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Thai Economist advises political parties to promise to increase Patient Visit time to 15 min!!!!

Top economist Ammar Siamwala and senior health experts have called on political parties to issue ambitious public health policies for the upcoming election that allow patients to see doctors for at least 15 minutes - for improved diagnosis of their problems at state hospitals.

"I want to see all political parties promise people that whenever they go to hospital they will have at least 15 minutes to see doctors each time. Today, patients have only 5 minutes to see doctors," Ammar said.

He spoke at a roundtable discussion titled "Political Party Policy on Public Health and Wellbeing for Thai people" held by The Nation and its sister paper Krungthep Turakij.

Academics and key leaders from political parties including the Democrat party, Pheu Thai party, and Bhum Jai Thai party attended the discussion.

Participants at the discussion were asked to present ideas on how to strengthen the public health system.

Ammar said that to date, patients were just able to access healthcare services at hospital but they had only five minutes to see doctors.

Political parties had to think and create a public health policy to improve not only accessible healthcare but also the quality of medical services, he said.

Bringing people for medical services for mild symptoms at a primarycare unit instead of allowing them to get treatment at hospitals was another test for political parties to come up with a policy to reduce crowding at hospitals.

"Patients should have about an hour to see a doctor and undergo treatment at hospital," he said.

Over the past few years, parties' health policies focused on extending medical services without concerning about budget limitations.

"We know that the 30baht healthcare scheme, introduced as a former health policy by Thaksin Shinawatra, is seen as the best public health policy and that it helped people to access medical services without worrying about the cost of treatment. But governments didn't think if there would be enough in the budget to support the scheme or not.

"This is why we have seen an overflow of patients in many state hospitals over past few years," he said.

The administration of Prime Minister Abhisit Vejjajiva had also invested a lot of money to upgrade primary care units nationwide to health promoting hospitals. Instead of improving primary care services, government just changed only the plate showing the name of health promoting hospital.

"It would be better if government promise to people that it will increase the number of doctor to provide medical services for people in rural areas," a senior academic of Thailand Development Research Institute (TDRI) at said.

Meanwhile, National Health Commission secretary general Dr Amphon Jindawattana said political parties' public health policies do not go beyond than putting a lot of money into medical treatment instead of health care promotion and prevention.

"If all political parties do not change their direction in public health policy from medical treatment to health care prevention, county would face bankruptcy in nearly future," a senior health official said.

Amphon said political parties should have strong commitment to issue public health policy that protect people health.

To create public health policy in a long term, Health Insurance System Research Office's director, Dr Samrit Srithamrongsawas said all political parties should eliminate the gab in country's three health care scheme.

Democrat Party spokesman Dr Buranat Samutrak said Democrat has issued seven public health policies for this time general election including reducing the gap between three health care fund, allowing family member of Social Security Scheme's subscriber to receive medical benefit under the scheme, making a fiveyear blueprint for country's National Health Security Fund financial management.

  The party's public health policies also include improving civil servant medical benefit and control the budget for the scheme, improving medical services at state health care units, allowing state hospital to run administration and operation as private hospital but under government's control, developing emergency medical services, and enhancing local authority to develop health services to support local people.

Meanwhile, Bhum Jai Thai party member Manit Nopamornbodi said his party will improve the quality of medical services especially in health promoting hospital.

To help people in rural areas access medical treatment, he said the party will issue public health policy that produce large number of medical personnel to work at health promoting hospital within 10 years.

He believed that this policy would reduce the overflow of patient and workload for physician at general hospital.

Moreover, local authority will be allowed to help Public Health Ministry to develop health care services for people.

Pheu Thai Party deputy leader Vichan Meenchaiyanant said his party will bring the 30bath copayment back after former Prime Minister General Surayud Chulanont's administration had abolished the copayment scheme and made universal care scheme free.

Paying 30bath for receiving medical serviced at hospital will ensure people to get health care services with good quality.

His party's public health policy will also extend the medical services after the office hours but patient will need to pay Bt 300 to get medical services at state hospital.

"This money will be collected to buy medical devices and other products to treat patient," he said.

As Thailand will enter to the ageing society next few years, Vichan said Pheu Thai Party will introduce a second home for elderly people. They could stay and enjoy creative activities. Health volunteers at local areas will take care them.

To prevent Thai women from cervical cancer, he said the party is now considering to push the idea that allow young girl aged under 15yearold to receive preventive vaccine against cervical cancer.

~ from reuters

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Confused Parents over too many vaccinations!!!

