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Dr Saqib Bashir (Dermatology)


Mr Eddie Challoner & Mr Aaron Sweeney (Vascular Surgery)

1st Surgeon in London to use EVLT Laser Treatment 

Internationally renowned vascular surgeon, Eddie Chaloner, is a pioneer, innovator and advocate for the minimally invasive treatment of varicose veins.  Together with leading UK surgeon Aaron Sweeney, they are at the forefront of international research and are active in training other surgeons in the latest vein surgery techniques.  Radiance Vein Clinic was the first in the UK to offer the revolutionary injection-free and painless ClariVein® treatment.

Prof Tony Kochhar (Orthopaedics Shoulder)

Professor Tony Kochhar is a shoulder expert and upper limb surgeon, fully trained in Trauma and Orthopaedic surgery. He is able to help patients with all shoulder, elbow, and wrist problems and has a commitment to best practice for all his patients.

Dr Carl Shakespeare (Cardiology)

I have been an invasive consultant cardiologist and general physician in the NHS for the last 25 years at Queen Elizabeth Hospital and latterly, St Thomas’s Hospital.This experience hasprovided the benefit of evaluating both the specialist cardiological and other medical clinical symptoms. In the past, I have also been an intensivist for the first 5 years of being a consultant. The mainstay of my career has been as an invasive cardiologist with a broad experience in echocardiography, transoesophageal echocardiography, pacemaker implantation and invasive coronary angiography.

Over the years, I have become accredited in cardiac MRI and cardiac CT angiography (US Board certified in 2009). Currently, apart from general cardiology, my main sub-specialist interest is in hypertension.

Schoen Clinic (Anxiety, Mood & Eating Disorders)

Schoen Clinic Centre for Mental Health Chelsea
13a Radnor Walk
London SW3 4BP

General Telephone Enquiries
+44 20 3146 2300

Schoen Clinic (Orthopaedic & Spinal)

Schoen Clinic Orthopaedic & Spinal Hospital London
66 Wigmore Street
London W1U 2SB

General Telephone Enquiries
++020 3820 4056

Fortius Clinic (Orthopaedics Sports)

Fortius Surgical Centre

Fortius Surgical Centre
18 Bentinck Street
W1U 2EU+44 (0) 203 805 4760

Lanserhoff Clinic (Sports & Lifestyle Medicine)

Get in Touch

Lanserhof at The Arts Club
17-18 Dover Street, Mayfair
London, UK

+44 20 3967 6969


London Clinic of Nutrition

The easiest and quickest way to speak with us is by calling 020 3332 0030 and a member of the team will be on hand to answer your queries. To request further information or a call back please enter your details below.

Ms Jessica O’Dwyer (Nutrition)


Dr Andy Zamar (Psychiatry)

Dr Alistair McNair (Gastroenterology)

Mr Sam Singh (Orthopaedics Foot)

After qualifying as an undergraduate from Cambridge University, Sam Singh undertook a full training program in Orthopaedic surgery in London, where he gained fellowship of the Royal College of Surgeons. To learn the latest techniques in the very specialist field of Foot and Ankle surgery, he completed a fellowship in Foot and Ankle surgery at Harvard University under the auspices of Dr. Michael Wilson MD and Dr. Christopher Chiodo MD.


Miss Leila Hanna (Gynaecology)

Miss Hanna has more than 30 years’ experience as a consultant gynaecologist and obstetrician and established some of the very first IVF services in London. As a Senior Research Fellow to Professor Robert Winston, she was part of the team that delivered the first IVF quads in the northern hemisphere.

Mr Jonathan Walczak (Orthopaedics Hip & Knee)

Mr Jonathan Walczak is a highly experienced consultant orthopaedic and trauma surgeon, with private clinics at BMI Chelsfield Park Hospital, BMI The Sloane Hospital, BMI Shirley Oaks and KIMS Hospital in Kent. Mr Walczak specialises in hip and knee replacements, keyhole knee surgery, sports injuries, anterior cruciate ligament repair and bursitis. He is also experienced in the management of knee arthritis. A keen runner and cyclist, he understands the needs of athletes and is committed to helping people of all abilities to return to sports and physical activity where possible.

Dr Abbi Lulsegged (Endocrinology)

Dr Abbi Lulsegged is a Consultant in General Medicine, Endocrinology and Diabetes. He qualified from Guys and St Thomas Medical Schools in London and went on to study Diabetes and Endocrinology in the Royal Free, University College London and St Thomas Hospital. He works at Kings College Hospital and has practising privileges at BMI Sloane, Chelsfield Park Hospital and Blackheath Hospital. He enjoys all manner of general Endocrinology and as a special interest in unexplained medical conditions, obesity, fatigue and reversing or promoting resolution of type 2 diabetes in amenable cases. He has an interest in Nutrition and addressing where possible, the root cause of problems. 

Mr Alwyn D’Souza (Otolaryngology)

Alwyn D’Souza has a wealth of experience in the medical and surgical management of general ENT (otorhinolaryngology) conditions alongside Reconstructive and Aesthetic Facial Plastic Surgery (face, head & neck).


London Clinic – Harley Street Area, W1G 6BW

5 Devonshire Place
Self-Pay: +44 (0)20 3613 8133

More than a Hospital

We invest in improving patients’ lives beyond treatment. We help them to move on with their lives. We’re more than a hospital.

The London General Practice

24hr Urgent Care, 7 days a week Fast access to an out of hours GP, 24hrs a day, 7 days a week.
The London General Practice, 114a Harley Street, London, W1G 7JL
0207 935 1000

Physician’s Clinic – Harley Street Area, W1G 0PU

We can provide acute medical admission for private patients to The Princess Grace Hospital or The Harley Street Clinic, leading private hospitals located within 500 yards of our clinic.

Access 365: GPs can access our 365 acute medical admissions service by calling this number between 6AM and 10PM 365 days per year
The Physicians’ Clinic, 13 – 14 Devonshire Street, London W1G 7AE
0207 034 8180

Harley Street Health Centre

The Harley Street Health Centre is delighted to launch our home visit service – an experienced doctor to your home, hotel or office, 7 days a week, from 8 am to midnight.

Harley Street Area

13, Queen Anne Street, London, W1G 9JH


City of London

3 Lombard Court, London, EC3V 9BJ


Wellington Hospital – St Johns Wood, NW8 9LE

Opening Times 8am – 8pm Monday to Sunday
Urgent Care 020 3733 5849
1. Urgent Care Centre Chelsea :: The Lister Hospital, Chelsea Bridge Road, London SW1W 8RH :: 020 3910 2412
2. Urgent Care Centre St John’s Wood :: The Wellington Hospital, 8A Wellington Place, London NW8 9LE :: 020 3910 2412
3. Urgent Care Centre Marylebone :: The Princess Grace Hospital 42-52 Nottingham Place, London W1U 5NY :: 020 3910 2412

Two microbiota subtypes identified in irritable bowel syndrome with distinct responses to the low FODMAP diet | Gut


IBSP (pathogenic-like) and IBSH (health-like) subtypes. IBSP microbiomes were enriched in Firmicutes and genes for amino acid and carbohydrate metabolism, but depleted in Bacteroidetes species. IBSH microbiomes were similar to controls.

The clinical response to the low FODMAP diet was greater in IBSP subjects compared with IBSH (p=0.02).


  • It can be helpful to test IBS patients’ Gut Biome before recommending a FODMAP diet.
  • The FODMAP diet can be expected to be most helpful to patients with HIGH fermicutes and LOW bacteroides species.

HIV Transmission Rates After Exposure

BMJ Paper looking at management of potential BBV after a needlestick injury

“The estimated risk for HIV transmission after injury through a needle contaminated with HIV infected blood and after mucous membrane exposure is 0.3% and 0.09% respectively.8,9”


8. Bell DM. Occupational risk of HIV virus infection in heath care workers: an overview. Am J Med1997;102(5B):9–15.PubMedGoogle Scholar

9. Ippolito G, Puro V, De Carli G. The Italian study group on occupational risk of HIV infection. The risk of occupational HIV infection in health care workers. Arch Intern Med1993;153:1451.CrossRefPubMedWeb of ScienceGoogle Scholar

Other infections

The risk associated with a single parenteral exposure to blood from a source patient who has HBV infection ranges from 6% in HBV “e” antigen negative patients to as high as 40% in “e” antigen positive.12 The average incidence of seroconversion to HCV after needlestick injury from an HCV positive source is 1.8% (range 0%–7%).13

Thinking Better: Clinical Decision Making & Bias

Podcast Summary: Freakonomics Radio

The podcast doesn’t directly address CDM but (a) it does refer to lessons from psychotherapy and (b) several of the points made can be applied to clinical medicine.

Book Source:

Thinking Better: The Art of the Shortcut in Math and Life, Marcus du Sautoy 

Major Reference:

“Thinking Better” is almost a response to Daniel Kahneman’s “Thinking Fast & Thinking Slow” (2011)

Aristotle described work in different ways: Praxis is loved work that is done for its own sake. Poiesis is required work that is done to accomplish a task or purpose (which is probably the actual object of desire) .
(this might be related to Aristotle’s concept of Phronesis, practical wisdom that Roger Neighbour referred to)

One heuristic (cognitive bias) is of generalisation (TBC) = What’s happening around me is what happens elsewhere.

Some problems require slow thinking eg the travelling salesman problem can’t be solved more quickly by using a shortcut
(perhaps there’s a difference between problems with one unique solution and problems with multiple valid alternative outcomes)

Susie Orbach observed that: “It’s hard, impossible to unlearn a language.” ==> Just as we can’t unlearn a language, it’s hard to unwrap, forget or break thought triggers which are often embedded since childhood

Fasting & Blood Pressure, Gut Biome Link

From the Original Article

One of the most widely used animal models of hypertension are spontaneously hypertensive stroke-prone (SHRSP) rats, a line of rats that develop hypertension at six weeks of age, much earlier than control animals. Like hypertensive humans, these rats show gut dysbiosis.

To investigate whether gut dysbiosis contributes to the development of hypertension, the researchers transferred gut microbiota from SHRSP rats to rats with normal blood pressure. The previously healthy rats to develop high blood pressure, pointing towards a causal relationship between gut dysbiosis and hypertension.

Could changing the feeding pattern through fasting reduce the blood pressure of the SHRSP rats?

To test this, the researchers split the SHRSP rats into two groups: one group had unlimited access to food, while the other group was fed only every other day. After nine weeks, the rats that had unlimited access to food had developed high blood pressure, as is expected for the SHRSP model. In contrast, rats that were fed only every other day did not develop high blood pressure.

Faecal Transplant Experiments further demonstrate the causal nature of the Gut Biome

The researchers observed that germ-free rats that had received microbiota from the fasting SHRSP rats had lower blood pressure than germ-free rats that had received microbiota from normal-fed SHRSP rats. With this, the researchers discovered that modulating the gut microbiota

Further Questions
  • Exactly what is the gut dysbiosis, which species?
  • Is there a similar difference between normotensive and hypertensive humans?
  • Does alternate day fasting affect human BP the same for hypertensives?
  • Does the same dysbiosis affect normotensive humans? Could it be an identifiable risk factor/ predictor?
  • Hypertension is strongly age related in humans ==> therefore ==> Is dysbiosis age related?

