One-day career conference organised by Shared Services (formerly part of London Deanery)
Date : Friday 20 September 2013
Venue : Senate House, London University, Malet Street
The day includes practical sessions on the recruitment process, CV writing and preparing for interviews. 1:1 Rapid Review sessions with careers experts can be booked on the day.
Certificates of attendance will be issued to delegates who return a feedback form at the end of the conference. Certificates can be added to training portfolios.
Thursday, August 22, 2013
Thursday, July 18, 2013
The British Library e-journal collections
Although the British Library is open to those who has a genuine need to use its collections, most of its electronic resources and journal collections are only available from the BL workstations within the Library's Reading Rooms and Business & IP Centre, to access this resource you need to apply for a Reader Pass.
A Reader Pass will be given if you have a legitimate personal, work-related or academic research purpose or if the specialised material you wish to use is unavailable in other public or academic libraries.
You can apply in person at the Reader Registration office at the British Library's main site, 96 Euston Road, St Pancras, London NW1 2DB
You will need to bring identification : proof of home address and proof of signature.
Opening hours: 10am-8pm Monday; 9.30am-8pm Tuesday – Thursday; 9.30am-5pm Friday and Saturday
A Reader Pass will be given if you have a legitimate personal, work-related or academic research purpose or if the specialised material you wish to use is unavailable in other public or academic libraries.
You can apply in person at the Reader Registration office at the British Library's main site, 96 Euston Road, St Pancras, London NW1 2DB
You will need to bring identification : proof of home address and proof of signature.
Opening hours: 10am-8pm Monday; 9.30am-8pm Tuesday – Thursday; 9.30am-5pm Friday and Saturday
What are open access journals?
Open-access journals are scholarly journals available online to everyone without restriction. Most of these journals are available 12 months after publication but some are available immediately.
Some major sources of open access journals in biomedicine :
Some major sources of open access journals in biomedicine :
- PubMed Central® (PMC) : A free archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health's National Library of Medicine. Launched in February 2000, PMC is a repository for journal literature deposited by participating publishers as well as authors worldwide. Publishers and individual authors continue to hold copyright on their material in PMC and users must abide by the terms defined by the copyright holder.
- Europe PubMed Central :
The UK PubMed Central, mirrored on the US PMC was funded and developed by the Wellcome Trust and the British Library and available in January 2007. On 1 November 2012, it was rebranded Europe PubMed Central to reflect its wider international scope and content. This will increase the volume of open access material available to researchers, academics and the public. - BioMed Central
- Free Medical Journals Online Most titles are free 6 months after publication, some after a year.
Why we can't trust clinical guidelines - BMJ
Clinical guidelines are recommendations on the appropriate treatment and care of people with specific diseases and conditions. They are based on the best available evidence with the aim to help healthcare professionals in their work, but they do not replace their knowledge and skills.
A recent article published in the BMJ, written by a medical investigative journalist, raised the issue that despite repeated calls to limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists.
The article refers to the drug alteplase, a clot-busting drug given for acute stroke, the guideline recommendation was based on 12 studies, but only two of them found any benefit, and five of them had to be stopped early due to increased risk of brain haemorrhage or increased death rates.
Another example is the conflict between the 1990 guidelines recommending steroids for acute spinal injury and the 2013 cllinical recommendations against using steroids in acute spinal injury.
Based on a poll, the author finds that many doctors know that many guidelines are not supported by research evidence but would continue prescribing the treatment for the fear of "malpractice" or criticism by colleagues if they fail to follow the standard.
Another conflict of interest raised in the article is that many of the guideline committee members and panellists have strong ties with the industry and that their connection would have significant influence in deciding the best guidelines on good medical care and what doctors should prescribe. The author concluded that these problems are wide spread and this is the opportunity that the medical profession takes a long hard look at itself.
According to the BMJ website, this article is one of the most read and has sparkled a lot debate among the readers.
One of the responses came from the Delfini group (US) - saying that large number of physicians and others involved in health care decision-making may not understand that many research studies are not valid or reported sufficiently, they may also lack the skills to be able to critically appraise the research evidence. The remedy is ensuring the transparency in guidelines and that all guideline developers have basic critical appraisal skills.
Source : Jeanne Lenzer. Why we can’t trust clinical guidelines. BMJ 2013;346:f3998 (Published 19 June 2013) full text via Athens
Read all the responses
A recent article published in the BMJ, written by a medical investigative journalist, raised the issue that despite repeated calls to limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists.
The article refers to the drug alteplase, a clot-busting drug given for acute stroke, the guideline recommendation was based on 12 studies, but only two of them found any benefit, and five of them had to be stopped early due to increased risk of brain haemorrhage or increased death rates.
Another example is the conflict between the 1990 guidelines recommending steroids for acute spinal injury and the 2013 cllinical recommendations against using steroids in acute spinal injury.
Based on a poll, the author finds that many doctors know that many guidelines are not supported by research evidence but would continue prescribing the treatment for the fear of "malpractice" or criticism by colleagues if they fail to follow the standard.
