Stroke patients missing out on life-saving surgery

Despite previous warnings, patients with symptoms of stroke or transient ischemic attack (TIA or ‘mini stroke’) are missing out on life saving operations because they fail to recognise the symptoms, and when they do, they are routinely treated as low priority cases in the NHS, says a UK surgical audit published today (22^nd July).

The UK Audit of Vascular Surgical Services and Carotid Endarterectomy, which also flags up significant variations in the quality of vascular care provision in the UK, has prompted surgeons to call for an urgent review of vascular services.  Ensuring that these high risk patients are fast-tracked into hospital - in the same way as potential heart attack patients - would avoid hundreds of needless deaths every year.

Irrefutable evidence exists that shows patients who show classic symptoms of TIA – facial or arm weakness, speech problems and blurred vision - are at risk of having a severe stroke if they do not receive surgery of the neck arteries (carotid endarterectomy or CEA) as soon as possible, ideally within 48 hours but no longer than 14 days.

However, a lack of public awareness of the symptoms of TIA combined with poor professional understanding of treatment and referral options, mean that instead of being treated as emergency cases at the first sign of symptoms, thousands of patients are waiting weeks or sometimes months for an operation that may be of no benefit by the time they receive it.  In practical terms, if patients undergo surgery within two weeks, experts predict that around 200 strokes could be prevented for every 1,000 operations.

The National Institute for Health and Clinical Excellence (NICE) sets a timeframe of two weeks from symptoms to surgery, while the Government’s National Stroke Strategy (NSS) is 48 hours.  The audit shows that only 3% of patients made the NSS guideline and approximately a third of patients made the NICE guideline of 14 days. Currently, the average wait from symptom to surgery is 28 days and referral to surgery is 19 days.  Most delays in meeting the two week timeframe relate to presentation and referral, with 18% of patients failing to present to a GP or hospital and 40% not being referred on from primary care. 

However, 18% of patients missed the deadline due to the limited availability of staff or operating time and 9% due to a lack of imaging equipment, prompting surgeons to call for an immediate review of the organisation of vascular services.

Each year in the UK, around 120,000 people have a stroke and 20-30% die within a month.  Stroke is the largest single cause of significant adult disability, with nearly a million people living with the devastating after-effects. Stroke costs the economy £7 billion yearly and £2.8bn in direct hospital care.   Of the estimated 10,000 patients per year who might benefit from carotid endarterectomy only 4,500 operations are performed annually in the UK.   Stroke is a preventable and treatable disease and with better recognition of people at highest risk, early surgical intervention can significantly reduce the incidence and severity of stroke.    

Professor Ross Naylor, consultant vascular surgeon at Leicester Royal Infirmary and member of the UK Audit Steering Group, said:

“Given the very high initial risk of stroke after a patient presents with their first symptom, achieving the NSS guideline of 48 hours from symptom to surgery must be our ultimate goal and multi-disciplinary team working is key to achieving this. Evidence shows that the best quality of care comes from those centres which are geared up to offer rapid access to TIA clinics which offer immediate access to imaging of the brain and its blood vessels.  These centres can then quickly identify high risk for stroke patients, start their medical therapy and arrange for their immediate transfer to the nearest Vascular Surgery unit for urgent surgery. Healthcare purchasers and providers must stop tolerating delays in the system and address the problems. Strokes and TIAs are emergencies and must be treated as such.”

Vascular Society Audit chairman and Consultant vascular surgeon, Mr David Mitchell said:

"This study shows that services are currently not organised well enough to deliver the standards of care set out in NICE guidelines, or the NSS targets.  A comprehensive service fit for purpose for urgent carotid surgery is unlikely to occur without centralisation of in-patient vascular services which would be achieved most effectively by the creation of formal networks of specialists working together 24 hours a day, 7 days a week”.
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Nearly half of Britons not interested in life-saving equipment

Nearly half the people in the UK aren’t interested in applying for lifesaving heart equipment in their community or work place.

That's according to the survey the British Heart Foundation (BHF) did with Home Retail Group, owner of Argos and Homebase, which showed;

• 44 per cent of people ‘weren’t interested in applying for a defibrillator’ or said that ‘it wasn’t their job to apply for one’.
• 20 per cent knew of a defibrillator in their work place or community with 80 per cent admitting that they ‘hadn’t ever thought about it’ or thought they were ‘only located in medical centres’.
• 30 per cent of people didn't know the recommended response time to use a defibrillator.

