Berita Asalusil

One fifth of drips 'are dangerous'

Written By Unknown on Selasa, 10 Desember 2013 | 21.24

9 December 2013 Last updated at 20:21 ET By James Gallagher Health and science reporter, BBC News

A fifth of patients on an intravenous drip develop complications because they are given the wrong levels of fluid, according to a review of guidance in England and Wales.

Too much fluid can cause heart failure and too little leads to kidney problems.

The National Institute for Health and Care Excellence (NICE) said doctors and nurses needed better drip training.

Patients' groups said the scale of the problem was "staggering".

Thousands of people each year need a drip in hospital. But NICE warns that staff are putting lives in danger due to a lack of education in managing intravenous drips.

It has developed new guidelines for the NHS in England and Wales.

Dr Mike Stroud, a gastroenterology consultant at Southampton University Hospitals NHS Trust, who developed the guidelines, said: "Doctors and other health professionals are not well educated in terms of what a patient needs and that is astonishing really.

"This needs to change."

Drip chief

Hospitals will also be expected to appoint an "intravenous fluid champion" and patients' drips will need to be managed and monitored more closely.

Katie Scales, a consultant nurse at Imperial College Healthcare NHS Trust, said: "The majority of patients who receive intravenous fluids do so without complications but this is not the case for every patient.

"This NICE guideline is an important lever for improvement and may ultimately help to save lives."

Katherine Murphy, the chief executive of the Patients' Association, said the guidelines were "very welcome" due to the "staggering" figure of one in five patients developing complications.

"It's essential that all staff receive support and training in the administration of IV fluids and hospitals should ensure time is dedicated to this," she added.

Dr Mike Durkin, director of patient safety at NHS England, said: "I welcome this new guidance.

"Hospitals across the country need to ensure that the recommendations are implemented as routine practice so that the clinical effectiveness of infusion fluids are maximised and any risks are minimised."

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Jail sentence for PIP implant boss

10 December 2013 Last updated at 06:52 ET

The boss of a French company which distributed defective breast implants around the world has been sentenced to four years in prison for fraud.

Jean-Claude Mas, the founder of the PIP company, was also fined 75,000 euros (£63,000) by a court in Marseille.

The company's sale of faulty implants caused a global health scare with an estimated 300,000 women in 65 countries affected.

The company used sub-standard silicone gel, causing many implants to rupture.

Four other former PIP executives were also convicted and given lesser sentences.

Continue reading the main story

About 300,000 women in 65 countries are believed to have received PIP implants
Europe was a major market but more than half went to Latin America
They were not sold in the United States
42,000 British, 30,000 French, 25,000 Brazilian, 15,000 Colombian and 16,000 Venezuelan women received PIP implants

With more than 5,000 women registered as plaintiffs in the case, the trial was considered one of the biggest in French legal history.

The health scare came to public attention in 2011 when the French government recommended that women have PIP implants removed due to an abnormally high rupture rate.

There was confusion as British health authorities said there was no need for routine removal - though they later agreed to replace the implants to put women's minds at rest.

The issue of whether the sub-standard silicone used in the implants posed any danger was not resolved by the trial, AFP news agency notes.

'Under-reported'

Mas, 74, showed no sign of emotion as sentence was passed. His defence lawyer, Yves Haddad, said he planned to appeal.

He and the others had all admitted to fraud.

PIP's director-general was sentenced to three years in prison, two of which were suspended.

The company's head of quality control received two years, one of them suspended, and the head of research and development was sentenced to 18 months, suspended.

Throughout the trial, Mas had denied the silicone used was harmful while all but one of the other defendants said they had not been aware of the risks.

When an implant ruptures, the silicone gel filling can leak into the body. Some women will not notice anything at all, and there is no evidence of an increased cancer risk.

However, it can result in the formation of scar tissue that can change the shape and feel of the breast. The gel can be an irritant, causing pain and inflammation. It can also be more difficult to remove an implant once it has ruptured.

France's Health Products Agency (ANSM) has to date registered more than 7,500 implant ruptures and 3,000 cases of undesirable effects, mainly inflammations, among the 30,000 women using PIP products in France.

In a report released in June, the ANSM noted: "Taking into account the known under-reporting of medical device incidents, the number of women actually explanted may be greater than the number of cases reported to the agency."

'Too little'

Isabelle Traeger, who received a PIP implant and attended the trial, said earlier that four years would be too little for what Mas had done.

"They explained what was in them [the implants]," she told Reuters news agency.

