Nanoparticles- the future of medical treatments?

In Spain they have been developing a chemical process whereby nano-particles can be hollowed out into different shapes and used in aiding scans and drug therapies. Scientists at the Catalan Institution of Nanotechnology has been refining the 'galvanic effect', whereby gold cations oxidise silver atoms at room temperature. The silver ions formed then dissolves in a given solution and the solid gold metal is deposited on the silver cube. This leads so some surfaces of the silver solid being protected whilst further redox occurs; this leads to a single hole in the cube. This then catalyses the 'Kirkendall effect' where silver atoms 'migrate' to the gold on the outside creating a void in the cube.

The galvanic effect and the Kirkendall effect have been around for years however the reactions were too aggressive. Now the process is more successful; scientists have altered the method to make the silver more resistant, the cationic gold less aggressive and bi-products which do not interfere. This gives scientists an increased ability to control the shape of the nano particles. These can be used to develop MRI scanning techniques and administrating controlled drugs on a nano-scale.

I'M GOING TO MEDICAL SCHOOL!

Yesterday I got an email from UCAS informing me that my status has changed. I logged on to find an offer from Brighton and Sussex Medical School! I nearly forgot how to breathe when I read 'unconditional' on my computer screen. It felt almost surreal, I've spent the last 3 years working towards this place, determined to reach my goal. It honestly felt like a life changing moment. I am going to follow my dreams and become a doctor.
 As a carer I am able to provide personal care for the elderly and  use communication and teamwork on a day to day basis. A career in medicine will allow me to take this further and will challenge me both emotionally and intellectually. It is everything I could have wished for.

Alzheimer's News

Can Eating Fish Protect Against Alzheimer's?
Several newspapers have reported that people who eat grilled or baked fish once a week are 5 times less likely to develop Alzheimer's disease. The study conducted at Pittsburgh University has looked at the relationship between eating fish and cognitive decline. It is thought to be linked to the omega-3 fatty acids  however the study did not consider other lifestyle of dietary factors.
A New Alzheimer's Jab in the UK?
A new injection is being tested aiming to slow the progression of Alzheimer's disease. The medication works by accelerating the break down of Amyloid Beta. These protein plaques which build up in the brain cause the microfibrils to lose their integrity and lead to cognitive decline. The drug, Gantenerumab, is being given to 50 patients with mild to moderate symptoms on a month;y basis. Alzheimer's Research UK believe the drug is very promising however there is still a long way to go and more research is required.
http://www.netdoctor.co.uk/interactive/news/uk-scientists-trial-alzheimers-jab--id801231020-t116.html

Sleeping Trends- Student BMJ Dec 11

As I am currently on the night shifts, I thought this was a relevant article found in eyespy of this month's Student BMJ!
Australian researchers have found that teenagers who go to bed and wake up earlier are physically healthier than those who have a later routine. Adolescence who go to bed and get up later are 2.16 times more likely to be obese, even though they have slept for the same amount of hours. They were also found to spend more time in front of the television and 30 minutes less physical activity.
This knowledge could be used to inform young people on the effects of sleeping routine. In addition to previous research suggesting that a lack of sleep can contribute to obesity; this research suggests that the time you get your sleep is also a factor.

Bowel cancer screening

Around 16 000 people in the UK die from bowel cancer ever year. The current bowel cancer screening programme is said to reduce the total deaths by a sixth however work in the journal Gut suggests that more sensitive measures are required. It has been proposed that the techniques can leave tumours in certain parts of the colon undetected and undiagnosed.
People being tested have their faeces checked for signs of abnormal bleeding and those with further testing required are normally sent for a colonoscopy. NHS Cancer Screening Programmes are pleased that they are on target to reduced the bowel cancer deaths by 16% by the means of early detection.
A study conducted at Nottingham University has found that it is more difficult to detect tumours on the right side of the colon. Statistics suggest that 25% of all colon tumours exist in the right. Researchers are still unsure why cancers in this area are hard to detect. Possible explanations include that they grow faster or are less likely to bleed.
There is a much better screening test available however due to the economic climate, we do not currently have the funds.

Liver Disease Epidemic?

A health warning in the North East of the country has been reported after the number of alcoholic liver disease patients (early thirties) has increased by 400% in 8 years. It should also be noted that nationally we have seen an increase of 61%.

Specialists believe the cost of alcohol and the way in which it is advertised have lead to our 'drinking culture'. This appears to be having a massive affect on the health of the nation. Many young people are being diagnosed with terminal liver disease and unless we change our drinking habits this is only likely to worsen.
One of the major issues is that alcohol is widely available and teenagers are drinking from a younger age. However we are working towards altering the rules on advertising and broadcasting the sale of alcohol, which should hopefully help to alter the public's view on drinking.

I think this article shows the importance of prevention campaigns and informing the right populations to make sure the message comes across. This should influence our behaviour and hopes to change it for the better.
http://www.bbc.co.uk/news/uk-england-15997695

NCFE Community Mental Health and Psychiatry Level 4

I've just passed my first assignment and I am well on my way towards submitting my second one to my online tutor. Doing this home learning course is giving me a chance to explore an area of medicine which I am interested in. It is also providing the opportunity to partake in formal education alongside the practical and emotional learning which I am getting from working in the nursing home.

Assignment one looked at the role of advocacy and the community mental health team. I used research from internet journals to evaluate their effectiveness in several different essays. My next assignment is about the Mental Health Act and is broken down into 5 parts looking at different aspects of the law including sectioning a patient. Once I have completed assignment 2 I can start exploring specific mental health conditions and the implications of associated problems. Whilst studying my A level in Psychology I particularly enjoyed learning about schizophrenia. I think this qualification will fuel my interest in mental health and give me a chance to look at conditions which I haven't studied before.

Facebook Friends corresponds to brain size- Student BMJ Dec

I got my StudentBMJ delivered to my door this morning- always something I look forward to at the beginning of a new month!

