Fetuses with defects in a molecular machine that edits information cells use to make proteins can develop a rare form of dwarfism, according to a new study led by researchers at the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

The defect, triggered by a tiny gene mutation, causes microcephalic osteodysplastic primoridal dwarfism type 1 (MOPD1), a rare developmental disorder that greatly slows growth in the uterus and causes severe brain and organ abnormalities, deformities of the arms and legs, and death in infancy or early childhood. “Primordial” dwarfism is dwarfism that begins before birth.

The findings could lead to a test for people who unknowingly carry a copy of the mutation, to a better understanding of RNA splicing and to whether mutations of this type that arise during an individual’s lifetime contribute to the development of cancer or other diseases.

The study is published in the April 8th issue of the journal Science.

“Our findings show that minor intron splicing plays a critical role in human development,” says study leader Dr. Albert de la Chapelle, professor of medicine and co-leader of the OSUCCC James Molecular Biology and Cancer Genetics Program. “Splicing of RNA is one of the most fundamental molecular events in cells”.

The genetic information stored in a person’s DNA is usually used by cells to make proteins. This process begins when the information in a gene is copied as a long strand of messenger RNA (mRNA).

After that, non-essential parts of the mRNA, regions called introns, are removed to produce the mature mRNA. The introns are cut out by molecular machines called spliceosomes, which also join the free ends of the cut mRNA back together again.

There are two types of spliceosomes, major and minor. Minor spliceosomes account for less than 1 percent of all splicing, but they still affect hundreds of genes in the human genome. This study shows that defects in minor spliceosomes can have profound consequences.

“Individuals who have inherited two defective copies of the gene for this critical component of the minor spliceosome cannot efficiently splice out minor-class introns, and this leads to the developmental defects seen in MOPD1,” Dr. Albert de la Chapelle says.

Dr. Albert de la Chapelle and his colleagues discovered that the mutation occurs in a gene called RNU4ATAC, located on chromosome 2. However, achieving that discovery proved extremely difficult because of the gene’s unusual nature and location.

The search began when the OSUCCC – James researchers learned that several children had been born with a severe, unnamed disorder in Ohio’s Amish population. They identified the disease as MOPD I and worked for several years to determine where in the genome the responsible gene was located, but without success.

A break came when they used a strategy called homozygosity mapping. This narrowed the gene’s location to an area of chromosome 2, a region that included several known genes. The researchers spent more years sequencing and studying these genes, but their work failed to uncover any likely candidates among them.

Only when the researchers used state-of-the-art next-generation deep sequencing technologies did they identify RNU4ATAC and learn that it was an unusual gene. Instead of producing a protein, it encoded a special kind of molecule called a “small nuclear RNA.” Furthermore, they learned that the unusual molecule was part of a spliceosome.

In collaboration with Dr. Richard Padgett and other specialists in RNA splicing at the Cleveland Clinic, the team showed that the mutations reduced splicing efficiency by 90 percent.

“We are now asking clinicians around the world for samples we can test from children and their families who are suspected of suffering from MOPD1 or similar conditions,” de la Chapelle says. “This research may help us determine which family members may unknowingly carry a copy of the harmful mutation, and to understand how these mutations can have such severe developmental consequences.”