Another conflict of interest raised in the article is that many of the guideline committee members and panellists have strong ties with the industry and that their connection would have significant influence in deciding the best guidelines on good medical care and what doctors should prescribe. The author concluded that these problems are wide spread and this is the opportunity that the medical profession takes a long hard look at itself.
According to the BMJ website, this article is one of the most read and has sparkled a lot debate among the readers.
One of the responses came from the Delfini group (US) - saying that large number of physicians and others involved in health care decision-making may not understand that many research studies are not valid or reported sufficiently, they may also lack the skills to be able to critically appraise the research evidence. The remedy is ensuring the transparency in guidelines and that all guideline developers have basic critical appraisal skills.
Source : Jeanne Lenzer. Why we can’t trust clinical guidelines. BMJ 2013;346:f3998 (Published 19 June 2013) full text via Athens
Read all the responses
Is using surgical death rates the best way to assess performance - The Lancet
The NHS England made public the mortality rates of 7 types of surgery for individual surgeons last week by publishing the data on the NHS Choices website with the aim that it would provide transparency, help patients choose their surgeons and improve the quality of care.
However a study carried out by researchers at the London School of Hygiene & Tropical Medicine, published in the Lancet, said concentrating on the death rates for individual surgeons will not spot poor performance in certain fields and could lead to "false complacency".
The researchers argued that for some specialties, the number of procedures that a surgeon does annually is low, so the chance of identifying poor performance is also low. Based on the number of surgeries performed over 3 years, they found that 75% of UK heart surgeons perform sufficient procedures to give 60% power to use death rate to identify the poor peformance, 56% perfom enough procedures to give 80% power. However, for other procedures, the number of surgeons performing enough surgeries is much lower, eg for bowel resection, only 17% of surgeons perform enough of these surgeries to give 60% power to use death rate to identify the poor peformance and no surgeons perofrm enough surgeries to give 80% power.
They also noted that experienced surgeons my be more likely to operate in high- risk cases that may have much higher risk of mortality, this does not necessarily indicate poor performance of these surgeons.
The authors recommended a number of options to assess performance more reliably including pooling death data over a longer period of time, pooling death rates within specialties or per hospital. Other patient outcomes, such as post-operative bleeding, bleeding, infection, pain , further surgery or readmission could also provide better assessment of surgical performance.
Source: Walker K, Neuburger J, Groene O, et al. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. The Lancet. Published online July 5 2013 ( f/t via Athens)
However a study carried out by researchers at the London School of Hygiene & Tropical Medicine, published in the Lancet, said concentrating on the death rates for individual surgeons will not spot poor performance in certain fields and could lead to "false complacency".
The researchers argued that for some specialties, the number of procedures that a surgeon does annually is low, so the chance of identifying poor performance is also low. Based on the number of surgeries performed over 3 years, they found that 75% of UK heart surgeons perform sufficient procedures to give 60% power to use death rate to identify the poor peformance, 56% perfom enough procedures to give 80% power. However, for other procedures, the number of surgeons performing enough surgeries is much lower, eg for bowel resection, only 17% of surgeons perform enough of these surgeries to give 60% power to use death rate to identify the poor peformance and no surgeons perofrm enough surgeries to give 80% power.
They also noted that experienced surgeons my be more likely to operate in high- risk cases that may have much higher risk of mortality, this does not necessarily indicate poor performance of these surgeons.
The authors recommended a number of options to assess performance more reliably including pooling death data over a longer period of time, pooling death rates within specialties or per hospital. Other patient outcomes, such as post-operative bleeding, bleeding, infection, pain , further surgery or readmission could also provide better assessment of surgical performance.
Source: Walker K, Neuburger J, Groene O, et al. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. The Lancet. Published online July 5 2013 ( f/t via Athens)
Thursday, April 11, 2013
Books for FRCA exam
Suggested books for FRCA exam :
Access to anaesthetics. Primary FRCA,; Pocket book 1, 2 3. Pharmacology and clinical MCQs / Kirsty MacLennan. 2007
Clinical notes for the FRCA / Charles D. Deakin. - 3rd ed. 2011
Dr Podcast scripts for the Final FRCA / edited by Rebecca A. Leslie ... [et al.]. 2011
MCQs for the primary FRCA / B.S.K. Kamath, Sarah Turle. 2010
MCQs for the primary FRCA / Khaled Elfituri ... [et al.] ; Tony Bailey, illustrations. 2010
SAQs for the final FRCA / James R. Shorthouse, Graham Barker, Carl Waldmann. 2011
SBA and MTF MCQs for the primary FRCA / James Nickells, Benjamin Walton.2012
SBAs and MCQs for the final FRCA / edited by Rakesh Tandon. 2012
SBAs for the final FRCA / James Nickells, Tobias Everett, Benjamin Walton. 2010
Structured oral examination practice for the final FRCA / edited by Rakesh Tandon. 2012
Total revision for the FRCA / James Holding, Sarah Chieveley-Williams, Tim Isitt. - 2nd ed. 2007
