Training Blog

Scientists claim that they are getting closer to curing colour blindness using gene therapy. In one study a US team, lead by Professor Jay Neitz were able to restore full colour vision to adult monkeys who were unable to distinguish between red and green. Experts believe that although more studies are needed, the same treatment could potentially work for humans who are colour blind. Until recently they had not thought it was possible to manipulate the adult brain in this way. Scientists believed that adding new sensory information could only be carried out in the earliest years of life; as this is when the brain is at its most malleable.

The study took place 2 years ago and the monkeys improved vision has remained stable ever since. The plan for Professor Neitz’s team is to continue to monitor the animals in order to evaluate the long term effects of the treatment and remain hopeful that a similar idea could be applied to humans who are colour blind.

There are several forms of colour blindness, the most common of which is inherited red/green colour blindness, which passed on through a faulty colour vision gene on an X chromosome. However colour blindness can occur as a result of diseases such as macular degeneration or from side effects of medicines. Statistics show that this research could benefit approximately 7% of men and 1% of women born with genetic colour deficiencies.

This research seems to be the first in primates to address the colour vision deficiencies and indicate that intact cells are modifiable in their colour perception.

Although there is still alot more research to be done before the test is carried out on humans or becomes available in clinics it seems to be a massive step towards curing genetic abnormalities.

Health Secretary Andy Burnham has announced plans to scrap GP catchment areas in England within a year. It follows a claim that ministers want to introduce greater choice into the family doctor system, as they believe that it will drive up standards. The government has trying to get more from GPs ever since their pay rocketed with the introduction of a new contract in 2004. It started with GPs staying open for longer but the idea of ending catchment areas was on the cards before Gordon Brown became prime minister. Lord Darzi mentioned the idea when he revealed his review of the health service in 2008. At the moment catchment areas vary in size; in rural areas doctors see patients up to 40 miles away whilst city-based doctors often only see patients up t0 a 2 mile radius

Patient choice is already a well established right in hospital care with people entitled to choose from any hospital in the country for treatment. Mr Burnham states: “I want the best to be available to everyone, not according to where they live. Too often people’s choice of GP practice is unnecessarily limited by practice boundaries, so, with the profession, I want to open up real choice in primary care.” He also argues that people’s choice of a GP should be based on their own needs – not by lines on a map

Some think that if the Conservatives win the next election they aim to make GP practices become practice based commissioners. This would mean that the majority of their commissioning functions would be carried through federations of GP practices that operate as consortiums. This proposal would mean a reduction in the commissioning role of PCTs in some areas.
Under the Tories:

• The merger of PCTs would be welcomed but not forced
• All GP practices would be expected to become practice based commissioners
• Trusts would be expected to negotiate prices for acute care at a rate under the PbR price
• The Conservatives would welcome such mergers as part of an organic process but stress they would be voluntary. They hope to encourage more GPs to take up commissioning by turning the currently indicative budgets into real cash budgets.

Shadow Secretary of State for Health, Andrew Lansley states that it would give practices real opportunities to save and reinvest. It would also give them control over contracts and how patients are treated. Lansley stresses that any underspends would remain for the use for patient care, not profits. Health project leader at the Social Market Foundation think tank, David Furness, said the implications of an enhanced role for practice based commissioning were “much more significant than has been [previously] discussed”.

When asked if the Conservatives wanted to see more such mergers such as those in London, the response was: “It would be perfectly reasonable to aggregate, but it will be up to them [PCTs] to decide. It would be done on an organic bottom-up way if [they] choose to do so.”

Within the NHS, sources who have been asked to advise the Conservatives on the development of their health policy, said they thought the party would ideally like to see strategic health authorities and PCTs merged to create maybe 40 strategic commissioning bodies, organised around city regions. It is thought that this would rectify the problem that PCTs are perceived as being “too small” to be able to negotiate good value from large acute hospitals.

However, a spokesman for the Conservatives denied that the party were planning to merge SHAs and PCTs, saying that it was “very clear that’s not what we are planning”. He does also add that they do foresee SHAs moving their focus away from providers as more become foundation trusts. However Tory leader David Cameron and Mr Lansley have pledged they will not subject the NHS to another round of structural reorganisation.