A FEW SHOTS TOO MANY

Nowadays, Indian parents go for two lines of vaccinations. First, there is the list rolled out by IAP, a scientifically empowered group comprising paediatrics across the country. Two, there is a national immunisation schedule approved by the government that terms five basic vaccines as compulsory. These are Diphtheria Pertussis Tetanus (DPT), Hepatitis B, Oral Polio, BCG and Measles vaccines.

The IAP list has these “optional” vaccines: Typhoid, Haemophilus Influenza Type B (HIB), Hepatitis-A and Varicella (chicken pox). Other vaccines, according to IAP, which could be given after discussions with parents, are: Pneumococcal conjugate and Rotaviral.

This is not all. IAP adds new vaccines in its schedule depending on their importance and efficacy by reviewing relevant international data and its relevance to the Indian settings.

After backing pneumococcal (for pneumonia), mencivac or meningococcal vaccine and injectable polio vaccines, it has now pitched for the cervical cancer vaccine for girls. Three doses of human papilloma virus (HPV) vaccine, according to IAP, should be given at 0, 1-2 and six months.

THE COST FACTOR

The national immunisation schedule, on the other hand, has different considerations. “The government adds a vaccine in its schedule on the basis of its feasibility in terms of price and availability in India,” said Dr M K Bhan, secretary, Department of Biotechnology, Government of India.

Take, for instance,the vaccine against chicken pox: “The disease is not a major health threat, so it does not find a place in the national immunisation schedule,” said a senior official in the Union Health Ministry.

“While the high cost of vaccine is an issue, my problem is that how could the immunity of a child who goes to a private doctor be different from those who follows the government recommendations. This makes me think whether these vaccines are really important or are meant just for minting money. Since I can afford them, I follow the paediatrician’s advice,” said Kriti Sharma, who works with a multi-national company.

Dr Ajay Khera, Deputy Commissioner, Routine Immunisation programme in the Union Health Ministry, says that “managing an individual is different from managing a big health programme”.

“The cost of a vaccine may not be important for an individual but such factors have to be consideration in a government immunisation programme,” he said.

NEED FOR UNIFORMITY

The word ‘optional’ is troubling the doctors as well.

“The new vaccines are not bad. But the recommendations keep changing and even we get confused at times. It is important to bring in uniformity,” said Dr Satwinder Kapoor, consultant, paediatrician, Max Hospital, Pitampura, New Delhi.

Interestingly, vaccines recommended to be used in the national immunisation programme differ from state to state.

The vaccine schedule for Delhi has a typhoid vaccine and MMR vaccine. Likewise, the Japanese Encephalitis (JE) vaccine is recommended in UP and adjoining states. The Hepatitis B vaccine has been recently introduced in some of the states.

Doctors working in the government sector face another dilemma. “It is understandable that India is a democratic country and allows paediatricians to offer a wide choice to parents. In the government sector, however, it is difficult to answer people as to why children who visit us need not have certain shots,” said Dr Vinod Kumar Paul, Head of Department, Paediatrics, All India Institute of Medical Sciences (AIIMS).

Dr Paul and his team examine 300-400 children every day. He says he himself feels that vaccines like pentavalent and Rotavirus should also be given to children who follow the government schedule. “These vaccines tackle important diseases. I hope they make it to our list as well.”

The immunisation schedule was simple a couple of years ago. And so was life.

Deepa Chopra, another mother, says: “I had no confusion when I used to take my first child for vaccinations seven years ago. But now I am faced with a barrage of pricks for my two-year-old. There are too many options, too many brands now.”

Dr Sanjeev Bagai, CEO and senior paediatrician, Batra hospital, says the immunisation schedule should be clear-cut without specifying the optional vaccines so as to end the confusion .

“Internationally and nationally, a lot of varying immunisation schedules are used. Words such as optional should not be printed on the chart. The newer vaccines of HPV and pneumococcal are extremely essential, but as they are termed optional, parents are obviously questioning them.”

With the list of new vaccines growing, parents are skipping the optional ones, especially those which are not life-threatening.

“Why should I unnecessarily give a shot to my child for something like chicken pox if it is not life-threatening. I have decided not to go for it,” said Sangeeta Malik, another parent.

  Game for JABS?

  National immunisation schedule

Diphtheria Pertussis Tetanus (DPT), Hepatitis B, Oral Polio, BCG and Measles.

IAP’s optional vaccines

Typhoid, Haemophilus Influenza Type B (HIB), Hepatitis-A and Varicella (chicken pox).

