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Doctors 'Failing Acutely Ill Patients'

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Cardiac arrests in hospitals could be prevented if doctors recognise and act on early warning signs more quickly, a health watchdog has said.

More than a third (38%) of cardiac arrests in acutely ill patients could be avoided by improving their assessment and response to deterioration, researchers finds.

Experts from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) criticised senior doctors for failing their patients by not supporting junior colleagues.

Almost half (47%) of patient assessments when they reached hospital was not good enough, the NCEPOD report shows, and warning signs that a patient was deteriorating and may suffer a cardiac arrest were seen in three-quarters of cases.

The study, Time To Intervene?, finds that warning signs were not picked up in 35% of those patients, not acted on in 56% and not communicated to senior doctors in 55%.

Report author and NCEPOD lead clinical co-ordinator Dr George Findlay said: "The recognition of acute illness, response to it and escalation of concerns to consultants when patients are deteriorating is not happening consistently across hospitals.

"Senior doctors must be involved in the care-planning process for acutely ill patients at an earlier stage and support junior doctors to recognise the warning signs when a patient is deteriorating."

Improved decision-making is also needed for when CPR (cardiopulmonary resuscitation) should be given to a patient and when it should not, known as DNACPR (do not attempt cardiopulmonary resuscitation).

Dr Findlay said: "The lack of senior input fails patients by both missing the opportunity to halt deterioration and also by failing to question if CPR will actually improve outcome."

Even when a DNACPR decision had been made it was not always followed, and 52 patients underwent CPR despite their explicit DNACPR decision, the report finds.

Dr Findlay said performing CPR is the default decision doctors take where no explicit alternative exists, but pointed out: "This does not excuse lack of clarity around the role of CPR for individual patients. CPR status must be considered and recorded for all acute admissions, if not on initial admission then at the first consultant review."

NCEPOD chairman Bertie Leigh said: "In nearly half of all the cases we reviewed there was a failure to formulate an appropriate care plan on admission and a failure, often over several days, to find out what the patient's wishes were, and to carry them out.

"We are at a crossroads. All of us need to recognise and accept the limits of what can be achieved in medicine to the benefit of the patient and a ceiling of treatment described and agreed with the patient wherever possible.

"Doctors should only administer CPR where a patient has consented, or if the doctor is satisfied it is in the patient's best interests."

A Department of Health spokesman said: "Assessment and follow-up monitoring of a patient's condition when they are in hospital is obviously a critical part of delivering high-quality patient care. We expect doctors to ensure that patients are assessed effectively on admission and that changes in their condition are closely monitored.

"It is critical that hospitals have processes in place for junior doctors to escalate their concerns to senior colleagues, and for senior doctors to work with junior colleagues on recognising the warning signs of cardiac arrest at an early stage."


Cancer Rates Soar Due To Spread Of 'Western Lifestyle'

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Unhealthy Western ways of living are likely to fuel a massive surge in cancer rates around the world, experts have claimed.

A study predicts a more than 75% increase in the global cancer burden by 2030. In the poorest countries, the rise could be in excess of 90%.

The number of people worldwide diagnosed with cancer each year is forecast to swell from 12·7 million in 2008 to 22.2 million within the next 20 years.

The trend is blamed on the spread of Western lifestyles to developing countries, where more people are now eating convenience food, becoming obese and smoking.

smoking

A number of common cancers are linked to unhealthy high-income living, including those affecting the breast, prostate and bowel.

Substantial rises in the incidence of these diseases are likely to offset falling rates of others associated with infections, including cervical and stomach cancers, say researchers.

Scientists based their findings on a snapshot of cancer statistics collected from 184 countries in 2008.

The incidence and death rate estimates were recorded on the Globocan database compiled by the International Agency for Research on Cancer (IARC).

They showed how cancer patterns varied according to four levels of human development, measured on a Human Development Index (HDI) scale.

This information was used to project how the cancer burden was likely to change in 2030, taking into account forecasts of population size, ageing and national development.

The results are published online in the journal The Lancet Oncology.

Study leader Dr Freddie Bray, from the IARC in Lyon, France, said: "Cancer is already the leading cause of death in many high-income countries and is set to become a major cause of morbidity (illness) and mortality in the next decades in every nation of the world.