Optical Illusion

Ottawa ankle rules | Radiology Reference Article | Radiopaedia.org


Radiology is indicated if there is;

1. inability to weight bear (four steps) immediately after the injury and in emergency department


2. point tenderness at;

  • posterior edge (of distal 6 cm) or tip lateral malleolus
  • posterior edge (of distal 6 cm) or tip medial malleolus
  • the base of the fifth metatarsal
  • the navicular


Fast Foods & Phthalates

Original Academic Article

Phthalate and novel plasticizer concentrations in food items from U.S. fast food chains: a preliminary analysis | Journal of Exposure Science & Environmental Epidemiology


Summary: by USA Today

From their website:

MARINA PITOFSKY | USA TODAY | 6:30 pm EDT October 27, 2021

A new study shows that chemicals known as phthalates, which have been linked to health problems, have been detected in food from popular chains like McDonald’s, Chipotle and more.  

The peer-reviewed analysis was published this week in the Journal of Exposure Science & Environmental Epidemiology by researchers from George Washington University, the Southwest Research Institute (San Antonio, Texas), Boston University and Harvard University.

The research includes items from McDonald’s, Burger King, Pizza Hut, Domino’s, Taco Bell and Chipotle locations in San Antonio, Texas. Researchers obtained 64 food samples of hamburgers, fries, chicken nuggets, chicken burritos and cheese pizza from the chains.

They found that over 80% of the foods contained a phthalate called DnBP. And 70% contained the phthalate DEHP. Both of the chemicals have been linked to reproductive health problems.  

Food containing meat, such as chicken burritos and cheeseburgers, had higher levels of the chemicals studied, while cheese pizza had the lowest levels.   

Phthalates … have been linked to reproductive problems, learning and attention problems in children and more


https:// d4drivers.uk/locations/central-london/

Fatty acid found in palm oil linked to spread of cancer


palmitic acid promoted metastasis in mouth and skin cancers.

Covid: Pfizer and AstraZeneca jabs effective against Indian variant – study – BBC News


The BBC report that:

  • The Pfizer and AstraZeneca coronavirus vaccines are highly effective against the variant identified in India after two doses.
  • Two jabs of either vaccine give a similar level of protection against symptomatic disease from the Indian variant as they do for the Kent one.
  • However, both vaccines were only 33% effective against the Indian variant three weeks after the first dose. This compared with 50% effectiveness against the Kent variant.
  • The Pfizer vaccine was found to be 88% effective at stopping symptomatic disease from the Indian variant two weeks after the second dose, compared with 93% effectiveness against the Kent variant.
  • The AstraZeneca jab was 60% effective against the Indian variant, compared with 66% against the Kent variant.

Never Events in General Practice

Acts of omission

  1. A planned referral of a patient, prompted by a clinical suspicion of cancer, is not sent.


  1. An abnormal test result is received by a practice but not considered for action, or the considered action is not performed.

Prescribing medication, when known, absolute contraindications exist

  1. Prescribing teratogenic drugs to a patient known to be pregnant.
  2. Prescribing combined oral contraceptive after previous confirmed DVT/PE.
  3. Prescribing oestrogen-only HRT for women with intact uterus.
  4. Prescribing a drug to a patient that has correctly been recorded in the practice system as having previously caused them a severe adverse reaction.

Medication (prescribing, dispensing, administration, monitoring)

  1. Prescribing ‘high risk’ medication without ensuring adequate monitoring took place and results were satisfactory.
  2. Giving the right drug via the wrong route or at the wrong site.
  3. Prescribing immunosuppressives daily rather than weekly (unless initiated by a specialist for a specific clinical condition, eg leukaemia).
  4. Prescribing aspirin for a patient under 12 years old (unless recommended by a specialist for a specific condition, eg Kawasaki’s disease).

Medicolegal and ethical incidents

  1. Physical assault of patients or healthcare workers.
  2. Ignoring a patient’s living will.
  3. A practice team member working while intoxicated.
  4. Losing controlled drugs.

Clinical management

  1. Not referring a patient presenting with and treated for anaphylaxis to secondary care for observation.
  2. Not referring a child suspected to have non accidental injuries urgently.
  3. Performing a cervical smear without visualising the cervical os.

Practice systems

  1. A practice does not have an up-to-date and secure backup of their data.
  2. Medical waste and hazardous substances discarded in an inappropriate manner.
  3. Emergency medical equipment, eg defibrillator, is not in working order, maintained, available or checked regularly.
  4. A needlestick injury due to a failure to dispose of ‘sharps’ in compliance with national guidance and regulations.

ABCD Skin Dermatoscopy

Covid Testing

We’ve seen many “patients” who aren’t ill – and haven’t been ill at any time – with Coronovirus symptoms but need a Coronovirus test for “non-clinical” reasons. The commonest situation is when people are travelling abroad but we’ve also done tests in other cases like health/care workers (before they were more widely available) or before people (usually the boss of a company or factory) return to work and meet co-workers again for the first time.


We’ve set up a special Package Price for non-clinical Covid Tests.

We can undertake the testing 6 days a week and can usually provide the result on the next working day*. Once the result is received we will provide the Lab Report and a formal Doctor’s Letter also known as a Medical Declaration Letter; of course if the result is positive then we make the required statutory notifications to Public Health England.

Blood Antibody Test

(have you “ever” had a Coronovirus infection)


Swab PCR Antigen Test

(have you currently got a Coronovirus infection)


These packages represent a saving of over £140 each compared to a routine appointment, test and Doctors letter. The packages are not suitable for patients who are currently unwell, who have had symptoms of Coronovirus, who think they might have had Coronovirus in the past or patients who need any other medical assessment/ advice – these patient’s should book a routine new patient appointment.

Where are the Tests Done?

The test are usually done in a face to face appointment with Dr Kumar-Beurg at one of our off-base clinic sites which are;

  • Sparkly Smile Dental Practice, SE3 0TA
  • Healthwise Natural Therapy Centre, SE3 8XA
  • Keats House, SE1 9RS

Provided the booking is made with enough notice: we can send a home self-test kit for you to do the Naso-pharyngeal Swab Antibody test yourself ar home


What’s the Turn-Around Time?

* The officially published turn-around time for routine tests is 48-72 hours from the labs receiving the samples. Therefore we can’t guarantee anything else. However when there is a specific time consideration we make special arrangements for transport as well as fast lab processing and we usually receive (so far we’ve always received) results the next working day.

This means that we can meet the needs of people who are travelling abroad and have to have a swab test within a strict window, usually 48 hr or 72 hr, before departure – or run the risk of 14 days quarantine on arrival.

In fact 2 of first 3 patients we saw for pre-Travel Dr’s Letters were ones who’d been turned away from the airport because their results from elsewhere weren’t adequate and they absolutely had to have a Dr’s Letter within 20 hours (approx) for them to catch the next flight.

One important factor if considering home self-testing is about sample delivery to the Lab. TDL (The Doctors Laboratory) is in the Harley Street area of West London and for time sensitive tests we use a courier to transport the sample within hours. If a test is done at home then the sample can be posted in fact the home test kit is provided with a pre-paid mailing envelop but if the result is time sensitive then we suggest – strongly suggest – that the sample is either delivered by hand or sent by courier to the lab and that we are notified by phone immediately so that we can alert the Sample Reception Desk.

Test Specific Further Information

Details about each of the tests can be found at the links below.

Covid Swab Test Leaflet

Covid Blood Test Leaflet


How to Proceed

  • If you’d like to proceed with one of the Coronovirus tests then please call us on 02084347028 or email enquiries@cld.ht.
  • The next step will be for you/ every person needing the test to complete an online Health Questionnaire which will be directly sent to the Dr.
  • Then a firm appointment time & place will be arranged and full payment taken in advance.


Covid Blood Test FAQ

Coronovirus Antibody Blood Test FAQ Leaflet

This leaflet is intended for patients of Dr Kumar-Beurg who have already discussed and decided to go ahead with Covid-19 antibody blood test and it serves as a reminder about advice that is usually given to patients during consultation. If you do not understand the following or feel it doesn’t apply to you then please ignore it or contact us for clarification.


What Test is Done?

We offer both the nasopharyngeal PCR swab and the the antibody blood test to detect if a patient is “currently suffering from” or has “ever been exposed to” Coronovirus Covid-19. This test is the Antibody Blood Test which tells if a patient has been exposed to Coronovirus more than 14-21 days ago. The test detects the presence of immunoglobulins in the blood (IgG); these are the molecules that are made by the immune system to fight an infection when it is first encountered. The presence of Coronovirus specific IgG indicates that the patient has been exposed to the infection (1).


Who Should Do the Test?

The antibody test is best done 14-21 days after the first symptom(s) of Coronovirus. These include fever, cough, loss of taste/ smell, diarrhoea/ abdominal pain/ loss of appetite and fatigue/ “brain-fog”. However there is clear evidence that some people (possibly many people) can have the Coronovirus infection without suffering any symptoms (2) so it’s almost impossible to judge by a person’s symptoms alone.


Is the Test Accurate and Reliable?

The one word answer is – Yes.

It should be noted that the subject of antibody testing is controversial in the UK because the Government, NHS and PHE have not agreed and approved any of the antibody tests for use by the NHS.

Bedside testing kits – similar to pregnancy test kits – have claimed to give instant results (based on IgM and IgG antibodies), however, there are questions about the accuracy of these tests. Therefore, we recommend using a lab-based test.

The blood is processed by The Doctors Laboratory (TDL) which is a very well established service just off Harley Street in London that we have used for several years  – it’s the largest Private Practice lab in the UK and also does extensive testing for the NHS including ones for Coronovirus.

The actual lab machinery is made by Abbott which is again based in the UK and is one of the leading global brands for medical equipment and it’s the same machine that’s been used regularly for years for similar tests. The Abbott test has been in use around the world including the USA (3) since the start of the Covid pandemic and was awarded a CE mark and approved for European-wide use on 29th April (4) & (5).

The test is described as having a 100% sensitivity (which means that it will detect the antibody in all the blood samples that have it) and 99.5 specificity (it will give the correct answer, negative in 99.5% of the blood samples that are free of antibody). This means that the lab technique has a negligible/ zero false negative rate (ie if there are antibodies in the sample then they’ll be detected).

In the real world there are also other factors that can affect the accuracy of lab tests (such as immonusuppresive disease or medications) and one of the major sources of controversy at Governmental level seems to be the impact of false positives when the actual prevalence of infection in the population is relatively low (6).


How Do I Take the Sample From Myself?         << Self Test Antibody Blood Tests Not Currently Available >>

The test is a fingerprick blood sample that uses a self-administered, spring-loaded lancet rather than a needle & syringe phlebotomy sample to draw the blood.

Before you take the sample it’s helpful (but not necessarily essential) to;

  • Make sure you’re well hydrated, have had plenty of water to drink beforehand
  • Make sure you’re warm and relaxed
  • Hold your hand(s) in a bowl or sink full of warm water for 5-6 minutes and
  • Wash your hands with soap & dry them before doing taking the sample.