I found an interesting and quirky article from the Proceedings of the Royal Society about brain structure and functioning when looking at social networking. The number of Facebook friends 'reliably predicts' the amount of grey matter in areas of the brain associated with social perception and associative memory (right superior temporal sulcus- yellow on the diagram 1). Grey matter is made up of neuronal cell bodies, it processes information and controls memories, emotions and intellect (we studied this in A2 Biology).

They also found a link between the size of real life peer group and the amount of grey matter in an area used for emotional learning and memory consolidation (amygdala- see diagram 2).

Diagram 1 is sourced from http://www.headway.org.uk/About-the-brain.aspx
Diagram 2 is sourced from http://northofneutral.wordpress.com/2009/11/12/beware-of-amygdala-hijacks/

National Strike wont affect 'urgent NHS care'

I haven't written any posts for a couple of days as I've been back on the night shifts again and so I've been feeling utterly exhausted. Luckily I am off until Saturday night so I have some time to catch up on sleep and get a 'normal' routine back.
Today over 2 million people are going on strike, including all of our local schools. It is expected that one fifth of the NHS workforce will be included in these statistics- the biggest strike in 20 years. NHS employers reassure the public that contingency plans will be put in place to ensure that A&E, cancer treatment and End-of-life care all have enough staff to function adequately. However non emergency treatments and routine appointments may suffer from the strike. This can only worsen the current issues regarding waiting lists- hopefully patients will get seen as soon as possible and it wont create too much of a backlog.

Change in HPV vaccine

The Department of Health has announced that a new vaccine will replace the HPV vaccine.Girls (aged 12-13) will now receive a vaccine which will protect them against cervical cancer and genital warts.

The new vaccine 'Gardasil' will replace 'Cervarix', a cheaper vaccine used from 2008. Both jabs protect against Human Papilloma virus (HPV) types 16 & 18 which cause over 70% of cervical cancer cases. Gardasil also protects against types 6 & 11 which cause genital warts. It is thought that we may be able to significantly reduce the prevalence of this sexually transmitted infection as well as preventing 400 deaths from cervical cancer.

This article shows how healthcare is forever changing both in terms of technology and funding. It has now become economically viable to change to a more expensive vaccine in order to provide people with further protection.

Support for the suicidal person- BMJ Nov 2011

A Code of conduct for Care Assistants

The government are setting up new standards for carers who look after the elderly and ensuring that they all have minimum training. This is due to a questionable quality of care given by some individuals. It is believed if there was more safe guarding on the qualification of care assistants we could be more confident that more carers would do the job properly. The government had proposed to set up compulsory registration for healthcare assistants however, Mr Lansley reported that is couldn't be justified in our current economic climate.

This article is particularly interesting to me, as I am currently working as a carer in a nursing home. Despite being paid minimum wage to do a difficult and demanding job, I can say from the heart that I get a genuine 'buzz' from making a personal difference to the patients' lives. Also I can go home after my 12 hour shift knowing that as a team we have done our best to cater for their personal needs. These horrific stories of poor quality care really do shock me, it makes you wonder why they are working within healthcare!? Setting up a code of conduct will hopefully ensure that other homes across the country can provide decent care for those who need it most.

Due to all these nightmare stories in the media about abuse and neglect of the elderly, I often feel some of the relatives do not respect the carers. This is made more complicated when you have residents with dementia. For example, one lady told her daughter that she hadn't had anything to eat all day, literally minutes after I had finished feeding her a roast dinner. It makes us look disgraceful, especially when we have to try and justify ourselves.
There is another muddled lady who asks for the toilet every 10-15 minutes, even after we have just taken her. We take her regularly throughout the day, however it is certainly not every 10 minutes as this would mean neglecting the needs of the other clients if we focused all our time in her (plus you cannot physically pass waste every 10 minutes- unless you had a medical problem). When visitors come into the lounge and hear her ask for the toilet, it looks incredibly bad on our behalf when we don't take her. I feel that the bad publicity that carers are getting nationally is affecting the trust people have in care assistants. It sometimes feels like there is a huge generalisation and that we are being punished for the sins of those people who abuse the gift of being able to help someone who needs it. 

NHS need to target their hidden waiting list

Patients are supposed to be seen by the NHS within 18 weeks however over 250 000 patients have waited for more than their fair share of time. Health Ministers say we must aim to reduce this backlog to 50 000 by April 2012. It is believed that there isn't a bit enough incentive to reduce these hidden waiting lists as it could be justified to leave patients for over 18 weeks for clinical reasons (such as weight loss) or personal/ work commitments.
Andrew Lansley states that next year we will 'clamp down on this practice' to ensure patients are treated. By extending the contractual conditions patients past the 18 week marker will not be forgotten, giving an increased incentive for hospitals to treat their patients. Lansley explains that if we can reduce the 'volume of growth' for the demand of NHS resources we will be more able to treat the patients who have become lost in the system.

Patients' own stem cells used to repair their hearts- The Lancet

Encouraging results have come from a study looking at the safety and health improvements when using cardiac cells to repair damaged tissues of the heart. In the trial patients with heart failure had tissue removed from the right atrial appendage during a heart bypass operation.

The stem cells isolated from this cardiac tissue were cultured (until there were 2 million cells per patient) given before being injected into the patient 100 days later. 7/14 of the patients were given stem cell treatment with the other patients remaining in the control group.

The doctors worked out the percentage efficiency by looking at the left ventricle ejection fraction (% of blood leaving LV per beat). There was 30.3% increase which then raised by 38.5% after 4 months. However some doctors are concerned that the placebo effect has not been controlled with no placebo treatment given to those 7 control patients. Also it can be noted by experts that ejection fraction is not the same as a measurement for the quality of life.

The use of stem cells from the bone marrow is also being investigated in London with randomised clinincal trials looking to help patients within 6 hours of a heart attack in NHS trusts. Although results are also 'promising' we are still at early stages.

