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Friday, November 18, 2011

Liver cell implant 'world first'

  By Fergus Walsh Medical correspondent, BBC News  Iyaad Syed: 'A miracle boy' Doctors in London say they have cured a baby boy of a life-threatening disease which was destroying his liver.

They implanted cells which acted like a temporary liver, allowing the damaged organ to recover.

The team at King's College Hospital in south London say the technique is a world first.

Eight-month-old Iyaad Syed now looks the picture of health - but six months ago he was close to death. A virus had damaged his liver causing it to fail.

Instead of going on a waiting list for a transplant, doctors injected donor liver cells into his abdomen.

These processed toxins and produced vital proteins - acting rather like a temporary liver.

The cells were coated with a chemical found in algae which prevented them from being attacked by the immune system.

Continue reading the main story
This new technique is certainly ground-breaking and we would welcome the results of further clinical trials to see if it could become a standard treatment for both adults and children”

End Quote Andrew Langford Chief Executive of the British Liver Trust After two weeks his own liver had begun to recover.

Professor Anil Dhawan, a liver specialist at King's College Hospital, says the whole team at the hospital is delighted:

"This is the first time this treatment has been used to treat a child with acute liver failure. It's only a few months back when I first saw this child who was so sick requiring support on dialysis and a breathing machine.

"We think we have given him another chance of life and seeing him now six months down the road with nearly normal liver function is remarkable."

Dr Ragai Mitry, Head of Liver Processing at King's, who helped in developing the technique, said:

"We are very pleased the transplanted liver cells have helped in supporting and delivering the missing metabolic functions of Iyaad's failing liver."

Iyaad's father, Jahangeer, said his son was "a miracle boy". He added: "Once he had the treatment after 48 hours he started to get better and hope came back. It is brilliant and we are very proud of him."

Professor Anil Dhawan: "As a team at the hospital, we are very happy"

Clinical trials

The question now is whether the technique could be used to benefit other patients with acute liver failure. The team at King's is urging caution - a large clinical trial is needed to test the effectiveness of the technique.

A key benefit over a liver transplant is that Iyaad will not need to take anti-rejection drugs known as immuno suppressants.

Andrew Langford, Chief Executive of the British Liver Trust, said: "The principle of this new technique is certainly ground-breaking and we would welcome the results of further clinical trials to see if it could become a standard treatment for both adults and children.

"Sadly, we have reached a breaking point with our transplant list in the UK, where approximately 100 people die waiting for a donor liver to become available each year."

King's College Hospital is part of King's Health Partners Academic Health Sciences Centre (AHSC), a collaboration between King's College Hospital; Guy's and St Thomas'; and South London and Maudsley NHS Foundation Trusts, with King's College London university. The partnership aims to accelerate the transition of research from bench to bedside.

Midwives told 'involve the dads'

 Skin-to-skin contact with the father after Caesarean section has been found to help calm the baby Midwives are being asked to make more of an effort to involve fathers-to-be in maternity care.

The Royal College of Midwives (RCM) says too often the dad is left out of the process.

It suggests top tips to help include the father, like offering him a chair as well as his partner, during antenatal appointments.

And staff should prepare the man to be a helpful birth partner, so he knows what to do in the labour room.

The 16-page guide Reaching Out: Involving Fathers in Maternity Care is a joint publication produced by the RCM, the Department of Health, the Royal College of Obstetricians and Gynaecologists and the Fatherhood Institute.

Male friendly

To address the issue of fathers being the "invisible parent", maternity wards should provide men's lifestyle magazines to help make fathers feel comfortable, the guidance suggests, and antenatal classes should be arranged around their work commitments and even football fixtures, it says.

Continue reading the main story
There is now substantial evidence of the benefits resulting from fathers being involved in their partner's maternity care”

End Quote Cathy Warwick, general secretary of the RCM Launching the guidance, Public Health Minister Anne Milton said: "Becoming a parent is hugely exciting but it can be a challenging time. Fathers want to feel involved throughout their partner's pregnancy and this guide is a step to making that happen."

The guide criticises the way maternity care is organised in many units in the UK, saying services tend to exclude fathers.

And many mothers feel their male partners receive little or no support.

Cathy Warwick, general secretary of the RCM, said: "A father's role should not begin and end at conception. There is now substantial evidence of the benefits resulting from fathers being involved in their partner's maternity care.

"Most women want their partners to be involved in their pregnancy."

She said encouraging men to engage in the experience helped strengthen the bond between the father and his child. It is also an opportunity to spot stress or depression among new dads.