Total revision for the primary FRCA / Yogen Amin ... [et al.]. - 2nd ed. 2007
Access to anaesthetics. Primary FRCA,; Pocket book 1, 2 3. Pharmacology and clinical MCQs / Kirsty MacLennan. 2007
Clinical notes for the FRCA / Charles D. Deakin. - 3rd ed. 2011
Dr Podcast scripts for the Final FRCA / edited by Rebecca A. Leslie ... [et al.]. 2011
MCQs for the primary FRCA / B.S.K. Kamath, Sarah Turle. 2010
MCQs for the primary FRCA / Khaled Elfituri ... [et al.] ; Tony Bailey, illustrations. 2010
SAQs for the final FRCA / James R. Shorthouse, Graham Barker, Carl Waldmann. 2011
SBA and MTF MCQs for the primary FRCA / James Nickells, Benjamin Walton.2012
SBAs and MCQs for the final FRCA / edited by Rakesh Tandon. 2012
SBAs for the final FRCA / James Nickells, Tobias Everett, Benjamin Walton. 2010
Structured oral examination practice for the final FRCA / edited by Rakesh Tandon. 2012
Total revision for the FRCA / James Holding, Sarah Chieveley-Williams, Tim Isitt. - 2nd ed. 2007
Total revision for the primary FRCA / Yogen Amin ... [et al.]. - 2nd ed. 2007
Tuesday, March 19, 2013
Patients consciousness during surgery
According to the NewScientists, anaesthesia wears off in about 0.02% of surgeries worldwide. In 2008, a study conducted by Washington University School of Medicine in St. Louis found that around 30,000 Americans a year awaken during surgical procedures, more often in children, sometimes experiencing intense pain and terror.
Researchers at the Massachusetts Institute of Technology (MIT) led by Emery Brown used an EEG cap with 64 electrodes to keep track of patients' brain activity across multiple brain regions as unconsciousness was induced using general anaesthetic. The team identified patterns related to consciousness and unconsciousness, and were thereby able to determine when a patient was waking up.
In the UK, about 2 % of hospitals do EEG monitoring during surgery, but only 3 or 4 electrodes are used. It only monitors one region of the brain, but the MIT team’s 64-electrode cap could bring new insight into patients’ levels of awareness during surgery, although it requires patients to shave their heads and EEG measurements are very sensitive to mechanical and electrical interference. The technique is not yet available in clinical settings.
Source: Consciousness signature warns of awareness during surgery. New Scientists, March 2013
Fewer patients awake during surgery
A new report published by the Royal College of Anaesthetists found that 153 cases of accidental awareness reported in 2011 across the UK, about 1 in every 15,000 general anaesthetics, a lot less than had been thought. Previous study found that about 1 in 500 patients were aware or awake under general anaesthetics. However, the leader of the new report, Professor Jaideep Pandit, says that under-reporting is possible partly because anaesthetists do not routinely see patients after an operation, so may not be aware of the awareness report. Sometimes patients do not report the incident.
Pandit says brain monitoring systems are available in about two-thirds of UK hospitals, but most anesthesiologists do not use them and there is a debate over how useful the monitors are. He is planning more research to focus on patient experience.
Source: Pandit JJ, Cook TM, Jonker WR, et al. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. British Journal of Anaesthesia. Published online March 13 2013
Researchers at the Massachusetts Institute of Technology (MIT) led by Emery Brown used an EEG cap with 64 electrodes to keep track of patients' brain activity across multiple brain regions as unconsciousness was induced using general anaesthetic. The team identified patterns related to consciousness and unconsciousness, and were thereby able to determine when a patient was waking up.
In the UK, about 2 % of hospitals do EEG monitoring during surgery, but only 3 or 4 electrodes are used. It only monitors one region of the brain, but the MIT team’s 64-electrode cap could bring new insight into patients’ levels of awareness during surgery, although it requires patients to shave their heads and EEG measurements are very sensitive to mechanical and electrical interference. The technique is not yet available in clinical settings.
Source: Consciousness signature warns of awareness during surgery. New Scientists, March 2013
Fewer patients awake during surgery
A new report published by the Royal College of Anaesthetists found that 153 cases of accidental awareness reported in 2011 across the UK, about 1 in every 15,000 general anaesthetics, a lot less than had been thought. Previous study found that about 1 in 500 patients were aware or awake under general anaesthetics. However, the leader of the new report, Professor Jaideep Pandit, says that under-reporting is possible partly because anaesthetists do not routinely see patients after an operation, so may not be aware of the awareness report. Sometimes patients do not report the incident.
Pandit says brain monitoring systems are available in about two-thirds of UK hospitals, but most anesthesiologists do not use them and there is a debate over how useful the monitors are. He is planning more research to focus on patient experience.
Source: Pandit JJ, Cook TM, Jonker WR, et al. A national survey of anaesthetists (NAP5 Baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. British Journal of Anaesthesia. Published online March 13 2013
Monday, March 18, 2013
Patient safety strategies - a call for physician leadership
According to the editorial articles in the March issue of the Annals of Internal Medicine , tens of thousands of patients die each year in the US of diagnostic errors, teamwork and communiction errors and failure to receive evidence-based interventions.
A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.
The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .
They recommended 10 patient safety strategies for immediate implementation.