When you use the lancet it’s preferable to apply it to the side of your finger, not the main fingerpad.

If you can stand up while taking the sample and keep the bottle on a low table while you milk the finger for blood then that’s usually easier – but – if you feel even slightly faint or unsteady then please make sure you’re seated to do the test.


How Do I Return the Sample to the Lab?

To prepare the sample for return;

  • Make sure that your sample bottle has been labelled with your name, date of birth and the test date
  • Put the sample bottle back into the folding plastic bottle holder and put the bottle holder back into the clear plastic bag. 
  • If possible then please write the date of collection on the request form and …
  • Make sure the request form is inside the yellow-white plastic mailing bag.
  • Put the clear sample bag with the specimen into mailing bag and seal it shut.
  • The mailing mag already has the lab’s address and postage paid stamp on it.

To dispatch the bag you can either;

  1. Send it using the pre-paid Royal Mail service. Because of service disruptions since the UK went into lock-down I think it’s better to use an alternative but if you decide to post the sample then I strongly recommend taking the sample to a post office in the morning and sending it as guaranteed next-day delivery. 
  2. Use a courier such as www.gophr.com or https://apc-overnight.com/ 0800 373737. 
  3. Use a taxi service (if they agree) such as Uber or a local minicab firm. 


How Long Does it Take to Get the Result?

The sample takes 2-3 days to process and the result will be sent to you by email.

What Does a Negative Result (“Anti-SARS CoV 2 IgG Result: NOT Detected”) Mean?  

A negative test result completed in the correct time frame would suggest you have not previously suffered from COVID-19 – there are very few exceptions to that. This means that if you’re exposed to the Covid virus in future then you may develop the infection. 

What Does a Positive Result (“Anti-SARS CoV 2 IgG Result: IgG Detected”) Mean?  

If the result says “2019-nCoV IgG Detected ” then that means that you have had the Coronovirus infection.  

The national guidance and instructions are being frequently updated so please make sure to read the up-to-date information on the links below which are available in multiple languages (7,8,9). The main points you need to know are;

  1. A positive test result indicates you have had the virus.
  2. It is not yet known whether this grants any future immunity to the virus which means you may be able to get the virus more than once.
  3. Whether or not previous exposure confers immunity, we don’t know how long the antibodies will remain in your system. Other coronavirus antibodies, such as ones that cause the common cold, usually stay in the body for 1-2 years. 
  4. If you get worse then you should seek further medical attention. You can contact us but please be aware that Cloud Health only offers routine booked appointments and does not offer an unscheduled or Out Of Hours Service. If you need more urgent care than we can provide then please telephone 111 or 999 as appropriate. Please do not go to a GP surgery, a Walk-in Centre or an A&E Department unless you’ve been given special instructions over the phone and told exactly where to go.
  5. There is no requirement or recommendation to do contact tracing or testing at this time but your household members should seek medical advice if they start to show any symptoms of Coronovirus.
  6. Covid-19 is a “notifiable disease” and all Doctors making a diagnosis are legally required to inform Public Health England (PHE). We will also send a copy of positive results to your registered NHS practice and recommend that you contact them (by phone/ online) to discuss the result with them.



(1) https://www.corelaboratory.abbott/int/en/offerings/segments/infectious-disease/sars-cov-2

(2) https://jamanetwork.com/journals/jama/fullarticle/2762028?guestAccessKey=9e4e116a-7ab4-4a98-97b7-9b0bbedb5c6f

(3) https://www.evaluate.com/vantage/articles/analysis/spotlight/covid-19-antibody-tests-face-very-specific-problem

(4) https://www.abbott.co.uk/media-center/news/CE-mark-and-immediate-availability-of-its-COVID-19-laboratory-based-antibody-test.html

(5) https://www.independent.co.uk/news/health/coronavirus-antibody-test-approval-news-europe-uk-accuracy-abbot-a9490026.html

(6)  https://soundcloud.com/bmjpodcasts/talk-evidence-covid-19-update-lack-of-testing-transparency-how-to-give-good-debate at 15.01 minutes

(7) https://www.nhs.uk/conditions/coronavirus-covid-19/

(8) https://www.gov.uk/coronavirus 

(9) https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection


Covid Swab Test FAQ

Coronovirus PCR Antigen Swab Test FAQ Leaflet

This leaflet is intended for patients of Dr Kumar-Beurg who have already discussed and decided to go ahead with Covid-19 swab testing and it serves as a reminder about advice that is usually given to patients during consultation. If you do not understand the following or feel it doesn’t apply to you then please ignore it or contact us for clarification.


What Test is Done?

We offer both the nasopharyngeal PCR swab and the the antibody blood test to detect if a patient is “currently suffering from” or has “ever been exposed to” Coronovirus Covid-19. This test is the Naso-Pharyngeal Swab which tells if the patient has active Coronovirus infection at the time of taking the swab.


Who Should Do the Test?

The test can be done to make a diagnosis in people who have current symptoms – at the time of testing – that are suggestive of Coronovirus. These include fever, cough, loss of taste/ smell, diarrhoea/ abdominal pain/ loss of appetite and fatigue/ “brain-fog”. It should not be done by people who think that they might have had the infection and already recovered. However there is clear evidence that some people (possibly many people) can have the Coronovirus infection without suffering any symptoms so it’s almost impossible to judge by a person’s symptoms alone.


Is the Test Accurate and Reliable?

The one word answer is – Yes.

The swab is processed by The Doctors Laboratory (TDL) which is a very well established service just off Harley Street in London that we have used for several years – it’s the largest Private Practice lab in the UK and also does extensive testing for the NHS including these PCR swab tests for Coronovirus.

The assays used at TDL show a minimum sensitivity of 98% (which means that if there’s any virus present on the swab then there’s less than a 2% chance of it being missed) and a specificity of 100%, with no cross-reactivity with other viruses (which means that it never gives a false positive result). These are the tests currently used by the NHS and are approved by Public Health England. They are fully compliant with government guidelines.

However no test is perfect and there will be some “false negatives” which is when the test says a person is free of a disease even though they do actually have it. With the Covid swab test the biggest reason for false negatives seems to be either (a) the person wasn’t shedding virus when the swab was taken or (b) the swab didn’t sample – didn’t touch – the area where the virus was present.


How Do I Take the Sample from Myself?

There are instructions in the kit; my personal guidance is to try to do the sample first thing in the morning on a Monday – Thursday and;

  • It’s easier to have someone help/ do it for you.
  • Only touch the outside of the collection tube and the red swab handle. Be very careful not touch the white cotton bud or the white stick of the swab.
  • Moisten the cotton bud with a few drops of tap water.
  • Pu the stick into your mouth as far as possible on the left hand side till it touches the left tonsil or the back of your throat … then … move it around and twist it around at least four times to ensure it makes good contact with a large area of the inside of your mouth/ throat.
  • Do the same on the right side of your tonsils/ throat.
  • Insert the swab up your left nostril as far as it will comfortably go … then … move it around and twist it around at least four times.
  • Do the same with your right nostril.
  • Put the swab back into the collection tube and press to click it closed.

There is a helpful video (although it is intended for health professionals) available at 2.27 minutes at https://www.youtube.com/watch?v=qPRuKEzzz40&t=201s.


How Do I Return the Sample to the Lab?

To prepare the sample for return;

  • Put the collection tube back into the clear plastic sample bag.
  • If possible then please write the date of collection on the request form and …
  • Make sure the request form is in the clear sample bag.
  • Press to close the clear sample bag.
  • Put the clear sample bag into the yellow-white plastic mailing bag and seal it shut.
  • The mailing mag already has the lab’s address and postage paid stamp on it.

To dispatch the bag you can either;

  1. Send it using the pre-paid Royal Mail service. Because of service disruptions since the UK went into lock-down I think it’s better to use an alternative but if you decide to post the sample then I strongly recommend taking the sample to a post office in the morning and sending it as guaranteed next-day delivery but if the test is time sensitive then I recommend …
  2. Use a courier such as www.gophr.com or https://apc-overnight.com/ 0800 373737 … or …
  3. Use a taxi service (if they agree) such as Uber or a local minicab firm .. or …
  4. Delivery the sample to the lab yourself by hand as soon as it’s been done.


How Long Does it Take to Get the Result?

The official turn-around time for the samples is 2-3 days however we take steps to speed that up and usually have a result within 2 days of it getting to the lab and for very time sensitive tests we have always received the result the next working day (or sooner). As soon as we receive the result it will be sent to you by email, you will also receive a formal Dr’s Letter or Medical Declaration Letter and a hardcopy will be sent by post.


What Happens if Coronovirus is Detected? 

If the result says ” 2019-nCoV PCR Detected ” then that means that you do have the Coronovirus infection.  

The national guidance and instructions are being frequently updated so please make sure to read the up-to-date information on the links below (multiple languages). The main points you need to know are;

  1. Coronovirus is a “notifiable infection” which means that Doctors are obliged by law to inform Public Health England about every patient diagnosed with it. We will do that and PHE might make contact with you. We will also notify your registered NHS GP/ Practice with a copy of the test result. We recommend that you telephone or email your NHS GP/ Practice to make sure they know that you’ve been diagnosed with Coronvirus – do not go to the surgery in person. You don’t have to tell 111 that you’ve been diagnosed with coronovirus however it might be helpful to you especially if you need local help to isolate.
  2. You should self-isolate for 7 days – that means avoiding contact even with other people in your own household, please see the bullet points below.
  3. Your whole household should self-isolate for 14 days – that’s even more strict than the normal “social distancing” and “lock-down” rules and means none of your household going out of the house at all, not even for shopping, essential work or exercise. There are many local charities, social and church groups that are helping people who are staying indoors and some of them are listed below.
  4. If you get worse then you should seek further medical attention. You can contact us but please be aware that Cloud Health only offers routine booked appointments and does not offer an unscheduled or Out Of Hours Service. If you need more urgent care than we can provide then please telephone 111 or 999 as appropriate. Please do not go to a GP surgery, a Walk-in Centre or an A&E Department unless you’ve been given special instructions over the phone and told exactly where to go.
  5. There is no requirement or recommendation to do contact tracing or testing at this time but your household members should seek medical advice if they start to show any symptoms of Coronovirus.
  6. You may want to consider contacting people you have been in contact with in the two weeks prior to the test.


Self-Isolation Tips

  • You should try to use rooms that other household members don’t go into, keep the door of your room closed and open the windows as much as possible. If you do have to use the same rooms (eg bathroom) then …
  • you should try to go into the room after everyone else has finished using it … 
  • before you leave you should wipe down all surfaces with a disinfectant and …
  • keep any “contaminated” tissues/ wipes/ rags etc away from other people.
  • You should try to avoid eating with household members, ask them to leave food on a table/ tray outside your room and take it inside to eat. If possible use disposable plates/ cutlery, if not then they should wear long washing up gloves to handle any dirty crockery and not use those gloves for anything else.
  • Your clothes and bed-sheets can be cleaned with a normal or hot cycle in the washing machine – they don’t need to be boiled or destroyed.