Post Graduate Communication Conference 9/11/11

On Thursday I had the opportunity to be an active observers on a communication course alongside doctors and dentists. This postgraduate conference day was focused on communication skills associated with teaching and learning.
During the day we learnt about body language, the importance of engaging with the learner and used actors and role play sessions to practice and learn.
The course started with a world cafe activity, in which we moved tables and discussed skills and attributes possessed by good leaders, teachers and how to give good criticism.
http://www.theworldcafe.com/
We went on to look at cultural differences and issues surrounding different common beliefs. Sometimes we do make assumptions that every reads from the same hymn sheet, however this is often not the case. By being patient and courteous we can reach a common ground. It is all the people involved's responsibility to adapt to the changes and to be curious rather than judgemental.
We later looked at assertion and how it is very different from aggression. Assertion is expressing yourself without putting yourself or others down.

During the day I had the chance to speak to and work with doctors and dentists. One of the junior doctors I spoke to noted how different post graduate learning as a newly qualified doctor to the teaching in medical school in terms of support and style. I spoke to an optometrist who got into his field of speciality after working on eyes in surgery. He explained that the hardest part of the job is not being able to help all his patients. It is difficult when you are presented with blind patients who you cannot give them their sight back. Sometimes he felt he wasn't making a difference to the patients he cares for.

I really understand this feeling of helplessness as when working with the elderly, it is inevitable that their conditions will get worse over time. I feel you have to look to make a difference to them in other ways such as  through conversations and showing an interest in their lives.
I also spoke to a doctor who focuses on  palliative care in a hospice setting, she had originally trained as a nurse. We shared a discussion in our tea break about how important it is to offer patients good communication and the time to talk towards the end of their lives. She had real faith that the personal attributes and experience I possess will really help me in my future medical career.

You Don't Know Jack 2010- Dr Jack Kevorkian

I watched this film today, and several times it made me really consider what I think about assisted suicide. Particular scenes were difficult to watch with strong emotional themes, I found the piece to be quite heavy going.
Dr Jack Kevorkian, played by Al Pacino, is compassionate about helping people to end their lives in order to escape suffering. He helped over 130 patients to end their lives using either potassium chloride or carbon dioxide gas. His strong feelings come from feeling lost and helpless after witnessing his mother suffer at the end of her life.

The first patient he assists is an ageing lady suffering from Alzheimer's disease. I found this scene quite unnerving to watch as the patient appears physically well and although she has mental deterioration, it is not at an advanced level (she can still currently function and live in her own home).However Dr Kevorkian still granted her wish and took her to the woods to use the 'Mercytron' in his camper van.
 As a care assistant in a nursing home, I have day-to-day experience of working with elderly patients who are affected by dementia and confusion. The thought of giving one of these ladies I care for, the means to give themselves a lethal substance does not sit nicely in my mind.

Throughout the film, the related controversies are illustrated with many religious groups protesting outside court buildings and his own home. Dr Death, as he is known, finds himself sneaking around like a criminal helping these people to end their suffering whilst assisted suicide was still legal in Michigan.
The emotional accounts given by those suffering from numerous conditions, which are affecting the quality of their lives, helps Kevorkian to win numerous court cases. He feels that a doctor is a healing profession and that living in agony is not living at all. As an audience it makes us empathise with these individuals whose day-to-day lives are so painful that all they wish for is to end it.

There is a huge emphasis on a 'dignified death' something which is portrayed when helping most of the patients. However in 1993, after Kevorkian was struck off as a physician, there was an incident whilst helping Mr Gale, a patient seeking assistance to die. To save resources the doctor made a cage to go over the patients' head in order to reuse the CO2 gas; since he had lost his access to supplies. The patient was over heating and struggling in distress when the gas could not escape and asked for the 'treatment' to be stopped before proceeding with the suicide.Was this a dignified death? also did this patient have the mental capacity to make this decision? If he changed his mind, did he have some doubt about going through with it? This particular incident highlights lots of relevant issues against euthanasia and physician assisted suicide.

Jack faced constant battles with the law to help his patients and there as still debates now about whether this is murder. The court said that aiding suicide is the same as the common law of murder. However Jack challenged that common laws are outdated e.g. it is a crime to not worship god or to change your religious views and that the work he does could never be compared to murder.

Some may argue that he then went too far, others call him a hero. Dr Death performed active euthanasia for Tom Youk by injecting him with a lethal substance. Kevorkian wanted to fight for the patients' rights to choose to end their lives so produced a video which he hoped would bring supporters to help him tackles the supreme court. However in court Kevorkian was found guilty and given a 10-25 year sentence for murder.

In 2009 Jack was released at the age of 79 after 8 and a half years in prison. The supreme court refused to here his case.
Although this is a screen play, the following links demonstrate how real this story is and help to bring things back to the controversial debate on-going worldwide.
Tom's euthanasia
Hearing from Tom's brother
Interview after 8 years in prison

Light can treat cancer??

In the US they have found that a drug which attaches to tumours can be activated by waves of light. This study has suggested that particular areas can be targeted without damaging surrounding tissues.
The National Cancer Institute used an antibody which is complementary to the surface proteins of the tumour. IR700 is a light receptive substance which is activated by infra-red light. This chemical was attached to the antibody and used on mice with inserted tumours in an environment with IR light. Compared to the control group, the tumour volume was significantly reduced.
Cancer Research UK reported that photo-dynamic therapy or using antibodies has been successful in treating cancers so combining the treatments provides a promising answer.
It is important to consider that researchers are still at the animal testing stage and therefore we cannot be certain of how this treatment will affect humans.

GMC no longer registering medical students- November Student BMJ

The General Medical Council has decided that UK medical students are not to be registered when they start their training as it would bring no benefit to patients or added protection. The registration is required by all doctors to be able to practise medicine in the country. A 2010 review has suggested that rather than checking the fitness to practice at the point if registration by the GMC, local management of students would be quicker and more efficient. New students will be given 'welcome to medicine' packs when they start their degrees since the support alongside the GMC regulation is being removed. They have also made the decision to give provisional registration reference numbers to students at the beginning of their fifth year rather than at the end- giving them batter access to the NHS.
I am interested to know whether this will make a difference to those training to become doctors?

