Woman wins bid to use dead daughter's eggs

Woman wins bid to use dead daughter’s eggs

  • 30 June 2016
  • From the section Health

Share this with

Courts generic

A woman who wants to use her dead daughter’s frozen eggs to give birth to her own grandchild has won a Court of Appeal battle.

The 60-year-old woman was appealing against the UK regulator’s refusal to allow her to take her only child’s eggs to a US clinic.

Her daughter, who died in 2011, was said to have asked her mother to carry her babies.

The mother lost a High Court case last year.

She was subsequently granted permission to challenge the decision at the Court of Appeal in London, before a panel of three judges.

No written consent

The UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), said, in 2014, that the daughter’s eggs could not be released from storage in London because she had not given her full written consent before she had died from bowel cancer at the age of 28.

But, in the latest legal proceedings, lawyers acting for the mother told the judges she wanted to fulfil her daughter’s wishes to carry a child created from her frozen eggs and “raise that child”.

The mother’s wish is to take the eggs to a clinic in New York to be used with donor sperm.

Jenni Richards QC said that if the judges did not overturn the High Court’s ruling, the “inevitable” consequence would be that the eggs “will simply be allowed to perish”.

Ms Richards argued that there was “clear evidence” of what the daughter, known only as ‘A’, wanted to happen to her eggs after she died, and that “all available evidence” showed she wanted her mother “to have her child after death”.

Export decision

The appeal was opposed by the HFEA, which said it had great sympathy for the parents of the dead daughter, known only as Mr and Mrs M.

The HFEA said: “The law requires us to consider whether there is sufficient evidence of informed consent. After looking at the matter in great detail we decided that there wasn’t, a decision which was supported by the High Court last September.

“Today’s judgment by the Court of Appeal reaffirms the need for informed consent but concludes that there is sufficient evidence of Mr and Mrs M’s daughter’s true wishes.”

The HFEA said it would now reconsider the case as soon as possible.

Visit the Source Site

Powered by WPeMatico

Woman wins bid to use dead daughter's eggs

Woman wins bid to use dead daughter’s eggs

  • 30 June 2016
  • From the section Health

Share this with

Courts generic

A woman who wants to use her dead daughter’s frozen eggs to give birth to her own grandchild has won a Court of Appeal battle.

The 60-year-old woman was appealing against the UK regulator’s refusal to allow her to take her only child’s eggs to a US clinic.

Her daughter, who died in 2011, was said to have asked her mother to carry her babies.

The mother lost a High Court case last year.

She was subsequently granted permission to challenge the decision at the Court of Appeal in London, before a panel of three judges.

No written consent

The UK fertility regulator, the Human Fertilisation and Embryology Authority (HFEA), said, in 2014, that the daughter’s eggs could not be released from storage in London because she had not given her full written consent before she had died from bowel cancer at the age of 28.

But, in the latest legal proceedings, lawyers acting for the mother told the judges she wanted to fulfil her daughter’s wishes to carry a child created from her frozen eggs and “raise that child”.

The mother’s wish is to take the eggs to a clinic in New York to be used with donor sperm.

Jenni Richards QC said that if the judges did not overturn the High Court’s ruling, the “inevitable” consequence would be that the eggs “will simply be allowed to perish”.

Ms Richards argued that there was “clear evidence” of what the daughter, known only as ‘A’, wanted to happen to her eggs after she died, and that “all available evidence” showed she wanted her mother “to have her child after death”.

Export decision

The appeal was opposed by the HFEA, which said it had great sympathy for the parents of the dead daughter, known only as Mr and Mrs M.

The HFEA said: “The law requires us to consider whether there is sufficient evidence of informed consent. After looking at the matter in great detail we decided that there wasn’t, a decision which was supported by the High Court last September.

“Today’s judgment by the Court of Appeal reaffirms the need for informed consent but concludes that there is sufficient evidence of Mr and Mrs M’s daughter’s true wishes.”

The HFEA said it would now reconsider the case as soon as possible.

