HealthPad

Structured educational courses to help people living with diabetes manage their condition are not working.
 
A few closed service providers dominate diabetes education in the UK, and according to the last National Diabetes Audit, less than 2% of the 3.8 million diagnosed with diabetes attend any form of structured education.
 
The non-dramatic, insidious and chronic nature of diabetes masks the fact that it has become a global epidemic with the potential to overwhelm national health systems, if education can't halt its progress. 
 
Although advances in diabetes research are significant, the horizon for a cure is still distant. At this moment in time, the best option to halt the progression of diabetes is convenient, fast and effective education.
 

A new test, called ADNEX, reported in the British Medical Journal in October 2014 helps to identify different types and stages of ovarian cancer more accurately, which scientists claim will reduce the incidences of unnecessary surgeries. 
 
Accurate, simple and ready
The test, developed by an international team led by Imperial College London and KU Leuven, Belgium, is based on patient data, a simple blood test, and features that can be identified on an ultrasound scan. Doctors can use it simply by entering patient data into a smartphone app. It's highly accurate, and discriminates between benign and malignant tumours, and also identifies different types of malignant tumours.
 
Successful treatment depends on accurate diagnosis, and diagnosis of ovarian cancer can be challenging. According to Professor Tom Bourne, Department of Surgery and Cancer at Imperial College London, "The way we assess women with ovarian cysts for the presence of cancer and select treatment lacks accuracy. This new approach to classifying ovarian tumours can help doctors make the right management decisions, which will improve the outcome for women with cancer. It will also reduce the likelihood of women with all types of cysts having excessive or unnecessary treatment that may impact on their fertility." 

In October 2014 Harvard professor Douglas Melton announced a breakthrough in the treatment of type-1 diabetes by creating stem cells that produce insulin.

Melton demonstrated that mice treated with transplanted pancreatic cells are still producing insulin months after being injected. Testing in primates is now underway at the University of Chicago, and clinical studies in humans should begin in just a few years.

"Most patients are sick of hearing that something's just around the corner," says Melton, but he's convinced that his research represents a significant turning point in the fight against diabetes.

Type-1
Type-1 diabetes, which usually occurs in children, is an autoimmune disease in which the body attacks its own beta cells of the pancreas and destroys their ability to make insulin. It's a devastating lifelong chronic condition, which affects some three million Americans and 400,000 English people. Treatment is daily insulin doses, a healthy diet and regular physical activity.

Was the UK Department of Health (DH) right to axe its telehealth project?

Telehealth
Telehealth is a combination of medical devices and communication technology used to monitor diseases and symptoms, and support health and social care remotely. It represents a solution to the challenges of rising healthcare costs, an aging population, and the increasing prevalence of chronic diseases.

The Whole Systems Demonstrator Project
The DH's Whole Systems Demonstrator (WSD) project was an ill-conceived top-down endeavour doomed to fail. It cost £31m, and was the world's largest randomised control trial of telehealth involving 7,000 patients, 240 primary care practices across three UK sites.
 
3millionpeople
In 2011 an interim evaluation concluded that the WSD project could achieve a 45% reduction in mortality rates, a 15% drop in A&E visits, a 14% reduction in bed-days, and an 8% reduction in tariff costs.

These estimates are in line with international findings. Based on a review of some 2,000 studies, GlobalMed concludes that telehealth has reduced hospital re-admissions by 83%, decreased home nursing visits by 66%, and lowered overall costs by more than 30%. Nothing else has worked to reduce such costs.
 
It was projected that by 2017 three million people in England with long term conditions would be recording their medical data and vital signs remotely, and sending them, via email and text, directly to GPs. This could save the NHS £1.2 billion a year, and significantly enhance the quality of patient care.

Diabetic foot ulcers (DFU) are responsible for more hospitalizations than any other complication of diabetes, and the biggest cause of amputation. Of the 26 million people in the US, and some 3.8 million in the UK diagnosed with diabetes, as many as 25% may experience a DFU in their lifetime. 
 