In 2008 a £1,000,000 trial was launched to find out if giving young offenders nutritional supplements reduced anti-social behaviour in prison. In the study 1,000 young offenders from 3 institutions in the UK were given a mixture of vitamins, minerals and essential fatty acid supplements on top of their normal prison diet. The behaviour of these offenders was compared to those on the placebo. The study was essentially a larger scale version of a study that was carried out in Aylesbury, which had shown a favourable impact on violence and ill discipline. The idea that better nutrition can change behaviour is a very attractive one, doing this is in the form of a pill is both simple and very cheap

It is important to point out that the aim of the study was not about improving prison food, which the team believe is – from a nutritional perspective at least – more than satisfactory. According to a Professor at Oxford University, Professor John Stein: “The problem is that prisoners do not make good dietary choices, and that’s what we’re trying to overcome.

The idea that what we eat can have an impact upon how we behave is not a new concept. However Frances Cook says: “A society which really believes that a young offender society which really believes a young offender can be cured by a capsule which he takes back to his cell and consumes with his chips has got some serious thinking to do.”

The impact of fish oil on anti-social behaviour takes us into uncharted waters. It appears to be highly effective, and the only ‘risk’ from a better diet is better health. Omega-3 was one of the main components of the cocktail of 30 nutrients to bring the offender’s intake of vitamins and minerals up to the government’s recommended daily amount. The researchers were looking for evidence the supplements were helping the participants curb impulsive urges which are viewed as a key features of anti-social behaviour.

The results showed that the offenders taking the capsules committed approximately 26% fewer disciplinary offences than those taking a placebo and committed 37% fewer violent crimes.

The findings are encouraging but it seems to me that it is like closing the stable door after the horse has already bolted as it is impossible to identify young offenders before they offend purely because there are too many people in the UK so it would take far too long and be very expensive. It is also likely to cause unrest as it involves singling people out. Alternatively issue it to all minors, but this is not a guaranteed way to eliminate young offenders as people still have free will and other issues in there lives such as poverty, family breakdowns and various other problems.

Statistics show than in Britain one in 10 can’t sleep at night. New online treatments for insomnia could be the cure that is only a click away? Of course there are those who are critical of this new treatment such as Jim Horne who claims that: “The more personal the approach between the person who is the sufferer and the therapist, the better.”

There is help available from the NHS for insomniacs, unfortunately places are often very limited and the waiting lists are long. This new cure is free and are currently being offered on a commercial basis from the United States. Those who are critical of this new theory claim that it sounds rather like a spam email “End sleepless nights once and for all – at home.” However over the past few years, researchers have been developing internet-based courses designed to do exactly that.

Those who support the theory claim that it can be as effective as face-to-face cognitive behavioural therapy. Everyone knows the folk remedies for sleeplessness

• Drink warm milk,
• Take a hot bath,
• Sip herbal tea,
• Count sheep.

More often than not these don’t work, therefore your only option is to hope sleep will come, or to get one of the places on the waiting list for cognitive behavioural therapist, whilst putting up with the wakeful nights and groggy days while you wait.

With insomnia being one of the most common mental health problem with less than 50% of sufferers mentioning it to their GP. It is thought that many people feel that it is too trivial to mention to their GP or they believe they can manage on their own.

The online treatments may have the potential to ease this pressure due to the shortage of therapists trained to deal with insomnia, although the NHS is trying to help the situation by traning more therapists. inging insomnia treatment to the internet.

If you are having trouble sleeping here are a few top tips from the experts:

• Stay positive – if you worry about not sleeping, you won’t sleep
• Good sleepers try to stay awake – don’t dwell on falling asleep
• One bad night isn’t the end of good sleeping patterns – there’s always tomorrow

Here are a few things not to do:

• Don’t nap – the bed shouldn’t be for anything but sleep and sex
• Don’t stay in bed longer than 20 minutes. If you’re not asleep, get up and do something else until you feel tired

Daniel Hannan, a Tory MEP (Member of European Parliament) who criticised the NHS on American TV was accused of being “unpatriotic” by Andy Burnham, who is the Health Secretary. He claimed that the NHS is unfair and outdated and should be scrapped. Hannan made a series of appearances on American television over several weeks, and was quoted as describing the NHS as “60 year mistake” and he “wouldn’t wish it on anyone”. This rather brutal attack on the NHS came about following Obama’s proposal to introduce a similar system in America. Mr Hannan has repeatedly stressed that the views he expressed on U.S TV were his own and not those of the party but that Roger Helmer, a fellow Tory MEP who reports claim he said on BBC Radio 4’s PM programme: “I think Dan has done us a service by raising these issues which need to be looked at”. Burnham said: “What has happened within the last 48 hours is what Cameron has feared most because it lays bare the Tories’ deep ambivalence towards the NHS.”

