World of Health

It has long been part of a routine trip to the doctor’s office that your blood pressure gets checked to inspect the flow of blood and state of your heart. But the latest advice is that instead of just checking one arm’s pressure, readings should be taken from both arms and compared.

A significant difference between the two readings would indicate an increase in the risk of vascular disease, and ultimately death. A study by Dr Clark and colleagues from the Peninsula College at Essex University created a metastudy looking at 28 studies where the majority of patients had high blood pressure, and a third had normal levels.

Their research found that if there is a difference in the systolic blood pressure between the arms of10 mercurial millimetres, then the risk of asymptomatic peripheral vascular disease increased. If the difference between the arms is as much as 15 millimetres of mercury then there is an increase in the risk of cerebrovascular disease, and a 70% higher rate in cardiovascular mortality, and the risk of death from all causes goes up by 60%.

This evidence all shows that doctors need to check the pressure in both arms, and compare the difference to see the whole story.

New figures from Bupa have revealed that nearly a third of UK women (29%) have said that they have never gone for any kind of health screening. This includes cervical smear tests that are vital to detect the early onset of detecting abnormal and pre-cancerous cells that could result in cervical cancer.

Cervical cancer is diagnosed in around 2900 women every year and is one of the most preventable and treatable cancers. Over the past 25 years, deaths from cervical cancer have dropped dramatically, due to the amount of women who regularly attend cervical screenings.

Many of these women said that they are put off going for a smear due to the lack of information on what is actually involved and the worry of how they would deal with the news if they received an abnormal result. To help with this, Bupa are offering fresh advice on the subject.
Dr Katrina Herren, Medical Director, Bupa Health and Wellbeing, said: “Cervical screening detects pre-cancerous cells which can develop into cervical cancer. Early detection of pre-cancerous cells is vitally important in preventing cervical cancer so if your test does detect these abnormal cells, don’t panic. It means that the cells which could develop into the cancer have been detected and can be monitored closely or treated to prevent them developing into cancer.”

A cervical screening is a simple procedure carried out by a doctor or qualified nurse which can detect pre-cancerous cells inside the cervix which can develop into cervical cancer. Early detection of changes to cervical cells is vitally important in minimising the impact of the disease, which is why all women over the age of 25 are encouraged to have cervical screens.

A cervical smear test is just one of the tests included in Bupa’s female health assessment. For women who are primarily concerned with their breast and gynaecological health, Bupa Female Health offers a thorough check and the opportunity to discuss any health concerns you have. This 60 minute assessment focuses on the early detection of breast and gynaecological conditions as well as other health risks such as diabetes.

For more information about cervical cancer and screenings please visit: www.bupa.co.uk/individuals/health-information/directory/c/ce….

Whether you call it “Janopause” or “Drynuary” or just a month-long ‘recovery period’, the common British practice of abstaining from alcohol for the month of January as compensation for a drinking free-for-all during the holidays is likely to do more harm than good. That’s the opinion of health experts from everywhere, including the British Liver Trust.

The idea that you can give your liver a month’s rest and expect it to recover from excess and be as good as new in February is a fond hope, not a reality.  The results of many studies and much research all indicate that continual long term consumption of alcohol does serious damage to the liver which is not reversible by short ‘dry spells’.

The liver is the body’s largest organ, but it’s not indestructible.  It works as a filter to remove and destroy toxic substances (like alcohol) in the bloodstream.  It also processes fats, stores vitamins, synthesizes cholesterol and does all sorts of other jobs to keep the body functioning at its best.  When it is overloaded with toxins, the enzymes secreted to break them down can cause scarring of the liver, blocking blood vessels and leading to cirrhosis, liver failure, and death.

To add more warnings, medical experts suggest that taking a short break from alcohol – a ‘Janopause’ if you like – tends to encourage the abstainer to make up for lost time when the break time is up.  This puts even more pressure on the abused liver and is likely to accelerate the progress of damage.  There may be no blatant symptoms in early or even late stages of liver disease, so by the time you start to feel pain it may be too late for any rejuvenation to take place.

If total abstinence is not an option for you, try giving your liver a break for a few days every week of the year.  For those who feel they need to drink up in a hurry before David Cameron’s new tax on booze takes effect, you’ll still spend less on alcohol if you only drink on two or three days of the week, and your liver will last longer.

The intensive care unit found in hospitals is one of the most costly areas of any facility, but it is also the one that is possibly the most needed. The critical nature of the intensive care unit means that hospital administrators are very unlikely to reduce the amount of funding that they are putting towards it.