Movember

I've just donated money toward my cousin's boyfriend who is growing a beard to raise money and awareness for prostate and testicular cancer. 'Movember' is a monthly campaign whereby men across the world are encouraged to grow a moustache. These men, the 'Mo Bros' are promoting the awareness which hopefully is encouraging people to talk about prostate cancer. It may also work by encouraging other men to go for a prostate examination.

With 1 in 9 men suffering from prostate cancer and one man dying each hour of everyday, this is a worthwhile cause. It is the most common cancer type within the male population. Testicular cancer is expected to kill 70 men in 2011. Unlike prostate cancer, which largely affects those over 50, testicular cancer is most common for those aged between 15-44. Men are encouraged to self examine regularly and to be aware of the size and shape of their testicles so they can report changes to their doctor.

The money raised in Movember is going to used to increase awareness and education as well as towards research. It is thought that global collaborative research projects are more effective than individual ones as multidisciplinary teams of key researchers can work together to increase the chance of a break through in less time.
uk.movember.com/?home

Organ donation

Yesterday I received my November issue of Student BMJ, which was nice to find on my doorstep when I got home from work! On one of the first couple of pages there was a short piece on organ donations and medical student had given their personal opinions on the matter. This made me think about how I felt about it; once I no longer need my organ why not give them to someone else who would gain from them. This morning I registered on the NHS website to become an organ donor.

To me, it is no different to passing down clothes I have outgrown to my siblings or giving old possessions to a charity shop. I can however understand that some are squeamish at the thought of being dissected and that other might not want to donate some organs such as their eyes as they feel they are unique to them. Also I can imagine that it is easier to donate your own organs than for your grieving relatives to make the decision for you. Some would be comforted that there is an upside to this traumatic event of losing someone, however others may find it hard to 'let go' and could not bear the physical thought of their loved ones being cut.

An article on the BBC news about a week ago looked at the success of organ donation in Scotland and are looking at setting up an 'opt out' scheme whereby all patients donate their organs unless they say otherwise. 37% of Scots have registered as donors however a further 600 donations are required. Changing to an opt out system hopes to increase the donations to save more lives however there are some issues to overcome before we can take patients assumed consent.

BBC weblink

Teenage Gastric Balloon trial- BBC News

In Sheffield they have planned to trial the gastric balloon on 10 children (aged 13-18) who weigh between 14-20 stone. Although very few studies have been carried out on young people, it has been very effective with adults. The specialist children's hospital has intended to offer it as an option where other treatments have been unsuccessful.
Doctors have said that lifestyle advice is very important in helping young people to lose weight and that the gastric balloon is not a quick fix.
A gastric balloon works by inserting a silicon bag of saline or water into the patient's stomach and inflating it. The pressure created in the stomach gives the patient a sensation of fullness after eating a small portion. The balloon is usually removed after a maximum of 6 months and the patient must continue to eat smaller portions in order to maintain weight loss.
If the trial is approved, the young people will be followed over 2 years to see if the balloon has helped them to lose weight. They will also be working with the behavioural support team to try and support the adolescents to keep the weight off long term.
However before the doctors can go ahead with the trial, the ethics committee must agree.

http://www.bbc.co.uk/news/uk-england-south-yorkshire-15478078

World population reaches 7 billion today- The Guardian, Independent, BBC News

A baby born in the Philippines has been given the title of the 7 billionth baby by the EU. Today has been named seven billion Day to try and draw attention towards population growth. Through a campaign of woman's rights, reproductive health and inequalities, the UN population fund hopes to raise awareness.

A consultant of infectious disease has expressed that media about population always focuses on poorer countries even though more resources are used my babies born in First World countries. If resources were distributed equitably the whole population could be healthy, fed and sheltered well.

Dr Thapa from WHO reported that we are too focused on the numbers rather than quality and that if the population decreases this will not necessarily improve lives. It is believed that quality and quantity are both important.
A doctor from Ethiopia believes population has risen due to an inequality of healthcare spending and the lack of available contraceptive. 

More family planning and important information on sexual health is required but religious and cultural sensitivity must be respected.

Alzheimer's breakthrough

Early research has investigated the reason for the toxicity of beya amyloid peptides and whether it is linked to heredity.

In Alzheimer's disease beta amyloid plaques form in the brain alongside tau proteins which form tangles. Researchers at Whitehead Institute for Biomedical Research have created a GM yeast model and used it to screeb for genes which could alter the toxicity of amyloid beta. These genes idenified also affected the toxicity of beta amyloid peptides in worms and rat brain cells.

The model has also demonstrated that beta amyloid also disrupts endocytosis (absorbing and moving substances into the cell using vesicles) in yeast cells. Interestingly, the genes which regulate endocytosis in humans has already been identified as a risk factor for Alzheimer's.

Researchers are confident that these finding with the yeast model will be applicable to humans, however we are only at the early stages of research and will need to run experiments using human cells before this we can look at how to use the results to diagnose and treat the disease.

You may have noticed that over time I have made several posts on Alzheimer's disease. After attending Medlink and writing a medical report on the disease with a friend, I have become very interested in the news regarding treatment and diagnosis. I also decided to do my Year 12 biology coursework on Alzheimer's which gave me further opportunity to look at drug developments and the NICE recommendations.

This is the link for my medical report published on the web:
http://www.medlink-uk.org/Site/documents/Alzheimers2010/DayJ&BiggsK.pdf





http://www.nhs.uk/news/2011/10October/Pages/alzheimers-disease-genes-yeast.aspx

Latest stories surrounding euthanasia

Firstly let's look at the law regarding the topic:

The 1961 Suicide Act makes it an offence to encourage or assist a suicide or a suicide attempt in England and Wales. Anyone breaking this law could serve 14 years in prison.

There is no specific law on assisted suicide in Scotland, creating some uncertainty although in theory someone could be prosecuted under homicide legislation.