New vaccines in the IAP list

Pneumococcal (for pneumonia), mencivac or meningococcal, injectable polio vaccine, and human papilloma virus (HPV) vaccine against cervical cancer in girls

~ from reuters

Teena Thacker Posted online: Sat Apr 16 2011, 00:00 hrs

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World Malaria Day 2011: Africa's fight continues

Fourth annual event to raise awareness for malaria to eradicate deaths by 2015

BY: Melissa Rudd | Mon Apr 25, 2011

      Today is World Malaria Day - the fourth annual event instituted by the World Health Assembly to recognise the global effort to provide effective control of malaria and create awareness about the deadly disease.

The World Health Orgaisation's statistics show that malaria infects more than 500 million people per year and kills more than a million. The majority of these deaths occur in sub-Saharan Africa.

The theme of World Malaria Day this year is 'Achieving Progress and Impact' which emphasises the international community's renewed efforts to make progress towards zero malaria deaths by 2015, which recently included Hollywood stars raising $750,000. The slogan of the celebration for the WHO African Region is "Together, we can achieve more".

 The fight against malaria is being helped by access to affordable, safe and effective anti-malarial combination treatments across the world, as well as protective insecticide treated nets and other preventive measures.

This year’s celebration marks the end of the UN Decade to Roll Back Malaria (2001-2010). In Africa, 11 countries had reduced the burden of malaria by at least 50 percent at the end of 2010

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Pakistan highlights the roles of clinical pharmacists

In a bid to underline the role and importance of clinical pharmacists in changing health care system in Pakistan, Shifa International Hospital is organising the 1st National Conference of Patient Care Pharmacist today (Saturday). 

Director General (Health) Asad Hafeez will be the chief guest at the conference, which is to be followed by a workshop tomorrow (Sunday). According to Shafqat Ali Hamdani, chief organiser of the conference, dissemination of knowledge about patient care pharmacist in Pakistan, increasing interaction and sharing of experiences among pharmacists to find solution to health care issues and challenges, and highlighting the role of clinical pharmacists in the changing health care system are the main objectives of the event. He said clinical pharmacists were experts in therapeutic use of medications, adding they provide medication therapy evaluations and recommendations to patients and other health care professionals. 

Hamdani said clinical pharmacists were a primary source of scientifically valid information and advice regarding safe, appropriate and cost-effective use of medications. He said clinical pharmacy practice was chiefly about prescribing drugs, administering drugs, documenting professional services, reviewing drug use, communication, counselling, consultation and prevention of medication errors. “There is a need to amplify the role of clinical pharmacy in health care system. The clinical pharmacist’s role should be central in the countrywide health care systems with accessibility to ensure patient safety and quality of services,” he said. 

The conference organiser said Pharmacy Services Department of the hospital was organising the event where physicians, pharmacists, pharmacy academics, students and technicians, microbiologists and paramedics would be in attendance in large numbers. According to Hamdani, the conference’s topics are ‘Clinical Pharmacist in Changing Health Care System of Pakistan’, ‘Role of Pharmacist in Antibiotics Selection’, ‘Impact of Technology in Pharmacy Practice’, ‘Role of Community Care Pharmacist’, ‘Career Path’, ‘Skill Development’, ‘Quality Management System and Pharmacy’, ‘Oncology Practice’, ‘Need of Changes in Current Curriculum’, ‘Advancement of Drug Research for Patient Care and Patient Safety in Clinical Trials’, while the workshop will focus on proper storage medicine and medication error and its prevention. Meanwhile, the Histopathology Department of Shifa Hospital is organising a workshop on ‘Immunohistochemical Techniques’ at the hospital tomorrow (Sunday) under the umbrella of the Histopathology and Cytology Society of Pakistan. 

~ from reuters

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Court grants parents time to get a second opinion from a cancer expert abroad

THE PARENTS of a four-year-old boy who have concerns about the continuation of a particular regime of cancer treatment for him should be given time to explore other medical opinion, the President of the High Court said yesterday.

Mr Justice Nicholas Kearns said it would be wrong for him to direct the child, who has leukaemia, to undergo further “distressing” treatment in circumstances where there was no imminent threat to his life and where his parents wanted to seek a second opinion from abroad.

In those circumstances, the judge adjourned to May 3rd an application by the Health Service Executive for an order allowing it to continue giving the child, who also has Down syndrome, the treatment which has been recommended by doctors.

The court heard the child was in remission and the parents, who had consented to 23 weeks of the treatment, which had very painful effects last year, were prepared to give further permission if there was any relapse. In the meantime, they wanted time to consult cancer experts abroad.

The HSE brought the application last week after the court was told the boy needed the treatment, which the HSE described as life-saving.