Source:
Darrell E. Ward
Ohio State University Medical Center Continue reading →

American Medical Association Executive Vice President Michael Maves on Tuesday sent a memo to the heads of state medical associations and physician specialty societies addressing an agreement reached by AMA officials with lawmakers to develop a set of quality measures for physician care, CQ HealthBeat reports. In the memo, Maves writes that the agreement is feasible and does not indicate that AMA agreed to a “pay-for-performance” system without receiving assurances that doctors would receive sufficient reimbursements to treat Medicare patients (Carey, CQ HealthBeat, 2/22). On Dec. 16, 2005, AMA reached an agreement with congressional leaders to develop about 140 standard measures of performance for physicians covering 34 clinical areas by the end of 2006. Performance measures to be developed by AMA will be intended to provide information on whether doctors follow best practices when treating patients. According to the agreement, doctors beginning in 2007 will report to the federal government “on at least three to five quality measures per physician.” The agreement adds that doctors “should receive” some additional payment to reflect the costs of collecting and reporting the data. “By the end of 2007, physician groups will have developed performance measures to cover a majority of Medicare spending for physician services,” according to the agreement. The agreement was signed by AMA Chair Duane Cady, Sen. Chuck Grassley (R-Iowa), and Reps. Nathan Deal (R-Ga.) and Bill Thomas (R-Calif.) (Kaiser Daily Health Policy Report, 2/21). In response, a Feb. 10 letter sent to Cady from seven medical specialty groups said that it would be “difficult if not impossible” to achieve that goal of 140 measures by the end of the year. The letter also said that AMA did not consult with other physician groups before signing the agreement.

Maves’ Memo
Maves’ memo says that “there continues to be some misunderstanding about the agreement’s timetable and its payment implications.” He says that developing the 140 measures by the end of the year is not too ambitious a timetable because 90 measures have been developed by the AMA-led Consortium for Physician Quality Improvement and 10 new clinical topics currently are being developed. Maves writes, “[M]easures developed to date account for conditions covering a substantial portion of Medicare spending, and having measures that cover a majority of Medicare spending is an achievable goal.” Maves adds that Congress must enact legislation before a pay-for-performance system could be put in place. In addition, the agreement was necessary because Grassley, Thomas and Deal “have made clear that they will not support simply continuing to pass short-term relief to avert sustainable growth rate pay cuts without substantial movement towards quality improvement,” Maves writes. He says, “By demonstrating progress on quality reporting, we will be in a better position to secure congressional action on the Medicare physician pay cuts slated to begin in 2007.” David Lovett, director of the Washington office of the American Academy of Orthopaedic Surgeons, said his group still expects a response from Cady to their Feb. 10 letter (CQ HealthBeat, 2/22).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . ?© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Currently there is a lack of evidence that keeping pregnant women with high blood pressure in bed for a prolonged period of time improves the chance of a healthy delivery. Prolonged bed rest is disruptive to women’s lives, carries the risk of generating blood clots, and may be expensive.

Women who are pregnant and have high blood pressure are frequently advised to restrict their activity. This may extend to full bed rest in hospital for some. Before such recommendations can be made, there should be clear evidence that bed rest improves the chance of giving birth to a healthy child, because the procedure is disruptive, risks generating blood clots, and may be costly.

A systematic review, however, found that despite the widespread practice, few people had conducted research to see if it is indeed beneficial. The Cochrane Review Authors found four small research trials that involved 449 women. At best, bed rest appeared to have only a marginal effect on preventing blood pressure rising even further or the risk of giving birth prematurely. However, these data need to be confirmed in larger, well-designed trials.

One trial showed that, compared to women whose activity was not restricted, more women who had extended bed rest said they would not do it again in future pregnancies.

“At present there is insufficient evidence to provide clear guidance for clinical practice. Therefore, bed rest should not be recommended routinely for hypertension in pregnancy,” says lead author Shireen Meher, a research fellow in the Division of Perinatal and Reproductive Medicine, at The University of Liverpool, UK.

Review title: Meher S et al. Bed rest with or without hospitalization for hypertension during pregnancy. The Cochrane Database of Systematic Reviews 2005, Issue 4.

John Wiley & Sons, Inc.
interscience.wiley
The Cochrane Library newsletter, 2005, Issue 4 Continue reading →

Despite fears to the contrary, the use of drugs to end life without patient request has not increased since euthanasia was legalized in Belgium, states an article in CMAJ (Canadian Medical Association Journal)).

Euthanasia and physician-assisted suicide are controversial issues in the medical world. There are fears that the legalization of euthanasia will result in an increase in the use of life-ending drugs without explicit patient request, especially for vulnerable people such as seniors.