To date, more than 100 UK citizens have travelled to Dignitas in Switzerland to end their lives.

Although some cases have been considered by the DPP, no relative has yet been prosecuted.

http://news.bbc.co.uk/1/hi/programmes/hardtalk/9577291.stm

Sept 11

http://www.telegraph.co.uk/health/healthnews/8830679/Cliff-Richard-why-I-would-consider-euthanasia.html 17/10/11

An assisted suicide machine is being auctioned later this month in the US, alongside the personal possessions of Dr. Kevorkian. 2 different machines has been used to help end the lives of 130 people; 'the death machine, where users pressed a button to inject themselves with lethal drugs and the 'mercy machine' which used a gas mask attached to CO canister. In 1999 he was convicted of second degree murder and served 8 years in prison and was famously known for saying 'dying isn't a crime'. A film on Kevorkian's life was broadcasted on television in the States last year. I am currently trying to find a copy of the film.

(http://www.5newsonline.com/news/sns-rt-us-usa-kevorkian-auctiontre79a4rp-20111011,0,6641049.story?track=rss)

Interesting articles regarding abortion and fertility treatment

An article in the Guardian on family planning states that 1/4 of births in the world are unplanned. Also 42 million abortions have occurred with over 68 000 women killed.

The Abortion Act 1967 (mainland UK) states that abortions must be carried out up to 24 week from the point of conception in licensed clinics or hospitals. Legally two doctors must agree that the abortion would cause less damage to the mother that continuing with the pregnancy (physically and mentally). However an article published last April in the Telegraph reported of an Italian baby who survived 20 hours after being aborted at 22 weeks. The hospital chaplain discovered the baby, who had been aborted after it was discovered that he was disabled, still breathing and was transferred to a specialist neo-natal care unit. As an Italian citizen, the baby boy now has the right to health and legally has the right to life.

This article has highlighted how a child at 22 weeks (2 weeks short of the upper limit of abortion) is able to survive outside the mother's body. In 2005 a mother who had tried to abort her son three times gave birth at 24 weeks to her son who is still alive today. Should the upper limit of abortion be lowered? If a foetus of 24 weeks can survive as an individual, are they considered a person with potential rather than a potential person? By 24 weeks a foetus is nearly fully developed; it has little fat but has fully formed taste buds and it's brain is rapidly growing. This brings up ethical issues looking at what age does a foetus become a child? Philosopher, Glover uses a cake analogy to illustrate the difficulties of differentiating between the two. When you are baking a cake, when do you consider it to be a cake? Is it a cake when it's eggs, flour, butter and sugar? How about when it's a tin full of smooth cake mixture? Or is it not a cake until it comes out of the oven fully baked and ready to eat? From this analogy you can see that it is not logically possible to pinpoint the moment an unborn child goes from a cluster of cells to a foetus to a human being.

(http://www.telegraph.co.uk/news/worldnews/europe/italy/7646540/Baby-boy-survives-for-nearly-two-days-after-abortion.html)

In June 2010, an article against lowering the upper limits of abortion states that at 24 weeks a foetus cannot feel pain. According to the Royal College of Obstetrics and Gynaecologists, at this stage the brain is not developed enough to experience pain or consciousness. The studies have suggested that when a child is aborted at the upper limits (due to foetal abnormalities or risk to the mother's health) the chemical environment in the uterus induces 'a continuous sleep-like unconsciousness' and the foetus does not suffer. I think there are however still issues around whether this is ethically right, considering that they may be fit enough to survive outside the uterus.

(http://www.guardian.co.uk/lifeandstyle/2010/jun/25/human-foetus-no-pain-24-weeks)

One particular article more recently in the news (The Guardian 23/09/11) which caught my attention looks at an American couple who have made the decision to reduce their pregnancy from twins to a single foetus.

After 6 years of fertility treatment, a 45 year old lady became pregnant with twins and at 14 weeks decided to abort only one of her unborn children. She explained that since she had created her children artificially, she felt she had the choice to terminate one of their lives. For her the decision was easy, she believed that of she had 2 children she would only be able to give them half the love that they deserved. I can imagine that mothers who have more than one child may argue that it doesn't matter how many children you have, you will still have unconditional love for that child. If you have 4 children, does that mean that you only love each child a quarter of the amount that a single child would receive.

The procedure requires injecting potassium chloride into one of the foetus' chest. Over time it then shrivels overtime and remains in uterus until birth. The physicians need to view the procedure under an ultra sound scanner, which is visually explicit and can be quite disturbing.

There is something about separating twins that we seem to find more controversial than aborting a single child. Is this because we see twins as being lifelong best friends? Or is it because we can not imagine having to select one child over another. For that surviving child, finding out that you had a twin brother or sister who your parents chose to kill, must be something overly difficult. When the child realises that there was a 50% chance that they themselves would be terminated, I cant even start to imagine how that might affect them psychologically.

Some may say that aborting only one child is somewhat better than aborting both twins as this would mean the loss of only one life. However others believe that choosing one over the other is actually worse. I think this story is complicated by the fact that fertility treatment has been used. The family must have had some idea that there was a chance of having a multiple pregnancy when they decided to have the fertility treatment. Now they believe that they can pick and choose to reduce the pregnancy. Some may argue that this is just a step to far, however others may question why this is unacceptable when abortion is becoming increasingly accepted in society.

(http://www.guardian.co.uk/world/2011/sep/23/pregnancy-reduction-fertility-abortion-america)

An exciting new media- 'Medikidz' Medical Superhero Comics (BMJ)

After the article I read the other week about the bad press the NHS were receiving, I was pleasantly surprise to come across these new comics which education patients about medical conditions. There are 5 superheroes (Axon, Pump, Chi, Skinderella and Gastro- can you guess which areas?!) which specialise in a certain part of the body and take the child through the causes, symptoms and possible treatment. With 23 different titles, each issue addresses one single condition by using fun analogies to help children understand medical jargon.