Preoperative and anesthesia checklists
Bundles
that include checklists to prevent central line-associated bloodstream infections
Interventions to reduce urinary catheter use
Bundles of various strategies to prevent ventilator-associated pneumonia
Hand hygiene
The do-not-use list for hazardous abbreviations
Interventions to reduce pressure ulcers
Barrier precautions to prevent infections
Use of real-time ultrasonography for central line placement
Interventions to improve prophylaxis for venous thromboembolisms.
Other recommendations include developing interventions that focus on fall prevention, limiting adverse drug reactions, medication reconciliation, reducing radiation exposure from unnecessary medical procedures and developing better informed consent policies.
To read the free f/t articles :Editorial
Making Health Care Safer: A Critical Review of Evidence Supporting Strategies to Improve Patient Safety
A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.
The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .
They recommended 10 patient safety strategies for immediate implementation.
To read the free f/t articles :Editorial
- Strategies to improve patient safety: the evidence base matures
- Patient safety strategies: a call for physician leadership
Patient satisfaction - BMJ article
The patient satisfaction chasm: the gap between hospital management and frontline clinicians
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012 (f/t via Athens)
Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.
Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.
Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.
Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012 (f/t via Athens)
Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.
Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.
Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.
Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.
Tuesday, July 31, 2012
Most severely obese children have cardiovascular risk
A new study published in Archives of Disease in Childhood suggested that two thirds of severely obese children have at least one cardiovascular risk factor.
The findings were based on data from the Dutch Paediatric Surveillance Unit on children aged 2-18 between 2005 an d 2007. Paediatricians were asked to report information on children's cardiovascular risk factors - high blood pressure, fasting blood glucose levels and blood fats.
The study found that 307 out of 363 children were correctly classified severely obese, 52% were boys and they tended to be more severely obese at younger age but girls were obese at older age. Nearly 1 in 3 severely obese children came from single parent family. 67% had at least 1 cardiovascular risk factor, 56% had hypertension and 54% had high levels of bad cholesterol, 14% had high fasting blood glucose, and 1% already had type 2 diabetes. The authors said "high prevalence of hypertension and abnormal lipids may lead to cardiovascular disease in young adulthood.”
Critics noted some limitatons to the study, eg, a lack of internationally agreed criteria for diagnosing severe obesity in children, the difficulty of generalising the study results to other populations due to the small size of the study, the ethnicities of the children might also have an effect on the results.
Source: Van Emmerik NMA, Renders CM, van de Veer M, et al. High cardiovascular risk in severely obese young children and adolescents. Archives of Disease in Childhood. Published online July 23, 2012
(full text via Athens)
The findings were based on data from the Dutch Paediatric Surveillance Unit on children aged 2-18 between 2005 an d 2007. Paediatricians were asked to report information on children's cardiovascular risk factors - high blood pressure, fasting blood glucose levels and blood fats.
The study found that 307 out of 363 children were correctly classified severely obese, 52% were boys and they tended to be more severely obese at younger age but girls were obese at older age. Nearly 1 in 3 severely obese children came from single parent family. 67% had at least 1 cardiovascular risk factor, 56% had hypertension and 54% had high levels of bad cholesterol, 14% had high fasting blood glucose, and 1% already had type 2 diabetes. The authors said "high prevalence of hypertension and abnormal lipids may lead to cardiovascular disease in young adulthood.”
Critics noted some limitatons to the study, eg, a lack of internationally agreed criteria for diagnosing severe obesity in children, the difficulty of generalising the study results to other populations due to the small size of the study, the ethnicities of the children might also have an effect on the results.
Source: Van Emmerik NMA, Renders CM, van de Veer M, et al. High cardiovascular risk in severely obese young children and adolescents. Archives of Disease in Childhood. Published online July 23, 2012
(full text via Athens)
Wednesday, July 25, 2012
Increasing dietary antioxidant intake could cut pancreatic cancer risk
According to a new study published in Gut, more than 250,000 people die from pancreatic cancer each year around the world and only 3% - 5% of the patients survive beyond 5 years. It is difficult to detect and often not diagnosed until it is advanced. Smoking and type 2 diabetes are major risk factors, the researchers thought diet may have an impact in the incidence of the cancer.
The researchers examined data from the Norfolk arm of the European Prospective Investiagtion of Cancer (EPIC) study investigating the lifestyle and dietary factors associated with pancreatic cancer, including more than 23,600 participants aged 40 - 74 between 1993 and 1997. All participants had completed a comprehensive food diary tracking the type of food and amount they ate during a 7 day period, as welll as the methods they used to prepare the food, the nutrient value of each person is calculated. The nutrient intakes of the pancreatic cancer patients were comapred with 4000 healthy individuals to see if there were any difference.
The researchers found that within 10 years entering thte study, 49 developed pancreatic cancer, increased to 86 by 2010. They survived 6 months after diagnosis on average. Those eating a combination of the highest three quartiles of all of vitamins C and E and selenium had a decreased risk of pancreatic cancer. Researchers said the finding is not a chance finding, if the association is causal, 1 in 12 cancers might be prevented by avoiding the lowest intakes, but they point out that the study cannot show it is causal link therefore the need for studies in other populations.