Euthanasia and/or physician-assisted suicide have been decriminalized in the US states of Oregon (1997) and Washington State (2009), as well as three European countries: Belgium and the Netherlands (2002) and Luxemburg (2009). Recently, the legalization debate has ignited in several countries, including Canada where a proposed bill was defeated by Parliament in April and the National Assembly of Quebec has launched consultations on the right to die through euthanasia.

The CMAJ study by a team of Belgian and Dutch researchers found 208 physician-assisted deaths in their sample of death certificates in Flemish Belgium. Euthanasia and physician-assisted suicide occurred in 2% of all Flemish deaths and the use of life-ending drugs without request occurred in 1.8% of deaths. Euthanasia and physician-assisted suicide were performed often in patients younger than 80 years (79.6%), in cancer patients (80.2%) and in people dying at home (50.3%). The use of life-ending drugs without explicit request often involved patients over the age of 80 (53%) and deaths in hospital ( 67%).

Despite the lack of explicit patient request, the use of life-ending drugs was in most cases discussed with patients’ families and health professional colleagues.

“The use of life-ending drugs without explicit patient request occurs predominantly in hospital and among elderly patients who are mostly in an irreversible coma or demented,” write Dr. Kenneth Chambaere, Vrije Universiteit, Brussel, and coauthors. “This fits the description of ‘vulnerable’ patient groups at risk of life-ending without request. Due attention should therefore be paid to protecting these particular patient groups from such practices. However, these patients are not proportionally more at risk than other patient groups.”

The researchers also found that in deaths without explicit request, mostly opioids were used along with benzodiazepines, although the efficacy of opioids in hastening death may be overestimated. They urge the need for advance care planning in the case of unpredictable end-of-life illnesses and decision-making.

Source:
Kim Barnhardt
Canadian Medical Association Journal Continue reading →

The health burden of an Asian strain of the parasitic flatworm
schistosomiasis is more damaging to the global health burden than
previously thought, according to a study published on March 5, 2008 in
the open-access journal PLoS Neglected Tropical Diseases.

Schistosomiasis, a parasitic flatworm of the genus Schistosoma,
can localize in several parts of the body but commonly affects the
intestines. Symptoms include abdominal pain, fever, cough, diarrhea,
abnormally high eosinophil count, and enlargement of the liver and
spleen, and it is transmitted through certain species of snails. It
primarily infects people in developing countries, infecting an
estimated 207 million people in 76 (mostly developing)
countries. There are several species of the Schistosoma
genus that affect humans — this study focused on Schistosomiasis
japonica, found in China and the Philippines.

Through the Global Burden of Disease project, the World Health
Organization (WHO) estimates the incidence, prevalence, severity, and
length of over 130 major causes of illness, injury, and death
throughout the world. A statistical measure known as the
disability-adjusted life year (DALY) is used, which means to estimate
the number of years of life lost due to premature death and any years
lost in disability. This data is often used by policy makers to
determine the level of funding for prevention programs, treatment
efforts, and research.

According to the WHO, schistosomiasis has a low disease burden, with a
0.005 DALY score on a scale of 0 (for perfect health) to 1 (for death.)
However, the burder of schistosomiasis has not been examined in more
than a decade. To this end, the researchers performed a literature
search to find data, and a decision model approach to re-examine the
burden of this disease.  The researchers calculated that the
symptoms of Schistosomiasis japonica is 7 to 46
times greater than the current estimate. The team arrived at an
estimate of 0.098 to 0.186. This study is the first to focus on one
strain of the disease, and it is part of an ever growing group of
evidence that this common parasitic disease is more damaging than
previously estimated for global health.

“Schistosomiasis
has a detrimental impact on nutrition and growth and development and
can lead to major organ damage and death,” study author Julia
Finkelstein , of the Harvard School of Public Health, Boston, USA,
says. “Current
measures may severely underestimate the disability-related impact of
the infection and need to be revised.”