With their official partner Home Retail Group, the BHF are trying to help save thousands of lives and have already raised more than £2.5 million to put defibrillators where they're needed most.

Since 1996, the BHF have provided over 6,000 public defibrillators with 700 machines funded through the partnership with Home Retail Group.

Making a difference

Ceri Wootton, Community Affairs Manager for Home Retail Group, said: “Most defibrillators can be positioned anywhere members of the public congregate but 33 per cent of people we asked thought you could only find them in medical centres.

"Through our network of over 1,000 stores, we have placed over 700 defibrillators while also trying and trying to encourage customers and the communities we work in to apply for a defibrillator.

“The survey results indicate the need for more defibrillators to be deployed strategically in areas of greatest need which could make all the difference in saving someone’s life. The BHF works hard to find the right locations so if there isn’t one in a suitable public facility near you, contact them.”

Safe and easy to use

Defibrillators are used to shock a person’s heart when they suffer a cardiac arrest. Research shows that using a defibrillator within five minutes of collapse provides the best possible outcome. For every minute that passes chances of survival decrease by 14 per cent.

Claire O’Neill, Heart Save Programme Lead at the BHF, said: “As success depends on reducing the time between the patient collapsing and providing a shock with the defibrillator, it is important that people recognise the signs and symptoms of a cardiac arrest and have the confidence to act quickly.

“They are designed to be used by members of the public, and are very effective at guiding the operator through the process of administering the shock. While it is highly desirable that those who may be called upon to use a defibrillator should be trained in their use, no inhibitions should be placed on any person willing to use one. They are safe and easy to use, and will not allow a shock to be given to a victim who does not require one.
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Is your AED cooking nicely?

Are you cooking your AED?

There's a lot of debate around the AED industry at the moment about outdoor cabinets for AED's particularly locked ones.

Conventional outdoor AED cabinets heat up just like your car. 

They build up super heated air and become a virtual greenhouse.  This can put your AED out of commission & cause permanent damage to it. 

Heartstation tested a competitor’s outdoor AED cabinet on an 80°F day in Chicago, and the temperature shot up to 125°F in less than 2 hours!  This temperature is above all AED manufacturers’ maximum storage & operational recommendations.  Imagine what happens after several hours on a really hot day. 

An AED that doesn’t work because it’s overheated can be worse than no AED at all...talk about a lawsuit waiting to happen!
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Tea tree oil may provide skin cancer treatment

Australian scientists believe tea tree oil may provide a safe and effective treatment for non-melanoma skin cancers and pre-cancerous growths.

Tests on animals suggest that the natural oil may prevent tumour growth and encourage existing tumours to shrink.

Researchers grew solid tumours under the skin of mice and treated them with a tea tree oil formulation.

They found that the tumours started to shrink within a day of treatment and were undetectable within three days.

Dr Sara Greay, whose findings are published in the journal Cancer Chemotherapy Pharmacology, said that the team were 'very excited' by their results.

'[We] are hoping to find funding for a small clinical trial of about 50 people with pre-cancerous lesions, with the aim of preventing the development of skin cancers,' she revealed.

Non-melanoma skin cancer is the most common type of cancer in the UK and is almost always caused by long-term exposure to the sun.

Sun damage is most common in people with fair skin and light-coloured hair and eyes.
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"No evidence" that A&E target improves care

Senior doctors have claimed that there is no evidence that the four-hour accident and emergency target benefits clinical care

The target was introduced at 90 per cent in 2004, remained at 98 per cent since 2005, and has now been lowered to 95 per cent by the new coalition government.

Writing in the British Medical Journal, a group of senior doctors argue that the four-hour standard has not benefited clinical care and has encouraged a shift away from needs-led care.

They showed that, in 2004, there was a 'spike' in the percentage of patients who were admitted to hospital or discharged during the last 20 minutes of the four hours.

Data for 2008-09, based on 12.2 million patients at English emergency departments, show that the spike was still occurring nationally and was even larger than in 2004.

'Good evidence-based indicators of quality in emergency medicine need development,' the experts wrote.

'We have no evidence that the 98 per cent four-hour target benefits clinical care, and our findings suggest that it has encouraged target-led rather than needs-led care.'