"This study serves as an important reference point in drawing attention to the need for global action to reduce the increasing burden of cancer."

Poor countries with a low HDI currently experience high rates of infection-linked cancers, such as cervical, stomach and liver cancers, and Kaposi's sarcoma.

But rich countries with a high HDI, such as the UK, US, and Australia, are more afflicted by cancers associated with smoking, obesity, diet and reproductive risk factors, such as not having children.

In both "high" and "very high" HDI regions four of these cancers - breast, lung, bowel and prostate - now account for over half the total cancer burden, the study showed.

Almost 40% of global cases of cancer in 2008 occurred in very high HDI countries, even though these regions contained just 15% of the world's population.

The research predicts medium HDI countries, such as South Africa, China and India, experiencing a 78% upsurge in cancer rates by 2030.

A 93% rise is forecast for low HDI countries, including those in sub-Saharan Africa.

Dr Christopher Wild, director of the IARC, said: "This study reveals the dynamic nature of cancer patterns in a given region of the world over time.

"Countries must take account of the specific challenges they will face and prioritise targeted interventions to combat the projected increases in cancer burden via effective primary prevention strategies, early detection, and effective treatment programmes."

How 'Flying The Flag' Beats Bingo Wings

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If you’re planning on embracing the Jubilee this weekend, here’s another reason to pick up your Union flag – waving it could burn 137 calories an hour.

A recent study by fashion retailer Littlewoods.com and the University of Lincoln, School of Sport and Exercise Science found that waving your red, white and blue flag "enthusiastically" for an hour burns off the same amount of calories that are contained in a portion of Coronation chicken.

waving flag

The unlikely bingo wing buster could help the nation burn off 106bn calories throughout the Jubilee and other patriotic events coming this summer, such as the Olympics and Euro 2012, suggests the fun piece of research.

SEE ALSO:

And it looks like people in the Midlands are set to have the most toned arms in Britain, as 50% admit to having their flags ready for the weekend.

Waving enthusiastically can increase calorific expenditure by 66%, compared to standing still and not waving at all, the research suggests.

Study author Geoff Middleton advises: “Flag waving predominately uses the muscles of the upper arms, shoulders and upper torso – so either get two flags or change your waving arms frequently otherwise you may notice the difference in your arms at the end of the summer."

If flag waving isn't your thing, take a look at other inspiring ways to keep fit...


Or check out how the world keeps fit...


Premature Babies 'More Likely To Suffer From Depression And Psychosis'

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Premature babies are significantly more likely than average to suffer serious mental disorders, such as schizophrenia, in later life, a study has found.

The risk increases for those babies that are born much too soon, when a pregnancy lasts less than 32 weeks.

Compared with normal term babies, they are three times more likely to be hospitalised for a psychiatric problem at age 16 or older, researchers found.

Very premature babies have more than twice the normal chance of developing schizophrenia and other forms of psychosis.

Their risk of bipolar disorder is increased more than seven-fold, while the chances of developing major depression and eating disorders are raised 2.9 and 3.5 times.

Brain injuries resulting from birth complications are thought to cause the increased risk, however experts stressed that the chances of a premature baby having a serious psychiatric problem were still small.

Rates of hospitalisation for psychosis are raised from two in 1,000 to around four in 1,000. The vast majority of pre-term babies turn out healthy and normal.

Both Sir Winston Churchill and Albert Einstein were famously premature.

However experts saw that to some extent, babies born moderately prematurely at 32 to 36 weeks were more likely to have depression, psychosis and bipolar disorder.

In this case the risk of psychosis was raised 1.6 times, of bipolar disorder 2.7 times, and of serious depression 1.3 times.

Researchers believe the pattern is due to the impact of being born prematurely on early brain development. However, why some children are affected and others not is unknown.

Premature babies are also far more prone to developmental problems such as attention deficit hyperactivity disorder (ADHD), conduct disorder and autism.

The new research, reported in the Archives of General Psychiatry, is based on a study of almost 1.5 million Swedish birth and medical records from 1973 and 1985.

Every child admitted to hospital with a first episode of a psychiatric disorder by 2002 was identified.

Dr Chiara Nosarti, from the Institute of Psychiatry at King's College London, said: "We found a very strong link between premature birth and a range of psychiatric disorders. Since we considered only the most severe cases that resulted in hospitalisation, it may be that in real terms this link is even stronger.