Daddy care Parents Emily and Ed MacKenzie and Rob Williams from the Fatherhood Institute debate a father's role in hospital maternity care

Trusts that have already introduced measures to involve fathers have reported reduced workloads for midwives.

At the maternity centre at University Hospital of North Staffordshire NHS trust, antenatal classes have been held on Sunday afternoons to fit around fathers' jobs and football matches. The trust says it has led to a reduction in women being admitted to hospital before labour is in full swing.

The Princess Anne wing at the Royal United hospital in Bath, run by Great Western Hospitals NHS foundation trust, now provides reclining chairs for fathers to sleep in.

Ed McKenzie, 32, a financial adviser from Bath, stayed overnight on a chair in the Princess Anne wing to help care for his wife, Emily, 32, and their son Jack, who is now five months old.

He said: "Emily said it was fantastic to have me there. It allowed her to concentrate on the breast-feeding and me to concentrate on nappy changing and getting food and drink."

Rob Williams, from the Fatherhood Institute, said some men might not want to be cajoled by midwives into taking a more active role. But he said the benefits of taking a front seat far outweighed any short-term stress incurred.

"We are keen for fathers to be as well informed as possible."

Near-death experience 'in mind'

"manifestations of normal brain functions gone awry", researchers say.Psychologists from Edinburgh University and the Medical Research Council in Cambridge reviewed existing research.They say phenomena such as out-of-body experiences or encounters with dead relatives are tricks of the mind rather than a glimpse of the afterlife.One of the researchers, Dr Caroline Watt, said: "Our brains are very good at fooling us."The researchers say that many common near-death experiences could be caused by the brain's attempt to make sense of unusual sensations and perceptions occurring during a traumatic event. Dr Watt, of the University of Edinburgh, said: "Some of the studies we examined show that many of the people experiencing a near-death experience were not actually in danger of dying, although most thought they were. "The scientific evidence suggests that all aspects of the near-death experience have a biological basis."Bliss and euphoria One of the most frequently reported features of near-death experiences is an awareness of being dead - but the researchers say these feelings are not limited to near-death experiences.Continue reading the main story Taken together, the scientific experience suggests that all aspects of near-death experience have a neuro-physiological or psychological basis.”End Quote Researchers There is a condition called "Cotard" - or "walking corpse" syndrome, where a person believes they are dead. It has been seen following trauma and during the advanced stages of typhoid and multiple sclerosis.Out-of-body experiences, where people feel they are floating above themselves, are also commonly reported.But Swiss researchers found such experiences could be artificially induced by stimulating the right temporoparietal junction in the brain that plays a role in perception and awareness.The "tunnel of light" sensation reported by those who believe they are having a near-death experience can also be artificially induced.Pilots flying at G-force can sometimes experience "hypertensive syncope" which causes tunnel-like peripheral or even central visual loss for up to eight seconds.And a US study suggested the light at the end of the tunnel can be explained by poor blood and oxygen supply to the eye.The feelings of bliss and euphoria, meanwhile, can be recreated with drugs such as ketamine and amphetamine.The paper also suggests the action of noradrenaline, a hormone released by the mid-brain, can evoke positive emotions, hallucinations and other features of the near-death experience. Writing in the journal Trends in Cognitive Science, the researchers say: "Taken together, the scientific experience suggests that all aspects of near-death experience have a neuro-physiological or psychological basis."Dr Sam Parnia, director of resuscitation research at the State University of New York and author of What Happens When We Die said: "Every experience, whether near-death or otherwise such as depression, happiness and love is mediated by the brain. "In fact many experiences share the same brain regions, and so it is not unusual to be able to reproduce them. "Discovering those areas or reproducing them, doesn't imply the experience is not real. By the same token, we wouldn't say love, happiness and depression are not real. "Furthermore many people accurately report "seeing" events taking place at a time when the brain doesn't function (such as during cardiac arrest). These cannot be explained by brain changes, since the brain had shut down and 'flatlined'. "While seeming real to those who experience them, near death experiences provide a glimpse of what it is like to die for the rest of us".

NHS long waits crackdown ordered

 Patients should be seen within 18 weeks for non-emergency care in England Ministers are ordering a crackdown on "hidden" waiting in the NHS in England.

Hospitals currently have to see non-urgent patients within 18 weeks but there are nearly 250,000 on lists who have waited for longer than this.

Ministers believe there is not enough incentive for these patients to be treated, meaning some are left "languishing" unnecessarily.

They are demanding NHS managers reduce the number of long waiters by about 50,000 by April.