Visit the Source Site

Powered by WPeMatico

Parents 'let down' by Bristol Children's Hospital cardiac ward

Parents ‘let down’ by Bristol Children’s Hospital cardiac ward

  • 30 June 2016
  • From the section Bristol

Share this with

Media captionSean Turner suffered a cardiac arrest in his father’s arms at Bristol Royal Children’s Hospital

Children receiving cardiac treatment at Bristol Children’s Hospital were repeatedly given poor care and parents were let down, a review has found.

An independent report revealed nurses were regularly under pressure and there was poor communication with families.

It follows the deaths of at least seven children, who were treated on Ward 32.

However, the review said there was no evidence to suggest failings on the scale of a previous inquiry in 2001 into baby heart deaths in Bristol.

The report made a series of recommendations to the University Hospitals Bristol NHS Foundation Trust, NHS England and the Department of Health.

‘Whitewashed’

It also recommended NHS England should commission a review of paediatric intensive care services across England.

The report found no evidence to suggest there were failures in care and treatment of the nature identified in the 2001 public inquiry, which found 35 babies died and dozens more were left brain-damaged between 1991 and 1995 at Bristol Royal Infirmary.

The outcomes of care at the children’s hospital were “broadly comparable” with those of other centres caring for children with congenital heart disease, the report said.

The review was launched in 2014 after the parents of four-year-old Sean Turner, who died in March 2012, tweeted the NHS’s medical director.

Image caption

The inquiry was launched following the deaths of several children at the Bristol Royal Hospital for Children

Steve and Yolanda Turner, from Wiltshire, pleaded with Prof Sir Bruce Keogh to “sort this out” after a coroner ruled the hospital had not failed Sean.

He suffered a brain haemorrhage and cardiac arrest six weeks after undergoing corrective heart surgery.

Sean’s parents blamed doctors and nursing staff for transferring their son to Ward 32 – a specialist children’s heart unit – from intensive care too soon.

They claim medics also missed clear signs of his worsening condition.

Ms Turner said she had “expected a more aggressive investigation”.

“I don’t think it has gone far enough,” she said.

“Certainly, within Sean’s own report there are areas we feel that the review has not gone far enough; they have not been brave enough to really properly investigate.

“We still feel there are areas that are whitewashed over, ignored, it’s disappointing.”


Analysis – Hugh Pym, BBC health editor

Children’s cardiac services in Bristol are back in the news – a public inquiry in 2001 found major shortcomings and while the latest report concluded there was nothing on a similar scale this time, it does say patients were at risk of harm because of poor care.

This affected patients from all over the south west of England and south Wales receiving specialist care in the city.

There are wider implications too. The report finds limited capacity in Bristol’s paediatric intensive care unit put heavy strains on families, and there could be a similar problem at other hospitals. It calls for a national review, which NHS England has agreed to carry out.

The treatment of children with congenital heart disease is highly complex and specialised and the report’s authors say they hope the review helps strengthen the delivery of these services across the country.


Eleanor Grey QC, chair of the report, said: “Some [families] received good care and had good outcomes. Others did not.”

She said that “a very large expert panel” looked at the findings and “it was their judgements about care which was reflected in those individual reports, which we delivered personally and confidentially to families”.

“We will meet with the families and discuss what is in their individual reports,” she added.

She said 32 recommendations had been made that “require action not just on the part of the Bristol Royal Hospital for Children but also NHS England and the Department of Health”.

Laurence Vick, a medical negligence solicitor who represents families of children who died or were injured, said it would be “a struggle” for parents to accept the report, which they felt was “less than critical”.

“Unfortunately, particularly the bereaved parents remain convinced that the failings at Bristol caused or contributed to the deaths of their children,” he said.

‘Deeply sorry’

A separate Care Quality Commission review found the standard of care was comparable with other centres in the UK but recommended better communication with children and their parents before and after surgery.

Robert Woolley, chief executive of University Hospitals Bristol NHS Foundation Trust, said he “fully accepted” the findings of the two reports, and claimed some improvements had already been made.

“We are deeply sorry for the things we got wrong – for when our care fell below acceptable standards, for not supporting some families as well as we could have and for not always learning adequately from our mistakes,” he said.

“We didn’t get it right for these families, and I’d like to apologise to the families unreservedly.”

About 10 families from across England and Wales are believed to be taking legal action against the University Hospitals Bristol NHS Foundation Trust, including seven whose children were treated on Ward 32.