Yesterday, Felix McEnroy, for the HSE, said the parents had taken the view that if there was any relapse, they would immediately re-engage with the treatment. The hospital’s position was, if this treatment was completed, the child would have an 80 per cent chance of survival, which was “extraordinary” in this situation.

The HSE was obliged to vindicate the legal and constitutional rights of the child, counsel said.

While the HSE respected the rights of the parents to fair procedures, time was running out and the risks were “unacceptable”, he added.

The court heard earlier this week the boy’s parents were not prepared to go to the next, more “intensive stage” of treatment, and their objections were scientific rather than philosophical.

When the matter came back before Mr Justice Kearns yesterday, he said he would like to speak with the parents in the hope resort to the courts could be avoided. After a short adjournment, the parents arrived in court.

The judge spoke with them in private and afterwards said he was satisfied the parents were “completely responsible” and had the very best interests of the child at heart.

He was also satisfied they understood the concerns of the hospital and that it was operating in accordance with international practice.

He was further satisfied they understood, by deferring treatment, this ran the risk of a dis-improvement in the child’s condition. However, there was no imminent risk to the boy by allowing a reasonably short deferral of the matter until May 3rd, he said.

The judge added he hoped the good rapport between the parents and the hospital would continue and the inquiries they planned to make over the next two weeks would bring them to a situation where they had the best possible knowledge available.

~ from reuters

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Injectable gel to treat arthritis!!!

They have made an injectable gel that could spell the future for treating rheumatoid arthritis or its cousin osteoarthritis, diseases characterized by often debilitating pain in the joints. 

Among its advantages, the gel could allow the targeted release of medicine at an affected joint, and could dispense that medicine on demand in response to enzymes associated with arthritic flare-ups. 

"We think that this platform could be useful for multiple medical applications including the localized treatment of cancer, ocular disease, and cardiovascular disease," said Jeffrey Karp, leader of the research and co-director of the Center for Regenerative Therapeutics at BWH. 

The researchers tackled the problem by first determining the key criteria for a successful locally administered arthritis treatment. In addition to having the ability to release drug on demand, for example, the delivery vehicle should be injectable through a small needle and allow high concentrations of the drug. 

The team ultimately determined that an injectable gel seemed most promising. 

~ from reuters

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Australian travellers are given unnecessarily vaccinations!!!

Travellers are being given injections they don't need from doctors who don't know enough about some diseases and who rush consultations, a consumer group has found.

A report from Choice has found travellers seeking vaccinations are vulnerable to overservicing and upselling.

Choice spokeswoman Ingrid Just said GPs may prescribe unnecessary shots because they lack experience and information about the risk of certain diseases or hurry through consultations.

Advertisement: Story continues below 

"It's wrong to give travellers shots they don't need and it's unsafe if they walk away from the doctor's surgery without ones they do," she says in a statement.

The average cost of a single travel vaccine can vary from $45 to $85, with the yellow fever vaccine costing $75 per shot.

Malaria pills cost between $1-$5 a day and the multi-shot regime for rabies and Japanese B encephalitis can amount to $300-$360.

One Choice staffer going on an eight-week trip to the Middle East and Africa was told by her GP to find out which shots she needed and then come back and see him.

She went to a travel clinic that explained which were necessary and which were optional based on her travel itinerary.

"The informed advice cut a potential $1000 travel vaccination bill down to $500," Choice said in the statement on Thursday.

Vaccinations may be slightly more expensive at special travel clinics but travellers are less likely to receive and pay for shots they don't need, the group found.

"With one in 11 Australians heading overseas each year, travel vaccinations are big business.

"If you have ambitious travel plans, ask around and find an experienced travel doctor. Not only could it save you money but also your health."

The DFAT website and state and territory health departments also offer up to date information on travel vaccinations.

 ~ from reuters

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U.S. Hospital Errors Run Rampant and Often Go Unreported!!!

Medical errors occur much more often in U.S. hospitals than previously estimated. According to a study recently published in the journal Health Affairs, numerous hospital errors go undetected. In fact, at least 90 percent of hospital errors resulting in patient injury, infection, and other issues are not recorded.

The research indicates that about one in three Americans will suffer from a medical error during a hospital stay, and range from bedsores, to foreign objects left in the body from surgical procedures, to deadly staph infections. Findings indicate that about ten times as many hospital errors occur than previously estimated.

A 1999 report by the U.S. Institute of Medicine estimating that as many as 98,000 deaths and over 1 million injuries occur due to medical errors each year sparked strong efforts to track patient safety. Although progress has being made, the standard of quality is still sorely lacking. Susan Dentzer, editor-in-chief of Health Affairs, pointed out, “Without doubt, we’ve seen improvements in health care over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow.” She went on to explain, “It’s clear that we still have a great deal of work to do in order to achieve a health care system that is consistently high-quality—that is, safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.”