"Inflammable substances, substances to make your car work, and that at a certain point they said to the engineer who made them, 'How did you make them? How did you mix together these substances?' And he said, 'You use your best guess'.

"And then they asked him, 'Could you repeat what you just said?'. ' You use your best guess'. Which explains why there were women in the room who had been much more seriously affected, as well as others who actually are coping quite well.

"Can you imagine? It's a matter of chance. A dollop more, a bit more, a bit less. And he'll get four years for that? For what is put in your body using one's best guess. We don't even give horses their food according to a 'best guess'."

A UK report into the the PIP implant scandal concluded that the gel material was not toxic or carcinogenic, and did not cause a long-term threat to human health.

Nonetheless Mas and others have also been charged in separate and ongoing manslaughter and financial fraud investigations into the scandal.

The manslaughter inquiry is related to the suspicious 2010 death from cancer of a woman who was fitted with PIP implants.

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Ketamine 'should be made Class B'

10 December 2013 Last updated at 08:57 ET

The drug ketamine should be upgraded from a Class C drug to Class B, government advisers have recommended.

The Advisory Council on the Misuse of Drugs said new evidence had shown frequent ketamine use could cause "severe and disabling" bladder damage.

Under the new classification, illegal possession of ketamine could lead to a five-year jail sentence.

Ketamine is an anaesthetic used for operations on humans and animals that has become a popular recreational drug.

Home Office figures released in the summer showed that in the past year about 120,000 people aged 16-59 in England and Wales took ketamine, which is best known by the street names K, Special K and Vitamin K.

'Bladders removed'

Home Secretary Theresa May asked the Council to review the evidence on ketamine last year amid increased concern about its popularity and potential harm the drug can cause.

Continue reading the main story

"Molly", 25, is waiting for a bladder-stretching operation after damaging it by taking ketamine.

"It sounds a bit strange to say you're looking forward to an operation - but I'm hoping it'll be the start of an end.

"I have to go the toilet three times an hour. It takes me ages, and it's absolute agony.

"The only thing that takes that away is ketamine. It's sort of like a vicious cycle.

"I'm actually peeing blood - sizeable blood clots.

"Ketamine being Class C is completely ridiculous.

"It has not taken that long for me to completely ruin my bladder."

It has gathered new evidence suggesting some people are taking large amounts of ketamine every day, risking severe damage to their bladders.

In the most serious cases users have had to undergo surgery to have their bladders removed.

The council said the decision to reclassify ketamine was not unanimous, but was backed by a majority of its members.

The advisory group's chairman, Prof Les Iversen, said he was not sure if the home secretary would take their advice and reclassify the drug, saying: "I've learnt that you give advice and it's not always taken."

An upgrade from Class C to Class B means those found in possession of the drug would face up to five years in prison, up from two, and those caught supplying it up to 14 years prison or an unlimited fine.

The average prison sentence served for possession of a Class B drug in 2012 was just over two months, while people convicted of supply served an average of 17 months.

Other Class B drugs include amphetamines and cannabis.

The council also recommended that ministers consider tighter controls on the way the drug is stored by pharmacies and hospitals.

Prof David Nutt, a former government adviser, said that if rules on the legal use of ketamine were changed and it had to be kept under lock and key, vets would not be able to use the drug in the field and animals "will suffer".

He said there was no evidence the drug was being taken from clinical stores, "so there is absolutely no need for this change".

Prof Valerie Curran, professor of psychopharmacology at University College London, agreed, and added that she was pleased the medical community would be consulted before the final decision was made.

"Molly", 25, is waiting for an operation to stretch her bladder after she damaged it through ketamine use.

She said it was "agony" to go to the toilet, and there were often "sizeable blood clots" in her urine.

"Ketamine being Class C is completely ridiculous. It's not taken that long for me to completely ruin my bladder," she told the BBC's Newsbeat.

Please turn on JavaScript. Media requires JavaScript to play.

Ketamine users talk about the health problems they have experienced (first published July 2011)

First reports of ketamine being used as a recreational drug emerged soon after its release on to the market in 1965.

It gained popularity in the UK nightclub scene in the early 1990s as people bought it in the mistaken belief that it was ecstasy.

Ketamine is dose-specific, so the amount taken determines the level of effect.

It comes in various forms, most commonly as a powder, but also as a liquid and a tablet.

At low doses the user may feel euphoric, experience waves of energy, and possibly synaesthesia - sensations such as seeing sounds or hearing colours.

However, some evidence suggests that use of the drug has an effect on memory, which persists for longer than three days after use, and becomes worse for regular users of the drug.

