Exam Break

Having broken up from school, for a revision break over easter, I'm going to take a short break from my blog. This is because if i've fortunate enough to get a medicine offer, the grades are the most important thing! I wish everyone else studying for their A2 exams, or alternatively GCSE's or AS the best of luck! Along with best wishes for medicine applicants! Thank you,
Sarah

NHS 7 Day Working

Evidence shows that the limited availability of some hospital services at weekends, can have detrimental outcomes for patients, including raising the risk of mortality, for example deaths can be 11% higher on a saturday, and 16% higher on a Sunday. These mortality rates are increased because of variable staffing levels on the weekend, fewer decision makers at consultant level, lack of consistent support units and a lack of community based and primary care services that could prevent unnecessary admissions.  The need for change is also identified in Patient experience at weekends, the length of hospital stays and readmission rates.

Therefore the NHS is aiming to provide a more patient focussed service, the change is proposed by Professor Sir Bruce Keogh, and will take three years to implement. A major part of this is making NHS services seven days a week. This seven day working scheme will lead to new clinical standards, the board of NHS England has set out new standards for hospitals, for example,  all emergency admissions will be sen by a consultant in 14 hours and patients in intensive care and other high dependency units can be reviewed twice a day. There will be seven day access to diagnostic tests, for example X-rays, ultrasounds, MRI scans and pathology. Making seven day working will provide weekend access to multi-disciplinary teams including nurses, physios and other support staff. The increase in consultants will reduce the amount of patients being discharged on a monday and improve patient outcome, because delaying discharge can adversely affect their outcome as it increases there vulnerability to hospital inquired infections.

Using all resources seven days a week, is more financially beneficial, whilst currently there is poor management of hospital resources. The scottish administration has committed to having consultants on the ward 7 days a week, while Wales and Northern Ireland have yet to decide.

References:
http://bma.org.uk/working-for-change/the-changing-nhs/nhs-culture/seven-day-services
http://www.england.nhs.uk/tag/seven-day-services/
http://www.bbc.co.uk/news/uk-25381319
http://www.england.nhs.uk/ourwork/qual-clin-lead/7-day-week/7ds/
http://www.england.nhs.uk/2013/12/15/sir-bruce-keogh-7ds/
http://www.rcn.org.uk/newsevents/news/article/uk/7_day_working_in_the_nhs

Sperm, Egg and Gamete Storage

A widow, Beth Warren, whose husband lost his life to cancer, stored her husband’s sperm for IVF; for once she was stable ‘emotionally, financially and professionally.’ Beth wanted to extend the storage of the sperm, so she will have more time available to decide whether to conceive a child. However, gametes and embryo’s can be stored for 10 years, and when the statutory storage period comes to an end, the gametes and embryos must be destroyed.  For this reason the UK regulators, the Human Fertilisation and Embryology Authority (HFEA), said that the sperm could not be stored beyond April 2015. This is because there was no written consent, previous to her husband’s death specifying that his gametes could be stored beyond the statutory period.  Extending storage is done in ten-year periods; the law allows sperm and eggs to be stored for up to 55 years, if consent is regularly renewed.

The HEFA, is dedicated to the licensing and monitoring UK fertility clinics and all the UK research involving human embryos, and providing impartial and authoritative information to the public. Alternative ways against the HFEA’s appeal could be to export the sperm so they could be used for fertility treatment in another country. Within the UK, all clinics are controlled by the HFEA. The HFE Act of 1990 was changed in July 2007, and so the EU Tissues and Cells Directive (EUTCD) became part of the UK law. This allows the transfer of sperm, eggs and embryos between accredited clinics, within the European Economic Area.  However the donor of the sperm (or eggs) would have to give consent for the transfer, and in the case of Beth, this would not be possible. Or alternatively, the sperm could also be used to create embryos, which could be frozen and stored to seven years. 