Visit the Source Site

Powered by WPeMatico

Parents 'let down' by Bristol Children's Hospital cardiac ward

Parents ‘let down’ by Bristol Children’s Hospital cardiac ward

  • 30 June 2016
  • From the section Bristol

Share this with

Media captionSean Turner suffered a cardiac arrest in his father’s arms at Bristol Royal Children’s Hospital

Children receiving cardiac treatment at Bristol Children’s Hospital were repeatedly given poor care and parents were let down, a review has found.

An independent report revealed nurses were regularly under pressure and there was poor communication with families.

It follows the deaths of at least seven children, who were treated on Ward 32.

However, the review said there was no evidence to suggest failings on the scale of a previous inquiry in 2001 into baby heart deaths in Bristol.

The report made a series of recommendations to the University Hospitals Bristol NHS Foundation Trust, NHS England and the Department of Health.

‘Whitewashed’

It also recommended NHS England should commission a review of paediatric intensive care services across England.

The report found no evidence to suggest there were failures in care and treatment of the nature identified in the 2001 public inquiry, which found 35 babies died and dozens more were left brain-damaged between 1991 and 1995 at Bristol Royal Infirmary.

The outcomes of care at the children’s hospital were “broadly comparable” with those of other centres caring for children with congenital heart disease, the report said.

The review was launched in 2014 after the parents of four-year-old Sean Turner, who died in March 2012, tweeted the NHS’s medical director.

Image caption

The inquiry was launched following the deaths of several children at the Bristol Royal Hospital for Children

Steve and Yolanda Turner, from Wiltshire, pleaded with Prof Sir Bruce Keogh to “sort this out” after a coroner ruled the hospital had not failed Sean.

He suffered a brain haemorrhage and cardiac arrest six weeks after undergoing corrective heart surgery.

Sean’s parents blamed doctors and nursing staff for transferring their son to Ward 32 – a specialist children’s heart unit – from intensive care too soon.

They claim medics also missed clear signs of his worsening condition.

Ms Turner said she had “expected a more aggressive investigation”.

“I don’t think it has gone far enough,” she said.

“Certainly, within Sean’s own report there are areas we feel that the review has not gone far enough; they have not been brave enough to really properly investigate.

“We still feel there are areas that are whitewashed over, ignored, it’s disappointing.”


Analysis – Hugh Pym, BBC health editor

Children’s cardiac services in Bristol are back in the news – a public inquiry in 2001 found major shortcomings and while the latest report concluded there was nothing on a similar scale this time, it does say patients were at risk of harm because of poor care.

This affected patients from all over the south west of England and south Wales receiving specialist care in the city.

There are wider implications too. The report finds limited capacity in Bristol’s paediatric intensive care unit put heavy strains on families, and there could be a similar problem at other hospitals. It calls for a national review, which NHS England has agreed to carry out.

The treatment of children with congenital heart disease is highly complex and specialised and the report’s authors say they hope the review helps strengthen the delivery of these services across the country.


Eleanor Grey QC, chair of the report, said: “Some [families] received good care and had good outcomes. Others did not.”

She said that “a very large expert panel” looked at the findings and “it was their judgements about care which was reflected in those individual reports, which we delivered personally and confidentially to families”.

“We will meet with the families and discuss what is in their individual reports,” she added.

She said 32 recommendations had been made that “require action not just on the part of the Bristol Royal Hospital for Children but also NHS England and the Department of Health”.

Laurence Vick, a medical negligence solicitor who represents families of children who died or were injured, said it would be “a struggle” for parents to accept the report, which they felt was “less than critical”.

“Unfortunately, particularly the bereaved parents remain convinced that the failings at Bristol caused or contributed to the deaths of their children,” he said.

‘Deeply sorry’

A separate Care Quality Commission review found the standard of care was comparable with other centres in the UK but recommended better communication with children and their parents before and after surgery.

Robert Woolley, chief executive of University Hospitals Bristol NHS Foundation Trust, said he “fully accepted” the findings of the two reports, and claimed some improvements had already been made.

“We are deeply sorry for the things we got wrong – for when our care fell below acceptable standards, for not supporting some families as well as we could have and for not always learning adequately from our mistakes,” he said.

