Tag

Frequently misdiagnosed
The frequent misdiagnosis of ovarian cancer means that it often presents late when it has already metastasized. It's the most aggressive gynecological malady, with poor survival rates: only 40% survive beyond five years, and it can affect any woman.
 
The reason why early symptoms are difficult to detect is because inside the abdomen, the ovary has a lot of space to grow into before it starts to press onto other structures such as the uterus, bowel and bladder.
 
Early detection is key
All women should be on guard of the symptoms, which may be vague at first, and similar to other conditions, such as digestive disorders. The commonest symptoms are discomfort or pain in the lower abdomen or pelvis, and also there may be backache or a swelling felt.
 
There is a survival rate of up to 90% when ovarian cancer is caught early, compared with less than 30% if it is discovered in the later stages. 

Increasing incidence in younger women
Around 1 in 55 women will get ovarian cancer at some time in their life, and it is more common over the age of 40. Less than 1 in 20 ovary cancers occur in women younger than this. There are inherited factors involved in some cases, and research is underway to find out how best to screen women at increased risk of the disease. Since the mid-1970s, the incidence of ovarian cancer in women between 15 and 39 has increased by some 56%.
 
Takeaway
Currently, early detection, and rapid referral to a specialist gynaecological cancer unit is the key to transforming survival rates for ovarian cancer. Patients therefore have to rely on seeing a doctor, and being correctly diagnosed in time. 
 

Increasing incidence
For reasons not completely understood, the incidence of type-1 diabetes has been increasing throughout the world at about three to five per cent a year, and is most prevalent in Europe. This is troubling, because type-1 diabetes has the potential to disable or kill people early in their lives.

The search to discover why type-1 diabetes is increasing resembles the penultimate chapter of an Agatha Christie mystery, where there are many suspects, but no prime candidate. The last chapter to explain the increasing incidence of type-1 diabetes is yet to be written.  
 
Parents unaware of symptoms
A 2012 UK report suggests that parents are unaware of the warning signs of type-1 diabetes: thirstiness, tiredness, weight loss and frequently passing urine. As a consequence 25% of children with the condition are diagnosed once they are already seriously ill with diabetic ketoacidosis (DKA). DKA occurs because a severe lack of insulin upsets the body's normal chemical balance, and leads to the production of poisonous chemicals called ketones. This build-up can be life threatening, and needs immediate specialist treatment in hospital.

The challenge of cell production
Making industrial quantities of the insulin-producing cells of the pancreas has been a Holy Grail of diabetes research. All previous attempts have failed to achieve scalable quantities of the mature beta cells that could be of practical benefit to people living with diabetes.

Just over 20 years ago when Professor Melton's son Sam was diagnosed with type-1 diabetes Melton promised that he would find a cure. He was further inspired when his daughter at 14 was also diagnosed with type-1 diabetes.

According to Melton, it should be possible to produce 'scalable' quantities of beta pancreatic cells from stem cells in industrial-sized bioreactors, and then transplant them into a patient to protect them from immune attack. This would result in an effective cure.

"The biggest hurdle has been to get glucose-sensing, insulin-secreting beta cells, and that's what our group has done," says Melton.

In addition to offering a new form of treatment, and possibly a 'cure' for type-1 diabetes, Melton believes his discovery could also offer hope for the 10% of people living with type-2 diabetes who have to rely on regular insulin injections.

Takeaway
If Professor Melton is successful, not only will his discovery honour a promise to his children, but also it'll be a medical game-changer on a par with antibiotics and bacterial infections.

GP's wrath should have been expected
Despite its projected success, the DH's telehealth project was quietly axed, following a London School of Economics (LSE) study, which concluded that the project, "does not seem to be a cost-effective addition to standard support and treatment", and GPs complaining of a "tsunami" of data.
 
Too much importance was given to the LSE study, and not enough to GPs. The DH failed to understand how to change a large healthcare system. As a consequence the UK telehealth project was a bolt on to a poorly integrated care system not adapted to telehealth, and was sure to incur the wrath of GPs.

Despite endeavours to train more GPs and expand community nurses, there is abundant evidence to suggest that GPs struggle under large and growing workloads, and reports of stress and burnout are common. Not a group you would impose change upon from the top. 

A human system which uses technology
The DH wrongly viewed telehealth as a technology system, and healthcare as a machine with processes and activities that delivers services to patients. Telehealth is a human system, which uses technology.