London Doctors Clinic – Sports Medicals

EveryMedical Sports Medicals

Marathon Medical

Medical Specialists – Sports Medicals

Information Leaflet 2016



Mr Amer Khan – Orthopaedics, Knee & Ankle

From their website;

Clinical interests;
Knee – ALL Arthroscopic Knee Surgery including ACL reconstruction & repair
Multiligament and revision ACL & multi-ligament Knee Surgery
Meniscal repair and transplant surgery • Cartilage regeneration surgery
Knee Replacement
Shoulder – ALL Arthroscopic shoulder surgery including rotator cuff repair, SLAP repair and arthroscopic stabilisation procedures
Shoulder Replacement
Hip Sports injuries – arthroscopic hip surgery including debridement for femoroacetabular impingement and labral repair.

Mr Sam Singh – Foot and Ankle Orthopaedic Surgeon, Bunion Specialist

From Their Website;

Sam Singh is a Consultant Orthopaedic Surgeon, specialising in complex Foot and Ankle problems.

Running one of the largest NHS Foot and Ankle units in England, Sam Singh takes complex referrals from all over London and the South-East, managing non-surgical and surgical techniques for both common and rare injuries, including:

  • Ankle sports injuries

  • Fracture and Sprains

  • Bunions, deformed feet and hammertoes

  • Morton’s Neuroma and tendon disorders

  • Arthritis of the foot and ankle

  • Achilles tendonitis

  • Major deformity correction


Mr John Walczack – Orthopaedics, Hip & Knee

From their own website;


Hip problems

Knee injuries

Foot Problems

Sports injuries

Mr Mark Phillips – Orthopaedics, Hand

from their website;

Special interests

  • Hand & Wrist Surgery
  • Complex Trauma Reconstruction, including bone and soft tissue loss
  • ‘Orthoplastic’ reconstruction
  • Acceleration and optimisation of fracture healing
  • Treatment of delayed union of fractures and map-united and un-united fractures




Doctors at Petts Wood Surgery

If Cloud Health can’t meet your needs then the following service may be able to help; http://www.doctorsatpettswood.co.uk

The Private GP Clinic in Sevenoaks

If Cloud Health can’t meet your needs then the following service may be of interest; http://www.theprivategpclinic.co.uk

A ‘smart’ way to spot schizophrenia signs – http://www.bbc.co.uk/news/health-34656921

From their website;

Most people with a diagnosis of schizophrenia recognise warning signs that they are getting unwell – for example poor sleep or increased anxiety.

Intervening early can prevent a full-blown psychotic episode. … prompt assistance could avoid months of distress.

I’ll be trialling a smartphone app called ExPRESS. The aim is to help people track their own warning signs of relapse. It asks them a series of personalised questions every week and sends this information securely to their care team. If warning signs increase above a critical level, the patient and their team take action to prevent relapse.


Basic symptoms

  • Being hypersensitive to sounds
  • Straight things appear crooked, and shapes can be distorted
  • Increased indecisiveness about small things
  • Difficulty multitasking
  • Problems understanding or thinking of common words
  • A feeling of disconnection
  • Micropsia or macropsia – things seeming bigger or smaller than they actually are

Zipnosis raises $17M to accelerate growth of virtual service, add chronic conditions – MedCity NewsMedCity News

A telehealth company that developed a white labeled virtual care service has raised $17 million in a Series A round, according to a company statement.

Patients pay a service fee of about $25-$35 to use the service. They are asked a series of questions, an algorithm processes their responses, and the system uses that information to produce a clinical note, which is directed to the most appropriate physician. The idea is that patients get their query addressed in a few minutes through email, or by phone or video interaction if necessary.

Pearce said its approach has focused on 90 simple acute primary care conditions. Among them, common medical conditions such as sinus infections, bladder infections, pink eye, and colds. But he said Zipnosis is beginning to expand to chronic conditions. By the end of the first quarter, he said it would add hypertension and hyperlipidemia to the illnesses it covers.


Source: Zipnosis raises $17M to accelerate growth of virtual service, add chronic conditions – MedCity NewsMedCity News

With 37 acquisitions, 2015 tops 2014 for digital health M&A | MobiHealthNews

The final quarter of 2015 brought eight more digital health acquisitions, plus some larger scale acquisitions that could have reverberations throughout the world of digital health. The list below includes exits for a number of longtime and well-known players like Misfit, Lively, and Zamzee, though some of those acquisitions were under better circumstances than others.

A few buyers stand out with multiple acquisitions throughout the year.

  • Indian practice management company Practo topped the list with four acquisitions: Insta Health, Qikwell, Fitho, and Genii. 

  • Welltok picked up Zamzee, Silverlink, and Predilytics.

  • Under Armour bought MyFitnessPal, Endomondo, and Gritness. And finally,

  • IBM bought Explorys, Phytel, and Merge. And, still worth mentioning with just two 2015 acqusitions, Weight Watchers picked up Weilo and Hot5, both presumably to build out its mobile offering.

  • Fossil Group will buy wearables company Misfit for $260 million, the companies announced in November.

  • In October, San Diego, California-based PatientSafe Solutions bought the assets of Merck subsidiary Vree Health for an undisclosed amount. The acquisition will help the care coordination and provider workflow company expand its offerings to the home care market in addition to the hospital.

Source: With 37 acquisitions, 2015 tops 2014 for digital health M&A | MobiHealthNews

17 Game-Changing Health Start-ups | Inc.com

This post from 17th March 2012, nearly four years ago offers an interesting reflection on how the sector looked not so long ago.

Healthcare in the U.S. is largely a mess thanks to unfit citizens, underinformed doctors, and confounding and inefficient processes. Here’s a slew of innovative companies working to change all that.

Source: 17 Game-Changing Health Start-ups | Inc.com



Cloud, mobile among top EHR trends to watch in 2016, consultant says | Healthcare IT News

Demand and technological capabilities are driving change, Cathy Riesenwitz, a researcher with software firm Capterra, told Healthcare IT News.

With the market for electronic health records predicted to be worth about $35.2 billion by 2019, the steady rise of data has increased the need to strengthen the software to make data more accessible, reduce errors and increase the ease of use.

1. EHRs are moving toward the cloud.

2. EHRs will improve the patient portal experience. 

3. Telemedicine will finally find its stride.

4. EHRs are going mobile.

Source: Cloud, mobile among top EHR trends to watch in 2016, consultant says | Healthcare IT News

mHealth at CES 2016: Will It Be Enough to Attract Healthcare?

With mHealth on tap at CES 2016, healthcare just might pay attention

Source: mHealth at CES 2016: Will It Be Enough to Attract Healthcare?

Turning to Telehealth For a Good Night’s Sleep

Consumers, doctors turn to telehealth to battle sleep disorders

Source: Turning to Telehealth For a Good Night’s Sleep

The Value of Consumer Access & Use of Online Health Records

Lo Res  Version of the Infografic published by the Health IT Buzz Bloga service of HHS’s Office of the National Coordinator* for Health Information Technology (ONC).


Original – in full detail – available on their website



* About ONC

The Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).

ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.

Parts of London have higher TB rates than Iraq or Rwanda

Parts of London have higher TB rates than Iraq or Rwanda – http://www.bbc.co.uk/news/uk-england-london-34637968


Study suggests that excess fat around the waist is an increased health risk even at a normal weight and BMI


From their own website;

Normal weight women with extra belly fat had nearly a 50 percent increased risk of death during the study period versus a normal weight woman whose weight was more equally distributed throughout her body. Compared to obese women (measured by BMI only), the normal weight women with belly fat had a 32 percent higher risk of early death, the researchers found.

Dr. David Katz, director of the Yale University Prevention Research Center, in New Haven, Conn., and president of the American College of Lifestyle Medicine, said the study findings raise the question: who would have more belly fat and still be at a normal weight according to their BMI?

Some people are more prone to depositing excess fat around the middle, he said. This can lead to fat accumulation in vital organs, especially the liver, he explained.

Another group may be those who have excess body fat and illness, perhaps in early stages, causing loss of lean body mass, Katz said. Although it’s not clear from this study how many people might fall into this category, he added.

Regardless of why someone has gained weight around the middle, Katz said, “We have long known that all varieties of overweight are not created equal with regard to health risk, and that central obesity is the most concerning variety.”

In his editorial, Poirier wrote, “These new data provide evidence that clinicians should look beyond BMI. Although assessing for total fat mass with BMI to identify patients at greater cardiovascular risk is a good start, it is not sufficient.”

Xiaomi’s Mi Band Pulse is a $15 fitness tracker with a heart rate sensor | Android Central


From their website;

Xiaomi has unveiled its second-generation fitness tracker in China over the weekend, the Mi Band Pulse. Set to go on sale on November 11 — or Singles’ Day — the tracker comes with an optical heart rate sensor, retaining a design that’s similar to its predecessor.

The Mi Band Pulse shares the $15 (99 Yuan) asking price as the first-gen model, making it one of the most affordable fitness trackers available today. The addition of the heart rate sensor means that it now offers a more comprehensive activity tracking solution, which includes steps tracking, calorie intake and quality of sleep.

New Xiaomi Mi Band 2 with optical heart rate sensor


With more pictures this is the xiaomi mi-band pulse on their own website.

Xiaomi website says the fitness band will calculate calories burned but one thing it doesn’t clarify is how the device tracks calories, which is a feature described on the Android Central website.

The addition of the heart rate sensor means that it now offers a more comprehensive activity tracking solution, which includes steps tracking, calorie intake and quality of sleep. – Android Central.

The 116 things that can give you cancer – the full list … International Agency for Research on Cancer via the Guardian

The 116 things that can give you cancer – the full list


From their website

The 116 things that can give you cancer – the full list
Rocked by the news that processed meat could be terribly bad for you? Well, chimney sweeping, salted fish and fracking also appear on the list compiled by the International Agency for Research on Cancer
Aisha Gani and Benedict Nicholson
Published: 07:00 GMT+00:00 Wed 28 October 2015
Follow Aisha Gani
The World Health Organisation said processed meats are among the most carcinogenic substances along with cigarettes, alcohol, sunbeds and arsenic.
The World Health Organisation said processed meats are among the most carcinogenic substances along with cigarettes, alcohol, sunbeds and arsenic. Composite: Rex, Alamy
After Monday’s bombshell news from the World Health Organisation that bacon, ham and sausages are carcinogenic, you can be forgiven for wondering just what exactly is safe for you to come into contact with – let alone eat.

Handily, the International Agency for Research on Cancer – a body that collects and publishes cancer figures worldwide – has a list of the 116 substances and activities (for some of them are more verb than noun) that are now considered to cause cancer.

Processed meats rank alongside smoking as cancer causes – WHO

Red meat isn’t on the list – that only probably causes cancer. This is the IARC’s group 1 list – the stuff it says definitely is carcinogenic. The IARC splits the list into three categories, which it calls “exposure circumstances”, “mixtures” and “agents”.