Critics say it is important to note that the study only found a correlation with pancreatic cancer risk in people taking very low levels of these antioxidants. High levels of intake was not better than moderate levels of consumption. Too high levels of intake of these supplements and other vitamins and minerals are associated with different types of danger, people should seek advice before making changes to food or dietary supplement intake.
Source: Dietary antioxidants and the aetiology of pancreatic cancer: a cohort study using data from food diaries and biomarkers. Gut 2012, doi:10.1136/gutjnl-2011-301908 Full text via Athens.
The researchers examined data from the Norfolk arm of the European Prospective Investiagtion of Cancer (EPIC) study investigating the lifestyle and dietary factors associated with pancreatic cancer, including more than 23,600 participants aged 40 - 74 between 1993 and 1997. All participants had completed a comprehensive food diary tracking the type of food and amount they ate during a 7 day period, as welll as the methods they used to prepare the food, the nutrient value of each person is calculated. The nutrient intakes of the pancreatic cancer patients were comapred with 4000 healthy individuals to see if there were any difference.
The researchers found that within 10 years entering thte study, 49 developed pancreatic cancer, increased to 86 by 2010. They survived 6 months after diagnosis on average. Those eating a combination of the highest three quartiles of all of vitamins C and E and selenium had a decreased risk of pancreatic cancer. Researchers said the finding is not a chance finding, if the association is causal, 1 in 12 cancers might be prevented by avoiding the lowest intakes, but they point out that the study cannot show it is causal link therefore the need for studies in other populations.
Critics say it is important to note that the study only found a correlation with pancreatic cancer risk in people taking very low levels of these antioxidants. High levels of intake was not better than moderate levels of consumption. Too high levels of intake of these supplements and other vitamins and minerals are associated with different types of danger, people should seek advice before making changes to food or dietary supplement intake.
Source: Dietary antioxidants and the aetiology of pancreatic cancer: a cohort study using data from food diaries and biomarkers. Gut 2012, doi:10.1136/gutjnl-2011-301908 Full text via Athens.
Tuesday, July 24, 2012
Surgery may not be the best for prostate cancer
According to a 15-year study., most patient diagnosed with prostate cancer at a very early stage will choose surgery or radiation treatments with the adverse effects of impotence or incontinence. About 10% choose no treatment at all, this is called watchful waiting or active surveillance or expectant management, normally not recommended by their doctors. The study, published in New England Journal of Medicine, found that patients with early stage prostate cancer survived the disease whether they opt for surgery or not.
731 men diagnosed with prostate cancer after having high PSA levels were randomly assigned to radical prostatectomy or observation and followed through January 2010. They found that radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation. More than 1 in 5 in the surgery group had adverse effects from their operation.
The study suggests that most prostate cancers are not life-threatening, but most patients are given radical prostatectomy and they believe that treatment will eliminate the risk. Many men report pressurised by their doctors and families to seek aggressive treatment. The lead author of the study said the study shows that observation can be a wise and preferred option for most men diagnosed with prostate cancer detected with PSA.
However not all experts agree with the study's conclusion, but all feel that more research is needed to identify which cancer would be harmless and slow-growing. Some said that education and teaching is needed to understand the concept that not all cancers are the same.
Source : Radical Prostatectomy versus Observation for Localized Prostate Cancer. New England Journal of Medicine 2012; 367:203-213 (July 19, 2012), Abstract only, full text via Athens 90 days after publication.
731 men diagnosed with prostate cancer after having high PSA levels were randomly assigned to radical prostatectomy or observation and followed through January 2010. They found that radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation. More than 1 in 5 in the surgery group had adverse effects from their operation.
The study suggests that most prostate cancers are not life-threatening, but most patients are given radical prostatectomy and they believe that treatment will eliminate the risk. Many men report pressurised by their doctors and families to seek aggressive treatment. The lead author of the study said the study shows that observation can be a wise and preferred option for most men diagnosed with prostate cancer detected with PSA.
However not all experts agree with the study's conclusion, but all feel that more research is needed to identify which cancer would be harmless and slow-growing. Some said that education and teaching is needed to understand the concept that not all cancers are the same.
Source : Radical Prostatectomy versus Observation for Localized Prostate Cancer. New England Journal of Medicine 2012; 367:203-213 (July 19, 2012), Abstract only, full text via Athens 90 days after publication.
The cost of knowledge
The British Government announced on Tuesday 16 July 2012 that scientific research funded by British taxpayers' money will be free to access online by 2014, The Guardian reported. The announcement was made in response to the Finch Report that was commissioned by the Wellcome Trust in April 2012 to find a solution for open access to scientific research following the "academic spring" where thousands of researchers protested to boycot journals that publishers charged academic institutions high subscription fees for access.
The "academic spring" was sparked by a blog article posted in January this year by Tim Gowers, a distinguished mathematician at Cambridge University and winner of Fields Medal, unhappy with the high charges imposed by publishers on UK universities for access to research work produced by his peers and largely funded by taxpayers, therefore decided to decline to submit or review papers for any academic journals published by Elsevier.