Dr. Charles
King, of Case Western Reserve University, Cleveland, USA, who was not
involved in the study but wrote an accompanying Expert Commentary
article, predicted that, “Ultimately, these new measures
of schistosomiasis-associated disability will translate into a greater
priority to control schistosomiasis.” Integrating new approaches and
discoveries with these old estimates will, he says,”be essential
to providing a balanced and fair assessment of neglected tropical
diseases, and for properly setting disease control priorities for these
disabling diseases of poverty.”

About PLoS Neglected Tropical Diseases

PLoS Neglected Tropical Diseases (plosntds/)
is a peer-reviewed, open-access journal devoted to the pathology,
epidemiology, prevention, treatment, and control of the neglected
tropical diseases, as well as public policy relevant to this group of
diseases. All works published in PLoS Neglected Tropical Diseases are
open access, which means that everything is immediately and freely
available subject only to the condition that the original authorship
and source are properly attributed. The Public Library of Science uses
the Creative Commons Attribution License, and copyright is retained by
the authors.

About the Public Library of Science

The
Public Library of Science (PLoS) is a non-profit organization of
scientists and physicians committed to making the world’s scientific
and medical literature a freely available public resource. For more
information, visit plos.

Decision-Model
Estimation of the Age-Specific Disability Weight for Schistosomiasis
Japonica: A Systematic Review of the Literature
Julia L. Finkelstein, Mark D. Schleinitz, Helene Carabin, Stephen T.
McGarvey
PLoS Negl Trop Dis 2(3): e158.
doi:10.1371/journal.pntd.0000158
Click
Here For Full Article

Anna Sophia McKenney

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Care home residents, hospital patients and people who receive care at home will have more say in improving the quality of care services than ever before, the Care Quality Commission has pledged.

The Commission publishes Voices into Action, a charter for involving people in its work as the regulatory body for health and adult social care in England.

It also intends to make sure that the providers and commissioners of health and adult social care services ask for people’s views and that they respond to what they say.

Cynthia Bower, Chief Executive of the Care Quality Commission (CQC), said: “We believe that giving people a voice about the services they or their relatives receive is a vital part of getting things right and improving services for everyone.

“As the regulator, we put people who use services at the centre of everything we do, and we are passionate about involving them, their carers and their families in our work. We also expect providers of services, such as hospitals, health trusts, care homes and home-care agencies, to demonstrate that they actively seek people’s views and respond to what they say.

“Both providers and service users have told us that this leads to better services and has benefits not only for the service users but also for the staff. Being effectively involved increases people’s understanding and their confidence in the service, and leads to improvements in their health and well-being.”

Dame Joan Bakewell, who was appointed the Voice of Older People by the Government last November, will be the guest speaker at an event on 24 June to launch Voices into Action.

Dame Joan said: “It is an important principle that people who need to use health and social care services should be given the means to make their views known and to influence the way these vital services are delivered. This is particularly important for older people, and those who are disadvantaged for other reasons, who often go unheard in our society. That’s why I’m giving my full support to Voices into Action.”

The charter states that the Care Quality Commission will:

- conduct regular studies to find out people’s experiences of health and social care services;
- involve people who have experience of using services in its inspection work;
- set up special panels of people, such as one to represent the views of currently or recently detained mental health patients;
- consult widely on CQC policies and other topics, making a particular effort to reach people who are often missed out because of their disabilities or other circumstances;
- work with Local Involvement Networks (LINks) and seek ways of actively involving voluntary groups in the Commission’s functions;
- develop ways of assessing how well service providers and commissioners are involving people.

Voices into Action has been developed after wide consultation with individuals and groups across the country.

CQC next plans to consult on the measures it will use to assess how well providers of services are involving people. It will report yearly on how people have been involved and the difference it has made.