David Classen, a professor at the University of Utah School of Medicine in Salt Lake City, and colleagues, studied 795 patient records among three U.S. teaching hospitals and found that adverse events occurred among one-third of those admitted to hospitals. Findings showed that voluntary reporting by hospitals, in addition to the U.S. Agency for Healthcare Research and Quality’s method for tracking adverse events, were not sufficient in providing accurate information.

The authors wrote, “Hospitals that use such methods alone to measure their overall performance on patient safety may be seriously misjudging actual performance.” They further noted, “Reliance on such methods could produce misleading conclusions about safety in the U.S. health-care system and could misdirect patient-safety improvement efforts.

n the research team’s comparison of measuring systems for medical error detection, while voluntary reporting programs recorded only four medical errors, the use of system designed by the federal Agency for Healthcare Research and Quality for measuring hospital errors identified 35. However, use of the Institute for Healthcare Improvement’s new measuring tool detected 354 events that occurred among patients in the three facilities.

The researchers noted, “Our findings indicate that two methods commonly used by most care delivery organizations and supported by policy makers to measure the safety of care fail to detect more than 90 percent of the adverse events that occur among hospitalized patients.”

According to the research team, administrative data collected by hospitals is used in the U.S. Agency for Healthcare Research and Quality method of detecting medical errors and this is the standard method used by the Centers for Medicare and Medicaid Services in evaluating hospital safety. The Institute for Healthcare Improvement method detects incidences of “unintended physical injury resulting from, or contributed to, by medical care.” The new tool is now used by many American hospitals.

~ from reuters

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Restless leg syndrome drug approved!!!

For those who believe their twitchy legs are an illness -- there's another pill for that.

Restless legs syndrome -- in which creeping and tugging sensations make moving your legs an irresistible urge -- can now officially be treated with a seizure drug. The FDA approved gabapentin, or Horizant, on Thursday after two 12-week clinical trials showed it relieves the symptoms of restless legs syndrome, compared to a placebo.

People with restless legs syndrome get the overwhelming urge to move their legs, especially after lying down. The condition is worst at night, and sufferers sometimes have to pace for hours to relieve the discomfort. The cause of the twitchiness is mostly unknown; some suspect genetics is at least partly to blame, but the condition also can occur with diseases such as kidney failure and diabetes and with certain medications. 

But not all doctors and health experts agree the symptoms are an actual disorder or syndrome worthy of treatment (to the dismay of thosewith restless legs). Nor do they believe it’s as widespread as some say it is (by some estimates, 3% to 15% of the U.S. population).  

A paper titled Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick, presents the skeptics’ case via PLOS Medicine.

The Neurologica blog presents an equally compelling case that the condition is a significant problem.

Whether or not the syndrome is exaggerated, the drugs are real. Gabapentin is the third drug the FDA has approved to treat restless legs syndrome. It’s a type of anticonvulsant that quiets abnormal excitement in the brain.

And if two 12-week trials don’t seem exceptionally reassuring, sufferers can perhaps check out the other two approved drugs, Mirapex and Requip, both originally designed for treating Parkinson’s disease.

Both of those drugs work by taking the place of the brain chemical dopamine, which is needed to control movement. 

  All three drugs focus on the brain for leg (and other limb) relief. But it’s not clear how to combat the physical stress that comes from twitching your leg muscles. Heart problems might be more likely among people who toss and turn at night with twitchy legs, in another restless legs headline this week. Researchers found that twitching legs at night is linked to having a thicker heart wall and an increased risk of heart attack.

  The syndrome won’t be understood anytime soon. But perhaps it should be comforting that where a condition exists, a search for treatment will follow – if enough people have the condition, of course.

 ~ from reuters

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A TEENAGER who has used tanning booths since she was 12 has been ­diagnosed with skin cancer.

A TEENAGER who has used tanning booths since she was 12 has been ­diagnosed with skin ­cancer.

The unnamed 17-year-old from Teesside – who paid for sessions with her dinner money – was ­diagnosed with malignant melanoma last year but has since ­recovered. Skin expert Susan ­Waterfield said: “She is one of the youngest we’ve seen.”

Details of the girl’s battle came as new rules ban under-18s from sunbeds.

~ from reuters

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Biggest hospital in England facing a £40 Million budget crisis!!!

