Doctors admit death pathway problems

26 June 2013 Last updated at 22:03 ET

Nick TriggleBy Nick Triggle Health correspondent

GeriatricDying needs to be addressed at medical school, say doctors

There are problems with a controversial regime that allows doctors to withdraw treatment in the last days of life, doctors have admitted.

Members of the British Medical Association said dying patients may have been put on the Liverpool Care Pathway when it was not appropriate because hospitals were offered financial incentives to use it.

They also said some patients had stayed on it for weeks without follow-up.

An independent review is expected soon.

Ministers ordered the inquiry, chaired by the crossbench peer Baroness Neuberger, after it came under intense scrutiny in the media at the end of last year. There were reports it was being misused by hospitals that get financial payments for using it.

Relatives of dying patients had complained that their loved ones had been put on the pathway without consent.

When Care and Support Minister Norman Lamb announced there would be a review of the pathway at the turn of the year, he said he was concerned about the “unacceptable” cases that had come to light.

During a debate of the issue at the BMA annual conference in Edinburgh, doctors made it clear that the pathway was an important part of end-of-life care.

They were also critical of the media coverage.

But York GP Dr Mark Pickering said while some of the reporting had been “hysterical”, there were some problems.

“Among the media frenzy there were some valid points: relatives unaware that their family members were on the LCP; senior clinicians unaware that their patients were on the LCP; patients left on the LCP for weeks without any review or re-evaluation.”

He said these problems should have been addressed already.

But he also said the financial incentives offered to hospitals to get people on the pathway, a system put in place to reward good practice, “risks a tick-box culture” where patients were put on the LCP regardless of whether it was appropriate.

Medical student Sasha Marie, who wants to specialise in the care of the elderly, said part of the problem was the lack of exposure to the issue during training.

“We can’t escape death as doctors. But in medical school we focus so much on saving lives that dying is put to one side.”

Prof Baroness Finlay, a crossbench peer and palliative care doctor, agreed that training was a factor that needed to be addressed, but said that included other health professionals such as nurses as well as doctors.

She also said doctors needed to be aware that the LCP was not a “one-way street”, pointing out that 3% of patients put on it do not die at that time.

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Warnings over ‘unsafe’ diet pills

Greg DawsonBy Greg Dawson
Newsbeat reporter

Illegal slimming pills

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Slimming pills new

Government health officials say they’re increasingly worried about a rising number of counterfeit slimming pills being sold online to people in the UK.

The Medicines and Healthcare products Regulatory Agency (MHRA) says it has seized a record £12.2 million of fake and unlicensed medicines in the UK.

They say a large amount of these were unlicensed diet pills which often contain harmful ingredients.

A raid in Greater Manchester uncovered more than 12,000 slimming pills.

Newsbeat accompanied the MHRA on the raid.

“What we’re seeing is people going online, self diagnosing and self prescribing,” said Danny Lee Frost, from the agency.

“If someone goes online to buy these types of products and think they’re safe and healthy it’s our job to tell them ‘No they’re not.'”

Continue reading the main story

I got cold sweats, really bad insomnia, some heart problems. It was worst at night. I couldn’t sleep because my heart was going too fast. It felt like a heart attack

Chrissy Roberts

Nearly 1,300 UK based websites have also been shut as part of the crackdown.

‘Heart attack’

The risks of taking the diet pills include anything from short-term sickness to long to term heart-problems.

Chrissy Roberts Chrissy Roberts suffered from an eating disorder aged 16 (left), and pictured now

Chrissy Roberts, 18, from Southport bought some online when she was suffering an eating disorder.

“I was just a 16 years old and within three clicks I’d bought £60 worth of tablets. It was almost too easy for me to get them.”

Within a short time she became worried about the effects the pills were having.

“I got cold sweats, really bad insomnia, some heart problems.

“It was worst at night. I couldn’t sleep because my heart was going too fast. It felt like a heart attack.