Carcinogenic exposure circumstances

1 Tobacco smoking: The most common exposure to the stimulant, prepared from the leaves of the tobacco plant, is through burning it and smoking it from a cigarette or hookah pipe into the mouth and then releasing it. Smoking’s history dates back to as early as 5000–3000BC when the agricultural product began to be cultivated in South America.

2 Sunlamps and sunbeds: A tanning bed, a device that emits ultraviolet radiation for a cosmetic tan, can give humans overexposure to UV radiation, which can cause skin cancer, cataracts, and premature skin ageing.

3 Aluminium production: Increased lung and bladder cancer risks have been reported in workers in aluminium reduction plants. The fumes of chemicals the workers may inhale, and exposure to coal-tar pitch volatiles for long periods during the process, can cause cancer.

4 Arsenic in drinking water: The highly toxic chemical which is used to make certain alloys used in the manufacturing industry, can get into the drinking water supply, particularly in ground water. Arsenic is known to cause skin cancer, and linked to causing liver, lung, kidney, and bladder cancer.

5 Auramine production: Auramine can be used as an antiseptic agent as well as to make dyes. A study found there to be an excess of bladder tumours among men engaged in the manufacture of auramine, through inhaling harmful agents, such as formaldehyde and sulphur, during the manufacturing process.

6 Boot and shoe manufacture and repair: Linked to increased risk of nasal cancer and leukaemia, due to exposure to suspected carcinogens such as leather dust, benzene and other solvents, yet the risk of cancer in shoe manufacturing may vary depending on the duration and level of exposure.

Play Video. Duration: 00:16
7 Chimney sweeping: Cleaning chimneys of soot and dust, historically done by small boys who could climb the chimney but now done mechanically, could cause a very specific form of cancer – termed “chimney sweep” cancer. It could be caused by inhalation and accidental ingestion of coal and burnt wood fumes and residue.

8 Coal gasification: Studies of the cancer levels of workers who had occupational exposure to coal gasification – when coal is reacted with oxygen, steam and carbon dioxide to form a gas – showed there to be an excess of lung cancer.

9 Coal tar distillation: Derived from coal, coal-tar pitch is a thick black liquid that remains after the distillation of coal tar. It is used as a base for coatings and paint, in roofing and paving, and as a binder in asphalt products. Both coal tar and coal-tar pitch contain many chemical compounds, including carcinogens such as benzene. Human exposure to coal tars can be through inhalation, ingestion, and absorption through the skin. The general population can be exposed to coal tars in environmental contaminants.

10 Coke (fuel) production: Workers at coking plants and coal-tar production plants – where coal is refined to be used as a solid fuel – may be exposed to coke oven emissions, and have an excess risk of dying from lung cancer and kidney cancer.

A furniture-maker’s workshop
A furniture-maker’s workshop. Photograph: Sam Frost
11 Furniture and cabinet making: Furniture makers are shown to have a statistical increase in nasal cancer risk, with excessive exposure to wood dust, according to studies.

12 Haematite mining (underground) with exposure to radon: Mining hematite, an underground source of iron, workers are simultaneously exposed to radon – a radioactive carcinogen, which can cause a large increase in the risk of lung cancer.

How bad is meat for me? Frankly, the experts don’t know

13 Secondhand smoke: Otherwise known as passive smoking, a non-smoker’s risk of getting lung cancer can increase by a quarter by breathing in other people’s smoke. It may also increase the risk of cancers of the larynx (voice box) and pharynx (upper throat). It’s estimated that every year, secondhand smoke kills over 12,000 people in the UK from lung cancer, heart disease, stroke and the lung condition chronic obstructive pulmonary disease.

14 Iron and steel founding: Studies of iron and steel founding workers in various parts of the world showed them to have a significantly increased risk for lung cancer. Exposures in the iron and steel founding industry are complex and include a wide variety of known genotoxic and carcinogenic substances including metals and formaldehyde.

15 Isopropanol manufacture (strong-acid process): People in the isopropanol manufacturing industry may face an increased risk of developing cancer due to exposure to suspected carcinogens, such as diisopropyl sulphate, isopropyl oils and sulphuric acid. The colourless, flammable chemical compound with a strong odour has a wide variety of industrial, household and pharmaceutical uses. Isopropyl alcohol solution is found in rubbing alcohol, hand sanitiser, and disinfecting pads.

I’m not giving up my ham and mustard sandwich | Ann Robinson

16 Magenta dye manufacturing: The production of magenta dyes – purplish-red in colour and among the first synthetic dyes to be produced in the 1850s – has chemicals linked to bladder cancer. Yet some carcinogenic chemicals were banned from hair dyes in the 1970s.

17 Occupational exposure as a painter: Studies have found a link between work as a painter and risk of cancer. Deaths such as bladder cancer and leukaemia in such cases could have been from an exposure to benzene – a chemical at high levels that can cause cancer and found in paint production – mixed with other organic solvents. Cases of lung cancer may be from exposure to particles containing lead chromate and to asbestos in the paint trade.

18 Paving and roofing with coal-tar pitch: Paving with coal tar and coal-tar pitch may contain many chemical compounds, including carcinogens such as benzene.

A worker taps a rubber tree in Songon, Ivory Coast
A worker taps a rubber tree in Songon, Ivory Coast. Photograph: Thierry Gouegnon/Reuters
19 Rubber industry: Harvested mainly in the form of the latex from certain trees, the manufacturing process of stretchy material can cause the risk of developing cancer, caused by chemicals. Studies examining countries with workers in the rubber industry showed they were more likely to have cancers such as bladder cancer, lung cancer, and leukaemia.

20 Occupational exposure of strong inorganic acid mists containing sulphuric acid: The liquid aerosols formed by condensation of sulphuric acid vapour, which is highly corrosive, can cause a higher risk of getting lung cancer.

Carcinogenic mixtures

21 Naturally occurring mixtures of aflatoxins: Such toxins produced by certain species of fungi, are among the most carcinogenic substances known, and linked to increased risk of liver cancer.

Cans of beer on display in an off-licence
Cans of beer on display in an off-licence. Photograph: Christopher Furlong/Getty Images
22 Alcoholic beverages: Alcoholic beverage consumption is a cause of breast, colorectal, larynx, liver, oesophagus, oral cavity and pharynx cancers, and as a probable cause of pancreatic cancer, as classified by the IARC.

23 Areca nut: Areca nut is a mild stimulant, akin to coffee, that is chewed with betel leaf. It is known to cause increased risk of mouth and oesophageal cancer.

24 Betel quid without tobacco: A leaf indigenous to Asia, is chewed with areca nut as a stimulant and can increase the risk of oral cancer.

25 Betel quid with tobacco: Betel can increase the risk of oral cancer.

26 Coal-tar pitches: This thick black liquid contains many chemical compounds, including carcinogens such as benzene.

27 Coal tars: Coal tar, a bi-product of coke production, contains many chemical compounds, including benzene.

Hazelwood coal mines in Morwell, Australia
Hazelwood coal mines in Morwell, Australia. Photograph: Meredith O’Shea for the Guardian
28 Indoor emissions from household combustion of coal: Coal is one of the most well-known carcinogens in the public consciousness, due to the prevalence of cancer in miners. It is a risk if coal dust produced from old-fashioned coal-burning fires is inhaled.

29 Diesel exhaust: There is a cancer risk from inhaling exhaust fumes produced by a diesel internal combustion engine. Over 30 components of diesel oil are listed at various levels of carcinogenic by the IARC.

30 Mineral oils, untreated and mildly treated: The World Health Organisation classifies untreated or mildly treated mineral oils as group-1 carcinogens to humans. Highly refined oils are classified as group-3, meaning they are not suspected to be carcinogenic, yet due to insufficient findings, cannot be classified as harmless.

Ground to dust: fracking, silicosis and the politics of public health

31 Phenacetin, analgesic mixtures containing: Studies on this pain- and fever-reducing drug, now banned in some countries link it with renal, pelvic and other urothelial tumours in patients.

32 Plants containing aristolochic acid: Used in Chinese herbal medicine for centuries, this plant extract is found to cause kidney disease and urothelial cancer.

33 Polychlorinated biphenyls (PCBs): This synthetic compound, widely used in electrical equipment in the past, was banned at the end of the 1970s in many countries because of environmental concerns. Studies of PCBs in humans have found increased rates of melanomas, liver cancer, gall bladder cancer, biliary tract cancer, gastrointestinal tract cancer, and brain cancer, and may be linked to breast cancer. PCBs are known to cause a variety of cancers in animals.

34 Chinese-style salted fish: Diets that are very high in salt-cured meats and fish, or pickled foods – which are more common in parts of Asia and northern Africa – can increase the risk of nasopharyngeal cancer, related to the upper part of the throat behind the nose. These foods can be very high in nitrates and nitrites, which react with protein to form nitrosamines. These chemicals can damage DNA.

The hydraulic fracturing test site operated by Cuadrilla in Balcombe, England
A police officer stands guard on the perimeter of the hydraulic fracturing test site operated by Cuadrilla in Balcombe, England. Photograph: Leon Neal/AFP/Getty Images
35 Shale oils: The development of shale gas, including fracking, may release toxic chemicals into air, water and soil during the process. Chemicals used in fracking are known to be of concern and have been linked to an increased risk of cancer. Benzene, acrylamide, and formaldehyde are all listed by the IARC as human carcinogens.

36 Soots: Coal dust, principally from the burning of coal, had contributed to a specific chimney sweep cancer that was prevalent in the 19th century.

37 Smokeless tobacco products: Tobacco chewed as a stimulant, sometimes with other leaves such as betel, is specifically linked to cancers of the larynx and the mouth.

38 Wood dust: Awareness of wood dust as a carcinogen and cause of nasal cancer is on the rise. In 2011 a cabinet maker’s widow successfully sued for £375,000 after her husband’s death.

Something is going to kill you. Life is about what happens before that | JC Johnson

39 Processed meat: Meat that is cured or treated in some way, either for preservation or taste. Examples include ham, bacon and sausages. It was ranked as dangerous as tobacco in October 2015 by the World Health Organisation (WHO), with specific links to bowel cancer.