England’s biggest hospital trust is facing a £40million black hole in its budget for next year, it has emerged, capping a disastrous week for Andrew Lansley’s NHS reforms

Imperial College Healthcare Trust, which runs several well-known hospitals in west London and has a turnover of £910m, has also seen three senior executives announce their departure in the past few days.

It is still desperately trying to balance its books and may yet have to announce job cuts, while a “hit squad” could be ordered in by the capital’s health authority to clear up its financial problems.

The news is yet another blow to the ambitious plans of Mr Lansley, the Health Secretary, to reform the NHS.

Earlier this week he was humiliated as David Cameron and Nick Clegg announced an unprecedented “pause” in the passage of his flagship Health and Social Care Bill that could lead to substantial changes, following criticism from the public and the medical profession.

On Thursday his Cabinet colleague Iain Duncan Smith, the former Conservative Party leader, said publicly that patient waiting times had increased over the past year as he delivered a petition to Downing Street opposing local hospital unit closures.

Mr Lansley's troubles will likely continue into next week as the Royal College of Nursing holds its annual conference in Liverpool. He will not make a formal speech to the meeting, the first time a Health Secretary or Prime Minister has not done so in eight years, but still faces a rough reception as he attends a seminar to hear what nurses think of his policies.

Imperial’s financial problems will trouble the Health Secretary partly because it illustrates the difficulties the NHS faces in making savings of £20billion over the next three years, with many trusts already cutting posts and rationing services.

But Mr Lansley also wants all trusts to achieve Foundation Trust status by 2014, giving them more independence, which involves proving that they are financially viable and well-governed.

If Imperial - which runs Charing Cross, Hammersmith, Queen Charlotte’s & Chelsea, St Mary’s and the Western Eye hospitals – struggles meet the requirements to reach Foundation Trust status it means many more trusts are also likely to face difficulties.

According to the Health Service Journal, Imperial has published papers showing that current financial pressures will mean an underlying deficit for 2011-12, and despite a massive cost savings plan an “unidentified gap of £40m” between income and expenditure will remain. This is mainly because the Primary Care Trusts that currently provide its funding are cutting back on the treatment they commission.

It has also missed a target of recording 13 or fewer cases of the superbug MRSA and has a backlog of patients waiting more than the desired 18 weeks for treatment.

Meanwhile the resignations of Steve Smith, its chief executive, Tony Graff, its chief financial officer, and the retirement of Alistair Shearin, its chief information officer, will make it more difficult for the trust to ensure it is managed well.

Imperial has been working with the consultancy Ernst & Young on its cost-saving plans and is still trying to finalise its budget and submit a balanced operating plan.

If it is not approved by NHS London, the Strategic Health Authority for the capital, Imperial may have to apply for emergency funding from a body called the Challenged Trust Board and may have new directors imposed on it from above to turn around its performance.

Cymbeline Moore, head of public relations at Imperial, said: “The financial environment faced by acute trusts is extremely tough. The size and scale of cost reduction plans that large research-based trusts are being asked to make is very challenging. As with many of our counterparts, we are in ongoing constructive discussions with NHS London regarding our financial plans. We can confirm we are not in turnaround nor classed as a challenged trust.”

A spokesman for NHS London added: “There are always robust discussions at this time of year regarding hospital budgets. NHS trusts must agree their budgets and we are working closely with commissioners and providers of NHS care in London to make sure that their plans are credible and can be delivered.

“Imperial, like the whole of the NHS, is committed to managing constrained levels of funding, and using its budget more efficiently to meet demand for better services. The NHS in London is working hard to do this, while at the same time radically slimming down its management structures and managing the process of fundamental reform of the system.”

~from reuters

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Travellers to Europe must vaccinate their kids due to the measles outbreak!!!

SCOTS families jetting off on European holidays during the Easter break have been urged to vaccinate their children against measles following a rise in cases on the Continent.

Health Protection Scotland has issued a statement advising parents travelling to France to ensure that their children have received the MMR vaccine.

The statement, on the Travax website, reads: "Parents who are planning a holiday in France and have not had their children vaccinated or fully vaccinated against measles should ensure that their children have received the requisite number of doses of MMR vaccine for their age.

"Unimmunised adults who have not had the disease themselves may be considered for vaccination if thought to be at risk. Two doses of MMR vaccine are required to give adequate protection"

The move follows an outbreak in mainland Europe, where several countries including Denmark, France, Germany and the Netherlands have had increased numbers of measles cases so far this year, as reported by the World Health Organisation.

France reported more than 1,500 cases in 2009, more than 4,500 cases in 2010 and nearly 1,000 cases in January 2011. Turkey recently reported an outbreak in Istanbul, as well as cases linked to a large outbreak in Bulgaria in 2010.