“We didn’t get it right for these families, and I’d like to apologise to the families unreservedly.”

About 10 families from across England and Wales are believed to be taking legal action against the University Hospitals Bristol NHS Foundation Trust, including seven whose children were treated on Ward 32.

Visit the Source Site

Powered by WPeMatico

Zika sex research begins despite U.S. Congress funding impasse


It could take years to learn how long men infected with Zika are capable of sexually transmitting the virus, which can cause crippling birth defects and other serious neurological disorders.

In the meantime, health officials have warned couples to refrain from unprotected sex for six months after a male partner is infected. The extraordinary recommendation, based on a single report of Zika surviving 62 days in semen, could affect millions.

The grave risks associated with Zika, along with its potential reach, are driving U.S. health authorities to pursue research even though funding is mired in Congressional gridlock. A study of sexual transmission risk is one example of science that health officials said can’t wait for politics.

Borrowing money earmarked for other programs, the U.S. National Institute of Allergy and Infectious Diseases has started enrolling men infected with Zika in Brazil and Colombia in the study to determine how long the virus remains transmittable in semen. The study could take years to complete, but interim results could help public health officials fine-tune their recommendations on sex.

“We are going out on a limb, but we have to,” Dr. Anthony Fauci, director of the U.S. institute, said in an interview. “We can’t say we’re going to wait until we get all the money.”

Public health officials are alarmed by Zika’s transmission versatility, which has the potential to expand its reach. It is primarily spread by Aedes aegypti mosquitoes, as are the dengue and chikungunya viruses.

But at least 10 countries, including the United States and France, have reported Zika infections in people who had not traveled to an outbreak area but whose sexual partners had. This ability to spread through sex could help Zika gain a further foothold outside the warm habitats of its most effective agent, the mosquito.

    CAUTION IN LIEU OF ANSWERS

To protect women who are pregnant or trying to conceive, the U.S. Centers for Disease Control and Prevention recommended couples refrain from unprotected sex for six months – triple the 62 days the virus survived in the semen in one British case study. The World Health Organization recently issued similar guidance.

But such strict advice is not ideal, Dr. Anne Schuchat, a CDC deputy director, said in an interview.

“To tell people not to have sex until we get back to you is not a very satisfying recommendation,” she said. “We would like to have some more understanding of the sexual risk.”

In the U.S. territory of Puerto Rico, where more than 2,100 cases of infection have been reported since the start of the year, health officials are passing out Zika protection kits that include bug spray and condoms, along with the recommendation.

But the warning against unprotected sex isn’t going over very well, said Dr. Chris Prue, a CDC behavioral scientist who has studied the response.

“Condoms are not popular in a lot places,” she said. “There’s religious and personal preferences and lots of personal factors in that.”

U.S. lawmakers deadlocked over funding to fight the Zika virus on Tuesday, as Senate Democrats blocked a Republican proposal they said fell short of the challenge posed by the virus and hurt other health priorities. It was unclear when Congress would revisit the request by President Barack Obama for $1.9 billion.

FUNDING PRIORITIES

In the meantime, the White House has diverted more than $500 million earmarked for other projects for urgent Zika initiatives, including those where scientific opportunities will be lost if not acted upon immediately.

One such study will follow children born to women infected with Zika to identify the development of any disabilities not detected at birth. Other projects on the priority list include vaccine development and mosquito eradication.   One study underway will assess whether the risk of transmission is greater from men who experience Zika infection symptoms, such as fever and rash, than from those who don’t. This information is considered vital since most people experience no symptoms.

The study of infected men in Brazil and Colombia will test semen from thousands of men over time to determine how long Zika poses a risk to sexual partners. As long the virus can be grown in a laboratory from semen cell samples, infectious disease experts believe it is potentially contagious.

Zika typically clears the bloodstream about a week after infection, but it has been detected in urine for at least twice as long. Its persistence in semen in the British case study has caused some researchers to draw comparisons to other viruses.

HIV can last in blood and semen indefinitely, and the mosquito-borne West Nile virus can reside in the kidneys and urine for years, researchers said. One patient who survived the deadly Ebola outbreak had evidence of that virus in his semen for 18 months.

