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
Major deformity correction
If Cloud Health can’t meet your needs then the following service may be able to help; http://www.doctorsatpettswood.co.uk
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.
- 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.
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.
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.
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.
With mHealth on tap at CES 2016, healthcare just might pay attention
Consumers, doctors turn to telehealth to battle sleep disorders
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 – 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.”
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.
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.
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
42 Aristolochic acids and plants containing them
43 Arsenic and arsenic compounds
‘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)
52 Chloromethyl methyl ether
54 1,4-Butanediol dimethanesulfonate (Busulphan, Myleran)
55 Cadmium and cadmium compounds
57 Methyl-CCNU (1-(2-Chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea; Semustine)
58 Chromium(VI) compounds
60 Contraceptives, hormonal, combined forms (those containing both oestrogen and a progestogen)
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)
64 Dyes metabolized to benzidine
65 Epstein-Barr virus
66 Oestrogens, nonsteroidal
67 Oestrogens, steroidal
68 Oestrogen therapy, postmenopausal
69 Ethanol in alcoholic beverages
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
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
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)
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, source of solar radiation. Photograph: Nasa/Soho/EPA
106 Solar radiation
107 Talc containing asbestiform fibres
Health threat of sugar is vastly underestimated, study claims
110 Thiotepa (1,1’,1”-phosphinothioylidynetrisaziridine)
111 Thorium-232 and its decay products, administered intravenously as a colloidal dispersion of thorium-232 dioxide
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.
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 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.
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.
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.
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
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.
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.
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.”
From their website
Electronic Nose Sniffs Out Ovarian Cancer in Exhaled Breath
OCTOBER 6TH, 2015 EDITORS NANOMEDICINE, ONCOLOGY
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…
Gold Nanoparticle Sensor Proving Effective in Lung Cancer Detection in Early Trial
Breathalyzer for Lung Cancer Screening Shows Promise
“Electronic Nose” to Aid Asthma Diagnosis
Gold Particles for Lung CA Diagnosis from Breath
Diagnosis of lung cancer by the analysis of exhaled breath with a colorimetric sensor array.
Peter J Mazzone et al., Thorax, 2007
Compounds in exhaled breath could improve high-risk lung cancer screening
The Oncology Practice
Advances in electronic-nose technologies for the detection of volatile biomarker metabolites in the human breath.
Alphus D Wilson, Metabolites, 2015
Biomarkers May Improve Lung Cancer Screening
The Oncology Practice
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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]
· 1Department of Family Medicine, Mayo Clinic Rochester, USA firstname.lastname@example.org.
· 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]
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.
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).
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.
Take a look at @pulsetoday’s Tweet: https://twitter.com/pulsetoday/status/629000441041326081?s=09
Very interesting info graphic based on a recent study.
image from hitconsultant.net
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.
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.
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.
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  online symptom checkers  artificial intelligence diagnostic aids and  online consultation.
From their own website
Get instant medical second opinion online. Ask a Board Certified doctor for medical advice. Prices starting at 49$.
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 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.
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.
UK’s Biggest GP clinical information system, Emis widens data sharing ambitions
ColdBox Application Template
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.
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.”
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.
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.
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.
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.
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.
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
This is a widely used programme for monitoring childhood development in American.
Source: Bright Futures
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
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.”
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.
Health MOTs using whole body CT scans are putting patients at risk of cancer and may be banned under Government plans
The scans which cost between £300 and £2,000 are advertised widely by private healthcare companies as offering early detection of problems such as heart disease and cancer.
Government health advisors say any company offering whole body computerised tomography (CT) scans or lung scans to patients without any symptoms should stop immediately.
There are thought to be around 12,000 whole body or lung scans carried out every year in the UK and this is expected to grow.
This article gives a helpful reminder of current practice – it details the classic medical process of … history –> clinical examination –> beside tests –> laboratory tests. Of relevance to General Practice it explores the use of CRP and Procalcitonin tests. Thereafter it highlights upcoming technologies that show potential to be helpful in the future.