Meanwhile the Health Protection Agency (HPA) has issued advice to schools in England to make sure children are protected against the illness. A spokeswoman said overseas travel is an important factor in the spread of measles and that HPA units are writing to schools and health professionals in their local area.

~ from Reuters

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smartphones to combat malaria!!!

A team of graduate students has created a new smartphone application they say will allow healthcare workers in remote locations to diagnose malaria cases on the spot.

  But first, the students hope their application wins this weekend's Imagine Cup 2011 national finals in Seattle.

The 9th-annual Imagine Cup, sponsored by Microsoft, asks student entrants to "imagine a world where technology helps solve the toughest problems."

Tristan Gibeau, 25, a graduate computer engineering student at the University of Central Florida in Orlando, said his team's application fits the bill.

"It's going to make a difference in trying to contain the outbreak of malaria," said Gibeau, the project's software designer.

"In the big picture, it'll hopefully help in the fight against most diseases out there and make everybody's life a little easier."

His team's prototype is a Windows 7-equipped Samsung Focus smart phone modified with a microscopic camera lens.

Gibeau said the software application can take a picture of a blood sample, process the data to detect malaria parasites, quantify how much malaria is in the sample and point the parasites out to the phone user.

"It actually draws a red box around the clusters of malaria, and it actually notifies you how many it found," Gibeau said.

Although microscopic lenses are already available for smart phones, Gibeau said the software takes the concept's usefulness to another level.

It would enable a doctor or nurse working, for example, in an African village lacking Internet access to make a diagnosis without having to upload data for processing elsewhere.

However, once the data stored in the phone is uploaded, it can be used to spot disease trends, Gibeau said.

He said he is working on smart phone applications to detect sickle cell and other diseases and also plans to make the software easily adaptable to lab-based microscopes.

The smart phone application was the idea of team member Wilson To, a 25-year-old graduate student in comparative pathology at the University of California at Davis.

It builds upon a mobile microscope concept that To and a different team created to win last year's Imagine Cup national finals.

  ~ from reuters

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A do-it-yourself bowel cancer screening test!!!

A do-it-yourself bowel cancer screening kit has now attracted concern from the Health Ministry, after it was criticised by doctors.

However, the organisation representing community pharmacies has come to the defence of the group behind the scheme, saying the kits will save lives.

Beat Bowel Cancer Aotearoa, which has lobbied for an immediate national bowel cancer screening programme, yesterday introduced faecal occult blood test kits in pharmacies, for $59.99.

The kit includes brushes and test cards, so people can collect a faecal sample for posting to a Sydney lab for testing. Results letters, in the kit, would be then sent to the person and their doctor.

The kits have been criticised by the Medical Association, which said testing should be done with the support of a person's doctor.

John Childs, clinical director of the ministry's cancer programme, said Beat Bowel Cancer's claim that the kits could save 1000 lives a year was not supported by evidence.

"Best estimates suggest that an organised national screening programme in New Zealand could save up to 270 lives a year."

The kits were not an organised screening programme and were not free, which meant those most affected by bowel cancer, including Maori, Pacific and low socio-economic groups, were unlikely to benefit, he said.

Pharmacy Guild chief executive Annabel Young, however, said they were "a great first step for people who are worried and want to do something about it".

She dismissed the Medical Association's misgivings. "The results of the test go to the GP so there is no issue with them being out of the loop."

Beat Bowel Cancer chairwoman Sarah Derrett said doctors played a key role in bowel cancer detection and screening. "However, some GPs are reluctant to offer bowel cancer screening to their patients until a national screening programme is in place, yet this may take another eight to 10 years to eventuate."

~ from reuters

[medoptions-blog]

Measles poses a threat in US!!

Measles was declared eliminated in the United States in 2000, but cases continue to occur among U.S. residents who return from trips to other countries, as well as among foreign visitors to the United States, says a new government report.

"Measles importations and transmission from imported cases continue to pose a threat to U.S. residents," warns a team from the U.S. Centers for Disease Control and Prevention and various state health departments. "Travelers can be exposed to measles in the country of travel or while en route to and from that country, in airports or on airplanes," they add.

According to the researchers, young children are at greatest risk of complications or death from measles, which is highly contagious but can be prevented by vaccination.

In the first two months of this year, the CDC reported 13 cases of "imported measles" among U.S. residents, including seven cases of measles among American infants aged 6 to 23 months who had traveled to other countries.

The agency notes that that two-month total is comparable to the average annual caseload seen each year between 2001 and 2010.