There are however important ethical measures that can be adopted to ensure that the cost of running an intensive care unit is kept low. One of the most important measures that could be taken is assuring the people who leave the ICU do not come back to it because they have a relapse in their condition. Increasingly there are problems as insurance companies look to pay the smallest amount possible for their customer’s care they often look for an excuse to not have to pay the hospital.

Isansys Lifecare is a medical development company based in the United Kingdom and the Chief Executive is Keith Errey who has commented, “Around a third of patients who are discharged from ICU end up returning and this means that their care becomes very expensive again, it is easier to make sure that they are healthy enough to remain on a general ward before they are discharged.”

In an intensive care unit patient supervision is very rigorous and people are being constantly monitored by equipment as well as medical staff. Vital signs are being constantly measured and there are doctors on staff to deal with any situations where patient’s conditions take a turn for the worst.

Once a patient has been deemed fit enough to leave the ICU they are transferred to a general ward where there is less observation. If someone’s condition is improving this is the right place for them to be but all too often people are moved out who are about to suffer a relapse. Mr Errey continued, “The problem is on the general ward checks are only made every few hours and a lot can change in a patient’s condition between these checks. What is really needed is a way for patients to be monitored closely on the general ward without having the extreme cost associated with an ICU.

“Currently there is not a system that is capable of doing this but we think this is about to change as low-power wireless technology is going to make monitoring technology a lot easier.” His company developed a wireless cardiac monitor that comes at a very low cost. The device constantly measures ECG ratings and can alert medical staff to a change in the patient’s condition.

A medical professional can tell a great deal from an ECG reading and from it capable of determining the health of the patient. The device monitors the electrical activity of the heart and can inform a doctor about the condition of the heart as well as the rest of the body. There are also computer technologies that can predict when a person’s heart is about to cause them a medical problem.

Sustaining an injury, especially a head injury while playing sport is a regular hazard and scientists have long been concerned over people who are boxing, or playing cricket and hockey. However, researchers have recently raised concerns over another type of sport that can potentially be damaging to the brains of players. Scientists have recently been scanning the brains of football players who often use their head against the ball. Many of these players were shown to have subtle signs of damage to their brain.

Scientists from the Albert Einstein College of medicine which is located in New York studied around 40 football players who’ve been playing since they were children. The players were asked whether they regularly head the ball and it was found that those who did had brain injuries similar to those found in trauma patients.

The team of researchers was led by Dr Michael Lipton and he commented, “We were looking at the players for something called fractional anisotropy which measures how uniform water molecules are behaving in the brain. If they are behaving irregularly this suggests there is some form of brain damage.”

The study found that players who were regularly heading the ball had water molecules behaving in a more random fashion suggesting that their method of play was causing physical injury. The study found that the areas of the brain that were most affected included those responsible for executive functioning, memory and attention.

Dr Lipton continued, “These initial findings are quite worrying and this seems to be clear evidence showing that this type of play can cause the brain injury. From this we can make a clear recommendation to players that they should not be heading the ball. There does need to be further research conducted to see what the long-term effects of this type of brain injury might be. Hitting the ball with your head once off will not cause any serious damage but doing it repetitively might lead to the brain cells degenerating.”

ThinkFirst is a non-profit group that raised concerns that heading the ball might cause some form of brain injury. They’ve recently published guidelines on how to head the ball in a safe manner. Many people have become concerned that football is a sport that is particularly popular among children and the reports from ThinkFirst say that the technique should not be taught to children at a young age.”

The researchers behind the study are well aware that the technique is an important part of football and something they are unlikely to be able to ban. Therefore they have decided to try and find a safe limit for the number of times the head can hit a ball before damage becomes permanent. The study found that those who hit the ball with their head over 1000 times a year had the most significant brain injuries, this figure might seem very high but for someone who regularly plays football this means they will only be having to head the ball a few times a day.

Recent reports of another new strain of flu that people can contract from pigs has The World Health Organisation in a bit of a dilemma.  According to Dr. Keiji Fukuda, assistant director-general for health, security and environment at the WHO, so far the only confirmed cases are in the United States, specifically Pennsylvania, Indiana, Iowa and Maine, but they are watching very closely for indications that it may be spreading.