Download our Voices into action statement in different accessible formats

Notes

The Health and Social Care Act 2008 (which created the Care Quality Commission) sets out some requirements on involvement which say that the Commission must:

- focus on the needs and experiences of people who use health and adult social care services;
- have regard to the views and experience of people who use services (and their families and friends);
- have regard to the views and opinions of LINks;
- protect and promote the rights of people who use services; and
- publish a statement on how CQC will engage with people.

LINks (Local Involvement Networks) are being set up across the country to help people influence how health and social care services are run. LINks are independent and are made up of individuals and community groups whose job is to find out what the public think about local services and to make recommendations to those who run them.

Find out more on the Directgov website (opens in new window)

The Care Quality Commission (CQC) is the (new) independent regulator of all health and adult social care in England. We inspect all health and adult social care services in England, whether they are provided by the NHS, local authorities, private companies or voluntary organisations. We also protect the interests of people detained under the Mental Health Act. We make sure that essential common standards of quality are met everywhere care is provided, from hospitals to private care homes, and we work towards their improvement. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

Our work brings together (for the first time) independent regulation of health, mental health and adult social care. Before 1 April 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.

Source
Care Quality Commission Continue reading →

Professor Dinesh Bhugra has been elected unopposed as the next President of the Royal College of Psychiatrists and will begin his term of office during the College’s Annual General Meeting on Wednesday 2 July 2008.

Professor Bhugra is Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, Kings College London, and Honorary Consultant at the South London and Maudsley Trust. He has been Dean of the Royal College of Psychiatrists since 2003.

His research interests include professionalism in psychiatry, decision-making by psychiatrists, depression, schizophrenia, pathways into psychiatric care, deliberate self-harm, primary care, cross-cultural psychiatry, spirituality, psychosexual medicine and diversity.

Professor Bhugra has published widely, including books on cultural psychiatry, management, and religion and psychiatry. In 2006, after receiving a Wellcome Trust grant, he wrote a book entitled ‘Mad Tales from Bollywood: Portrayal of Mental Illness in Conventional Hindi Cinema’.

Professor Bhugra has been active in the College since 1985, and has chaired the Collegiate Trainees Committee (1987); the Overseas Doctors Training Committee (1996-present); and the Faculty of General and Community Psychiatry (1997-2001).

“It is an honour and a privilege to be elected to the Presidency of the Royal College of Psychiatrists,” said Prof. Bhugra. “I am particularly pleased to have received such overwhelming support from the members and fellows of the College.

“From my arrival in Cork nearly three decades ago, my journey through clinical and academic services in Leicester, Eastbourne, Guy’s and the Institute of Psychiatry at the Maudsley in London has been thoroughly enjoyable.

“My medical training was at the Armed Forces Medical College in Pune in India, and my psychiatric training here in the UK. After gaining clinical experience, I have devoted much time to training. As a result, the links between service development, standards of healthcare delivery and research have been my passion.

“I believe that the profession of psychiatry must be at the core of all medical care, ensuring that psychiatrists meet the mental health needs of all patients. The medical profession is at a crossroads, with serious threats to professionalism.

“The role and identity of psychiatrists must be strengthened, and the College must take a lead in defining professionalism for the 21st century. Most importantly, maintaining good standards for delivery of psychiatric services, and aspiring to top quality services that psychiatrists themselves will be willing to use, is the paramount challenge for the profession.

“I will work with key stakeholders to achieve this, including patients, carers, mental health professionals, the voluntary sector, and primary care.”

Professor Bhugra’s priorities are to:

1. review psychiatry’s contract with society through a re-evaluation of professionalism;

2. ensure that the College is relevant to its members by rewarding excellence, consultation and participation, and raising standards for practice and services;

3. support and represent the membership and trainees through changing times;

4. build stronger links with stakeholders;

5. build on existing links with the international community.

Royal College Of Psychiatrists Continue reading →

Slices of living human brain tissue are helping scientists learn which drugs can block the waves of death that engulf and engorge brain cells following a stroke.