Government figures suggest the number of ketamine-related deaths peaked at 21 in 2009, falling to six last year.

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IVF success 'downhill from age 37'

Written By Unknown on Minggu, 08 Desember 2013 | 21.24

6 December 2013 Last updated at 06:29 ET

The chances of a woman having a baby following IVF go "very rapidly downhill" from the age of 37, according to a study.

The University of Aberdeen study reports a woman's age affects the outcome of every single step of IVF.

Researchers studied data from 121,744 women from across the UK.

Continue reading the main story

We found that age impacted on every single hurdle that has to be overcome during the emotional rollercoaster that is IVF"

End Quote Prof Siladitya Bhattacharya University of Aberdeen

They found the chances of having a baby following IVF start to decline by the time the woman reaches her mid-30s, but especially from 37.

The team used data from women who underwent their very first cycle of IVF between 2000 and 2007 using their own eggs.

The research found that even after a pregnancy has been confirmed, women aged 38-39 were 43% more likely to have a miscarriage than women aged 18-34, while women aged 40-42 were almost twice as likely to lose the baby as the younger age group.

Prof Siladitya Bhattacharya, of the Reproductive Medicine team at the University of Aberdeen who led the research, said: "IVF comprises a number of key steps, each of which has to be successfully achieved before the next stage can be attempted.

"We found that age impacted on every single hurdle that has to be overcome during the emotional rollercoaster that is IVF.

"This influence of age is sustained at each stage of the IVF process.

"There is no point during an IVF treatment - even in women who have done well in a preceding stage - when age ceases to matter.

"Age has the capacity to increase the risk of treatment failure even in women who respond to hormonal treatment, have eggs harvested and embryos replaced."

'Dynamic' prediction

He concluded: "Many couples want to understand how their chances of having a baby evolve over the course of an IVF treatment.

"Previous work has been able to offer a global prediction of success in IVF.

"We hope our study provides a more accurate and dynamic way of predicting a couple's chances of treatment failure as they negotiate each step of IVF."

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Key NHS operations 'being rationed'

5 December 2013 Last updated at 19:32 ET By Nick Triggle Health correspondent, BBC News

The NHS in England appears to be rationing access to vital non-emergency hospital care, a review suggests.

The analysis by the Dr Foster research group looked at three key procedures - knee, hip and cataract operations.

For much of the past decade, patient numbers have been rising as would be expected with an ageing population.

But since 2010, the numbers have levelled off - with just one in eight areas now doing more hips and knees and one in five seeing rises in cataracts.

It comes amid mounting pressures on the health service.

The challenges facing A&E units have been well documented, but reports have also been emerging that non-emergency care is being squeezed too.

'Highly effective'

These findings - to be published on Monday in Dr Foster's annual hospital guide - provide perhaps the most comprehensive picture yet of what is happening.

The health care analysts looked at the number of operations being carried out for the three types of procedures - among the most life-enhancing done by the NHS - for the past decade.

It found virtually no change in the overall numbers over the past two years with the total numbers hovering around the 475,000 mark each year.

Hip replacements were the only treatment out of the three that were still going up - although the rate of increase has slowed.

Meanwhile, the number of cataract operations is at its lowest level for five years and 2012-13 saw the first fall in knee replacements for a decade.

Continue reading the main story

Cataracts - From 2002-03 to 2009-10 the numbers increased from 266,000 a year to a peak of just over 332,500, but since then they have fallen to under 322,000 - the lowest level for five years.
Knee replacements - The past year saw the first fall in numbers for a decade - albeit a small one - after the yearly total fell by 550 to just over 81,500 in 2012-13.
Hip replacements - The yearly total has continued to go up, but at a much slower rate of 2% a year on average since 2008. There were 71,000 operations carried out last year.

The review also provided details of what local areas were up to by looking at the individual figures for the 200-plus clinical commissioning groups which are now in charge of local health budgets.

'Very concerning'

The data showed that just 27 (13%) areas saw a significant rise in knee replacements over the past two years, 27 (13%) a rise for hip replacements and 40 (19%) a rise for cataracts.

Roger Taylor, co-founder of Dr Foster, said the findings suggested the squeeze on spending was having an impact on these "highly effective" treatments.

"There has been a sharp slow-down in activity. We are seeing some operations fall when normally we see them increasing by 4%, 5% or 6% a year."

Postcode search: Find out how your area is doing

The review will also highlight other areas of concern.