Carcinogenic agents and groups of agents

40 Acetaldehyde

41 4-Aminobiphenyl

42 Aristolochic acids and plants containing them

43 Arsenic and arsenic compounds

44 Asbestos

45 Azathioprine

46 Benzene

47 Benzidine

48 Benzo[a]pyrene

‘It’s scaremongering’: the world’s meatiest places react to WHO report

49 Beryllium and beryllium compounds

50 Chlornapazine (N,N-Bis(2-chloroethyl)-2-naphthylamine)

51 Bis(chloromethyl)ether

52 Chloromethyl methyl ether

53 1,3-Butadiene

54 1,4-Butanediol dimethanesulfonate (Busulphan, Myleran)

55 Cadmium and cadmium compounds

56 Chlorambucil

57 Methyl-CCNU (1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea; Semustine)

58 Chromium(VI) compounds

59 Ciclosporin

60 Contraceptives, hormonal, combined forms (those containing both oestrogen and a progestogen)

Contraceptive pills
Contraceptive pills. Photograph: Yay Media AS/Alamy
61 Contraceptives, oral, sequential forms of hormonal contraception (a period of oestrogen-only followed by a period of both oestrogen and a progestogen)

62 Cyclophosphamide

63 Diethylstilboestrol

64 Dyes metabolized to benzidine

65 Epstein-Barr virus

66 Oestrogens, nonsteroidal

67 Oestrogens, steroidal

68 Oestrogen therapy, postmenopausal

69 Ethanol in alcoholic beverages

70 Erionite

71 Ethylene oxide

72 Etoposide alone and in combination with cisplatin and bleomycin

The Kingdom by Damien Hirst
A tiger shark in formaldehyde (The Kingdom by Damien Hirst). Photograph: Sotheby’s/PA
73 Formaldehyde

74 Gallium arsenide

75 Helicobacter pylori (infection with)

76 Hepatitis B virus (chronic infection with)

77 Hepatitis C virus (chronic infection with)

78 Herbal remedies containing plant species of the genus Aristolochia

Food industry greets cancer links with a shrug – it’s been here before

79 Human immunodeficiency virus type 1 (infection with)

80 Human papillomavirus type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66

81 Human T-cell lymphotropic virus type-I

82 Melphalan

83 Methoxsalen (8-Methoxypsoralen) plus ultraviolet A-radiation

84 4,4’-methylene-bis(2-chloroaniline) (MOCA)

85 MOPP and other combined chemotherapy including alkylating agents

86 Mustard gas (sulphur mustard)

87 2-Naphthylamine

88 Neutron radiation

89 Nickel compounds

90 4-(N-Nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK)

91 N-Nitrosonornicotine (NNN)

92 Opisthorchis viverrini (infection with)

A woman wears a mask in front of Harbin railway station in China
A woman wears a mask in front of Harbin railway station in China as thick smog envelops the city. Photograph: Tao Zhang/Demotix/Corbis
93 Outdoor air pollution

94 Particulate matter in outdoor air pollution

95 Phosphorus-32, as phosphate

Addictive and probably carcinogenic: scientist reveals dangers of Daily Mail | Dean Burnett

96 Plutonium-239 and its decay products (may contain plutonium-240 and other isotopes), as aerosols

97 Radioiodines, short-lived isotopes, including iodine-131, from atomic reactor accidents and nuclear weapons detonation (exposure during childhood)

98 Radionuclides, α-particle-emitting, internally deposited

99 Radionuclides, β-particle-emitting, internally deposited

100 Radium-224 and its decay products

101 Radium-226 and its decay products

102 Radium-228 and its decay products

103 Radon-222 and its decay products

104 Schistosoma haematobium (infection with)

105 Silica, crystalline (inhaled in the form of quartz or cristobalite from occupational sources)

The sun
The sun, source of solar radiation. Photograph: Nasa/Soho/EPA
106 Solar radiation

107 Talc containing asbestiform fibres

108 Tamoxifen

Health threat of sugar is vastly underestimated, study claims

109 2,3,7,8-tetrachlorodibenzo-para-dioxin

110 Thiotepa (1,1’,1”-phosphinothioylidynetrisaziridine)

111 Thorium-232 and its decay products, administered intravenously as a colloidal dispersion of thorium-232 dioxide

112 Treosulfan

113 Ortho-toluidine

114 Vinyl chloride

115 Ultraviolet radiation

116 X-radiation and gamma radiation

Future gazing. People Can Live To Be 135 Years Old … But Only If They Believe They Can : LIFE : Tech Times


From their website.

Humans can grow as old as 135 years if they change the way they think about aging, one author and expert on geriatrics claims.

Rudi Westendorp says people’s mindset is the only reason that prevents them from coping with increased life expectancy. He is the author of “Growing Older Without Feeling Old: On Vitality and Ageing.”

Susannah Mushatt Jones is the oldest person alive at 116 years old. Westendorp thinks that this record is about to be broken because, he believes, the first person to reach the age of 135 has already been born. He claims that humans are gaining six hours in life expectancy every day, and he expects this to continue.

Westendorp, a geriatric medicine professor at the University of Copenhagen, says that over the past 100 years, our life expectancy has doubled from 40 years to 80. People, however, do not know how to adapt to the changes.

Most of us believe that our bodies will eventually deteriorate, he says, urging us to change our lifestyle by the time we reach 50. For Westendorp, people fail to grasp the notion that we can live longer. As a result, we limit and refrain from enjoying life to the fullest.

“They believe that when the maximum number of bends or heartbeats has been reached, it’s over, the organ is broken, the body is sick and the person dies,” says Westendorp.

Older people pass on their own habits, beliefs and expectations to their children, and these can greatly influence how the younger generations live their lives.

Beliefs about what the body can and cannot do at a certain age and their views about retirement and pensions are outdated, the author notes. Such notions emerged when lifespans were significantly shorter.

“It’s wrong to think we can take the life stories of our parents and grandparents as a blueprint for the way our own lives should unfold,” he points out.

“Who brings their children up in the realistic expectation that they will reach the age of 100?”

Westendorp encourages people to continually enjoy living healthy social lives. He said lonely, elderly people are most likely to die earlier than smokers. We should alter the way we think about aging: after all, aging is all in the mind, he says.

An example of “Nudge” – Leaving food on kitchen worktop can make you nearly 2 stone heavier | Daily Mail Online


From their website;

Women who kept breakfast cereal on work surfaces weighed 20lbs more
Those with a fruit bowl on display weighed 13lbs less than clear surfaces
Normal weight women more likely to have a designated snack cupboard
If you want to stay trim, make sure you keep your kitchen tidy.

Leaving food on the worktop can lead to over-eating, a study suggests.

If your spouse gains weight ‘your risk of obesity DOUBLES’  | Daily Mail Online


From their website;

Countless past pieces of research have linked marriage and weight gain
Study found when one spouse becomes obese their partner’s risk doubles
Men whose wives became obese were 78% more likely to follow suit
Having a husband who was obese linked to 89% chance a woman would be
Experts say similar changes in diet and physical activity are to blame

From Heart Attacks To Suicide, How Being A Perfectionist Can Impact Your Health


From their website;

According to Professor Gordon Flett, of the Department of Psychology at York University in Canada, about two in five people are perfectionists, and they typically fit into three main categories: The self-oriented perfectionist is the type who sets their own high personal standards of perfection, while the other-oriented perfectionist exacts high standards on others. Then, there is the socially prescribed perfectionist, who was forced into the mold by the other-oriented perfectionist holding them to higher standards. They all have one thing in common: every area of life is held to the exact same, impossible standard…
… it signals to your amygdala, the fear center in your brain, and the fight-or-flight center kicks in,” she said. “Perfectionists likely have an overactive fear center. In your brain, too much energy going to your fight-or-flight center means not enough energy going to everyday operations.”

As a result, we become exhausted, and this leaves us vulnerable to a whole list of things …

…You’ll Run Yourself Down

Perfectionism has long been linked to exhaustion and subsequent susceptibility to disease, better known as burnout. In a recent study, British researchers examined 43 studies conducted over the past two decades pertaining to perfectionistic-linked burnout. They found burnout was more rampant within the work environment, where inner levels of perfectionism were also supported by external pressures and a lack of validation.

But becoming run down physically and emotionally often sets you up for even greater physical health issues. “By thinking that you have to be perfect, you may be putting yourself at a level of stress that means you’re not going to be protected from health problems and, in fact, exposed to increased risk.”

A 2006 study conducted by Danielle Molnar of Brock University in Canada found that perfectionism and eventual burnout leads to more sick days. After evaluating participants for their levels of perfectionism, they found that those who experienced socially prescribed perfectionism had poorer overall physical health. This translated into more visits to the doctor, taking more days off from work, and experiencing a wide variety of health problems that compelled them to rate their own personal health as low.

But perfectionism-related stress not only leaves you more vulnerable to health issues, it can also slow your recovery. In Flett’s own research, he and his colleagues looked at 100 heart attack patients, and found the perfectionists were slower to recover and more susceptible to future cardiac issues. Slower recovery was also observed in perfectionists with Crohn’s disease and ulcerative colitis.

“Our studies show that when someone has a serious illness, like heart disease, that perfectionism… is a magnifier of difficulties and stressors. And if you don’t give up on the perfectionism, it’s going to hinder your recovery,” he said.

More alarmingly, a 2009 study found that earlier mortality was also more common among perfectionists. Prem Fry, a psychology professor at Trinity Western University in Canada, examined 450 adults aged 65 and older for 6.5 years. The participants were initially given a questionnaire to assess their levels of perfectionism, and then researchers observed their health for the follow-up years. Ultimately, they found that those with high perfectionist tendencies were 51 percent more likely to die earlier than those with lower perfectionist scores. They reasoned that this was likely due to the high levels of stress and anxiety they found in these people.

Accenture predicts 51 percent of digital health startups will fail within two years | mobihealthnews


From their website;

About half of all US digital health startups will fail within two years of launching, according to an Accenture report that analyzed 900 healthcare IT start-ups…
For comparison, a Bureau of Labor Statistics report shows that between 1994 and 2009, at the two year mark, between 20 percent and 26 percent of startups across all fields failed.

Accenture also found that digital health startups on the brink of failure, which they call “zombie” startups, raised nearly $4 billion in funding between 2008 and 2013 and that there are 1,700 patents between the 900 startups analyzed. The report explains that these startups are often “aqui-hired” for top talent, patents, and technologies.

“Rather than discard the investment that has been made in getting sputtering start-ups off the ground, it often makes sense for healthcare stakeholders to acquire them, salvage their best people and technologies and awaken them from a zombie-like existence,” Kaveh Safavi, managing director for Accenture’s global healthcare business, said in a statement…
Accenture predicts that in the next two years, another $2.5 billion will be invested in digital health startups. Almost 30 percent of these funds will be invested infrastructure, while 25 percent will be invested in engagement, 25 percent will be invested in treatment, and 21 percent will be invested in diagnosis.

GlucoTrack Non-Invasive Ear Lobe Glucometer to Go to Clinical Trial in U.S. | Medgadget


From their website;

The GlucoTrack uses an ear lobe clip-on similar to pulse oximeters to spot glucose levels through the skin. The sensor uses three different technologies to estimate blood glucose and sends its readings to a smartphone-like device that displays the numbers and keeps track of previous tests.

Leo Pharma leads $3.4M investment in melanoma app SkinVision | mobihealthnews


From their website;

Amsterdam-based dermatology app company SkinVision has raised $3.4 million from pharmaceutical company Leo Pharma with contributions from SkinVision’s existing investor and majority stakeholder Dutch investment firm Personal Health Solutions Capital. The complany plans to use the funding to move its app’s capabilities beyond melanoma recognition and into other skin conditions, according to a report in TechCrunch.

FUJIFILM SonoSite Announces CE Mark for iViz | Business Wire


From their website;

BOTHELL, Wash.–(BUSINESS WIRE)–FUJIFILM SonoSite Inc., a specialist in designing cutting-edge ultrasound tools and world-leading education for access to point-of-care visualization, today announced CE mark for its newest Point-of-Care solution: the iViz. Inspired by clinicians, the iViz is a new platform that augments the value of ultrasound for clinical users from hospital settings to clinics in remote villages with the ability to perform ultrasound when and where it is needed.