Health professionals, patients and their carers are the essential tools of telehealth. As they become more experienced in collecting, analysing and acting upon the information they receive from telehealth devices, so they become more integrated, and patients benefit and cost effectiveness increases.

Lessons for the DH

1. Healthcare is an organic system comprised of people operating in a context
2. Change is non-linear
3.  GPs are not commodities on which to impose change from the top, but sources of power, which can bring about change
4. Seeds of change should have been planted with GPs who perceive change as an opportunity for personal development and growth.  

 
Takeaway
The DH was right to axe its badly conceived telehealth project, but would be wrong to withdraw its support for telehealth.  

Poorly understood pathology
The exact mechanism by which diabetes impairs wound healing is not fully understood, and as a result, the management of DFUs is challenging, and has been a neglected area of healthcare research and planning. Current clinical practice is based more on opinion than scientific fact.
 
According to Hisham Rashid, a consultant vascular surgeon at Kings College Hospital, London who specializes in the surgical therapy for DFUs,  "Because the pathological processes of DFUs are complex, they tend to be poorly understood, and communication between the many specialties involved can be disjointed and insensitive to the needs of patients. One of the biggest recent improvements in foot care has been the close liaison of different specialties in multidisciplinary foot clinics."

Advances in therapeutics
Surgeons have tended to use free tissue transfer, as the treatment of choice for complex DFUs, but the length and intricacies of these procedures is contraindicated, and can lead to complications. This has led surgeons to turn to bioengineered alternative tissue in the reconstruction of these complex wounds.

One new bioengineered tissue for DFUs is an advanced bilayer skin replacement system designed to provide immediate wound closure, and permanent regeneration of the dermis. The product, Integra Dermal Regeneration Template, recently completed a clinical study, and an initial review suggests that the study has achieved its primary goal, which is complete wound closure at 16 weeks.

Takeaways
It's possible to reduce DFUs and consequent amputation rates by as much as 49 to 85%. This can be achieved through a care strategy, which combines prevention, close monitoring and education. According to Rashid, "Health professionals have an important role to play in enhancing the education for people living with diabetes in order to propel them towards self-management, and slow the onset of complications such as DFUs."

Evidence from a recent survey of people with diabetes, suggests patient outcomes will improve if GPs provide healthcare information in video clips rather than paper pamphlets.

Traditional patient information is failing
"An indication that the current paper and web-based diabetes information is failing to improve patient outcomes is the fact that the incidence rates of diabetes in the UK are escalating. Currently, a plethora of diabetes information is provided either in paper pamphlets or as digitalized text on websites, but patients want healthcare information in video clips, and greater connectivity with their health providers," says Dr Seth Rankin, managing partner, Wandsworth Medical Centre, who conducted the survey.

Despite the NHS spending £10 billion each year on diabetes care, between 2006 and 2011 the number of people diagnosed with diabetes in England increased by 25%: from 1.9 million to 2.5 million. Today, 3.8 million people have diabetes, and this number is expected to increase to 6.2 million by 2035. In 2013 there were 163,000 new diagnoses of diabetes in the UK, the biggest annual increase since 2008, and the five-year recurrence rates of diabetic foot ulcers are as high as 70%. The population increase over the past decade only explains some of these increases.

 

 

Improving outcomes
Organizations treat the distribution of diabetes information as ends in themselves, and report the quantity of information distributed, but not the impact it has on outcomes.
 
By simply asking patients with diabetes how, when and where they would like to receive information to help them manage their condition provides an important missing social link between health professionals and patients, and can help to improve outcomes.
 
Patients' views neither sought nor acted upon
"When we ask patients living with diabetes," says Rankin, "we get a clear picture of what patients want. The fact that patients' opinions are rarely sought, and even more rarely acted upon, might help to explain why the incidence rates of diabetes are escalating. There's no shortage of resources and technical competences in the UK to treat and manage diabetes. However, communications between doctors and their patients living with diabetes throughout their therapeutic journeys are weak. This inhibits patient education, slows self management and quickens the onset of complications," says Rankin. 

Patient survey 
In 2014, 140 people living with diabetes from two London primary care practices participated in a six-week project to improve doctor-patient communications. Patients received regular video clips via email from their health professionals and fellow patients to help them improve the management of their condition. At the end of the project patients' opinions were sought in an email survey, which yielded 51 responses: a response rate of 36%.
 