From their website;
New technologies that are likely to emerge as important diagnostic tools in future include nanoparticle probe technology and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOFMS). Nanosphere’s Verigene Gram-positive (BC-GP) blood culture assay is performed directly on positive blood cultures using nucleic acid extraction and PCR amplification. Target DNA is then hybridised to oligonucleotides on a microarray with automated qualitative analysis. The test was approved by the US Food and Drug Administration in 2014 and currently has the ability to identify 10 Gram-positive and 8 Gram-negative organisms along with multiple resistance genes. Currently, two MALDI-TOFMS platforms are available in the USA, MALDI Biotyper (Bruker Corporation, Billerica, Mass.) and VitekMS System (bio-Merieux, Durham, NC). MALDI-TOF performs MS on target molecules following ionisation and disintegration; these patterns are compared with known organism fingerprints. It is capable of analysing thousands of samples from specimens per day, including blood, sputum and urine. Another promising infection testing platform that uses PCR followed by electrospray ionisation MS (PCR/ESI-MS) technology is able to rapidly detect >800 bacteria, including unculturable organisms and three classes of antibiotic resistance markers, directly from clinical specimens. In a recent study of 331 blood samples it was able to detect twice as many organisms as culture.
1. Measures completed by parents
Ages and Stages Questionnaires (ASQ-3)
Parents’ Evaluation of Developmental Status (PEDS)
Parents’ Evaluation of Developmental Status – Developmental Milestones
2. Measures completed by professionals with involvement of parents
Child Development Inventory (CDI)
Child Development Review (CDR)
Bayley Scales of Infant and Toddler development
3. Measures completed by Health professionals
Mullen Scales of Early Learning (MSEL)
Battelle Developmental Inventory (BDI-2)
BDI-2 Screening Test
Brigance Early Childhood Screens
Griffiths Mental Development Scales
Schedule of Growing Skills (SGS-II)
From their own website
DEXA body fat, body composition, lean mass and muscle measurement in London and Manchester. Accurate & precise measurements for both men and women!
“We found the cognitive benefits of bilingualism come much earlier than reported in previous studies.”
From their own website
Upright Open MRI in London, Leeds, and Birmingham – the ideal solution for claustrophobic patients.
From their website;
“In our research, we found people who have Type 2 diabetes used significantly more antibiotics up to 15 years prior to diagnosis compared to healthy controls,” said one of the study’s authors, Kristian Hallundbæk Mikkelsen, MD, of Gentofte Hospital in Hellerup, Denmark. “Although we cannot infer causality from this study, the findings raise the possibility that antibiotics could raise the risk of Type 2 diabetes. Another equally compelling explanation may be that people develop Type 2 diabetes over the course of years and face a greater risk of infection during that time.”
From their own website
Europe’s leading food intolerance and allergy testing company. YorkTest develop tests to determine your food sensitivity.
From their own website
Welcome to our independent diagnostic imaging centre offering high quality MRI, Ultrasound, X-ray and DXA at an Affordable Price in Central London.
From their own website
High quality private MRI scans ideal for diagnosis of conditions, injuries or pain affecting the brain, spine, shoulder, elbow, wrist, hip, knee, ankle and foot.
This page gives 3 different tools to allow the clinical decision of whether antibiotics can be expected to be helpful in sinusitis or not.  Williams Prediction Rules,  Berg Prediction Rules and  the Task Force on Rhinosinusitis Rules from 1999, 92 and 97 respectively.
Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts
Currently the recommendation is that never-smokers should not be screened.
Smokers aged ≥65–80 y are a high-risk group who may benefit from screening –
It should be remembered that this study compared screening by CT scan VS screening by CXR.
Widely accepted opinion is that the statistical risk of lung cancer has returned to normal in ex-smokers who quit more than 15 years ago however this study suggests – but does not prove – that the lung cancer risk continues beyond that.