“We got very surprised by Ebola that it was hanging around for so long,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

“One of the big questions we have to ask is does Zika also cause a similar type of latency?”

(Additional reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Girion)


Visit the Source Site

Powered by WPeMatico

Zika sex research begins despite U.S. Congress funding impasse


It could take years to learn how long men infected with Zika are capable of sexually transmitting the virus, which can cause crippling birth defects and other serious neurological disorders.

In the meantime, health officials have warned couples to refrain from unprotected sex for six months after a male partner is infected. The extraordinary recommendation, based on a single report of Zika surviving 62 days in semen, could affect millions.

The grave risks associated with Zika, along with its potential reach, are driving U.S. health authorities to pursue research even though funding is mired in Congressional gridlock. A study of sexual transmission risk is one example of science that health officials said can’t wait for politics.

Borrowing money earmarked for other programs, the U.S. National Institute of Allergy and Infectious Diseases has started enrolling men infected with Zika in Brazil and Colombia in the study to determine how long the virus remains transmittable in semen. The study could take years to complete, but interim results could help public health officials fine-tune their recommendations on sex.

“We are going out on a limb, but we have to,” Dr. Anthony Fauci, director of the U.S. institute, said in an interview. “We can’t say we’re going to wait until we get all the money.”

Public health officials are alarmed by Zika’s transmission versatility, which has the potential to expand its reach. It is primarily spread by Aedes aegypti mosquitoes, as are the dengue and chikungunya viruses.

But at least 10 countries, including the United States and France, have reported Zika infections in people who had not traveled to an outbreak area but whose sexual partners had. This ability to spread through sex could help Zika gain a further foothold outside the warm habitats of its most effective agent, the mosquito.

    CAUTION IN LIEU OF ANSWERS

To protect women who are pregnant or trying to conceive, the U.S. Centers for Disease Control and Prevention recommended couples refrain from unprotected sex for six months – triple the 62 days the virus survived in the semen in one British case study. The World Health Organization recently issued similar guidance.

But such strict advice is not ideal, Dr. Anne Schuchat, a CDC deputy director, said in an interview.

“To tell people not to have sex until we get back to you is not a very satisfying recommendation,” she said. “We would like to have some more understanding of the sexual risk.”

In the U.S. territory of Puerto Rico, where more than 2,100 cases of infection have been reported since the start of the year, health officials are passing out Zika protection kits that include bug spray and condoms, along with the recommendation.

But the warning against unprotected sex isn’t going over very well, said Dr. Chris Prue, a CDC behavioral scientist who has studied the response.

“Condoms are not popular in a lot places,” she said. “There’s religious and personal preferences and lots of personal factors in that.”

U.S. lawmakers deadlocked over funding to fight the Zika virus on Tuesday, as Senate Democrats blocked a Republican proposal they said fell short of the challenge posed by the virus and hurt other health priorities. It was unclear when Congress would revisit the request by President Barack Obama for $1.9 billion.

FUNDING PRIORITIES

In the meantime, the White House has diverted more than $500 million earmarked for other projects for urgent Zika initiatives, including those where scientific opportunities will be lost if not acted upon immediately.

One such study will follow children born to women infected with Zika to identify the development of any disabilities not detected at birth. Other projects on the priority list include vaccine development and mosquito eradication.   One study underway will assess whether the risk of transmission is greater from men who experience Zika infection symptoms, such as fever and rash, than from those who don’t. This information is considered vital since most people experience no symptoms.

The study of infected men in Brazil and Colombia will test semen from thousands of men over time to determine how long Zika poses a risk to sexual partners. As long the virus can be grown in a laboratory from semen cell samples, infectious disease experts believe it is potentially contagious.

Zika typically clears the bloodstream about a week after infection, but it has been detected in urine for at least twice as long. Its persistence in semen in the British case study has caused some researchers to draw comparisons to other viruses.

HIV can last in blood and semen indefinitely, and the mosquito-borne West Nile virus can reside in the kidneys and urine for years, researchers said. One patient who survived the deadly Ebola outbreak had evidence of that virus in his semen for 18 months.

“We got very surprised by Ebola that it was hanging around for so long,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

“One of the big questions we have to ask is does Zika also cause a similar type of latency?”