The whole backlog is not being targeted as it is accepted that some patients wait longer than 18 weeks for justifiable clinical reasons - perhaps because they have to lose weight before having surgery or for personal or work commitments.

There is particular concern within the government about some of the longest waits being seen. Among the 250,000 who have been waiting for longer than 18 weeks are just over 100,000 who have waited for more than six months and 20,000 waiting at least a year.

Continue reading the main story

The government's latest NHS initiative is being viewed with a certain degree of irony within the health service.

This was an administration that came to power promising to move away from what it said was the target culture created by Labour.

Within months of seizing the reins ministers announced the 18-week waiting time target was being relaxed.

But that is not how it feels now for those on the front-line.

When criticism of the government's reforms was at its peak in the early summer the prime minister reiterated his commitment to the 18-week limit. Managers were left in no doubt, there was to be no let up.

And now there is growing concern about long waiters, ministers have responded by introducing what is effectively a new target to tackle the perverse incentives of an existing target.

However, these figures should be seen in the context of the total size of the waiting list, which currently stands at 2.6 million for non-emergency care, such as knee and hip replacements.

Health Secretary Andrew Lansley has blamed the targets established by the Labour government which he said had created a perverse incentive whereby the NHS was free to leave patients "languishing" on waiting lists.

He said: "Because of Labour's perverse approach, the NHS actually had an incentive not to treat patients.

"The new approach we will take from next year will clamp down on this practice. We will reduce the number of patients on hidden waiting lists, ensuring everyone gets access to the treatment they need."

Jo Webber, deputy policy director of the NHS Confederation, said she welcomed what the government was trying to do.

"This indicator will shine a spotlight on one of the many aspects of patient waiting the government does not currently measure."

Continue reading the main story There are currently 2.6 million patients on waiting lists for non-emergency treatment in EnglandOf those, nearly 250,000 have waited for longer than 18 weeksOf which, just over 100,000 have waited for longer than six months and 20,000 for more than a yearThe NHS sees about 300,000 in-patients a month and nearly 900,000 out-patientsBut shadow health secretary Andy Burnham said the government was having to introduce these new rules because of Mr Lansley's failure to "get a grip" on waiting times.

And he added the government's overhaul of the NHS would just make matter worse as NHS hospitals would become distracted by competing with the private sector.

"This will take us straight back to bad old days of the Tory NHS, where patients are forced to choose between waiting longer or paying to go private."

And Professor John Appleby, of the King's Fund, a health think tank, questioned whether the current system was creating perverse incentives.

He said there was some evidence the longest waits were actually going down.

"If they really want to tackle the longest waits they could simply say that no patient should wait longer than a year before treatment begins," he added.

NHS 'must cover spiritual health'

 Humans are spiritual entities, says the Archbishop of York Spiritual health must be a feature of the NHS bill for England, the Archbishop of York has insisted during debate in the House of Lords.

Dr John Sentamu told peers: "I am one of those who believe that human beings are psychosomatic spiritual entities."

The archbishop then told how he freed the spirit of a young girl, left petrified by seeing a goat sacrificed.

During a debate on an amendment he said: "Illness can be physical or mental but it can also be spiritual."

The amendment, tabled by psychiatrist and crossbench peer Baroness Hollins, called for the words to be inserted into a clause about the duty of the secretary of state, the NHS Commissioning Board and clinical commissioning groups to improve the quality of services.

Making his case, the Anglican archbishop argued that schools now emphasised students' spiritual dimensions, and said hospital chaplains' work addressed spiritual issues, as well as the physical and mental.

Witches' coven

He also told how when he first became a vicar in south London, he was invited to a home where there was "a presence", a phrase he said he did not understand at the time.

At the home, he said, he found a young girl who had been unable to move for nearly three weeks and would shout out in the middle of the night.

He was told the family had been to a witches' coven where a goat had been sacrificed. The young girl was petrified she would be next.

Visits from a GP, psychiatrist and psychologist did little to help, he said, but then he said a prayer, anointed the girl and lit a candle on his visit.

You can see the Archbishop's contribution 3hrs 23mins into this video

Shortly after, he received a phone call saying the girl was no longer terrified and was talking again.

"That was not mental or physical illness; there was something in her spirit that needed to be set free," he told his peers.

Dr Sentamu, 62, acknowledged the importance of highlighting mental and physical illnesses, but asked whether they needed to be spoken of "in almost separate categories" in the bill.

"I do not want to divide up a human person. Therefore, I believe that the bill covers people's needs without inserting the words 'physical and mental'.