Adult Self-Report Scale (ASRS v1.1) for ADHD Screens for presence of adult ADHD.
The ASRS is presented in an abbreviated form above and this short set of 6/18 questions can be considered as a quick screening tool.
The full ASRS consists of 18 questions is and is accepted under the DSM (Diagnostic and Statistical Manual) as being a valid tool. a positive result on the full ASRS is not diagnostic of ADHD but indicates that an appointment with a Doctor is needed.
Prescan – Full Body Scan – has been an active market leader in the field of Preventive Medical Examination and research both nationally and internationally.
The original Centor Criteria use 4 simple questions to assess the chances that a sore throat is caused by a bacterial infection.
Centor Score (Modified) for Strep Pharyngitis
This is a report about an interesting study but ultimately it may not have a strong relevance or applicability in most situations. The research was conducted in Mauritius and they swabbed the outside of 145 womens’ handbags and mens’ wallets. The primary finding was that 95% carried bacteria. However as they point out themselves;
From their website;
In about three-quarters (73%) this was scanty growth; 13% showed moderate growth and 14% showed heavy growth. … and … In fact, all of the things we use in the environment around us, like mobile phones, computers, keyboards and other equipment are all likely to carry some bacteria.
Otherwise there were interesting if unsurprising secondary findings;
From their website;
11% often placed them on kitchen tables
18% placed them on dining tables
18% allowed their children to handle them
82% never emptied them
Most women kept purses in handbags, most men in trouser pockets
In conclusion it might be fair to say that in day-to-day life this study does not have a notable impact. However in settings where individuals are particularly susceptible to infections then this study does back up and re-inforce the current practice of making every effort to reduce their exposure to risk.
Epidemiology & Commonest Cancers
Cancer Risk Factors – Family History
Cancer Risk Factors – Modifiable / Lifestyle
Cancer Risk Factors – Past Medical History / Non-Modifiable
National Screening Programmes
Advanced Cancer Screening or Early Detection
Symptom Triage Tools
download the app
|Major Cause||Percentage of Failures||Specific Pitfalls|
|Living too high for the business|
|Nonpayment of taxes|
|No knowledge of pricing|
|Lack of planning|
|No knowledge of financing|
|No experience in record-keeping|
|2||Unbalanced Experience or Lack of Managerial Experience||
|Poor credit granting practices|
|Expansion too rapid|
|Inadequate borrowing practices|
|3||Lack of Experiences in line of goods or services||
|Carry inadequate inventory|
|No knowledge of suppliers|
|Wasted advertising budget|
|5||Neglect, fraud, disaster||
Women should be able to get antibiotics for urinary tract infection without a prescription | The BMJ
From their website;
Uncomplicated cystitis is common and easily treated with drugs such as nitrofurantoin. Kyle Knox asks why women cannot treat themselves, without using up precious appointments in general practice
Acute uncomplicated urinary tract infections (AUUTIs) are common, especially in premenopausal, sexually active women, of whom about 30% will have been affected by age 26.1 AUUTIs usually resolve without sequelae and rarely progress to pyelonephritis, but they result in considerable morbidity, and the goal of treatment is to ameliorate the severity and duration of symptoms.
In one of the online BMJ responses;
(The article) argues that: a) the clinical recognition of an uncomplicated cystitis does not require the assessment of a health professional, b) there is good evidence of the efficacy and safety of a 3 day-course of Nitrofurantoin, and c) the threat of a growing resistance to Nitrofurantoin do not outweigh the benefits of easy access to this antibiotic. Thus, why cannot women with an uncomplicated cystitis treat themselves, without using up precious appointments in general practice?
Dr Maureen Baker, Chair of the Royal College of GPs, said: “Cystitis can cause a huge amount of discomfort for patients, and whilst antibiotics can help in some cases, they are not always the most appropriate treatment as the cause is not always bacterial.
“Aside from the patient safety risks associated with deregulating access to some of these powerful drugs, we are currently amidst an international drive to reduce antibiotic use, in order to curb growing global resistance to them.