(Additional reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Girion)


Visit the Source Site

Powered by WPeMatico

Shire says ADHD drug meets main goal of study

A sign sits in front of Shire's manufacturing facility in Lexington, Massachusetts July 18, 2014.   REUTERS/Brian Snyder
A sign sits in front of Shire’s manufacturing facility in Lexington, Massachusetts July 18, 2014.

Reuters/Brian Snyder


Irish drugmaker Shire Plc said a study testing an experimental drug to treat attention-deficit disorder met the main goal, bringing the drug one step closer to approval in the United States.

The company’s shares were up 3 percent at 4381 pence at 12.52 GMT on the London Stock Exchange on Wednesday. Shire’s U.S.-listed shares were up 3 percent at $176.28 in light premarket trading on the Nasdaq.

Shire, which sells Vyvanse and Intuniv to treat Attention-deficit/Hyperactivity Disorder (ADHD), has focused on developing treatments for the condition that affects about 4 percent of the U.S. population.

Data showed both doses of the experimental drug, SHP465, were better than a placebo in treating patients with Attention-deficit/Hyperactivity Disorder, Shire said.

Shire, which sponsored an awareness campaign on ADHD that included Maroon 5 singer Adam Levine in 2011, said if SHP465 was approved by the FDA, the company’s ADHD drug franchise would be protected up to 2029.

The company said it was on track to get the drug approved by the U.S. Food and Drug Administration in the second half of 2017.

Shire, which is still integrating its acquisition of Baxalta, had reported in April similar results from a late-stage safety and efficacy study.

(In paragraph 3 of June 29 story, corrects spelling of drug name to Vyvanse)

(Reporting by Vidya L Nathan in Bengaluru; Editing by Don Sebastian and Saumyadeb Chakrabarty)


Visit the Source Site

Powered by WPeMatico

Shire says ADHD drug meets main goal of study

A sign sits in front of Shire's manufacturing facility in Lexington, Massachusetts July 18, 2014.   REUTERS/Brian Snyder
A sign sits in front of Shire’s manufacturing facility in Lexington, Massachusetts July 18, 2014.

Reuters/Brian Snyder


Irish drugmaker Shire Plc said a study testing an experimental drug to treat attention-deficit disorder met the main goal, bringing the drug one step closer to approval in the United States.

The company’s shares were up 3 percent at 4381 pence at 12.52 GMT on the London Stock Exchange on Wednesday. Shire’s U.S.-listed shares were up 3 percent at $176.28 in light premarket trading on the Nasdaq.

Shire, which sells Vyvanse and Intuniv to treat Attention-deficit/Hyperactivity Disorder (ADHD), has focused on developing treatments for the condition that affects about 4 percent of the U.S. population.

Data showed both doses of the experimental drug, SHP465, were better than a placebo in treating patients with Attention-deficit/Hyperactivity Disorder, Shire said.

Shire, which sponsored an awareness campaign on ADHD that included Maroon 5 singer Adam Levine in 2011, said if SHP465 was approved by the FDA, the company’s ADHD drug franchise would be protected up to 2029.

The company said it was on track to get the drug approved by the U.S. Food and Drug Administration in the second half of 2017.

Shire, which is still integrating its acquisition of Baxalta, had reported in April similar results from a late-stage safety and efficacy study.

(In paragraph 3 of June 29 story, corrects spelling of drug name to Vyvanse)

(Reporting by Vidya L Nathan in Bengaluru; Editing by Don Sebastian and Saumyadeb Chakrabarty)


Visit the Source Site

Powered by WPeMatico

Gaps in CRC Screening in Seniors

Action Points

  • More than a fourth of healthy older patients did not have up-to-date screening for colorectal cancer (CRC), and a third of those with a positive fecal blood tests did not have timely follow-up.
  • Note that clinical guidelines uniformly recommend CRC screening for adults 50 to 75 but no consensus exists with regard to CRC screening in older patients.

More than a fourth of healthy older patients did not have up-to-date screening for colorectal cancer (CRC), and a third of those with a positive fecal blood tests did not have timely follow-up, an analysis of three large integrated health plans showed.