Meanwhile, a separate article in the British Medical Journal has identified an increased lack of flexibility in applying for speciality training.
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Lack of fitness does not lead to fatness

Inactivity does not lead to childhood obesity, a new study suggests.

Scientists at the Peninsula Medical School in Plymouth have been taking part in the EarlyBird Diabetes Study - which observes a group of city schoolchildren - for the past 11 years.

They have challenged the assumption that inactivity leads to fatness and believe that the reverse may in fact be true - that obesity leads to inactivity.

Publishing their findings in the Archives of Disease in Childhood, the scientists reveal that physical activity had no impact on weight change in those children involved in the study.

However, the presence of excess weight led to less activity, suggesting that a child's level of fatness influences changes in the physical activity over time.

Commenting on the findings, Professor Andy Ness from Bristol University said that the team may be partly right.

He told the BBC that his own research has found evidence that physical activity predicts changes in fatness.

'But that doesn't mean there's not something going on the other way. We think it's a combination,' he revealed.
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Botox to treat migraine?

Botox has been approved as a treatment for patients with chronic migraine.

The toxin has been licensed by the Medicines and Healthcare Products Regulatory Agency (MHRA) for adults with chronic migraine, which includes headaches on at least 15 days per month and migraine symptoms on at least eight of these days.

The approval makes Botox the first preventative treatment to receive a specific licence for use in patients with chronic migraine.

It follows a large phase-III clinical trial involving 1,384 patients, which found that patients who received Botox injections into specific head and neck muscles typically had fewer headache and migraine days than those who were given injections of a placebo (dummy treatment).

Wendy Thomas, chief executive of the Migraine Trust, commented: 'Chronic migraine is currently an under-researched, under-diagnosed and under-treated condition.

'We welcome new therapies, especially preventative medication, for this potentially disabling condition.'

NHS figures suggest that about 15 per cent of UK adults are affected by migraine.
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Sharing your sneeze?

About one in four people do not cover their mouth when they cough or sneeze, a new study has found.

Scientists at Otago University Wellington in New Zealand observed people in three public areas in the country's capital city.

Despite a recent public health campaign encouraging people to cover their mouth to prevent the spread of infectious diseases, researchers found that 26.7 per cent of coughs and sneezes went uncovered, while just 4.7 per cent were covered by a tissue, handkerchief or elbow.

Study author Nick Wilson, whose findings were presented at the International Conference on Emerging Infectious Diseases, commented: 'This study showed a low prevalence of recommended respiratory hygiene behaviours, suggesting that hygiene messages promoted in mass media campaigns have not been seen and/or have not been readily adopted by the public.'

Meanwhile, a study in the journal Thorax has revealed that the majority of hospital admissions and inpatient deaths from swine flu during the first wave of the pandemic in the UK in 2009 affected people with no previous underlying health problems or risk factors for the illness.
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Weight loss may ease menopause symptoms

Overweight women who suffer from hot flushes during menopause may benefit from losing weight, new research suggests.

A study by scientists at the University of California, San Francisco, found that about half of 338 overweight participants (average age 53) were bothered by hot flushes at the start of the six-month trial.

Those who took part in an intensive weight-loss programme typically reported an improvement in their hot flushes.

Writing in the Archives of Internal Medicine, the study authors noted that hot flushes are among the main concerns of women during and after menopause.

'In multiple observational studies, women with a higher body mass index (BMI) have reported more frequent or severe hot flushes compared with women with a lower BMI,' they revealed.

'Our findings indicate that women who are overweight or obese and experience bothersome hot flushes may also experience improvement in these symptoms after pursuing behavioural weight-loss strategies.'

NHS data show that the average age for a British woman to reach the menopause is 52.

Other common symptoms include night sweats, irritability and recurrent urinary tract infections.
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Parents warned not to use spoons for giving medicine

Parents have been advised not to use household spoons when giving medicine to children, as they vary greatly in size.

A study at the Alfa Institute of Biomedical Sciences in Athens, Greece, looked at 71 teaspoons and 49 tablespoons, which were obtained from 25 households.

The researchers found that teaspoons ranged in capacity from 2.5ml to 7.3ml, while tablespoons varied between 6.7ml and 13.4ml.

Professor Matthew Falagas, director of the Alfa Institute of Biomedical Sciences, revealed: 'A parent using one of the biggest domestic teaspoons would be giving their child 192 per cent more medicine than a parent using the smallest teaspoon, and the difference was 100 per cent for the tablespoons.