Hundreds of supporting comments were posted to him, one of his readers set up a website for academics to register their protest against Elsevier. More than 12,000 signatories have now been collected of which more than 800 are medical researchers, committed to refuse to peer review , submit or undertake editorial work for Elsevier journals. Elsevier publsihes more than 2000 journals, eg Science Direct journals.
In April this year, Harvard University informed its teaching and research staff that it could no longer afford the high prices imposed by many large journal publishers and encouraged its staff to submit their research to open access journals and resign from editorial boards that keep articles behind paywalls. The Univeristy said that the current system of journal pricing and access policies is unsustainable and universities will need to work together to take control of the scholarly publishing.
In the current publishing model, researchers submit articles to journal editors, the manuscript is sent for peer review, usually unpaid. If the work is accepted, it is published and then sold back to university libraries and other subscribers.
Advocates of open access argue that public-funded scientific research should be made freely available to the wider public and for economic benefits. However, one of the barriers of adopting the open access model is that, apart from the publishers and prices, research grants in the UK are distrbuted to universiities on their publication records, the more articles the academics get published in prestigious journals, the higher the chance of funding opportunities for their universities or departments, so some may be relunctant to move to open access publishing.
It is estimated that UK universities spend about £200m a year for purchasing access to the scientific journals, unfortunately many are restricted by the licence agreement with publishers to extend the journal access to their affiliated NHS organisations, NHS hospitals will have to pay for their journal access. In 2008, the British Government officially formed 5 academic health science centres (AHSC), these are partnerships between a university and NHS Trust with the aim to improve the quality of health services by bringing research, educaton and patient care closer together. The AHSCs should use the collective bargaining power with publishers to strike a deal to address the issue of HE/NHS inequality of access to electronic library resources.
If you are NHS doctors, authors and users of journal articles, would you consider following Harvard's action?
The "academic spring" was sparked by a blog article posted in January this year by Tim Gowers, a distinguished mathematician at Cambridge University and winner of Fields Medal, unhappy with the high charges imposed by publishers on UK universities for access to research work produced by his peers and largely funded by taxpayers, therefore decided to decline to submit or review papers for any academic journals published by Elsevier.
Hundreds of supporting comments were posted to him, one of his readers set up a website for academics to register their protest against Elsevier. More than 12,000 signatories have now been collected of which more than 800 are medical researchers, committed to refuse to peer review , submit or undertake editorial work for Elsevier journals. Elsevier publsihes more than 2000 journals, eg Science Direct journals.
In April this year, Harvard University informed its teaching and research staff that it could no longer afford the high prices imposed by many large journal publishers and encouraged its staff to submit their research to open access journals and resign from editorial boards that keep articles behind paywalls. The Univeristy said that the current system of journal pricing and access policies is unsustainable and universities will need to work together to take control of the scholarly publishing.
In the current publishing model, researchers submit articles to journal editors, the manuscript is sent for peer review, usually unpaid. If the work is accepted, it is published and then sold back to university libraries and other subscribers.
Advocates of open access argue that public-funded scientific research should be made freely available to the wider public and for economic benefits. However, one of the barriers of adopting the open access model is that, apart from the publishers and prices, research grants in the UK are distrbuted to universiities on their publication records, the more articles the academics get published in prestigious journals, the higher the chance of funding opportunities for their universities or departments, so some may be relunctant to move to open access publishing.
It is estimated that UK universities spend about £200m a year for purchasing access to the scientific journals, unfortunately many are restricted by the licence agreement with publishers to extend the journal access to their affiliated NHS organisations, NHS hospitals will have to pay for their journal access. In 2008, the British Government officially formed 5 academic health science centres (AHSC), these are partnerships between a university and NHS Trust with the aim to improve the quality of health services by bringing research, educaton and patient care closer together. The AHSCs should use the collective bargaining power with publishers to strike a deal to address the issue of HE/NHS inequality of access to electronic library resources.
If you are NHS doctors, authors and users of journal articles, would you consider following Harvard's action?
Thursday, July 12, 2012
BNF free app for NHS Athens users
An official BNF app has been launched by NICE and is now available as a free download for anyone with an NHS Athens account who uses Android and iPhone smartphones or iPod touch. Users will need to enter their NHS Athens details to activate the content.
The BNF app offers access to the latest prescribing information from the BNF at the touch of a button and allows for browsing, searching BNF content, and receiving updates. Once downloaded, the app can be run without an internet connection meaning that professionals can access the BNF wherever they are.
Eligible health and care professionals in England who do not yet have an NHS Athens password can register directly from their Smartphone by following the instruction displayed in Apple App store and
To use the NICE BNF app for the first time, you will need to:
3. Enter your NHS Athens username and password
For help or further details, ask the librarian at your NHS Trust.
The BNF app offers access to the latest prescribing information from the BNF at the touch of a button and allows for browsing, searching BNF content, and receiving updates. Once downloaded, the app can be run without an internet connection meaning that professionals can access the BNF wherever they are.