Blood test could detect Alzheimer’s years before a patient starts showing symptoms | Daily Mail Online


From their website;

Autoantibodies in blood could show if person will develop dementia
The biomarkers show risk of suffering Alzheimer’s and the stage it is at
It could lead to earlier treatment to slow progression of devastating illness
Scientists say patients could change lifestyle factors linked to the disease
Scientists are a step closer to developing a blood test that can detect Alzheimer’s disease

Big Brain Doesn’t Mean Big Smarts


From their website;

Having a big brain doesn’t guarantee you’ll have an outsized IQ, a new analysis indicates.

Researchers who examined 148 studies that included more than 8,000 people found only a weak association between brain size and IQ.

Supplements Don’t Benefit Prostate Cancer Patients


From their website;

A new study finds no evidence that men’s health supplements help prostate cancer patients.

Although popular, such supplements do not appear to lower the risk for experiencing radiation treatment side effects; the risk that localized cancer will spread; or the risk that prostate cancer patients will die from their disease, researchers found.

The study focused on supplement use among more than 2,200 men newly diagnosed with localized prostate cancer.

“We suspected that these pills were junk. Our study confirmed our suspicion,” said study lead author Dr. Nicholas Zaorsky, resident physician in radiation oncology at the Fox Chase Cancer Center in Philadelphia.

Healthcare leads all industries in data breaches | Government Health IT


From their website

Healthcare leads all industries in data breaches
September 17, 2015 | Jack McCarthy – Contributing Writer
POSTED IN: Privacy & Security
The healthcare sector experienced 187 data breaches in the first half of 2015, a startling number on its own, but even more so when considering that it accounts for 21.1 percent of all breaches worldwide.

That’s according to a report from data security company Gemalto.

“The healthcare industry historically has had the highest number of data breaches, and that was no different in the first half of 2015,” the report said.

The key finding is perhaps that the healthcare industry had 34 percent of its total records breached, amounting to 84 million data records compromised, the highest rate of any industry. Government accounted for the second highest rate of breaches at 77.2 million records lost, or 31.4 percent.

A contributing factor to the high rate of breaches encountered by the healthcare industry was the February heist of U.S. health insurance provider Anthem, in which criminal hackers broke into the firm’s servers and stole 78.8 million records that contain personally identifiable information, the report said.

The data breach, according to Anthem, extended into multiple brands that the company uses to market its healthcare plans, including Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross and Blue Shield, Amerigroup, Caremore, and UniCare, the report said.

Also listed among the companies experiencing the largest data breaches was electronic health records vendor Medical Informatics engineering, which has 3.9 million records compromised, the report said.

Overall, companies across all sectors are feeling increased pressure from attackers.

“The first six months of 2015 demonstrated that hackers continue to get past conventional perimeter security with relative ease, targeting nearly every industry and executing several high profile data breaches that scored tens of millions of data records each,” the authors of the report wrote. “And, while identity theft remains one of the leading types of data breaches, the first half of 2015 has shown a shift in attack targets … data records stolen from state-sponsored attacks rose dramatically compared to previous years and healthcare and government overtook retail as the major sectors under siege with the number of compromised data records.”

Electronic Nose Sniffs Out Ovarian Cancer in Exhaled Breath


From their website

Electronic Nose Sniffs Out Ovarian Cancer in Exhaled Breath

We know that exhaled breath contains biomarkers that point to presence of existing disease, including cancer, but their detection is challenging without bulky and expensive equipment. Building specialized devices that detect volatile organic compounds linked to disease requires large sensor arrays, a limitation that has made them currently impractical. Now researchers at Technion−Israel Institute of Technology and Carmel Medical Center in Haifa, Israel have developed tiny flexible sensors that are each able to replicate the work of many. In a study testing the breath of 43 volunteers that included 17 ovarian cancer patients, their sensors achieved an 82% accuracy of detection.

The sensors are flexible and are made of gold nanoparticles that have molecules onto which volatile organic compounds (VOCs) attach to. When captured, the different VOCs bend the sensors at different angles depending on their nature and provide more information than simply whether they’re there or not.

The researchers believe this technology can be applied to other cancers and different diseases, leading to cheap and easy to use diagnostic devices that require only a patient breath to work.

Study in NANO Letters: Dynamic Nanoparticle-Based Flexible Sensors: Diagnosis of Ovarian Carcinoma from Exhaled Breath…

Via: American Chemical Society…

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At Medgadget, we report on the latest medical technology news, interview leaders in the field, and file dispatches from medical events around the world.

1 in 10 “eConsults” shown to need f2f

Announcement/ Alert the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).

For the purposes of this study of more than 5,000 encounters, eConsults were text based messages (presumably email). Just over 500 (10%) needed a face to face appointment. The reason given for those appointments was enlightening – 75% were because of diagnostic uncertainty and only 1% were because of urgency or physical examination.

It would be interesting to analyse the specialties that were included and some of the detailed characteristics might shed even more light; for example age, sex, ethnicity/ language, educational attainment, severity of illness, underlying co-morbidity/ long term condition and the previous clinical history between doctor-patient.


From their website:

J Telemed Telecare. 2015 Sep 22. pii: 1357633X15602634. [Epub ahead of print]

Early e-consultation face-to-face conversions.

Pecina JL1, North F2.

Author information:

·  1Department of Family Medicine, Mayo Clinic Rochester, USA pecina.jennifer@mayo.edu.

·  2Department of Primary Care Internal Medicine, Mayo Clinic Rochester, USA.



E-consultations are asynchronous, text-based consultations. The specialist e-consultant answers clinical questions in a similar way to a standard consultation but the questions and answers are sent electronically. The e-consultant has access to some or all of the medical record but does not have contact with the patient. Although e-consultations are meant to substitute for face-to-face (F2F) consultations, a significant proportion of e-consultations are converted to F2F consultations.


We examined e-consultation content from a sample of e-consultations that had subsequent F2F visits in the same specialty as the e-consultation within 28 days of the e-consultation.


Out of 5115 e-consultations, there were a total of 547 (10.7%) early F2F conversions. One hundred and fifty-one e-consultations with subsequent early F2F conversions were reviewed in eight specialties. In 64% of the F2F conversions, specialists recommended the F2F consultations. In 75% there were complex diagnostic or treatment considerations. In only 1% was there a sense of medical urgency or a stated need for physical examination.


E-consultations convert to F2F consultations primarily at the request of the specialist. Diagnostic and treatment complexity appear to be the main reasons. We found little evidence that patients decided independently to get a F2F visit or that specialists needed a F2F visit to perform a physical examination. Although e-consultations might not be a complete substitute for F2F consultations, they may serve as an entry level consultation that could be supplemented by a video consultation as needed for cases with more diagnostic and treatment complexity.

© The Author(s) 2015.

PMID: 26395892 [PubMed – as supplied by publisher]

Healthcare startups: several things to be aware of

In the 21st century, the era of constantly advancing technologies, it is possible to build a flourishing business in such a serious field as medicine … Among the proposed healthcare startup projects, there are not so many of great quality and competitive design. Therefore, chasing such trendy terms as ‘big data’ and ‘globalization’ is actually not enough.

Source: Healthcare startups: several things to be aware of

In summary I’d say that the authors reminders are to consider that;
1- Patents and IPO protection – without which success is elusive
2- Data is the key – often more so than the ‘invention’ itself
3- Globalisation works – to find solutions as well as a market

Sertraline, an Anti-Depressant, May Change Brain Structures Differently in Depressed and Non-Depressed Individuals

Very interesting animal study.

From their own website;

Antidepressants are usually prescribed for individuals suffering from depression, which work by changing one or more of the neurotransmitters in the brain. Selective Serotonin Reuptake Inhibitors (SSRIs) are one such anti-depressant medication and inhibit the reabsorption of serotonin, thereby increasing the levels of this neurotransmitter. The shift in serotonin levels enables the brain cells to transmit messages better, and as a consequence, improve mood… Since Sertraline is prescribed for both depression and non-mood disorders, such as anorexia, bulimia, hot flashes, and post-traumatic stress disorder (PTSD), the current study was conducted to throw light on the effect of Sertraline on the brains of depressed, as well as non-depressed subjects… The results show:
In depressed monkeys, Sertraline increased the volume of the anterior cingulate cortex in the brain (the anterior cingulate cortex is involved in memory, cognition, learning, modulation of emotional behavior, spatial navigation, etc.).
Sertraline decreased the volume of the anterior cingulate cortex, as well as the hippocampus in non-depressed subjects (The hippocampal region is associated with memory and learning).


CT scans of the heart – British Heart Foundation

image from bhf.org.uk
image from bhf.org.uk


image from bhf.org.uk

image from bhf.org.uk


CT is a Computerised Tomography that produces multiple images of the heart from different angles. There are two ways in which a CT scan can be used for the heart.

Source: CT scans of the heart – British Heart Foundation

Medical Royal Colleges








No Guidelines








Home is the place to die with dignity, not a soulless hospital


Push doctor is not that much different to using a telephone.

Take a look at @pulsetoday’s Tweet: https://twitter.com/pulsetoday/status/629000441041326081?s=09

75% of Patients Wouldn’t Trust A Diagnosis Via Telemedicine


Very interesting info graphic based on a recent study.




image from hitconsultant.net


Telehealth Consult – Telemedicine Software | AMD Global Telemedicine

From their own website

Telehealth Consult is a web-based patient record system designed specifically for the needs of both live and deferred telemedicine consultations.

Source: Telehealth Consult – Telemedicine Software | AMD Global Telemedicine

Unforgiveness, depression, and health in later life: the protective factor of forgivingness

Recent study performed by the Department of Human Development & Family Studies, University of Missouri, USA

From the publisher’s website;

Conclusion: Forgiving others and the self may be protective of well-being when women feel unforgiven by others. These findings have implications for forgiveness intervention programs and contribute to literature pertaining to forgiveness and health in later life.


Digital Health Intelligence Limited

From their website;

People are keen to use digital health services, but have little knowledge of those already on offer and are keener for them to support than replace traditional services


The article goes on to detail that there is a low awareness about digi-health sevices that are already available, for example only 4% know that they can access their own GP records online.

Medical Second Opinion Services | Ask a Doctor Advice Online

Largely based in America there are an increaing number of online services which enable a patient to get a second opinion from an online Doctor. There is a mixture of online health services available and this contrasts with [1] online symptom checkers [2] artificial intelligence diagnostic aids and [3] online consultation.

From their own website

image from secondopinion.com
image from secondopinion.com

Get instant medical second opinion online. Ask a Board Certified doctor for medical advice. Prices starting at 49$.

Source: Medical Second Opinion Services | Ask a Doctor Advice Online

CliniCloud – Tech Specs

Clinicloud is a mobile phone based stethoscope and thermometer that is designed to allow online connection direct to a Dr and is due for release in September 2015.


From their own website

Digital Stethoscope + Non-contact Thermometer

CliniCloud is a connected medical kit designed for the home. Now you can closely monitor every fever, chill, cough, wheeze or cold. You can even get a medical consultation in the comfort of your own home.