'This increases the chance of a child receiving an overdose or indeed too little medication.'

In light of their findings, which are published in the International Journal of Clinical Practice, the study authors have advised parents to use calibrated medicine syringes to ensure they are dispensing the correct doses of liquid medication.

A spokesman for the Royal Pharmaceutical Society of Great Britain told the BBC that pharmacists 'always recommend that parents and carers only use spoons or syringes which are designed for the administration of medicines'.
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Asthma suffers face discrimination

Britons with severe asthma are often subjected to discrimination, a new report has found.

The 'Fighting for Breath' report, published by Asthma UK and the Severe Asthma National Network (SANN), has prompted calls for greater recognition of the disabling nature of the condition, which affects a quarter of a million people in the UK.

Policymakers, commissioners, healthcare professionals, employers and the general public are being urged to treat people with severe asthma with fairness and respect.

Neil Churchill, chief executive of Asthma UK, revealed: 'Our report shows that people with severe asthma are some of the most marginalised in society, living hidden lives, facing discrimination from many areas of society and missing out on vital life opportunities.

'The government must enable those affected and their carers to access the benefits they need, protect spending on specialist nurse posts, and develop and implement consistent standards for asthma across the UK.'

Beverley Hargadon, senior respiratory research nurse at SANN, added: 'We hope that this report provides guidance to improve the future quality of care provision for people with severe asthma and their carers.'

A recent scientific study suggested that mild and severe asthma may actually be two separate diseases.

Mild asthma affects far more people than severe asthma and can usually be controlled by taking inhaled steroids.

In severe asthma, treatments tend to be less effective and the condition can therefore be hard to manage.
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Serious failings at out of hours provider

The out-of-hours care provider Take Care Now has been found guilty of 'serious failings' by the NHS regulator.

A report by the Care Quality Commission (CQC) concluded that the firm had failed to learn from serious incidents involving diamorphine and had not made changes, despite warnings from a senior clinician.

Investigators also found that the care of patients may have been compromised by low levels of staff.

The CQC investigation was triggered by the death of David Gray, who died after receiving 100mg of diamorphine from a German out-of-hours doctor employed by Take Care Now.

Dr Daniel Ubani, the doctor in question, is no longer on the General Medical Council register and is not allowed to practise in the UK.

CQC chairman Dame Jo Williams commented: 'Take Care Now failed on many fronts. The lessons of its failure must resonate across the health service.'

The chairman noted that about seven million people contact GP out-of-hours services each year and said that providers, primary care trusts and individual clinicians 'all have a responsibility to ensure services are as safe as possible'.
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Workplace bullying can effect mental health

People who are being bullied at work should not suffer in silence, as their mental health could be at risk, an expert has said.

Emma Mamo, policy and campaigns manager at mental health charity Mind, said that victims should talk to a more senior member of management if they are unhappy.

She explained: 'The way we feel about our work can have a huge impact on the way we feel in our personal lives, and being bullied by colleagues can be tremendously damaging to our self-esteem and overall wellbeing.'

Ms Mamo revealed that people can experience stress and depression and may have to be signed off work as a result of bullying.

She claimed: 'No workplace should take bullying lightly - not only does it undermine performance at work, but it can have repercussions for mental health.'

Her comments were made after a poll by recruitment consultancy Reabur found that one-fifth of employees felt they had been bullied by their boss, yet only eight per cent had reported the incident.
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Flu jabs may be "thing of the past"

A new hi-tech skin patch could soon be used instead of injections to deliver vaccines, scientists have suggested.

The patches have already been tested on mice and were found to deliver flu vaccine effectively.

They consist of 100 'microneedles', each measuring just over half a millimetre, which deliver the vaccine.

The tiny needles then dissolve away and the backing is discarded.

According to scientists at the Georgia Institute of Technology in Atlanta, US, the patches are easy to use and can be administered by the patient without any need for medical training.

Lead researcher Professor Mark Prausnitz, whose findings are published in the journal Nature Medicine, commented: 'We have shown that a dissolving microneedle patch can vaccinate against influenza at least as well, and probably better than, a traditional hypodermic needle.'

Co-researcher Dr Sean Sullivan added: 'We envision people getting the patch in the mail or at a pharmacy and then self-administering it at home.'