Alongside these comics they are working on a children's online network so children around the world can talk to others with similar conditions and share their experiences in a safe environment. Student BMJ reports that 'having this sense of community can have a positive influence on their psychological state, thus enhancing their confidence and further improving their condition'.

This is a nice idea and hopefully will be used to teach children about medicine in a way which is both friendly and fun. I think it would be useful for doctors to inform parents of those suffering from life changing conditions about this magazine so they can make the decisions whether to get involved online and purchase the comics.

(www.medikidz.com/)

Animal articles and treating disease

In October's issue of Student BMJ, I found a couple of interesting articles relating to the use of animals in benefiting human health.

An animal discovery reported in the Student BMJ looks at how a chemical called Squalamine, found in shark livers could potentially be used to treat dengue fever, yellow fever, hepatitis B, C and D. The researchers became interested in the potential use of sharks after it was found they have more resistance to viruses than expected.
Squalamine can be easily produced synthetically and has already seen positive effects (with no major side effects) when used on patients in clinical trials to stop blood vessel growth in cancers.
It is thought that the chemical disrupts the membrane interactions required in viral replication. The inhibition of infection to blood vessel cells by dengue virus and human liver cells by hepatitis B and D has shown to be effect in tissue cultures.
This story can also be found on http://www.bbc.co.uk/news/health-14974605.


Another research article including animals looks at cancer. According to an article, sniffer dogs can now be trained to detect lung cancer. Three sets of volunteers were used; those who were healthy, those with lung cancer and those with chronic obstructive pulmonary disease. They we asked to exhale into a glass tube with fleece in. The dogs were presented with 5 glasses at a time (one 1 was cancerous) and were trained to touch the one containing lung cancer with their noses. They correctly identified 71/100 cancer samples and 372/400 non cancerous samples.

At the weekend I read an article on the BBC website which was also looking at lung cancer. A vaccine used alongside the chemotherapy treatment appears to slow the cancer's progression.
Vaccines for cancer work on the same ideas as vaccines against infection. They strengthen the body's immune system by producing memory cells so the individuals can tackle the infection themselves. However instead of protecting against invading pathogens, they train the body to attack tumours. As a cell divides uncontrollably and becomes cancerous, the surface proteins change shape. In theory this therefore allows the immune system to recognise the cell as foreign and destroy it.

Researchers in Strasbourg have conducted trials with 149 patients which had advanced lung cancer. Half were given a pox virus, which had been genetically modified to make a cancerous surface protein. All of the patients received standard chemotherapy treatment. 43% of those who received the vaccine experienced 6 months of 'progression free survival' and 35% of those who were in the control group.
Although the early stage study has indicated some success, we are still uncertain to the degree of the benefits.

This BBC article has come from a report in The Lancet Oncology; a trusted peer reviewed medical journal. (http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70259-5/abstract)
(http://www.bbc.co.uk/news/health-15401739)

Blood pressure meds can half the risk of Alzheimer's

Although those suffering from high blood pressure are at a higher risk of suffering from Alzheimer's disease, the newer drugs given to treat the condition are thought to provide added protection.

Bristol University have found that the drugs target a biochemical pathway, the renin angiotensin system, which us thought to be linked to the onset of Alzheimer's. When looking at 40 000 patients over 60 who were treated for hypertension, there was a decrease in risk by 53% from ARBs and 24% ACE inhibitors. This was compared to those with older hypertension treatments such as calcium channel blockers and beta blockers.

The drugs work by blocking the effects of the hormone angiotensin II; this results in the destruction of the amyloid plaques which build up in the brain of someone suffering from Alzheimer's.

The next step is to conduct clinical trials to see how ARBs and ACE inhibitors can prevent cognitive decline. They will be looking to see if they can stop mild cognitive impairment from progressing to dementia and if they can delay the progression of this degenerative disease.

After doing my pathology project on Alzheimer's disease and then my year 12 Biology coursework, I find articles on dementia of particular interest. I understand the pathology well enough to understand the effects of the medication and with my job at the nursing home can see the day to day application of the disease.

Article cited from The Daily Mail

Media can often be Misleading - BMJ Blogspot

Regularly national newspapers publish surveys where around 80% of people who haven't used the NHS for 5 years, rate the NHS as being poor however 80% of those who have used it praise it highly. (Blogs BMJ Patient editor P. Lapsley).

Non-users can not draw on personal experience and therefore have to place their judgements from stories in the media. Unfortunately, stories which shock and disgrace tend to make the headlines rather than tales of kindness and dedication. These occasional sad stories can be very damaging for the NHS's reputation and can undermine the morale of staff who are only trying to care for patients to the best of their ability in the majority of cases. Sometimes the care provided is with more modest resources than desired but care remains professional in a vast majority of cases.

I am not suggesting that we ignore cases where allegations have been made about neglect, as this is something that needs addressing, however I do believe that popular media should also show the fantastic work that the organisation does. I imagine some might argue that the healthcare professionals are merely 'doing their jobs' so should not be accredited by society in the media. However people would have more confidence in local healthcare services if the media could expose the remarkable commitment of the staff rather than only exposing these 'horror stories'

Are current EU rules putting patients at risk?

On the way to work I heard about the language issues which are thought to be affecting the quality of patient care on the radio. The House of Lords committee and the GMC believe that patients may be at risk due to free movement of GPs.

This was a bit issue in the news in 2008 when a German doctor gave a fatal overdose of painkillers to a patient on his first (and only) working shift in Britain. The doctor was accused of negligence and was given a sentenced suspension in Germany but was still able to practice in UK. This has lead people to believe that the current rules and questioning patient safety. Ministers and the GMC have expressed frustration at the current situation. The European commision have planned a review of the guidelines and we are to expect 'firm proposals' by the end of the year.

Andrew Lansley spoke on the BBC news about the changes which need to occur. When a doctor comes to the UK they need to be first registered with the GMC and then assessed for skills (and language) before they are put on the performers list and are able to work in general practice. Language tests can be used for this assessment; it is not against EU rules becasue it is for NHS employment. Therefore language tests can legally be applied to foreign doctors as an employment check; this is also the same for nurse, midwives and pharmacists.