Daniel Hannan claims that: “If 80% of Americans are getting better health care than we are in the UK then we ought to ask why, and we ought to ask how are we going to deliver equally good results.” For those who are not particularly familiar with the current health care system in America see The Difference between USA healthcare and the NHS

Tory leader David Cameron, vows to protect health from spending cuts that have been predicted for 2011 if he comes to power, he reiterates his commitment to the NHS and has made it clear that he does not share Hannan’s views and has distanced himself from Hannan. Cameron claims:”We are the party of the NHS, we back it, we are going to expand it, we have ring-fenced it and said that it will get more money under a Conservative government, and it is our number one mission to improve it.” He goes on to say: “He (Hannan) does have some quite eccentric views about some things, and political parties always include some people who don’t toe the party line on one issue or another issue.”

There are some who feel that Daniel Hannan should be disciplined for his comments about the NHS. Mr Hannan’s words have been seized on by Labour and the Liberal Democrats who have questioned the party’s commitment to the NHS. His critics state that Hannan’s words were an “insult” to the 1.4m NHS workers and “he should not be voicing those views in the foreign media in my view”. John Prescott has recorded a message accusing Mr Hannan of “misrepresentation of the NHS here in Britain”. Even the Prime Minister has publicly joined those who support the NHS by joining the welovetheNHS Twitter campaign, that was set up defend the health service from US attacks.

It would seem that Hannan’s comment has stirred alot of unrest within the British public and alot of people are pledging their support to the NHS. One of those is the physicist Professor Stephen Hawking, who claims that he would not be alive without it: “I have received a large amount of high-quality treatment without which I would not have survived.” Hawking, who has Lou Gehrig’s disease, was in Washington to be awarded the America’s highest civilian honour, the Presidential Medal of Freedom. An American newspaper subsequently used Prof Hawking as an example of the deficiencies of the NHS. “People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless,” it claimed.

As with any big institution there will be a few that oppose it but for the vast majority of people the NHS does work and saves millions of lives. For those that don’t like the NHS the UK also has the option of private healthcare so if you don’t want to use the NHS go private. Simple.

The chemical DEET which is found in many insect repellent sprays has been shown to be toxic and can cause fits in children, the current advice is that it should not be used by pregnant women. In research studies DEET blocked the enzyme cholinesterase, which is essential for sending messages between the muscles and the brain which can cause muscle spasms and in severe cases death. Other side effects of DEET are excessive salivation and eye watering.

DEET, is also known as diethyl toluamide, and is used in a many repellent sprays. Initially it was thought that the DEET simply altered the insects sense of smell to prevent them from detected the smell of the human. However on further study it was found that it acts on the enzyme which is present in both insects and mammals. Therefore the idea that it simply modifies insect behaviour is false as it directly inhibits enzyme activity in both mammal and insect nerves, research also shows that DEET interacts and strengthens the toxicity of carbamates, a class of insecticides also known to block acetylcholinesterase.

This research raises questions with regards to the safety of insect repellents, however at present it is mainly based on theory and tests on animals if you are at all concerned speak to a pharmacist or a doctor. Alternatively try alternatives from your health food shop

Under a new Strategic Health Authority Initiative nurses will be able to compare the quality of patient care against other trusts in England. The initiative ‘Energise for Excellence in Care’ is designed to improve fundamental nursing care, it is hoped that the tool should be available on website for the NHS Institute for Innovation and Improvement after it has been adapted.

The new tool is based on the ‘acuity/dependency’ tool which was developed by the Association of UK University Hospitals, which helps to categorise patients depending on their conditions (for example ‘stable’ or ‘unstable’) which can then be used to help inform staffing levels, skill mix and workforce development needs.