Eligible health and care professionals in England who do not yet have an NHS Athens password can register directly from their Smartphone by following the instruction displayed in Apple App store and
To download the app on Android, users will require the minimum operating system: 2.3.3 and up. Iphone and Ipod touch users will require the minimum operating system: iOS 4.3 or later.
To use the NICE BNF app for the first time, you will need to:
1. Click on 'Sign in'
2. You will be asked to sign in with your NHS Athens account. 3. Enter your NHS Athens username and password
4. If you do not have an Athens account, click Register.
5. Click Sign in again.
6. Downloading to device may take up to 10 minutes
For help or further details, ask the librarian at your NHS Trust.
Monday, December 05, 2011
Resources for GP AKT exams
The following resources may be of interest to GP trainees preparing for the AKT exam.
RCGP AKT sample questions - November 2011
GPST Society - run by the GP trainees in South-East Scotland to support other trainees in the area. The resources include guides and tips on passing the AKT exam, suggestions of useful resources etc, would be useful to GP trainees in other parts of UK.
gpst.info - run by Dr Mahibur Rahman, a GP who works in Birmingham, also the director of a commercial website, Emedica. The gpst.info website has some free MCQ questions for MRCP and tips for assessment, also advertisements about Emedica.
Books via Athens - click on books@ovid
Oxford Handbook series including : Oxford Handbook of General Practice. 3rd ed. and Oxford Textbook of Primary Medical Care. 1st ed.
BMJ Learning - GP trainee ( access via Athens )
Useful journal via PubMed Central (UK) - free open access
British Journal of General Practitionrs - 12 months after publication
BMJ Careers free articles : written by GP trainees
MRCGP applied knowledge test
MRCGP examination: applied knowledge test and clinical skills assessment
GP exam to change - July 2010
See also post on MRCP, MRCS free exam questions
RCGP AKT sample questions - November 2011
GPST Society - run by the GP trainees in South-East Scotland to support other trainees in the area. The resources include guides and tips on passing the AKT exam, suggestions of useful resources etc, would be useful to GP trainees in other parts of UK.
gpst.info - run by Dr Mahibur Rahman, a GP who works in Birmingham, also the director of a commercial website, Emedica. The gpst.info website has some free MCQ questions for MRCP and tips for assessment, also advertisements about Emedica.
Books via Athens - click on books@ovid
Oxford Handbook series including : Oxford Handbook of General Practice. 3rd ed. and Oxford Textbook of Primary Medical Care. 1st ed.
BMJ Learning - GP trainee ( access via Athens )
Useful journal via PubMed Central (UK) - free open access
British Journal of General Practitionrs - 12 months after publication
BMJ Careers free articles : written by GP trainees
MRCGP applied knowledge test
MRCGP examination: applied knowledge test and clinical skills assessment
GP exam to change - July 2010
See also post on MRCP, MRCS free exam questions
Tuesday, November 01, 2011
Living Books About Life - free ebooks
"Living Books About Life" is a collaboration between Open Humanities Press and 3 academic institutions: Coventry University, Goldsmiths, University of London, and University of Kent.
Funded by the Joint Information Systems Committee (JISC), 21 living books are created and published by Open Humanities Press (OHP), the unifying theme is life: e.g., air, agriculture, bioethics, cosmetic surgery, electronic waste, energy, neurology and pharmacology.
The editors said that the series represents an exciting new model for publishing, in a sustainable and low-cost manner in the future. These books can be freely shared with other academic and non-academic institutions and individuals. They constitute an engaging resource for researching and teaching relevant science issues across the humanities, a resource that is capable of enhancing the intellectual and pedagogic experience of working with open access materials.
All the books in the series are open to ongoing collaborative processes of writing, editing, updating, remixing and commenting by readers, thus engaged in rethinking ‘the book’ itself as living.
The attributions/bibliography of each book often links to free full-text, some have video clips added. You may be able to download these books to e-book readers such as Kindle and the iPad!
Funded by the Joint Information Systems Committee (JISC), 21 living books are created and published by Open Humanities Press (OHP), the unifying theme is life: e.g., air, agriculture, bioethics, cosmetic surgery, electronic waste, energy, neurology and pharmacology.
The editors said that the series represents an exciting new model for publishing, in a sustainable and low-cost manner in the future. These books can be freely shared with other academic and non-academic institutions and individuals. They constitute an engaging resource for researching and teaching relevant science issues across the humanities, a resource that is capable of enhancing the intellectual and pedagogic experience of working with open access materials.
All the books in the series are open to ongoing collaborative processes of writing, editing, updating, remixing and commenting by readers, thus engaged in rethinking ‘the book’ itself as living.
The attributions/bibliography of each book often links to free full-text, some have video clips added. You may be able to download these books to e-book readers such as Kindle and the iPad!
Thursday, October 27, 2011
Breast cancer screening review
Yesterday, the media reported that following an open letter by Susan Bewley, professor of complex obstetrics at King's College London, to the government's cancer chief, an independent investigation into breast cancer screening has been set up to try to settle the growing controversy around its benefits and potential harms.