Under the current European law we can not put a restraint on the movement of European doctors. However we can assess them in terms of employment; if there are questions about someone's fitness to practice this should be flagged up.

Garden House Hospice

I have been volunteering at Garden House, Letchworth, since May 2010 and have found it a valuable experience to understand end of life care both for the patient and their families.

Last Saturday, whilst I was cleaning the small kitchen towards the end of my shift, a lady came in for a chat. Her husband was critically ill and was rapidly going downhill. Previous to admission, he had been cared for at home, with his wife getting up at 4am to attend to his needs. It was a very stressful time for her and they had to rearrange their home and their routine. She explained how although she knew that his condition must be getting worse when he was admitted to the hospice, she felt a great deal of relief and comfort in knowing he was in safe hands. At the hospice he was receiving 24hour nursing care with access to medication for extreme pain relief.

I could see this was a very difficult time for her and tried to reassure her that she was doing the very best she could for him. She told me how the drugs he was on for pain relief had slowed his thinking processes making it harder to interact with him. She said that she really appreciated that there are not set visiting times, alike in a hospital ward, and that she is able to come in at meal times to help feed him. This way she could still feel connected to him.

We shared some moments and I had the opportunity to express how I felt when my Gran had been cared for by Garden House. We took some time to appreciate the successful nature of the hospice. The atmosphere is so calm and it is very clear that the staff are so dedicated to caring for the patients and their families. Being able to contribute to this organisation is such as honour. When my Gran was placed in a nursing home, where until she sadly passed away in January, she continually expressed how she missed Garden House. It was obviously somewhere that she felt safe and loved. As a family we decided to request that all donations at the funeral would go to the hospice as a token of our gratitude.

I think locally we are very lucky to have this service available. People who have no experience of a hospice environment often have a misconception that they are morbid places where people come to die. However from my experiences i have found this is certainly not the place.

Night Shifts

I've been working the 12 hour night shifts, and i'm not going to lie, I've found them quite challenging! I have enjoyed being able to learn the routine at night as it is quite different to the day, however it has taken a bit of adjustment. So has becoming nocturnal; sleeping during the day and staying up all night does feel a bit strange. I have found that it disrupts your usual eating routines and I also had several nose bleeds this week.

Although I'm not in a hospital setting, I have had to stay up all night, attend to clients at the early hours of the morning and get used to a totally different routine. I think getting the opportunity to work nights as a care assistant will help to prepare me for my future career in medicine. It has taught me about the nature of the work and also shown me that I can manage it!

Recruitment Crisis in Psychiatry - Student BMJ Oct 11

A negative image of psychiatry, plagued by the lingering stigma, has put future medics off the speciality. With 1/3 of core training posts, there were only 0.7 applicants place. The RCPsych and BMA are concerned with these statistics and believe that there are several issues which need addressing.

One reason for these figures are so low is likely to be due to the lack of early exposure to psychiatry in medical school and foundation programmes. Also undergraduate students perceive it as not being as scientific as other specialities and wrongly view the treatment as being less effective and evidence-based. As well as the stigma of the field of medicine, often being bad-mouthed by other medics, it can be seen as being separate from the rest of medicine. It could also be due to the low level of academic psychiatrists leading to reduced exposure.

A former member of BMA junior doctors committee, explains how even if medics do not want to go into a career in psychiatry, it is important that they learn about it. She writes in the article how an experience in psychiatry has helped her in her current job as an obs and gynae trainee. For example, she now understands the effects of anorexia and depression on fertility.

The lack of exposure is affecting students' interest in the field; most students are not exposed to a psychiatry placement until they are a F2 doctor and by then most people have almost made up their choice where they want to specialise.

However with no new money available for foundation year posts, they would need to reconfigure existing tracks as psychiatry would have to come out of existing resources. The BMA, psychiatry taskforce and RCPsych hope that their efforts to improve the perception of psychiatry through earlier exposure will lead to an increase in recruitment figures and reduce the stigma.

Daily Mail claims that 'Mustard Makes Your Muscles Massive'

An article on NHS Choices website explains how a plant based steroid, used to promote plant growth, has been used to increase the muscle protein of rats in laboratories. Feeding rats HB (28-homobrassinolide) for 24 days caused them to gain body weight and overall lean muscle mass. These effects did not increasing the level of androgen hormones unlike illegal anabolic steroids.

This article is interesting from a scientific point of view, however it currently lacks application to the human population. Brassinosteroids are plant chemicals found in pollen, seeds, leaves and other young vegetation. They are structurally similar to cholesterol-derived animal steroid hormones but have no function in animals. They are used to stimulate plant growth and regulate gene expression. Mustard seeds contain HB, however that does not mean that if human eat mustard, their lean muscle mass will increase. The Daily Mail has drawn false conclusions from the results to produce an article which is considered misleading.

I found this article interesting as it links back to the work I did on hormones, steroids and performance enhancing substances in preparation for my Unit 5 Biology exam.

'Let's Talk About....Recovery Star' interactive lecture 28/09/11

I attended an interactive lecture by SEPT on the mental health services in my local area and how the 'Recovery Star' framework works.

The star has 10 domains (each rated from 1-10 by service user/service provider):

1. managing mental health

2. identity and self esteem

3. trust and hope

4. relationships

5. work

6. responsibilities

7. social networks

8. living skills

9. self care

10. addictive behaviour

The service user can rate how they feel they score (out of 10) at the snapshot that they are assessed at, rather than scoring 'on general'. This star is hoped to be used by SEPT to improve care plans to make them more meaningful. They hope to look at the whole person rather than just their mental state and their medication. I am a true believer that a holistic approach is very important to give personal care. This will be offered to every service user, however no one will be forced to under take. The idea of the framework is to show development and to help the individual to improve, set targets and reflect on the progress that they have already made. Also it is important to remember that each service user's star is personal to them; not everyone will have the same end goal. One person may aim to raise their social skills from a 2/10 to 3/10, however someone else's target might be to reach 10/10.