The advance could be used to deliver vaccines such as the flu jab, which is offered to people in at-risk groups, including over-65s, those with serious medical conditions and poultry workers.
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How safe are sunbeds?

With the recession forcing many of us to stay at home this summer, it may seem even more tempting to achieve a tan artificially.

However, sunbeds increase your exposure to sunlight and subsequently give you a higher chance of developing skin cancer.

Statistics show that non-melanoma and malignant melanoma are the most commonly diagnosed cancers in the UK.

And according to Cancer Research UK, sunbeds are estimated to cause around 100 deaths from melanoma every year in the UK.

What's legal?

Until recently, sunbeds have been unregulated. However, in Scotland a new law banning under-18s from using tanning salons, and barring coin-operated and unsupervised machines, will come into effect in September 2009.

A similar scheme is under consideration in England and Wales.

How do sunbeds work?

Sunbeds cause the body to tan in exactly the same way as the sun, by emitting ultraviolet rays, UVA and UVB radiation, which stimulates melanin, a skin pigment.

Melanin is produced by cells called melanocytes. UV exposure stimulates these cells to divide, creating more melanin, which browns as it rises to the skin's surface and causes a tan.

How quickly we burn or tan depends on our skin type. Skin experts have classified skin types into six groups – type one for people with porcelain white skin (often accompanied by red hair, green eyes and lots of freckles), through to type six for natural black skin.

In between are groups ranging from those with fair to natural brown skin. The darker our skin, the more melanin we have and the better protected our skin is from ultraviolet light.

Sunbeds can emit either UVA or UVB rays from their fluorescent tubes, depending on the machine. Modern machines often produce higher levels of UVB to create a rapid and more natural tan. But UVB has a higher association with sunburn and cancer.

What are the risks?

Some modern tanning machines can emit UV radiation up to five times stronger than the midday Australian summer sun.

‘Sunbeds provide a strong dose of UV and you don’t know how much UV exposure you are getting,’ says Megan Dawe, senior skin cancer screening nurse at The Mole Clinic in London.

‘The changing colour when you tan shows the skin is being damaged.’
Cancer Research UK says using sunbeds under the age of 35 can increase the risk of melanoma by 75 per cent.

Professor James Ferguson, head of the University Department of Dermatology in Dundee, says UV damages the DNA in skin cells, which increases the risk of skin cancer and ages the skin.

Are there any benefits?

According to The Sunbed Association, UV exposure stimulates vitamin D production. This is essential for good bone health and can improve mood, helping to stem off conditions such as seasonal affective disorder (SAD).

It can also improve the appearance of skin conditions, such as psoriasis.

The association maintains that a tanning programme can be carefully controlled.

However, medical experts warn that daily casual exposure to sunlight, such as a 5-10 minute walk to and from the station, is enough to provide your body with all the vitamin D it needs.

This is because the body stockpiles what it needs in the summer for the winter.

Vitamin D can also be obtained through eating oily fish, eggs and other foods.

How to reduce the risks

Health experts warn against the use of sunbeds. But if you will use them, the British Photodermatology Group suggests no more than 20 treatments per year. Skin expert, Professor Ferguson, suggests below 10.

You should also:-

·    leave at least 48 hours between sessions
·    never sunbathe on the same day
·    wear goggles to protect the eyes
·    remove make-up in case it increases sensitivity to UV
·    keep time spent on a sunbed to a minimum, with less time spent on a UVB machine than one emitting UVA.

Be sun aware:-

·    Aftersun will soothe the skin, but won't prevent long-term damage or cancer.
·    For a risk-free tan, try a spray or rub-on chemical tan instead.
·    When you're out in the sun, use sun cream with a minimum of sun protection factor (SPF) 15.
·    Avoid sunbathing when the sun is at its strongest.

Who should not use sunbeds?

·    Under 18s.
·    Anyone with skin type one and two (people who never tan or who burn easily).
·    If you have a large number of moles.
·    If you freckle easily.
·    People who have a history of childhood sunburn.
·    If you have skin cancer or a family history of it.
·    People with sun-damaged skin.
·    If you take certain medications, such as antidepressants or antibiotics, which make your skin more sensitive to the sun (photosensitive).

What do to if you're worried

If you spot any changes to your skin, including freckles or moles that change shape, colour or size, or that start to itch, visit your GP who can refer you to a specialist.