“I thought I wouldn’t wake up sometimes.”

The usual advice to people considering slimming pills is to discuss it with a doctor.

Doctor Kate Adams

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GP ‘not a fan’ of slimming pills

Dr Kate Adams, who works at a surgery in East London said: “I’m not a fan. They’re not an answer to weight issues.

“There isn’t a quick fix, I think it’s about sensible eating and changing your lifestyle.”

The MHRA’s Acting Head of Enforcement, Nimo Ahmed, said: “When people buy medicines from an illegal website on the Internet they don’t know what they’re getting, where it came from or if it’s safe to take.

“The dose could be too high or too low, or the ingredients could break down incorrectly in the body which makes the medicine ineffective.”

Follow @BBCNewsbeat on Twitter.

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High rate of head injuries seen among Canadian youth

By Genevra Pittman

NEW YORK | Thu Jun 27, 2013 2:25pm EDT

NEW YORK (Reuters Health) – One in five Canadian teens reported a serious head injury in a new study, a rate researchers say is much higher than previous studies have found.

In a survey of 8,900 students in grades seven through 12, close to six percent reported losing consciousness for at least five minutes or being hospitalized for head trauma in the past year, and 20 percent reported ever having that type of injury.

Researchers found that students with poor grades and those who drank and smoked marijuana were especially likely to say they’d suffered a traumatic brain injury. Just under half of those injuries occurred outside of sports.

“Traumatic brain injury is preventable,” said Gabriela Ilie, who led the study at St. Michael’s Hospital in Toronto.

“If we know who’s more likely to be vulnerable, if we know under what conditions those injuries are occurring, we can talk to the parents, we can talk to the students, we can talk to hospitals, we can talk to communities, and together we can almost change our mindset in terms of how we see (this) injury,” she told Reuters Health.

Ilie, whose findings were published on Tuesday in the Journal of the American Medical Association, said she was “very surprised” at how many students reported a history of serious head trauma.

Close to half a million kids age 14 and under are seen in U.S. emergency rooms for a traumatic brain injury each year, according to the Centers for Disease Control and Prevention. For all types of traumatic brain injuries, including milder ones that don’t require hospitalization, the rates among U.S. kids are between 6 and 8 per 1,000, according to CDC.

It’s possible the new study’s results were skewed by having adolescents recalling their own injuries, the researchers said.

“The rates that they found are much, much higher than I think has previously been reported in any study,” said Dr. Matthew Eisenberg, who has studied concussions at Boston Children’s Hospital.

What’s more, the definition of head injury used here “gives you a pretty severe subset of injuries,” Eisenberg, who wasn’t involved in the new research, told Reuters Health.

He said the study will have to be repeated in other groups of teenagers to see if future findings match up. And there’s still the question of how drug use and poor school performance are related to concussions, he said, as this study doesn’t get at which came first.

“It doesn’t answer the question of cause and effect. It certainly makes sense to think that kids who are drinking are more likely to be injured. On the flip side, maybe if you’ve had a bad head injury, we know that things like depression and poor school performance go along with that.”


Earlier this month, results were released separately suggesting that concussion rates among U.S. 8-to-12-year old football players may be just as high as those on high school and college teams.

Researchers tracked injuries on 18 youth football teams and found 20 out of 468 players were diagnosed with concussions during a single season.

That injury rate – one for every 568 practices and games in which an athlete participates – is comparable with what researchers have reported for older players, Anthony Kontos of the University of Pittsburgh Medical Center and his colleagues said.

All but two of the concussions came during games – suggesting that efforts to prevent injuries in Pop Warner by limiting contact in practice may not have the intended effect, the researchers wrote in The Journal of Pediatrics.

Eisenberg pointed out that there were more people watching young athletes during games – including the researchers – which would make it easier to catch a concussion in that setting.

“On the other hand, it makes sense that you wouldn’t get as injured at practice,” he said. “Practice is in general probably less intense than a game.”