Findings

• 65% found video information about diabetes helpful
• 72% prefer diabetes information from GPs via email
• 70% want access to healthcare information anytime, anywhere and anyhow 
• 52% prefer healthcare information in video format to paper pamphlets
• 68% want more information about their condition
• 14% visit Diabetes UK's website
• 53% regularly search the Internet for information about diabetes care
• Only 19% can distinguish between good and bogus Internet healthcare information

 
Takeaways
"Providing diabetes information in short video clips featuring local health professionals, which can be easily browsed by patients, creates greater connectivity between doctors and patients.
Unlike health professionals and paper pamphlets, video clips never wear out, and are available 24-7, 365 days a year. Further, any number of people can access them at the same time, from anywhere, on any device.
Our survey suggests that videos clipsare effective in increasing patients' knowledge of diabetes, and propelling them towards self-management. Video clips could be used for all manner of patient information on all manner of conditions," says Rankin.

Molecular profiling
EUTROC employs a multi-disciplinary, collaborative, "bench-to-bedside" approach in order to expeditiously discover new therapies, which tailor medical treatment to the specific characteristics of specific cancers: personalised medicine.
 
Cancers are like people: not all are alike, and when examined at a molecular level they show that their genetic makeup is very different. Clinicians use molecular profiling to examine the genetic characteristics of a person's cancer as well as any unique biomarkers, which enables them to identify and create targeted therapies designed to work better for a specific cancer profile.
 
Combatting cancer resistance
Personalising treatment to target errors in specific cancers at the point of diagnosis fails to address the fact that cancers mutate in response to treatment. Even drugs that are initially effective may become ineffective as the cancer returns and re-establishes its ability to grow and spread. Cancer often behaves like a taxi navigating a way round a localised traffic jam

Patient survey
 
During the six- week project, over 50% of diabetes patients opened the emails sent, and watched the information videos about their condition.

The UK's National Institute for Health and Care Excellence (NICE) recently recommended that primary care doctors should identify people eligible for state-funded slimming classes run by private companies, such as Weight Watchers, an American company that offers various products and services to assist weight loss and maintenance.

UK facts
Obesity costs NHS England £5.1bn a year
25% of adults in England are obese
42% of men & 32% of women are overweight
A BMI of 30-35 cuts life expectancy by up to four years
A BMI of 40 plus cuts life expectancy by up to 10 years

Lose weight and save millions
NICE suggests that health professionals should raise the issue of weight loss in a "respectful and non-judgmental" way, by measuring their body mass index (BMI) to identify people who are eligible for referral for lifestyle weight management services. BMI is a person's weight in kilos divided by their height in meters squared.

About 25% of UK adults are obese with a BMI over 30 and 74% are overweight with a BMI above 25. Just a 3% reduction in weight could extend life expectancy, and reduce the risk of Type2 diabetes, high blood pressure and heart disease.

NICE argues that the cost of funding private weight loss programs for overweight people would be outweighed by the benefits. For example, preventing just a 1% increase in obesity would save the UK government nearly £100 million a year.

 

Lifestyle change rather than yo-yo dieting
In a recent study published in The Lancet Diabetes and Endocrinology, researchers suggest that weight loss at any age in adulthood is worthwhile and even transitory weight loss is beneficial to health.
 
The research examined the impact of lifelong patterns of weight change on cardiovascular risk factors in a group of 1,273 British men and women, followed since their birth in March 1946. It concluded that the longer a person is overweight the greater their propensity of cardiovascular problems in latter life and the greater risk of diabetes.
 
According to the lead author Professor John Deanfield from University College, London, "Our study is unique because it followed individuals for more than 60 years, and allowed us to assess the effect of modest, real-life changes in adiposity. . . .  Losing weight at any age can result in long-term cardiovascular health benefits, and support public health strategies."
 
Professor Mike Kelly, the director of the centre for public health at NICE, said the guidelines were about lifelong change rather than yo-yo dieting, when the weight is piled back on after initial success.

He stressed the importance of achievable goals: "We would like to offer an instant solution and a quick win . . .  but realistically it's important to bear in mind this is difficult. It's not just a question of 'for goodness sake pull yourself together and lose a stone'; it doesn't work like that. People find it difficult to do  . . it takes resolve, it takes encouragement."

mHealth proven support for weight management
Scott Lonnee, a bariatric dietitian at St George's Hospital, London echoes Kelly's sentiment, "Sensible lifestyle changes, which include sustained dietary changes and physical exercise can have significant healthcare benefits. Planning is important, and there are simple techniques to help individuals lose weight, which include, setting realistic and achievable targets, keeping diaries of what you eat and what exercise you take."
 