The proportion of patients with current screening and timely follow-up for positive tests was significantly lower in the subgroup ≥76 (P<0.001). Age influenced screening practices more so than comorbidities, particularly with respect to meeting current screening recommendations. Across all agree groups from 65 to 89, the likelihood of timely follow-up decreased significantly as comorbidities increased (P<0.001).

The age- and comorbidity-related decline in timely followup after an abnormal test result is “especially concerning, because the elderly patients in this study were all insured members of integrated healthcare systems with comprehensive patient tracking, advice, and proactive scheduling of colonoscopy appointments that many small primary care practices lack,” Carrie N. Klabunde, PhD, of the National Institutes of Health Office of Disease Prevention in Rockville, Md., and co-authors wrote in an article published online in the American Journal of Preventive Medicine.

The findings “suggest a need for reevaluating age-based screening guidelines and improving screening completion among the elderly,” they added.

Clinical guidelines uniformly recommend CRC screening for adults 50 to 75 to reduce the risk of CRC mortality. In contrast, no consensus exists with regard to CRC screening in older patients, as the U.S. Preventive Services Task Force, U.S. Multisociety Task Force, and American College of Physicians have differing positions on the issue.

The American Geriatrics Society has recommended an individualized approach to CRC screening that is not defined strictly by age. Several recent studies have provided support for individualized screening, suggesting that healthy patients >75 may benefit from screening, Klabunde and authors noted.

However, during the time period of the study, the USPSTF flatly recommended against screening for individuals older than 85, and discouraged it for those 76-85 unless they had special risk factors. The pattern of screening by age found in the current study generally matched those recommendations.

To examine the impact of age and comorbidities on CRC screening and follow-up, Klabunde and colleagues analyzed data for 846,267 older patients enrolled in three integrated health plans during 2011 and 2012. The outcomes of interest were up-to-date CRC screening (fecal occult blood test [FOBT] or fecal immunochemical testing [FIT] within the past 24 months, sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years) and timely follow-up of abnormal FOBT or FIT (colonoscopy within 3 months).

Patients 65 to 75 accounted for 64% of the study population, followed by 76 to 84 (28%), and 85 to 89 (8%). Comorbidities were defined by the Charlson index. Half the patient had a Charlson score of 0, and 20.4% had a comorbidity score of 1. About 10% had a Charlson score ≥4.

Overall, 72% of study members were up-to date with CRC screening: 63.3% of patients 65 to 69, 86% of those 70to 75, 55.4% of those 76 to 84, and 32% of those 85 to 89. Among patients who were up to date, the most recent screening test was FOBT or FIT testing in 38.1%, colonoscopy in 35.9%, sigmoidoscopy in 8.1%, and combination testing in 18.0%.

The authors found that 8.5% of patients tested by FOBT or FIT had positive results. Of those with positive tests, 64.9% had follow-up colonoscopy within 3 months.

“In most other practice settings in the U.S., I would expect colorectal cancer screening and follow up rates to be lower … a hypothesis that is supported by nationally representative data from the National Health Interview Survey,” Klabunde told MedPage Today.

The findings highlight the issue of appropriate selection of aging patients for screening, as well as the “considerable need for informed discussions between physicians and patients, and individualized screening decisions, because the relative harms and potential benefits of screening change with increasing age and comorbidity,” she added.

The progression from benign colonic polyp to adenoma to symptomatic malignancy often occurs over many years, complicating decision making about CRC screening in older patients.

“In deciding whether to offer screening at all to older patients and in helping them decide whether or not to get screened, consideration of quality life expectancy is key,” said Richard Wender, chief cancer control officer for the American Cancer Society. Development of a “health-adjusted age” or other individualized screening-decision model might be helpful to primary care clinicians, who often struggle with estimating life expectancy and do not routinely use available tools.

CRC screening needs for older patients notwithstanding, “most of the missed screening opportunities are actually in pre-Medicare populations, particularly those with no health insurance, Medicaid, or relative under-insurance,” Wender noted.

Klabunde and co-authors acknowledged several limitations of the study, notably, lack of information on patient preferences for CRC screening, functional limitations, and family history of CRC.

This work was supported by the National Cancer Institute.