It’s called anoxic depolarization and it primarily results from the brain getting insufficient blood and oxygen after a stroke, says Dr. Sergei Kirov, neuroscientist in the Medical College of Georgia Schools of Medicine and Graduate Studies.

The brain uses about 20 percent of the body’s total energy and about half of that is needed to run the pump that maintains healthy levels of sodium and potassium in and around brain cells. A stroke takes away the pump’s fuel, called ATP, so neurons and supportive astroglial cells quickly become bloated and dysfunctional. Cells die if the pumps don’t start working soon, Dr. Kirov says.

Resulting waves are responsible for much of the immediate brain cell death in the core of a stroke. Milder waves may continue to pound contiguous areas for hours or days, potentially increasing stroke size and damage. In this area called the penumbra, cells get a little more oxygen so there is the potential for recovery if the waves can be silenced, he says.

Dr. Kirov has been examining whether several drugs can stop the pounding of the penumbra in an animal model and has completed a small pilot study in human tissue. The scientist, who directs MCG’s Human Brain Laboratory, recently received a second grant from the National Institute of Neurological Disorders and Stroke to focus on the drugs’ potential in human tissue. “We only have one approved drug therapy for stroke and new approaches are needed to improve treatment for the third leading cause of death in western countries,” he says. He and others believe a focus on human tissue will better identify therapies that have real clinical merit.

A special report in the Nov. 29, 2007 issue of Stroke noted the failure in humans of numerous stroke therapies that looked promising in animal studies and outlined a new road map that includes better proof of efficacy in animal models as well as studies in human brain tissue focusing on the penumbra.

Dr. Kirov agrees. “Human brain slices as a model system can provide a missing link between animal models and patients and offer a unique chance to identify and study potentially useful therapeutics.”

He is getting live images of glowing human neurons or astroglial cells to look first at the simulated stroke and then at what protection different drugs provide. The tissue is removed primarily during epilepsy surgery at MCGHealth Medical Center and Children’s Medical Center. He replicates a stroke in the tissue by withholding oxygen and glucose then measures whether drugs can block anoxic depolarization.

There is plenty of living proof that cells can recover if the waves are short term: that’s essentially what happens in migraines. “Some people describe these moving through their visual field: a wave silencing, but not killing, the neurons,” Dr. Kirov says. Precisely what starts the wave remains an unanswered question. But he thinks he may be able to help delay or prevent the destructive electrical activity they bring without depressing usual central nervous system action.

He’s testing dibucaine, a local anesthetic known to impact ion channels, which regulate the flow of negatively and positively charged molecules in and out of cells. Positively charged potassium, for example, normally leaks out through ion channels. With anoxic depolarization, there’s too much sodium and too little potassium inside cells. He’s also studying two sigma receptor ligands, dextromethorphan and carbetapentane. Sigma receptors are ubiquitous in the body, but little is known about their role and what naturally activates them. Recent research suggests sigma receptors help protect cells from stress by ensuring an adequate level of the properly folded proteins they need for normal function. MCG Retinal Biologist Sylvia Smith and others have shown that sigma receptors are located within the endoplasmic reticulum of cells, which controls protein synthesis and regulates calcium levels. When needed, the receptors appear to chaperone these proteins to the cell powerhouse, or mitochondria. In his studies, Dr. Kirov is testing to see whether these sigma receptor ligands inhibit anoxic depolarization in humans to forecast translational success.

###

Source: Toni Baker

Medical College of Georgia Continue reading →

Cancer Research UK scientists have discovered a molecular ‘flag’ that predicts survival from prostate cancer at diagnosis, reveals a study published in the British Journal of Cancer.

The research led by pathologists based at the University of Liverpool measured the levels of a protein called heat shock protein-27 (Hsp-27) in prostate tissue samples taken from 553 men at the time they were diagnosed with prostate cancer. During a 15-year follow-up, the research showed that those men who tested positive for Hsp-27 at diagnosis were almost twice as likely to die from prostate cancer, than men who did not have the protein.