He said he was "content" that the bill, as it stood, covered all aspects of the human person simply by using the word "illness" .

"The element of the spiritual well-being of people is not on the face of the bill but I am absolutely convinced that, as it stands, my needs would be taken care of because it talks about 'the prevention, diagnosis or treatment of illness'."

The Health and Social Care Bill, if passed, would see GPs and other clinicians given much more responsibility for spending the budget in England, while greater competition with the private sector would be encouraged.

NHS seeks to cut attacks on staff

  More than 56,000 attacks were reported on NHS staff last year NHS security bosses, prosecutors and police have pledged closer working to crack down on violence against staff.

The number of attacks has consistently hovered around the 60,000 mark for the past six years - with sanctions taken in only a small fraction of cases.

The CPS, Association of Chief Police Officers and NHS Protect, the health service's security arm, have now signed a joint agreement for England.

It covers advice on sharing information and avoiding duplication of effort.

'Not tolerated'

Chief Constable Brian Moore, the Association of Chief Police Officers' lead for violence and public protection, admitted there were weaknesses that needed to be addressed.

He said the agreement would lead to the three parties working "more effectively".

Richard Hampton, of NHS Protect, added staff had the right to a "safe and secure working environment".

"Violence and abuse against them is highly disruptive for the delivery of treatment to patients and cannot be tolerated."

Last year more than 56,000 assaults were reported - although in three-fifths of cases, the incident was put down to a person's medical condition.

Nonetheless, sanctions - either a conviction or some kind of out-of-court action - were only taken in just over 1,000 cases.

'One in 12 teenagers self-harm'

  The study raises important questions about the prevention of suicide in early adulthood One in twelve people self-harm in their teenage years, a long-term study has found.

For most people the problem will resolve before adulthood but for 10% it will continue into their adult lives.

Teenage girls are more likely to self-harm than boys and are at greater risk of continuing as young adults.

The Lancet study findings have important implications for the treatment of mental health issues and prevention of suicide in young adults.

The study looked at almost 2,000 adolescents in Australia, repeatedly surveying them over a period of 15 years.

Researchers found that anxiety, depression, heavy alcohol use, cigarette smoking and cannabis use were all associated with self-harm.

The study suggests that self-cutting and burning were the commonest forms of self-harm during adolescence.

As 90% of teenagers who self-harmed stopped before they reached adulthood, the research should offer some reassurance to families, schools and clinicians, the authors of the study say.

But, Marjorie Wallace, chief executive of the mental health charity SANE, said:

"The figures showing that 90% have stopped by the time they reach their twenties should not seduce us into thinking that self harm is just a phase that young people will grow out of".

Suicide risk?

"Our research shows that counter to common perception, people self-harm and continue to self-harm at times throughout their lives to protect themselves from attempting suicide and their families and friends from experiencing their mental pain."

Because of the association between self-harm and suicide, the researchers suggest treating common teenage mental health problems could be part of an "important and hitherto unrecognised component" of preventing suicide in adults.

"Self-harm is one of the most significant predictors of completed suicide, " a lead author, Dr Paul Moran, of King's College London, said.

Continue reading the main story
In cases of self-harm it is vital to discover what is driving the child to take such drastic action ”

End Quote Sue Minto Head of ChildLine Of the people who have died by suicide, around 50-60% have a known history of self-harm, according to Professor Keith Hawton, Director of the Centre for Suicide Research, University of Oxford.

How many people who have self-harmed die due to suicide, is less clear.

'Hidden population'

But Professor Keith Hawton, who was not involved in the study, said the findings could broaden the focus of the Suicide Prevention Strategy for England, which he is working on.

"We now know from studies like this one..... that there is a very large population of youngsters who are self-harming in the community. And we estimate about one in eight of them go to hospital. So this is the hidden population," he said.

"Though a focus on hospital management is crucial, what we should perhaps be thinking more of is the management of self-harm at a community level, particularly how schools respond and how families can be helped to respond," he said.

The authors say it is important that people living or working with young people are able to spot signs of distress and find the help they deserve.

"Otherwise there may be persistent ramifications in later life," Dr Paul Moran said.

Sue Minto, Head of ChildLine, which last year dealt with 30,000 contacts from children about self-harm, suicide and depression, said:

"In cases of self-harm it is vital to discover what is driving the child to take such drastic action. Something is obviously making them extremely unhappy or frightened and until this is resolved it is likely they will continue to injure themselves or, in extreme cases, be driven to suicide".

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