Procalcitonin Blood Tests

Procalcitonin is an infrequently used blood test in primary care. In hospital medicine it has been shown to have good sensitivity in determining whether a patient is suffering from a bacterial infection. If it were to be used within a GP appointment then the test has the potential to assist the decision of whether or not antibiotics are needed for common complaints such as cough, sore throat or earache.



Gene associated with sudden cardiac death identified by ICD monitoring — ScienceDaily


Very early finding shows that amongst patients who have an implanted cardiac defibrillator there are two genes are more common in those who go on to have a potentially fatal ventricular arrhythmia. This genetic distribution appears to be seen in the general population too and this raisers the prospect of identifying some high/ higher risk individuals.

Digital Health Intelligence Limited – EMIS datasharing

UK’s Biggest GP clinical information system, Emis widens data sharing ambitions

ColdBox Application Template

Source: Digital Health Intelligence Limited

Handling Acute Stress – an HBR primer

A Simple Yet Powerful Way to Handle a Stress Episode https://hbr.org/2015/08/a-simple-yet-powerful-way-to-handle-a-stress-episode

This short essay starts with a familiar scenario and reminds us of a useful pair of definitions before an acronym to aside mindfulness.

(1) Acute vs Chronic Stress.
(2) Threat  vs Challenge.
(3) RAIN
Recognition: Consciously take notice of what is occurring in your body and mind. For example, “My mouth feels dry and there is a pit in my stomach. I feel like an idiot.”

Acceptance: Acknowledge that the stress response is present and allow it to be here. This doesn’t mean that you’re happy about it, but giving up the effort to resist it is, paradoxically, the quickest way to help it subside.

Investigation: Ask yourself calmly what thoughts and emotions are present, what stories you are telling yourself. Following this technique, the candidate might have answered, “I can’t believe I sound so lame. I’m afraid that I will lose this opportunity, that I will not be admitted to business school, that I will feel like a failure in front of my family and friends, and that I won’t have a successful career.”

Non-identification: Having recognized, accepted, and explored the implications of your stress symptoms, the final step is to realize that although you are experiencing them, they do not define you. “I am having the thought that I may feel like a failure” is very different from and much more manageable than “I am a failure.”

Predictor of child vocabulary in early speech:

Infants’ ability to relate words to objects at 12 months linked to language skills at 18 months — ScienceDaily


Cognitive development is broadly defined as the process by which babies and young children learn about the world around them, and includes the acquisition of problem solving, memory, perception and, of course, language.

At 12 months old, your infant’s ability to group objects according to the names associated with them — as opposed to their appearance alone — offers a glimpse into how his or her vocabulary will develop by the time they are 18 months, Northwestern University researchers have found.

Psychologist shows why talking to kids really matters — ScienceDaily


significant differences in both vocabulary and real-time language processing efficiency were already evident at age 18 months

By age 24 months, there was a six-month gap … in processing skills critical to language development.

Infants who heard more child-directed speech developed greater efficiency in language processing and learned new words more quickly. The results indicate that exposure to child-directed speech — as opposed to overheard speech — sharpens infants’ language processing skills, with cascading benefits for vocabulary learning.

Gene leads to nearsightedness when kids read — ScienceDaily


The genetic association that has been discovered is for a tendency to develop shortsightedness in the teenage years if the individual spends significant amounts of time reading.

Young black women have a higher frequency of BRCA mutations than previously reported — ScienceDaily

From Science Daily

Young black women are more likely to have aggressive types of breast cancer compared to non-Hispanic white women, … Women who have inherited mutations in the BRCA1 or BRCA2 genes are more likely to develop breast cancer or ovarian cancer, especially at a younger age. Approximately 5 percent of women with breast cancer in the United States have mutations in BRCA1 or BRCA2 based on estimates in non-Hispanic white women. Moffitt Cancer Center researchers  … discovered that 12.4 percent of the participants (young black women diagnosed with breast cancer at or below age 50) had mutations in either BRCA1 or BRCA2.



Home Health Technologies | Tractica

From a recently published analysis of Telehealth;

(Telehealth can be defined as) connected devices, services, and applications used by a consumer outside of a clinical setting for medical, health, or wellness purposes

… home health technology is becoming increasingly recognized by the healthcare industry as an effective means of curbing healthcare costs and producing better patient outcomes.

According to a recent report from Tractica, the global market for home health technologies will grow from $3.4 billion in 2014 to more than $13.7 billion by 2020.


IgG Food Intolerance Tests: What does the science say? « Science-Based Medicine

The Science Based Medicine website has in depth and detailed reviews on a wide range of subjects.

From their website;

Food allergies can be as real as drug allergies, and are arguably much harder to prevent. We can usually control when we get penicillin. But what about peanuts, eggs, or milk, all of which can also cause life-threatening anaphylaxis?  Food allergies seems to be growing: not only anaphylaxis, butmore people believe they have some sort of allergy to food.  Allergy is sometimes confused with the term “intolerance”, which seems more common, possibly as the availability of “food intolerance testing” grows. Food intolerance testing and screening is particularly popular among alternative practitioners. Testing can take different forms, but generally the consumer is screened against hundreds of food products and food additives. They are then provided with a list of foods they are “intolerant” to. … Children may be tested, too, and parents may be given a long list of foods they are told their child is intolerant of. I’ve seen the effects in the community, too. Think going “peanut free” is tough? A public school in my area sent home a list of forbidden food products: dairy, eggs, bananas, tree nuts, peanuts, soy, sesame, flax seed, kiwi, chicken, and bacon. Were these all true allergies? It’s not disclosed. Anaphylactic or not, the parents had informed the school, and the school had banned the food product.


At present, there are no reliable and validated clinical tests for the diagnosis of food intolerance. While intolerances are non-immune by definition, IgG testing is actively promoted for diagnosis, and to guide management. These tests lack both a sound scientific rationale and evidence of effectiveness. The lack of correlation between results and actual symptoms, and the risks resulting from unnecessary food avoidance, escalate the potential for harm from this test. Further, there is no published clinical evidence to support the use of IgG tests to determine the need for vitamins or supplements. In light of the lack of clinical relevance, and the potential for harm resulting from their use, allergy and immunology organizations worldwide advise against the use of IgG testing for food intolerance.



there’s a big gap between what many perceive as an allergy and what is clinically considered a true allergy




Bright Futures

This is a widely used programme for monitoring childhood development in American.





Source: Bright Futures


Source: www.zerotothree.org/public-policy/state-community-policy/nitcci/multidisciplinary-consultant-module-2.pdf


This American manual gives a list of assessment tools in the final appendix (p65) which includes the Ounce scale and ITFI which were not included/ reported on in the UCL paper.

Doctors voice concerns over plan for greater patient access to medical records | Society | The Guardian

From their website, Denis Campbell the Guardian’s Health Policy Editor writes;
(I think the articles is so good that I’m reproducing it in full

The health secretary, Jeremy Hunt, has announced plans to give patients in England access to their entire medical record by 2018, and to let them read and add to their GP record using their smartphone within a year.

The announcement at NHS England’s annual conference in Manchester prompted fears of a repeat of last year’s row over care.data, a programme in which patient records were shared outside the NHS without their consent. The opposition forced NHS England to halt the scheme temporarily while it addressed the concerns.

Phil Booth, coordinator of the campaign group MedConfidential, said: “Shoving highly sensitive information to patients via their smartphones really won’t help doctors treat them in 2016, and medical bodies like the Royal College of GPs have already pointed out it could expose the vulnerable to stalking, abuse and coercion, not to mention predatory companies who can’t wait to get their hands on such valuable data.”

Organisations representing doctors also expressed misgivings, with the British Medical Association (BMA) warning that vulnerable patients could be coerced by abusive partners to reveal what they had told their doctor.

Some doctors, especially GPs, are also concerned that, from 2018, notes that they and other health professionals have written in patients’ medical records, which they were never intended to see, will become known to the patients involved. For example, a GP may have recorded that a patient may be at risk of cancer because they smoke, but never told the person that directly.

Dame Fiona Caldicott, the national data guardian for health and care – whose role will be put on to a statutory footing as part of the overhaul of security – will take part in the review. As a first step, by January she will develop new guidelines for the protection of patients’ personal data, which every organisation providing health and care services will have to abide by.

That will be strengthened by using CQC inspections and the awarding of contracts by NHS England to ensure that stringent standards of data security are being applied.

As it stands patients can only view a summary of their medical history. But from 2018 they will be able to see their entire record, though it is not yet clear how that will happen.

Hunt said patient access to their own records would lead to mistakes being rectified and to patients taking their own health more seriously. Patients would be able to add what they see as useful information, such as the number of steps they walk each day, so their GP can monitor their physical activity, he said.

NHS in England delays sharing of medical records
Read more
The BMA said it had concerns about the security of patient records if they were to be placed online. “There is a big difference between being able to physically view private records in a secure, controlled environment of a practice and via a password that could be obtained by a third party,” a spokesman for the doctors’ union said.

Dr Maureen Baker, chair of the Royal College of GPs, said family doctors were already so busy that they did not have time to monitor and assess information added by patients themselves.

“GPs are under incredible pressure, seeing more patients than ever before, and we simply do not have the resources to analyse data that patients upload to their records as a matter of course,” Baker said.

“However, this data can be used to trigger conversations between GPs and their patients about leading healthier lifestyles – and as long as it is done safely and responsibly, this is something we would encourage.”


Health Secretary outlines vision for use of technology across NHS – News stories – GOV.UK

From their website,  several of the Health Secretary, Jeremy Hunt’s quotes;

Powerful patients need to know about the quality of healthcare being provided, but they also need to be able to harness the many innovations now becoming possible.

To most of us it feels like there has been more change in the way we book taxis, shop, bank or store photos than the way we access healthcare. Yet for every single one of us healthcare is more important than all of those things.

Experience from other countries suggests that opening up access to your own medical record leads to a profound change in culture in a way that is transformative for people with complex or long term conditions.

I also want patients not just to be able to read their medical record on their smartphone but to add to it, whether by recording their own comments or by plugging in their own wearable devices to it.

In addition, by the end of 2018 all doctors and nurses will be able to access the most up-to-date lifesaving information across GP surgeries, ambulance services and A&E departments, no matter where a patient is in England. By 2020 this will include the social care system as well.

As the internet drives forward the next wave of innovation, all over the world healthcare still seems to be at the back of the queue.

We will only really be putting patients first if we can give them confidence that every part of the system knows their care plan, is up to date with their progress and doesn’t need them to repeat their story time after time.

We no longer have to carry round our cheque books or boarding passes, and we shouldn’t accept any less when it comes to our health.

As the use of technology increases, so does the need to reassure the public that their personal medical data is being held securely.

Exciting though this all is, we will throw away these opportunities if the public do not believe they can trust us to look after their personal medical data securely.

The NHS has not yet won the public’s trust in an area that is vital for the future of patient care.

Nothing matters more to us than our health, and people rightly say we must be able to assure the security of confidential medical information.