At the last reports, only ten cases had been confirmed, the first in July of this year.  All except one were in children under ten, with the exception being a 58-year-old.  The virus has been identified as distantly related to the H3N2 viruses that were circulating among humans in the 1990′s, and the feeling at present is that most adults will already have some immunity to the new strain.

The WHO came under severe criticism from European officials in 2009 for labeling the H1N1 virus a ‘pandemic’ when outbreaks first occurred, rousing great alarm and much stockpiling of vaccines, only to find that the danger was considerably overrated.  The organisation is treading carefully in this flu season.  Researchers are hard at work, trying to figure out how much immunity the general population may have to the as yet unnamed virus.

If most people have antibodies already in their systems, there won’t be much danger from this swine-originating virus, and it will probably be confined to small groups of young children who have little immunity to anything, according to a flu expert at the University of Michigan, Dr. Arnold Monto.

However, Dr. Fukuda warns that if the virus continues to spread, even if only in children, there’s no reason it can’t cross U.S. borders.

A recent survey suggested that over 10 million people in the UK could be allergic to the home they live in. The survey has been conducted by Allergy UK and it involved over 1500 people. It found that nearly 60% of people had an allergic reaction to dust mites and a third were allergic to mould. Nearly half of all respondents said that they had an allergy to household pets.

Other figures that have been released by the NHS suggest that over 12 million people each year are receiving treatment for allergies. Of these, around half are expected to need specialist treatments because their allergies are so severe. It is estimated that around one third of the UK population have some form of allergy and these are caused by many factors in the home.

Many of these allergies occur in the bedroom and it is estimated there are 2 million dust mites in the average home. Allergy UK recommends that people take basic steps to reduce the number of allergens found in the house. Washing your bedding at a temperature of 60°C every week is an important step, as is steam cleaning carpets occasionally, as well as replacing pillows yearly and the mattress on a ten-year basis.

The Health Select Committee chairman has called the governments health premium policy half baked after a report has been made into the public health reforms, and he has called for the new scheme to be scrapped. The new health service is known as Public Health England and will see grants awarded to local authorities as per their needs. More funding will be provided to local authorities who have been able to improve the health of the population.

The committee however has raised many concerns that this will move resources away from areas with the most problems. A member of the group is Stephen Dorrell and he has said, “The government have incorrectly analysed our public bodies behaviour and the new policy just shows how deep the lack of understanding is.”

The chief executive of the Royal College of Nursing is Dr Peter Carter and he has said, “This new policy is going to increase the level of health inequality throughout the country, it is untried and untested and is not ready to be a part of our health system.”

The government also say that public health services are currently costing £4 billion and this is certainly something that has made people question the report. Mr Dorrell has commented that the only way this figure would be reached is if dentistry was included. He commented, “The figure seems to be entirely mythical and nothing more than the result of a mistake by Whitehall.”

Many members of the committee also suggested that the money could be used to achieve more useful goals, saying that there are plenty of other legitimate causes that need the money more. Many others have become concerned that ring fencing the money will mean that it is raided by local authorities for spending in other areas.

The British Medical Association has backed the committee saying that, for the protection of public health it is essential that Public Health England has real independence and that it is free from being constrained by the central government and is able to make decisions on its own.

Currently the NHS is facing its greatest financial challenge ever and there must be funding so the doctors can work to reduce health inequality and improving the health of all people in the UK.

The Labour MP in Easington is Graham Morris and he is a member of the health select committee and has said, “There are too many organisations that are able to directly influence and change governmental policy. This is not a position that the government should be in and it should not be manipulated by companies. It can stop this and it should make greater efforts to do so.”

The director of professional activities for the BMA has said the responsibility deals are giving too much power to the alcohol and food industries. She commented, “They are being allowed to dictate policy on public health and this is not something that is going to help the alcohol and obesity problems in the UK.”

Diabetic ketoacidosis Treatment

Initial treatment of dehydration caused by diabetic ketoacidosis should be carried out with 0.9% NaCl solution at a rate of 1 to 2 L every hour during the first 2 hours. Treatment is urgent and must be installed immediately, and has two main objectives, the correction of dehydration and correction of hyperglycaemia.

Additionally, they should monitor and treat electrolyte deficits and eliminate or treat the underlying cause or predisposing factors. In general, the goal is to remove the patient from acidosis in up to 6 hours.  Correction of dehydration can be attempted by mouth if the patient is oriented and aware.

Unfortunately the vast majority of patients have some degree of impaired alertness (disorientation, drowsiness, stupor, coma), and in this case is formally contraindicated with oral fluids because of the risk of aspiration.