These findings suggest that Hsp-27 could be used as a potential test to distinguish men with the aggressive forms of the cancer that need immediate treatment from men with slow-growing forms of prostate cancer, and with which they can live with for many years. At the moment, there are no reliable tests to make this distinction.

Lead author, Professor Chris Foster, a Cancer Research UK-funded scientist at the University of Liverpool’s School of Cancer Studies, said: “We have identified a link between the presence of Hsp-27 at diagnosis and a lower survival rate for prostate cancer. Our study shows that this protein marker – currently found in tissue samples – can give us a reliable and accurate indication of whether individual cancers will become aggressive. Currently, we are working on developing this finding into a blood test to monitor men with prostate cancer in order to determine when their individual disease needs treatment.”

Hsp-27 is a key component of signalling pathways that control the movement of cells around the body. The study also suggests that new drugs could be developed to block these signals and halt the spread of prostate cancer cells.

Professor Foster added: “If further research shows that blocking these cell message systems is successful, it could provide a new treatment for aggressive forms of prostate cancer.”

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: “These results are an important step towards tackling the long-standing question of how to treat men with prostate cancer once it has been diagnosed. The need for treatment varies greatly between patients – men with non-aggressive cancer can live with it for many years without needing therapy, while aggressive cancers require prompt treatment with combinations of surgery, radiotherapy and chemotherapy. But it is very difficult to distinguish who has which type of cancer.

“A marker molecule which identifies aggressive prostate cancer would help us target active treatment to patients who need it – avoiding unnecessary therapy, which can have side effects, to those who don’t.” She added: “The next stage would be to test this protein in large clinical trials to decide if how useful it could be for diagnosis or treatment.”

Notes

*Hsp-27 expression at diagnosis predicts poor clinical outcome in prostate cancer independent of ETS-gene rearrangement. British Journal of Cancer. CS Foster et al.

Prostate Cancer

Prostate cancer is the most common cancer in men in the UK, with around 34,000 new cases diagnosed every year. Around 10,000 men die from the disease each year in the UK.

There are several tests that are used to diagnose prostate cancer including the PSA blood test – PSA is a protein produced by both normal and cancerous prostate cells. A high level of PSA can be a sign of cancer but there is no one PSA reading that is considered ‘normal’ and average levels rise with age. PSA alone is not recommended for screening in the UK, as the evidence of its reliability is still very unclear.

Source
Cancer Research UK Continue reading →

Australian healthcare professionals were able to offer better mental health support to the victims of the 2005 Bali bombings, thanks to improved procedures and services introduced after the first explosions in 2002, according to the May issue of the UK-based Journal of Psychiatric and Mental Health Nursing.

Staff at the Royal Darwin Hospital – who treated many of the casualties – also received vital personal support from mental health nurses, especially as they waited anxiously for the first victims to arrive.

“The 2002 bombings were Australia’s first large-scale introduction to terrorist activity in the immediate geographical area and they initiated a new phase of trauma response for public health services in the country” says Anthony Guscott of Top End Mental Health Services, which provides in-patient and consultation liaison nursing services at the Royal Darwin Hospital.

“A national mental health response to mass trauma was established and this proved particularly useful to the Royal Darwin Hospital, which handled a large number of casualties from both bombings.”

The national group driving the national mental health guidance were also able to draw on their experiences of other traumatic events, including the Eyre Peninsula bushfires that killed nine people and injured 110 in South Australia in January 2005.

This national guidance was then used to shape more effective local front line mental health services to cover both day-to-day needs and cope with major incidents. For example, the Royal Darwin Hospital now has a round-the-clock mental health presence in the emergency department and other departments can call on out-of-hours’ support as needed.

Many of the bomb victims suffered profound mental health problems immediately after the bombings. In 2002 the mental health response was poorly planned, but the lessons learnt from the first incident meant that in 2005 patients’ physical and mental health needs were better co-ordinated by staff who had already recognised and established a stronger link between trauma and psychiatric support.