Dr Foster analysed data on what it called "ineffective operations".

These include procedures such as tonsillectomies and knee washouts where the benefits are marginal.

While overall the numbers being done had fallen by 8% in the past five years there are still 124 areas where their use has increased since 2010-11.

Mr Taylor added: "Money is being wasted on care that is of no benefit."

Colin Howie, vice president of the British Orthopaedic Association, said the findings were "very concerning".

"By trying to save money in the short term, it will cost the NHS and society in the long term. These are highly effective operations because they restore mobility and reduce disability.

"What is more, the research shows it is the most vulnerable in society - the elderly and poor - who are most likely to miss out."

A spokesman for NHS England said: "While the data raises important questions, we should be wary of leaping to the answers.

"Cataracts, knees and hip replacements are generally 'good' but it is still the case that they can be overused.

"We do a very significant number of these operations all over the country and it should not be taken as a given that this figure should automatically increase."

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Nelson Mandela: Aids campaigner

6 December 2013 Last updated at 06:35 ET

Though at first muted in his approach to the issues surrounding HIV/Aids, Nelson Mandela eventually became a dedicated and extremely effective advocate for a more vigorous approach to the disease.

When Mr Mandela was released from prison in February 1990, HIV/Aids had yet to make its full impact on South Africa.

Continue reading the main story

"Start Quote

We are facing a silent and invisible enemy that is threatening the very fabric of our society"

End Quote Nelson Mandela

Following his election as president four years later, Mr Mandela faced huge challenges and - like so many other world leaders at the time - failed to fully understand the depth of the problem and did little to help those with Aids.

At the time, the African National Congress (ANC) was gripped by an ongoing debate about both the causes of, and treatment for, Aids.

Some figures, like Thabo Mbeki, Mr Mandela's successor as president, openly questioned whether Aids was caused by HIV.

After Mr Mandela left office in 1999, he campaigned for more research into HIV/Aids, for education about safe sex and for better treatment for those affected. However, most South Africans still did not mention the disease in public.

Controversy within ANC

According to UN figures, the rate of HIV infection among adult South Africans rose from less than 1% in 1990 to about 17.9% by 2012.

South Africa is currently home to more people with the virus than any other country - 6.1 million of its citizens were infected with HIV in 2012, including 410,000 children (aged 0-14), out of a population of just over 51 million.

The causes of an epidemic on this scale have been many - primarily poverty, but also economic migration, the poor status of women, and unsafe sexual practices, have all contributed to the rapid spread of the disease.

Apart from the human misery caused by Aids, its economic impact has been huge, with South African economic growth rates badly affected.

Having put the issue of Aids on the back burner when in office, Mr Mandela began to make strong pronouncements on the subject after he stepped down in 1999.

Continue reading the main story

HIV/Aids in South Africa

People living with HIV: 6.1 million
Rate of infection in adults aged 15-49: 17.9%
Children aged 0-14 living with HIV: 410,000
Deaths due to Aids in 2012: 240,000
Orphans due to Aids aged 0-17: 2.5 million

Source: UNAids 2012

On World Aids Day in 2000, he sent out a hard-hitting message, saying: "Our country is facing a disaster of immeasurable proportions from HIV/Aids.

"We are facing a silent and invisible enemy that is threatening the very fabric of our society.

"Be faithful to one partner and use a condom... Give a child love, laughter and peace, not Aids."

Mr Mandela said his country should promote abstinence, the use of condoms, early treatment, counselling and drugs to reduce mother-to-child transmission.

Urgency

At the time, there was a marked reluctance on the part of the South African government to fund anti-retroviral drugs for those with HIV.

The then President Mbeki outraged many people when he told a US journalist that "personally, I don't know anybody who has died of Aids" and that he did not know if he had ever met anyone infected with HIV.

One of his ministers suggested that people with HIV eat garlic and beetroot to combat the infection.

In November 2003, Mr Mandela - and his Nelson Mandela Foundation - stepped up the campaign, launching an HIV/Aids fundraising campaign called 46664, after his prison number on Robben Island.

Continue reading the main story

1918 Born in the Eastern Cape

1943 Joined African National Congress

1956 Charged with high treason, but charges dropped after a four-year trial

1962 Arrested, convicted of incitement and leaving country without a passport, sentenced to five years in prison

1964 Charged with sabotage, sentenced to life

1990 Freed from prison

1993 Wins Nobel Peace Prize

1994 Elected first black president

1999 Steps down as leader

2001 Diagnosed with prostate cancer

2004 Retires from public life

2010 Last major public appearance at football World Cup in Johannesburg

He compared the urgency and drama of his country's struggle against HIV/Aids to the fight against apartheid.