References:

http://www.hfea.gov.uk/

http://www.nataliegambleassociates.co.uk/page/Storage-periods-for-gametes-and-embryos/56/

http://www.bbc.co.uk/news/health-26470656

Belgium Passed Bill Allowing Child Euthanasia

Previously this year, I wrote an article on the proposal for children's euthanasia by lethal injection within Belgium. This month (13th February), the bill allowing euthanasia for terminally ill children of any age, has been passed. By a vote of 86 to 44 with 12 abstentions, the lower house of Parliament approved the law which had previously been passed by the country’s Senate. Belgium will become the only country in the world to legalise euthanasia at any age, with both patient and parental consent. There are several conditions to the law:

• Patient must be conscious when making decision 
• Request must be approved by the parent and medical team
• Illness must be terminal, with no sign of improvement 
• Patient must be in great pain with no treatment available to alleviate their distress
• Psychologists must test children to confirm they understand what they are requesting

Opponents to the new law, argue that children should not be forced to make such a difficult decision. Furthermore Belgium has palliative care, which is considered to be the best within Europe, therefore the pain and difficulties for terminally ill children should be managed without euthanasia. 

The same bill, legalising child euthanasia, would also make euthanasia legal to adults suffering with the early stages of dementia. The patient would have to write a written declaration, that they wish to be euthanised if their health deteriorates, for example someone who is diagnosed with Alzheimer's. Previously, anyone could write declaration to be euthanised if health deteriorates, under the circumstances of irreversible coma and the written consent to have been written within the previous five years. The new bill would abolish the time limit for the consent to be written, as well as extending the conditions to early stages of dementia, as well as an irreversible coma. 

References:

http://www.bbc.co.uk/news/world-europe-26181615  

http://www.sbs.com.au/news/article/2014/02/17/controversy-belgium-approves-child-euthanasia

http://www.patientsrightscouncil.org/site/belgium/

http://life.nationalpost.com/2013/10/31/belgium-moves-to-make-euthanasia-legal-for-children-dementia-patients/

Schizophrenia

Schizophrenia is a chronic, severe and disabling psychological disorder affecting 1 in 100 people. It is sometimes described as a psychotic illness, where the patient may not be able to distinguish thoughts from reality. It is thought to be an inheritary disease, the risk is therefore higher if a first degree relative is affected, although the likelihood is less if a second degree relative (aunt, uncle, cousin) is affected, it is still higher than the risk for the rest of the population.  The highest risk is for identical twins; the likelihood of being affected is 40-65% for one twin, if the other has schizophrenia.

 Although unknown, the cause is thought to be caused by unbalanced levels of neurotransmitters, dopamine and serotonin. It has also been proven that the differences in brain structure and distribution of brain cells has been seen in some patients with schizophrenia. The risk is increased by abnormal growth of a baby whilst within the womb, including low birth rate and reduced head circumference. Any complications during pregnancy are thought to increase the risk, for example if the foetus is exposed to virus, bleeding or onset diabetes for the mother. During birth, and emergency caesarean section or lack of oxygen may increase the risk. Later on in life, stress and drug abuse can onset schizophrenia in those already vulnerable.

All symptoms are psychological; the main two are Hallucinations and delusions. Hallucinations, the most common type is where patients may hear voices other people do not hear. Other types of hallucinations include seeing objects or people, which are not there.  Delusions cause patients to believe other people are reading their minds, controlling their thoughts, or plotting harm to them. Further example of delusions is where they believe they are someone else. These symptoms make it difficult to hold a job or to care for themselves.

Treatment includes; antipsychotic medications, psychosocial medications, rehabilitation, family education, cognitive behavioural therapy and self help groups. Treating the condition is difficult because the cause is unknown, the medications and other types of treatments available are to ease the symptoms of schizophrenia and provides patients with the resources to live an everyday life.

References:

http://www.bmj.com/content/335/7610/91

http://www.nhs.uk/conditions/schizophrenia/Pages/Introduction.aspx

http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml?utm_source=publish2&utm_medium=referral&utm_campaign=www.kpbs.org

Crohns and colitis

Crohn's disease and colitis are often referred to together as inflammatory bowel disease (IBD.) Crohns is a chronic inflammatory disease of the intestines. It can affect the digestive system from mouth to the anus, and can causes breaks within the linings of both the small and large intestine. Whereas ulcerative colitis only typically affects the colon (large intestine) and inflammation caused by Crohns may be in patches, whereas inflammation due to ulcerative colitis is continuous.