"However, it is important to remember that even with the increased risk, these disorders still only affect 1% to 6% of the population."

An estimated one in 13 children are born prematurely in the UK each year. As a group, they are more likely than other children to require extra school support and to suffer a range of physical problems.

Dr Nosarti added: "We believe that the increased risk of mental disorders in those born very prematurely can be explained by subtle changes in brain development. The immature nervous system in those born prematurely is particularly vulnerable to neonatal brain injury resulting from birth complications."

Her team is now conducting a deeper investigation with the help of a group of men and women in their 20s and 30s who were born very prematurely.

As well as looking for reasons why some pre-term babies are more susceptible to psychiatric problems, the researchers will also search for "resilience factors".

Dr Nosarti suggested screening at-risk children at the age of five, using a questionnaire filled out by their parents to "flag up" potential problems.
Colleague Dr Abraham Reichenberg, also from the Institute of Psychiatry, said: "The results of this study suggest that we shouldn't stop worrying about pre-term babies when they cross the age of seven. We should have a second stage of monitoring at a later age.

"If their behaviour's a little odd it might suggest there is a future risk that is evolving. We just need to pay attention."

Early identification of children developing psychiatric problems would allow them to receive appropriate treatment before their symptoms worsen.

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Elton Wants Another Baby

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Sir Elton John has revealed he wants to have another baby - so his son has support when he is teased about not having a mother.

The pop superstar, 65, said he and partner David Furnish had talked about the prospect of Zachary being targeted over his untraditional family set-up before they fathered him with a surrogate mother 15 months ago.

In an interview with Guardian, Sir Elton said it was inevitable that the toddler would face pressure over his family life as he is growing up.

"I think it's difficult to be an only child, and to be an only child of someone famous," he said.

"I want him to have a sibling so he has someone to be with. I know when he goes to school there's going to be an awful lot of pressure, and I know he's going to have people saying, 'You don't have a mummy.'

"It's going to happen. We talked about it before we had him. I want someone to be at his side and back him up. We shall see."

The Rocket Man singer said the fact he was an only child of an unhappy marriage and spent a lot of time by himself listening to his parents argue was another reason why he wanted more children.

During the revealing interview, Sir Elton, who will perform at the Queen's Diamond Jubilee concert at Buckingham Palace tomorrow night, also revealed he worries about Zachary being spoilt by a global army-of well-wishers and friends.

He said: "At Christmas we bought him a swing for the garden and a little slide, and this was his Christmas present and his birthday present from us.

"But he had so many presents from other people throughout the world, which is touching, but we actually found it obscene."

The star, who has been know for his extravagant lifestyle, said they gave most of the gifts to charity.

'Wonder Drug' To Extend Life For Breast Cancer Patients

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A new wonder drug for one of the most aggressive forms of breast cancer could allow women to survive with the disease for months longer.

The smart drug not only prevents the spread of breast cancer but its side effects are much less severe, experts at the American Society for Clinical Oncology will hear today.

The T-DM1 drug will be used to treat patients suffering from HER2-positive breast cancer - one of the most aggressive forms of the disease.

Research has found the drug keeps cancer at bay for three months longer than conventional treatments, while it is so precise the side-effects, such as hair loss and severe diarrhoea commonly associated with other forms of chemotherapy, are significantly reduced.

Professor Paul Ellis, from Guy's Hospital in London, said: "These results are remarkable because for the first time in breast cancer we have been able to significantly improve efficacy while substantially reducing many of the unpleasant side effects associated with chemotherapy.

"HER2-positive breast cancer is very aggressive and once it progresses to the advanced stage it becomes very difficult to treat, so there is a real need for new treatment options, like T-DM1, that can keep cancer at bay while maintaining patients' quality of life."

T-DM1 could be available to patients in less than a year. But it does not yet have a licence to be administered in the UK and there are concerns the NHS will not be able to afford to pay for its widespread use.

Dr Eliot Sims, from King George Hospital in Ilford, Essex, told the Mail on Sunday: "Is the emergence of T-DM1 going to cause funding problems? You bet it will.

"It's been the holy grail of oncology to find magic bullets - treatments which attack breast cancer without causing side effects. This is a huge breakthrough, and it is unusual to see such dramatic improvements."

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