It is hoped that the new tool will enable nurses to deliver evidence-based care, that will include the development of new services where appropriate. In order to improve quality patient care indicators are key according to Lord Darzi’s Next Stage Review of the NHS, which was published summer 2008. In May 2009 a list of over 200 indicators that could be used to improve services across the NHS was published by the Government.

The Chief Executive David Nicholson will take personal responsibility for the ‘quality, innovation, productivity and prevention’ (or QIPP). It is also the focus of the DH management board. The Department of Health funded initiative; “Energise for Excellence in Care” is being led by senior nurses. Although it is hoped that this initiative will help the QIPP initiative it is important to stress that it also has wider goals, such as getting the nurses to focus on the things that really matter to patients. The initiative is also designed to give nurses permission to say what needs to be done and encourage nurses to reflect on the quality of the care that they are providing.

If nurses are consistently providing high quality care it may reduce costs for the NHS as fewer mistakes will be made and morale will improve as it is well known that low morale is detrimental to productivity and in this case patients. For more information see How morale levels affect the workplace

There are claims that over half of the children taking Tamiflu to cure swine flu suffered side effects such as nausea, insomnia and nightmares. The statistics show that 1 in 5 children had a neuropsychiatric side effect, such as poor concentration, inability to think clearly, problems sleeping, and feeling dazed or confused. The research that was carried out was flawed as there was no control group therefore it is impossible to say whether the symptoms were a result of the drug or the virus; however, there were no serious long term side

Participants for the study were selected differently in the three schools. In two schools (one primary and one secondary school) the researchers selected all the classes who were offered prophylaxis, (age 4-11 years in the primary school), and all of one year group in the secondary school (age 13-14 years). In the other secondary school, the questionnaire was offered only to pupils in four of the classes in the year group (age range 11-13 years). This is a flawed sample as there is no fixed criteria for selecting the participants for the research.

Here are a few of the questions that were asked to the sample:

• Whether children who had been offered Tamiflu had taken it?
• How long they took it for?
• Were they taking any other medication with Tamiflu?
• Were there symptoms after taking Tamiflu (including specific gastrointestinal and neuropsychiatric symptoms)?

Out of 256 schoolchildren, 103 replied which is 40% of the participants. The number of responses from the secondary school were higher than those from the primary school. The results show that only 48% of the primary schoolchildren in comparison to the 76%of the secondary schoolchildren. The most common side effects were nausea and vomiting, followed by mild neuropsychiatric effects such as difficulty sleeping, nightmares and poor concentration.

It is worth pointing out that Tamiflu has not been withdrawn and is still used to treat swine flu. All drugs come with side effects and not everybody experiences them, thus suggesting that Tamiflu is no different to any other medicine.

The government is planning to ban all private transplants of organs from dead donors in the UK. The ban comes as a result of media reports of patients from countries such as Greece and Italy paying to get on waiting lists for organs from British people, so due to the fact that organs are scarce the general consensus is that to ensure NHS patients don’t miss out no one should be allowed to pay for transplants. At present the ban is only been approved in England but is expected to come into place across the rest of the UK by October.

An enquiry carried out revealed that over 700 transplants, most of which were liver transplants, had been carried out on non-UK patients over the past 10 years. Of the 700 transplants 631 of those transplants used organs from dead donors and, of those, 314 were from outside the EU. It is worth pointing out that the enquiry uncovered no evidence of wrongdoing with regards to the allocation of the organs but came to the conclusion that no one should be able to pay for such operations. According EU law, some patients can receive treatment in other countries, if approved by their healthcare system, which then foots the bill, however the NHS should be more cautious when assessing patients’ eligibility as it is possible that some patients are receiving treatment when they should be refused. Some say that the NHS should work with other EU countries to help develop their own transplant scheme.

The ban only applies to transplants from dead donors private transplants can still be carried out using organs from living donors. Critics of the ban claim that the only reason people pay for transplants is the NHS takes so long that you will probably be dead before you get it. They also point out that it is illegal to sell your organs so why should hospitals be allowed to sell organs to the highest bidder, especially when there are not enough organs available for citizens of the UK. The organs should be allocated on the basis of who is in the greatest need instead of who can afford to pay.