Crohn’s disease is a non-contagious disease but the cause of it is unknown although it is suspected to be due to a bacterial infection and can be genetically inherited.  Within a patient with IBS the immune system is chronically activated by any molecules, not just harmful such as bacteria, viruses and fungi. It is this continued abnormal activation which results in chronic inflammation and ulceration. The gene NOD2 is thought to be responsible for the abnormal activation of the immune system; it is this gene which can be inherited. The symptoms and severity vary among patients and symptoms can fluctuate in periods of remission (inactivity) and relapse (activity.)  Symptoms include abdominal pain, diarrhea and rectal bleeding. In crohn’s disease pain is commonly experienced in the lower right abdomen and in colitis the lower left of the abdomen.

Neither Crohns nor Colitis has a cure, but there is medication available to induce remissions and maintain them whilst reducing side effects. Anti-inflammatory agents such as corticosteroids and antibiotics are often used. With most of the drugs there a negative side effects, such as with corticosteroids there is increased risk of acne, weight gain, cataracts, depression and high blood pressure. The biggest side effect with corticosteroids is aseptic necrosis; this is a condition in which there is death and degeneration of the hipbone.  Sometimes surgery is used as treatment to divert digestive waste away from the inflamed colon, such as a ileostomy; during this operation the ileum is disconnected from the colon and re-routed through a hole made in the abdomen, through which an external bag is attached to collect waste products. Usually after several months when the colon has recovered, the stoma (gap in abdomen) is closed and the ileum reattached to the colon.

References:

http://www.medicinenet.com/crohns_disease/article.htm
http://www.nhs.uk/Conditions/Crohns-disease/Pages/Treatment.aspx
http://www.nhs.uk/Conditions/Crohns-disease/Pages/Treatment.aspx
http://www.columbia-stmarys.org/Crohn_vs_Ulcerative_Colitis

Superbugs

A superbug is used to define an antibiotic resistant organism, where prevention is better than a cure due to the organism being resistant to one or more types of antibiotics. The most well known superbug is MRSA (Methicillin-Resistant Staphylococcus Aureus), however another common one is Clostridium difficile. Clostridium difficile causes damage to health when exposed, due to the release of potent toxins. There are other forms of Clostridium bacteria, for example Clostridium Tetani which is responsible for tetanus and Clostridium botulinum. 

There are high rates of Clostridium difficile in hospitals and nursing homes, due to the contraction of spores off contaminated surfaces. The spores pass through the alimentary tract until they reach the colon where they form colonies. The colon contains many species of bacteria, and under normal conditions these bacteria co-exist and prevent any one bacteria becoming dominant and effecting colon function. However antibiotics can destroy the balance of bacteria in the colon, and therefore reduce the competition for harmful bacteria, such as Clostridium difficile, which is unaffected by the antibiotic to become dominant.It is the toxins which the bacterium releases, which is responsible for causing the disease and symptoms. There are two main toxins, which enter the cells lining the colon by endocytosis which leads to disruption of the epithelial cells and causing damage to its structure and function. 

There are many symptoms, such as intense inflammation of the colon due to the body's white blood cells secreting cytokines to fight infection. However the most common symptom is diarrhoea, this is because the colon is responsible for absorbing water and in doing so forming solid faeces, failure in the function will therefore lead to less water being absorbed, and it will be transported through the colon resulting in diarrhoea. 

The main treatment against Clostridium difficile is antibiotics such as metronidazole and vancomycin. There is other types of treatment ranging from probiotics to faecal bacteriotherapy, however these are mainly at the clinical trials and not often used in practice. 

References:
http://www.gslaundries.co.uk/bugs.htm 
Biological Sciences Review- Volume 22, Number 3