Research commissioned by Weight Watchers, and recently published in the American Journal of Medicine, suggests that losing weight is significantly easier and more effective when individuals have access to online support, compared to weight loss among those who tried to lose weight on their own.
 
Takeaways
Pro-active mHealth strategies can help to change the way health professionals interact with patients. Information, guidance and support regularly sent to the mobiles of overweight individuals to help them lose weight and engage in lifestyle changes would save lives, prevent the onset of disease and save NHS England millions of pounds. Why is it not being done?   
 

What does the nephew of the 41st American President and the cousin of the 43rd have in common with an Indian doctor?

They're both passionate about using new technologies to provide high quality healthcare at affordable cost.

Bush and Shetty
Jonathan Bush, a relative of two former American Presidents, is the co-author of Where Does it Hurt? which calls for a healthcare revolution to give patients more choices, and affordable quality care.

A former Army medic and ambulance driver, Bush is the cofounder and CEO of athenahealth, one of the fastest growing American cloud-based service companies, which handles electronic medical records, billing, and patient communications for more than 50,000 US health providers.

Dr Devi Shetty is a brilliant heart surgeon, and veteran of more than 30,000 operations. However, his growing international reputation rests less on his medical skill, and more on his business brain. He wants to do for healthcare what Henry Ford did for the motorcar: "make quality healthcare affordable."

Shetty is the founder and chairman of Narayana Health, and by thinking differently to traditional healthcare providers, he's built, India's largest private hospital group comprised of 23 hospitals in 14 Indian cities.

 

Shetty practices what Bush preaches
Bush suggests that the only way America will provide convenient quality healthcare at affordable cost, is if doctors do what they're trained to do, others perform routine services for less: for example, nurse-intensivists relieve surgeons from ICUs, and most importantly, if healthcare entrepreneurs are encouraged to tap into the transformative power of the marketplace.

For the past 15 years Shetty has been practicing what Bush is now preaching.  Narayana Health provides high quality healthcare, with compassion at affordable cost on a large scale. For instance in 2013, its 1,000-bed specialist heart hospital in Bangalore alone, performed a staggering 6,000 operations, half of them on children. By contrast, in the same year, Great Ormond Street Hospital in London performed less than 600.

In addition to hospitals, Shetty has developed a telemedicine practice, which reaches 100 facilities throughout India and more than 50 in Africa. Narayana Health is also India’s largest kidney-care provider. Shetty has started a micro-insurance program backed by the government that enables three million farmers to have health coverage for as little as US$2 in annual premiums. Over the next five years, Shetty plans to grow Narayana Health four times its present size and become a 30,000-bed hospital chain.
 
Healthcare change will come from developing nations
Bush says, the only way to build a flourishing health marketplace that everyone wants and can afford is for Americans to demand more from their health providers, and accept greater responsibility for their own health.

This will not happen, and Shetty explains why.

Shetty argues that the greatest advances in healthcare will not come from wealthy nations like the US and UK, but from developing nations. Rapidly changing technologies provide opportunities for developing nations to leapfrog wealthy nations, which are encumbered by entrenched and aging technologies.
 
Hospitals in developing countries with few advanced procedures can quickly leapfrog world-class hospitals such as those in the US and the UK, says Shetty. Instead of slowly replacing aging technologies, they can quickly implement innovative operational designs, and state-of-the-art technologies, which gives them a competitive advantage.  
 
Narayana Health City Cayman
This is what Shetty has done in the Cayman Islands. Backed by Ascension, the largest private health network in the US, and the Cayman government, which has designated a 200-acre site for the development of Narayana Health City Cayman.
 
 The first phase, which opened in February 2014, is a 104-bed tertiary hospital, which provides surgeries for less than half the average US price, with quality outcomes that match or exceed the very best US hospitals.  Narayana Health City Cayman is expected to develop into a 2000-5000-bed conglomeration of JCI accredited multiple super speciality hospitals in a single campus providing affordable healthcare to thousands.
 
Takeaway
Americans will have access to high quality healthcare at affordable cost, but it won’t happen in the way that Bush anticipates. Grand Cayman is only a 30minute flight from Miami.