People living with diabetes are at risk of nerve damage (neuropathy), and problems with the blood supply to their feet (ischaemia). Nerve damage results in a reduced ability to feel pain, and therefore injuries often go un-noticed. Ischaemia can slow down wound healing. Both ischaemia and neuropathy can lead to DFUs. Infections in DFUs can lead to amputation.
 
The burden of DFUs
DFUs impose a substantial burden on public and private payers, doubling care costs per patient compared with diabetic patients without foot ulcers. In the US, ulcer care adds around US$9 to US$13 billion to the direct yearly costs associated with diabetes, and in the UK, around £650 million is spent on DFUs and amputations each year.
 
The five-year recurrence rates of DFUs are as high as 70%. People with diabetes with one lower limb amputation have a 50% risk of developing a serious ulcer in the second limb within two years. People with diabetes have a 50% mortality rate in the five years following an initial amputation. These numbers have not changed much in the past 30 years, despite significant advances in the medical and surgical therapies for people with diabetes.
  

In July 2014 the European Translational Research Network in Ovarian Cancer (EUTROC), held its annual conference in London. High on its agenda was cancer's resistance to established drugs.

Cancer is a complex disease. It arises from random "errors" in our genes, which regulate the growth of cells that make-up our bodies. Error-laden cells either die or survive, and multiply as a result of complex changes that scientists don't fully understood.
 
Translational medicine
Translational medicine is a rapidly growing discipline in biomedical research, which benefits from a recent technological revolution that allows scientists to monitor the behaviour of everyone of our 25,000 genes, identify almost every protein in an individual cell, and work to improve cancer therapies.
 
Ovarian cancer is the forth most common form of cancer in women, after breast, lung and bowel cancer. Each year, in the UK some 7,000 people are diagnosed with ovarian cancer, in the US it's 240,000. Most women are diagnosed once the cancer has spread beyond the ovaries, which makes treatment challenging, and mortality rates high. Only 10% of women diagnosed with ovarian cancer at the latest stage survive more that five years. 

Early in 2014, the Sunday Times kicked-off a campaign to give more people who would benefit from radiotherapy access to it, suggesting that NHS radiotherapy equipment is either out-dated or underutilised.
 
According to Lawrence Dallaglio, the former English rugby captain who campaigns for increased access to radiotherapy, "Cancer clinicians are being denied the use of technologies to treat patients that the rest of the civilised world uses as a matter of routine."
 
Dallaglio's intervention prompted a government plan to improve access to quality radiotherapy. Is it happening?
 
Radiotherapy in England
The UK government's 2011 cancer plan, Improving Outcomes: a Strategy for Cancer, states, "To improve outcomes from radiotherapy, there must be equitable access to high quality, safe, timely, protocol-driven quality-controlled services focused around patients' needs."
 
Over 50% of the 275,000 people diagnosed in England with cancer each year could benefit from radiotherapy as part of their treatment. However, access rates are only around 38%, and each year an estimated 36,000 patients who might benefit from radiotherapy, don't receive it. 

Keen to discover the effectiveness of short healthcare videos as a communication tool for patients, Dr. Seth Rankin, the managing partner of Wandsworth Medical Centre, London, emailed his patients living with diabetes short videos about their condition, and surveyed their opinions afterwards, which we report.
 
The clinicians
"Healthcare information in video format distributed directly to patients' mobiles is a more effective way to educate people living with diabetes, and propel them towards self management with an eye to slowing the onset of complications," says Rankin.    

According to Dr. Sufyan Hussain,an endocrinologist and lecturer from Imperial College, London, Clinical Lead on the Wandsworth project,  "Despite accounting for 10% of the NHS budget and 8% of UK's population diabetes healthcare systems still need considerable improvement, particularly in management, strategy and infrastructure. Communicating important health information via video, can help significantly to improve the quality of care and efficiency in an over burdened healthcare system."