Studies have been piling up showing the potential harms of concussions among kids, including headaches and memory problems. But questions remain about the long-term impacts of suffering a serious head injury during childhood, when the brain is still developing.

SOURCES: Journal of the American Medical Association, online June 25, 2013 and The Journal of Pediatrics, online June 10, 2013. The story was corrected to replace “Pop Warner” with “youth football” in subhead and the fourteenth paragraph in the story posted on Jun 25, 2013.]

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Take the test for HIV, take control

Have you ever been tested for Human Immunodeficiency Virus (HIV)? More than 1 million Americans are infected with HIV, yet approximately 1 in 5 of them don’t know it.

Medicare covers HIV screening for people with Medicare of any age who ask for the test, pregnant women, and people at increased risk for the infection (such as gay and bisexual men, injection drug users, or people with multiple sexual partners).

Early testing and diagnosis play key roles in reducing the spread of the disease, extending life expectancy, and cutting costs of care. At least 1 in 3 people in the U.S. who test positive for HIV is tested too late to get the full advantage of treatment. Testing is also an important first step in getting HIV-infected people the medical care and support they need to improve their health and help them maintain safer behaviors.

Visit Health & Human Services’ website to learn about National HIV Testing Day, June 27.

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Cells 're-grown' after spinal injury

25 June 2013 Last updated at 21:46 ET

By Helen Briggs BBC News

Spinal cord nerve cellsSpinal cord nerve cells

US scientists say they have made progress in repairing spinal cord injuries in paralysed rats.

Rats regained some bladder control after surgery to transplant nerve cells into the spinal cord, combined with injections of a cocktail of chemicals.

The study, published in the Journal of Neuroscience, could raise hopes for one day treating paralysed patients.

But UK experts say it will take several years of research before human clinical trials can be considered.

Scientists have tried for decades to use transplants of nerve cells to restore function in paralysed animals by bridging the gap in the broken spinal cord.

However, coaxing the cells to grow and form new connections has proved elusive.

One problem is the growth of scar tissue as the body’s responds to injury, which seems to block cell regeneration.

US scientists carried out complex surgery to transplant nerves from the rodents’ ribs into the gap in the middle of their spinal cord.

They also used a special “glue” that boosts cell growth together with a chemical that breaks down scar tissue in an attempt to encourage the nerve cells to regenerate and connect up.

The researchers found for the first time that injured nerve cells could re-grow for “remarkably long distances” (about 2cm).

They said that while the rats did not regain the ability to walk, they did recover some bladder function.

Lead author Dr Jerry Silver of Case Western Reserve Medical School, Cleveland, Ohio, said: “Although animals did not regain the ability to walk, they did recover a remarkable measure of urinary control.”

Co-author Dr Yu-Shang Lee of the Cleveland Clinic, Ohio, added: “This is the first time that significant bladder function has been restored via nerve regeneration after a devastating cord injury.”

The findings may help future efforts to restore other functions lost after spinal cord injury.

They also raise hope that similar strategies could one day be used to restore bladder function in people with severe spinal cord injuries.

Dr Silver said further animal experiments will be needed to see if the technique could work in humans.

He told BBC News: “If we can show in a larger animal that our technique works and does no additional harm I see no reason why we couldn’t move rapidly in humans.”

‘Remarkable advance’

Commenting on the study, Dr Elizabeth Bradbury of King’s College London said several challenges must be overcome before the therapy can be trialled in patients.

“There are a number of challenges before this therapy can be brought to the clinic,” she said.

“Nevertheless this is a remarkable advance which offers great hope for the future of restoring bladder function to spinal injured patients and if these challenges can be met we could be reaching clinical trials within three to five years.”

Dr John Williams, head of neuroscience and mental health at the Wellcome Trust, said the implications for people are not yet clear.

“This is one of a number of ways that one can approach restoration of bladder function in paralysed patients, but careful studies will be needed to optimise which of the technologies under investigation might be of most benefit to patients.”

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