Fluid replacement is usually initiated with a hypotonic solution of 0.45% NaCl concentration, in order to manage water essentially “free”, restoring intravascular volume and correcting dehydration.

Gradually and according to the patient’s improvement, isotonic solutions can be alternated with NaCl 0.9%, continuing hydration and replenishing the lost sodium diuresis without causing an electrolyte imbalance.

The correction of hyperglycaemia is performed with the administration of insulin by injection. The dose depends on the route used and the method used, for example, using the intramuscular (IM) or subcutaneous (SC). Usually indicated by 0.1 IU / kg body weight as initial dose, split half intravenously (IV) and the other half by the method chosen (IM or SC).

When using only the intravenous route (more practical) an initial dose of 0.15 UIN / kg is given. In both cases treatment is with an insulin infusion at doses of 0.1 UIN / kg / h.  Intramuscular insulin is an alternative when there is a continuous infusion pump or when intravenous access is difficult, as in the case of children.

It is essential to remember that monitoring blood levels of glucose, serum electrolytes, blood pH and serum osmolality must be closely monitored, once every hour.  To avoid dosing errors, adjust the dose according to the evolution and preventing disorders such as dilutional hyponatremia-refund excess fluid, cerebral edema, by altering the osmolarity-or hypo-insulin overdose.

Besides the above, replacement should be considered if the potassium concentration is less than 3.3 mEq / L, and bicarbonate if the pH is less than 7.0, although none of these measures must be a priority to the restoration of fluid and treatment of hyperglycaemia.

Although the concentration of potassium in the blood appears to be physiological, every patient with diabetic ketoacidosis has a decrease in body potassium which may prove grave.  Potassium is administered only if the patient has good renal function and is not disclosed in the early hours because that the patient is receiving rapid rehydration.

If potassium in blood plasma is less than 3.3 MEG / L they are usually given 40 mEq of potassium in 24 hours. If serum potassium is between 3.3 and 5 mEq / L they are given between 20 and 30 mEq in 24 hours. These measures must be maintained to achieve a glucose concentration exceeding 200 to 250 mg / dL.  Once this is achieved, the rest of the therapy should be consistent with individual patient characteristics and evolution.

The General Medical Council is stepping up its efforts to ensure that doctors entering the UK health service – notably those from overseas – are being given the correct support by their relative institutions. This, it says, is to ensure that professionals do not fall foul of General Medical Council laws and find themselves the subject of an investigation in the coming weeks, months and years.

Many doctors have faced the possibility of having sanctions imposed on them by the General Medical Council (GMC) and other regulators across the UK, forcing them to seek GMC legal advice to fight their corner. This latest move by the GMC only makes this possibility even greater, as it rolls out its program to give doctors an early understanding of the ethical and professional standards they are expected to meet, as well as how medicine is practised across England, Scotland, Wales and Northern Ireland.

It noted that there are already a number of solid local schemes to support doctors who are new to practice and the country in general, though it asserted that there is still mounting evidence of new doctors working in clinical practice with little or no preparation for UK regulation. Locum doctors were also identified as targets for the regulations, given that many are put into positions where they are taking on duties they have not been appropriately trained for.

As such, the GMC has stated its intentions to work with doctors’ employers and professional organisations to develop basic induction packages for all doctors. Niall Dickson, the chief executive of the GMC, said that challenges are clear despite excellent being across the board, and expected there to be a crackdown for early-stage professionals – something that could lead to a number of applications for legal advice to dispute future issues that may arise.

“Developing an induction programme for all doctors new to our register will give them the support they need to practise safely and to conform to UK standards,” Mr Dickson said. “This will provide greater assurance to patients that the doctor treating them is ready to start work on day one. We hope this report will contribute to a better understanding of the challenges the profession faces as well as challenging us and those we work with to redouble our efforts to improve standards and protect patients.”

The news follows the GMC’s announcement in late September that it has launched a major recruitment campaign to find the chair for its new tribunal service, which will manage all fitness to practise hearings for doctors. The Medical Practitioners Tribunal Service (MPTS) will form a key part of the GMC’s legal outlook, developing a modern and efficient adjudication service that both doctors and patients can trust. It will be separate from the rest of the GMC to create a clear distinction between bringing proceedings against doctors and running hearings.

The new chair is expected to be announced before the start of 2012, when the new service will become operational. Indeed, it may see the legal fortunes of doctors evolving in the coming weeks.