Service users, SEPT members, carers and mental healthcare professionals attended the meeting and had a range of different views on a number of topics. At the meeting there was a large discussion about who should fill out the recovery star. Some believed that the service user should fill out the star with their carer together whereas others believed that the service provider and service user should fill out the stars separately and then compare. Someone else pointed out that if the service provider rated the person as being lower than they thought they were it could be damaging. It would therefore depend on the vulnerability of the service user and the relationship they had with the carer/ service user.

Registered mental health charity 'Mind', has their own version of the Recovery Star. This could help them work alongside SEPT. Also if GPs were trained in how to use the Recovery Star, it could bring mental health services to local surgeries as well as psychiatric hospitals. Carers at the lecture commented that they would find the star useful to use at home whilst looking after their relative/partner. SEPT said they would take this into consideration.

At the lecture there was also a discussion over the success of day centres. Some of the people at the meeting had strong feelings against these institutions saying they were merely containing those with mental health issues and stopping them from getting their real lives back. One service user explained how she has been using the day centre services for the last 10 years and how it had played a strong part in her recovery. She told us how she integrates back into her 'normal' life for 6 out of 7 days but once a week she really benefits being with like minded people. For example, in everyday conversation people asked her what she do for a living; after being out of employment due to have bipolar disorder, it was a constant reminder that she was different. Having the link back to mental health services served as a secure place where she wasn't on show and could relax and express herself.

The different ideas around the day services have come from person experiences; this has shown me that like everything in the world, people are different and will recover in varied ways.

Overtime these day services have improved to provide service users a safe environment where they can interact with others, drink coffee, access the internet and play interactive computer games. In a SEPT day centre in Germany, they offer these modern services to give a comfortable setting to bridge the gap between integrating back into society. They have found that teaching the service users about their mental health problems (e.g. the pathology and how the medication works) they feel more involved in their recovery and that they can be in charge of their own lives. They have also been teaching the service users presentational skills so they can teach others about their conditions and even go on to starting a career in that field. I think it is really important that the service user is treated like a respected adult. The German day centre have seen an amazing 70% decrease in the relapse rates of the day centre users!

I found the interactive lecture a brilliant learning opportunity, it was informative and full of personal opinions and views from a range of different people involved in mental health services, be it service users or providers. As a member of SEPT, I will be checking my emails regularly in hope to attend other upcoming lectures.

Stem Cells progression

On the BBC news last night a story on a new method regarding the production of stem cells caught my interest. In the New York Stem Cell Foundation Laboratory they have had little success with the old somatic cloning technique. When they removed the genetic material from the egg and replaced it with skin cell chromosomes, the egg divided but then failed to go beyond the 6-12 stage.

However when they left the egg's own genetic material in place and added skin chromosomes, the egg developed. It developed to reach the blastocyst level which is the usual source of embryonic stem cells (with about 100 cells contained).

.

Because there are large ethical issues around producing and using embryos for therapeutic uses and then discarding the potential life form, a different route to stem cells has been used. A chemical baths can be used to 'reprogramme' an adult cell into a stem cell; the method does not require an egg. There are however concerns that these stem cells could not be used therapeutically as they are more prone to expressing cancer causing genes.

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Student BMJ subscription

I've just paid for the printed student BMJ to be delivered to my house, I also get access to all BMJ articles and blogs :)

I enjoy reading the online articles, particularly the monthly 'eyespy' pages. After studying stess and memory in AS psychology, I found an interesting article on stress hormones (cortisol and adrenaline). A British neuroscience review has concluded that these hormones help the brain store memories more effectively by a process called epigenetic modification. This is where the hormones alter the function of genes in neurones to enhance learning ability. However extreme stress can be damaging and can lead to persistent, traumatic memories which can contribute to mental illnesses.
Maybe this could explain why nerves before a drama performance or an exam can make you feel more alert. Sometimes when you're in exams you can think of things that you didn't think you knew, this could be due to the stress triggering your active neurones involved with memory? This could link to EWT too, about how a moderate level of fear can heighten the accuracy of people's accounts of an event to a certain level (I remember looking at a correlation between fear and memory).

It's nice being able to read articles about subjects I have studied because it adds a real life perspective to the topic. Also I understand how cortisol and adrenaline affect the body in stress pathways (fight or flight responses) and how fear can enhance memory. This has allow me to piece the article together around my prior knowledge to make good sense.

http://student.bmj.com/student/view-article.html?id=sbmj.d3639

Gay men can now give blood!

The ban since 1980 preventing men who have sex with men (MSM) from donating blood will be lifted in November. The Department of Health has announced that men can give blood as long as they have not had anal or oral sex with a man in the past 12 months and meet the other general donor selection criteria.This ban had been put in place to stop the spread of blood-borne viruses, it has now been considered safe to reduce the regulation. There is still a 12 month ban because sexually active gay men are at a higher risk of accumulating sexually acquired viruses. NHS blood and transplant hope that this will increase the number of blood donors in the future.
Article information and photo sourced from BBC News

'Time to Change' Survey shows our fathers are the last people we talk to about mental health

The 'Time to Change' campaign about the discrimination and stigma against people with mental health found that we are less likely to talk to our dads about mental health problems we suffer from. 26% talked to their GP first before telling their families and 37% of people talked to their partner before sharing their problems with parents and siblings. Only 1% of people would tell their dad first.
Charities 'Mind' and 'Rethink' are promoting a discussion of mental health to try and get people talking more openly about their problems. This is a national campaign which is touring up and down the country to try and reduce the stigma. The campaign, 'It's time to talk, it's time to change' aims to "break down those barriers and empower families to speak out so that people’s attitudes change towards mental health.”
I have ordered the annual review from the website so I can learn about the progress which has been made towards ending the discrimination of those suffering from mental illnesses. I am hoping to attend a lecture on mental health provided by SEPT at the end of the month (providing I get the day off work!).