Pop stars like Beyonce, Youssou N'Dour and Dave Stewart supported the campaign, and a star-studded concert, held in Cape Town in 2003, was seen by a worldwide television audience of two billion.

The money raised by Mr Mandela's initiatives has been used to fund research projects and provide practical support for South Africans with HIV/Aids.

The campaign received a further boost in 2005, when Mr Mandela shocked the nation by announcing that his son, Makgatho, had died of Aids.

He urged people to talk about HIV/Aids "to make it appear like a normal illness".

It was a significant move, which had a huge impact, said Michel Sidibe, head of the UN's Aids agency Unaids.

"The country has become a leader in the Aids response because of Mr Mandela, and is moving towards an Aids-free generation thanks to his campaigning," he said.

Mr Mandela also became a central figure in the African and global Aids movement, Mr Sidibe said.

"He was instrumental in laying the foundations of the modern Aids response and his influence helped save millions of lives and transformed health in Africa," he said.

"He was a statesman who had Aids at the top of his agenda and he used his stature and presence on the global stage to persuade world leaders to act decisively on Aids. His legacy will be felt by generations."

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IVF success 'downhill from age 37'

Written By Unknown on Sabtu, 07 Desember 2013 | 21.24

6 December 2013 Last updated at 06:29 ET

The chances of a woman having a baby following IVF go "very rapidly downhill" from the age of 37, according to a study.

The University of Aberdeen study reports a woman's age affects the outcome of every single step of IVF.

Researchers studied data from 121,744 women from across the UK.

Continue reading the main story

We found that age impacted on every single hurdle that has to be overcome during the emotional rollercoaster that is IVF"

End Quote Prof Siladitya Bhattacharya University of Aberdeen

They found the chances of having a baby following IVF start to decline by the time the woman reaches her mid-30s, but especially from 37.

The team used data from women who underwent their very first cycle of IVF between 2000 and 2007 using their own eggs.

"We found that age impacted on every single hurdle that has to be overcome during the emotional rollercoaster that is IVF.

"This influence of age is sustained at each stage of the IVF process.

"There is no point during an IVF treatment - even in women who have done well in a preceding stage - when age ceases to matter.

"Age has the capacity to increase the risk of treatment failure even in women who respond to hormonal treatment, have eggs harvested and embryos replaced."

'Dynamic' prediction

He concluded: "Many couples want to understand how their chances of having a baby evolve over the course of an IVF treatment.

"Previous work has been able to offer a global prediction of success in IVF.

"We hope our study provides a more accurate and dynamic way of predicting a couple's chances of treatment failure as they negotiate each step of IVF."

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Key NHS operations 'being rationed'

5 December 2013 Last updated at 19:32 ET By Nick Triggle Health correspondent, BBC News

The NHS in England appears to be rationing access to vital non-emergency hospital care, a review suggests.

The analysis by the Dr Foster research group looked at three key procedures - knee, hip and cataract operations.

For much of the past decade, patient numbers have been rising as would be expected with an ageing population.

But since 2010, the numbers have levelled off - with just one in eight areas now doing more hips and knees and one in five seeing rises in cataracts.

It comes amid mounting pressures on the health service.

The challenges facing A&E units have been well documented, but reports have also been emerging that non-emergency care is being squeezed too.

'Highly effective'

These findings - to be published on Monday in Dr Foster's annual hospital guide - provide perhaps the most comprehensive picture yet of what is happening.

The health care analysts looked at the number of operations being carried out for the three types of procedures - among the most life-enhancing done by the NHS - for the past decade.

It found virtually no change in the overall numbers over the past two years with the total numbers hovering around the 475,000 mark each year.

Hip replacements were the only treatment out of the three that were still going up - although the rate of increase has slowed.

Meanwhile, the number of cataract operations is at its lowest level for five years and 2012-13 saw the first fall in knee replacements for a decade.

Continue reading the main story

Cataracts - From 2002-03 to 2009-10 the numbers increased from 266,000 a year to a peak of just over 332,500, but since then they have fallen to under 322,000 - the lowest level for five years.
Knee replacements - The past year saw the first fall in numbers for a decade - albeit a small one - after the yearly total fell by 550 to just over 81,500 in 2012-13.
Hip replacements - The yearly total has continued to go up, but at a much slower rate of 2% a year on average since 2008. There were 71,000 operations carried out last year.