Just over 200 people were killed by the 2002 bombs, including 88 Australians, and hundreds more suffered burns and other injuries. Many of the victims injured in the suicide bombings at Paddy’s Bar and the Sari Club in Kuta were taken to the Royal Darwin Hospital to be stabilised before being moved to other hospitals. A high proportion had suffered chemical burns.

A senior psychiatrist and the director of mental health nursing were available to provide advice, but no psychiatric reviews were requested by staff who treated the victims or prepared them for transfer to hospitals in their home states.

The experience in 2005 was very different.

Twenty people were killed and 129 wounded in the bombings in October 2005 – four Australians died and 19 were injured. On this occasion the majority of deaths and injuries were caused by shrapnel rather than burns.

Top End Mental Health Services’ staff were involved in the trauma planning sessions as soon as word of the bombings reached the hospital.

The experienced mental health nurses who had previously worked with people affected by the Eyre Peninsula bushfires provided a high profile presence in the emergency department, for patients and staff alike, from the moment casualties were admitted. And all patients underwent a mental health review before being moved to hospitals in their home states.

“Staff saw victims who had severe shrapnel wounds and were physically and emotionally affected by the bombings” says Guscott.

“They experienced depersonalisation, disassociation, disbelief and anger. Many described greater physical pain than their injuries would be expected to cause, together with a physical ache over their losses, thoughts of what could have been and the futility of the situation.

“All spoke in their own ways of how they felt their safety and personal space had been violated.”

And because the 2005 bombs were detonated at dinner time, some victims found it difficult to eat and became anxious at mealtimes.

The early intervention by mental health nurses proved invaluable for many of the patients.

In a short period many changed from providing limited verbal responses to starting to communicate more confidently.

The mental health nurses also provided vital, confidential support for other hospital healthcare staff while they were waiting for the victims to arrive and ongoing support while they treated them.

“Some staff described the eeriness of the ward waiting to receive incoming patients and other were anxious about what to expect having been involved in caring for bomb victims three years earlier” says Guscott. “And a number of general nurses and support staff also experienced disturbing phenomena such as the smell of burning flesh – a throwback to the chemical burn victims treated by the hospital in 2002.”

Following the 2005 incident hospital staff also took part in feedback sessions run by mental health staff so that their comments could be used to make any further improvements to the major incident plan and identify any ongoing staff support that was needed.

Guscott doubts whether the Royal Darwin would have handled the second bombing as effectively without the lessons learnt from the first.

“The fact that mental health nurses had become a recognised part of the hospital establishment between the two incidents meant that staff worked together in a much more co-ordinated way to help the victims of the second bombing” he says. “They also recognised that the mental health nurses could provide them with the support they needed to handle the trauma.”

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* The Bali bombings and the evolving mental health response to disaster in Australia: lessons from Darwin. Guscott et al. Journal of Psychiatric and Mental Health Nursing. 14, 239-242. May 2007.

* Journal of Psychiatric and Mental Health Nursing is an international forum for the advancement of psychiatric and mental health nursing practice. It publishes peer reviewed papers which reflect developments in knowledge, attitudes and skills and integration of these into practice. blackwellpublishing/jpm

* Blackwell Publishing is the world’s leading society publisher, partnering with 665 medical, academic, and professional societies. Blackwell publishes over 800 journals and has over 6,000 books in print. The company employs over 1,000 staff members in offices in the US, UK, Australia, China, Singapore, Denmark, Germany and Japan and officially merged with John Wiley & Sons, Inc’s Scientific, Technical and Medical business in February 2007. Blackwell’s mission as an expert publisher is to create long-term partnerships with our clients that enhance learning, disseminate research, and improve the quality of professional practice. For more information on Blackwell Publishing, please visit blackwellpublishing/ or blackwell-synergy/.

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