Four of the children infected with measles in the 2011 cases had to be hospitalized due to severe measles-related complications, the CDC said.

It's likely that all of these cases could have been prevented if the children had received recommended vaccinations, the authors said.

Children aged 6 to 11 months should be given one dose of measles-mumps-rubella vaccine before traveling to other countries, and children aged 1 year and older should receive two doses (separated by at least 28 days) of the vaccine before international travel, the authors recommended.

Up-to-date vaccinations are also essential for international travelers of all ages, they added.

[medoptions-blog]

Caffeine contributes to development of diabetes!!!

A study has suggested that caffeine disrupts glucose metabolism and may contribute to the development and poor control of type 2 diabetes, which is a major public health problem . The study examines the latest evidence, contradicting earlier studies suggesting a protective effect of caffeine.

James Lane, PhD, Duke University, describes numerous studies that have demonstrated caffeine's potential for increasing insulin resistance (impaired glucose tolerance) in adults that do not have diabetes, an effect that could make susceptible individuals more likely to develop the disease. In adults with type 2 diabetes, studies have shown that the increase in blood glucose levels that occurs after they eat carbohydrates is exaggerated if they also consume a caffeinated beverage such as coffee.

This effect could contribute to higher glucose levels in people with diabetes and could compromise treatment aimed at controlling their blood glucose. "More than 220 million people worldwide have diabetes," Editor-in-Chief Jack E. James, PhD, School of Psychology, National University of Ireland, Galway, Ireland, said.

"The links that have been revealed between diabetes and the consumption of caffeine beverages (especially coffee) are of monumental importance when it is acknowledged that more than 80 per cent of the world's population consumes caffeine daily. "Dr. Lane's review of the topic gives the clearest account to date of what we know, what we don't know, and what needs to be done – urgently!" he stated.

~ from reuters

[medoptions-blog]

CT Scans for children on the rise in Hospitals!!!

According to a study released online this week in the journal Radiology, researchers found that children underwent five times more CT scans during ER visits in 2008 than they did 13 years before -- and 90 percent of the exams were done in hospitals that do not specialize in pediatrics. And, let's face it, children aren't small adults. Even scarier is that abdominal scans grew at a higher rate than head scans --though CTs of the abdomen expose kids to seven times more radiation than scans of the head. 

Perhaps the numbers alone are not too surprising in an age in which computed tomography -- and the clear, detailed images it produces -- has proven revolutionary in the diagnosis of all kinds of injuries and ailments. But with these rewards come significant risks, especially for children most susceptible to them, and the danger doesn't seem to be lighting much of a fire, for parents or the doctors they're trusting with their children's lives. 

It's not as if the American public is not terrified of radiation exposure. When full-body scanners made their debut in airports across the nation, air travelers were threatening a boycott, irate and uncomfortable about being forced to go through machines emitting low levels of radiation. 

And yet, most parents likely never think to question a doctor's decision to run a CT scan on a child complaining of stomach pain or headaches. Heck, plenty of parents probably push for the more extensive tests to make sure the worse-case scenarios are ruled out -- without thinking of the cost. And I'm not talking about the deductible. 

As for the doctors, defensive medicine is no doubt at the heart of some of the growing numbers. 

"There is going to be cases where physicians are ordering scans because they're afraid to be sued," said Dr. Edward Dauer, director of radiology at Florida Medical Center. "And that's where tort reform would help." 

I get that. I understand the reality of doctors having to make a living in a litigious climate in which any mistake or oversight can mean the end of their livelihood, and their financial security. And I get that this changes how they practice medicine. 

But those financial decisions come at the expense of our health and of our children's health. 

Put another way: It is not OK for a child to be exposed to a higher risk of cancer, just so a doctor can protect his career. So while we wait for tort reform, and some sanity to return to the medical industry, it's up to all of us to stop the madness where we can. 

When it comes to CT scans, that means parents must be their children's advocates. 

Make sure the benefits of having a CT in an emergency outweigh the risks. Ask the doctor whether a sonogram or an MRI, which do not use radiation, could do the trick just as well. And make sure the radiologist is modifying the dose to meet the child's weight and size. 

Doctors, too, must be well aware that they are subjecting their young patients to potentially consequential doses of radiation when ordering CTs, and they must make sure the tests are worth the very real risks. 

Once you do all that, though, it's a tough call. As a parent, I know that all too well. So I ask, how do you choose when your child is having an emergency? Do you go with the short-term gain of a detailed exam, at the long-term risk of radiation exposure, or do you forgo the test and hope for the best?