“Although the strain of antibiotics referenced in the article has actually seen very little resistance built up against it so far, making it more widely available would inevitably increase resistance to it and remove one of the few antibiotics with low resistance rates from the formulary, therefore adding to this global problem.
“GPs already face enormous pressure to prescribe antibiotics, and it often takes a lot of effort to persuade patients that they are not always the answer to treating illness – making them available without a prescription would simply undermine this. There is also the risk that bypassing the GP for patients with cystitis might lead to recurrent strains of the infection being treated inappropriately, and more serious conditions going undetected.
“Instead of increasing the availability of antibiotics for patients suffering from cystitis, we should concentrate our efforts on making alternative treatments to cystitis more widely available – and identifying new non-antibiotic strategies – to reduce the need for and resistance to the drugs, so that they will still be effective when our patients really need them.”
The key points are  consent  adequate assessment including consideration of access to previous records, modality of communication, need for physical examination.
The GMC guidance is given as;
60. Before you prescribe for a patient via telephone, video-link or online, you must satisfy yourself that you can make an adequate assessment, establish a dialogue and obtain the patient’s consent in accordance with the guidance at paragraphs 20–29.
61. You may prescribe only when you have adequate knowledge of the patient’s health, and are satisfied that the medicines serve the patient’s needs. You must consider:
a. the limitations of the medium through which you are communicating with the patient
b. the need for physical examination or other assessments
c. whether you have access to the patient’s medical records.
62. You must undertake a physical examination of patients before prescribing non-surgical cosmetic medicinal products such as Botox, Dysport or Vistabel or other injectable cosmetic medicines. You must not therefore prescribe these medicines by telephone, video-link, or online.
Update July 2015
A new EU law came into effect on 1 July 2015 that requires doctors to prescribe only drugs that are licensed for use where the patient lives – for example, when they are prescribing drugs via online consultations. >> Find out more in section 7 of the MHRA’s document (pdf)
2012 Guidance about requirements a website must adhere to (not all relevant to Cld.Ht);
Web Accessibility and the Disability Discrimination Act
The Data Protection Act
Consumer Protection (Distance Selling) Regulations
Electronic Commerce Regulations (EC Directive)
Payment Card Industry Data Security Standard (PCI DSS)
The EU Anti Spam Laws
The EU Cookie Directive
The BMA quotes the GMC guidance on advertising and elaborates with details (follow link)
Doctors may advertise their services, for example on the internet, in formal advertisements in newspapers or magazines, a practice leaflet, or an editorial or news piece in a newspaper. However, all advertising must follow the guidelines set out by the General Medical Council.
The GMC guidance states that any information provided about medical services MUST:
- comply with the law and guidance issues by the Advertising Standards Authority
- be factual and verifiable
- not make unjustifiable claims about the quality of service
- not offer guarantees of cures or exploit patients’ vulnerability or lack of medical knowledge
- not put pressure on people to use the service, for example, by arousing ill founded fear for their future health or by visiting or telephoning prospective patients
The potential pitfalls of social media that the BMA identifies are;
Patient confidentiality violations. ref(1)
Use of discriminatory & profane language. ref(1)
Depictions of intoxication and illicit substance use. ref(1)
Maintaining boundaries – sharing (professional’s) personal information
“Where you post significant amounts of personal information on social media, patients may gain unrestricted access and you need to consider carefully what impact this might have on your professional relationships.”
Maintaining boundaries – inappropriate Doctor-Patient relationships
“Social networking sites such as Facebook also facilitate the development of online friendship networks. Doctors and medical students have reported, for example, that patients and former patients have sent them friend requests on Facebook. We recommend that, in these circumstances, if you receive friend requests you should politely decline.“
Professionalism – consider the public interest argument of how the Public regards/ may regard the profession as a result
ref(1) – Chretien KC et al. (2009) Online Posting of Unprofessional Content by Medical Students. JAMA 302(12):1309-15.