The authors declared they had no potential conflicts of interest with respect to the research.


  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

last updated 06.30.2016

take posttest

Visit the Source Site

Powered by WPeMatico

Basketball Legend Pat Summitt's Death Points to Ravages of Early Alzheimer's

News Picture: Basketball Legend Pat Summitt's Death Points to Ravages of Early Alzheimer'sBy Margaret Steele
HealthDay Reporter

Latest Alzheimers News

TUESDAY, June 28, 2016 (HealthDay News) — Legendary coach Pat Summitt stared down myriad challenges as she thrust women’s college basketball onto the world stage. But her greatest foe wasn’t on the court — it was Alzheimer’s disease.

Summitt died Tuesday at age 64, after a remarkable coaching record, winning eight NCAA titles and nearly 1,100 games with the University of Tennessee Lady Vols.

The diagnosis of Alzheimer’s before her 60th birthday foretold the decline of her brilliant career and thrust Summitt into a new role: as chronicler of the ravages of this incurable brain disease.

“Since 2011, my mother has battled her toughest opponent, early onset dementia, ‘Alzheimer’s Type,’ and she did so with bravely fierce determination just as she did with every opponent she ever faced,” said her son, Tyler Summitt, the Associated Press reported.

“Even though it’s incredibly difficult to come to terms that she is no longer with us, we can all find peace in knowing she no longer carries the heavy burden of this disease,” he added.

Summitt, the winningest coach in Division I college basketball history, died peacefully in Knoxville due to complications from the disease, her son said.

She was 59 when she announced in 2011 that she had been diagnosed with early onset dementia. She coached one more season before retiring, and detailed her struggle with dementia in a co-written book released in March 2013.

“It’s hard to pinpoint the exact day that I first noticed something wrong,” Summitt wrote. “Over the course of a year, from 2010 to 2011, I began to experience a troubling series of lapses. I had to ask people to remind me of the same things, over and over. I’d ask three times in the space of an hour, ‘What time is my meeting again?’ — and then be late.”

In 2011, Summitt started a foundation in her name to fight Alzheimer’s, and it has raised millions of dollars, according to published reports.

The overwhelming majority of the 5.4 million Americans with Alzheimer’s are 65 and older. But approximately 200,000 of them are younger than 65, which is termed early onset Alzheimer’s, says the Alzheimer’s Association.

Like Summitt, many with early onset Alzheimer’s are in their 40s and 50s when the progressive brain disease strikes. Doctors don’t understand the cause of the disease in younger people, but researchers have begun to suspect genetics.

Because doctors aren’t looking for signs of Alzheimer’s in middle-aged people, the disorder may progress undetected, the Alzheimer’s Association notes. Patients often receive different diagnoses from different physicians, or they’re told symptoms such as memory loss are due to stress, the foundation adds.

Symptoms can vary, but the Alzheimer’s Association says key signs to watch for include: memory loss that disrupts daily life; challenges in planning or solving problems; difficulty completing familiar tasks; confusion with time or place; trouble understanding visual images; or new problems speaking or writing.

Other possible indicators include putting things in unusual places, decreased judgment, and withdrawal from work or social activities.

The Alzheimer’s Association suggests scheduling an appointment with a doctor if you notice any of these signs in yourself or a loved one.

While no one wants to hear a doctor confirm their suspicions, experts say early diagnosis is essential for building supports and making important decisions while you can.

As Summitt told supporters: “You can’t always control what happens, but you can control how you handle it.”

A press release from the Alzheimer’s Association said: “Coach Summitt faced Alzheimer’s disease, as only she could, strongly and publicly. One of the greatest coaches in the history of sports continued to be an educator and coach off the court, educating so many about Alzheimer’s disease and rallying people to take action and become involved in the Alzheimer’s cause,” said Harry Johns, president and CEO of the Alzheimer’s Association.

“Coach Summitt was a courageous advocate for this cause. In honor of her struggle and the challenges faced by millions of Americans, we will continue to aggressively pursue greater awareness, support for families and research that will slow, stop and ultimately cure Alzheimer’s disease,” he said.

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: June 28, 2016, media release, The Alzheimer’s Association; Associated Press

Visit the Source Site

Powered by WPeMatico