The NHS Breast Cancer Screening Programme began in 1988 and claimed that the scientific evidence demonstrates clearly that regular mammographic screening between the ages of 50 and 70 reduces mortality from the malignancy.
The 1st systematic review of breast cancer screening came from the Nordic Cochrane Centre, part of the Cochrane Collaboration, published in The Lancet in 2000. The review was based of 8 large RCTs with more than 182,000 women in the Nordic countries. The authors found that the quality of the trials were low and the data showed that for every 1000 women screened biennially throughout 12 years, only 1 breast-cancer death was avoided whereas the total number of deaths was increased by 6. The authors concluded that "Screening for breast cancer with mammography is unjustified".
The most recent update of this review was published on 19 January 2011. The authors said that it is not clear whether screening does more good than harm and women invited to screening should be fully informed of both the benefits and harms.
Source: Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2011, Issue 1
The NHS Breast Cancer Screening Programme began in 1988 and claimed that the scientific evidence demonstrates clearly that regular mammographic screening between the ages of 50 and 70 reduces mortality from the malignancy.
The 1st systematic review of breast cancer screening came from the Nordic Cochrane Centre, part of the Cochrane Collaboration, published in The Lancet in 2000. The review was based of 8 large RCTs with more than 182,000 women in the Nordic countries. The authors found that the quality of the trials were low and the data showed that for every 1000 women screened biennially throughout 12 years, only 1 breast-cancer death was avoided whereas the total number of deaths was increased by 6. The authors concluded that "Screening for breast cancer with mammography is unjustified".
The most recent update of this review was published on 19 January 2011. The authors said that it is not clear whether screening does more good than harm and women invited to screening should be fully informed of both the benefits and harms.
Source: Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2011, Issue 1
Monday, July 25, 2011
Do we need to drink 8 glasses of water a day?
A Scottish GP, Margaret McCarthney, wrote a feature article in the BMJ last week that the common recommendation to drink 6 to 8 glasses of water a day is "debunked nonsense", as a result, hundreds of comments, some agreeing, many disagreeing, were sent to the BMJ and other media.
The GP argued that there is no high quality evidence to support the recommendation and that too much water can lead to hyponatremia and other problems. She said that the "Hydration for Health" initiative, sponsored by Danone, maker of bottled water Volvic and Evian, has vested interests to re-inforce the myth. Dr McCarthney argued that reports that drinking more water can improve concentration and mental performance in kids have lacked evidence and that Hydration for Health has oversold the benefits of drinking more water without clear evidence to support it. "We should just say no", she said.
An expert noted that there is well established literature on the negative effects of dehydration on mental skills in adults and children. Another said that the author failed to mention an important US report(2004) that reviewed all studies.
Dr McCartheny argued that her article was to examine the evidence of the benefits that Danone claimed via "Hydration for Health" and was not a systematic review on the subject and she did not imply that it is dangerous for children to drink 6-8 glasses of water a day.
Source: Waterlogged? BMJ 2011; 343:d4280 doi: 10.1136/bmj.d4280 (Published 12 July 2011) , full text via Athens
The GP argued that there is no high quality evidence to support the recommendation and that too much water can lead to hyponatremia and other problems. She said that the "Hydration for Health" initiative, sponsored by Danone, maker of bottled water Volvic and Evian, has vested interests to re-inforce the myth. Dr McCarthney argued that reports that drinking more water can improve concentration and mental performance in kids have lacked evidence and that Hydration for Health has oversold the benefits of drinking more water without clear evidence to support it. "We should just say no", she said.
An expert noted that there is well established literature on the negative effects of dehydration on mental skills in adults and children. Another said that the author failed to mention an important US report(2004) that reviewed all studies.
Dr McCartheny argued that her article was to examine the evidence of the benefits that Danone claimed via "Hydration for Health" and was not a systematic review on the subject and she did not imply that it is dangerous for children to drink 6-8 glasses of water a day.
Source: Waterlogged? BMJ 2011; 343:d4280 doi: 10.1136/bmj.d4280 (Published 12 July 2011) , full text via Athens
Wednesday, July 13, 2011
Provenge therapy for advanced prostate cancer
Prostate cancer is one of the most common malignancy in North American males causing more than 30,000 deaths each year, up to 30% experience recurrence.
Chemotherapy and hormonal therapy are the usual treatment available to these patients, but many patients have progressed to castrate-resistant prostate cancer (CRPC) and chemotherapy has significant side effects.
A new study was published online in the journal Maturitas in May about a novel therapeutic cancer vaccine, Sipuleucel-T, or Provenge, produced by Dendreon Ltd, for the treatment of CRPC after randomized trials showed significant survival advantage compared to controls.
In April 2010, the US FDA approved the vaccine therapy for advanced prostate cancer that has failed to respond to hormone therapy. The therapy involves taking the patient's own immune cells, externally activated against prostate cancer antigen PAP and infuse back into the patient. The patient's own immune system will then create T-cells to attack these cells.
Provenge does not cure prostate cancer but trials show that it extends survival by 4 months or years for some patients. Phase I and Phase II trials show that the vaccine is safe but some patients suffer side effects such as fatigue, headache, back pain, joint pain etc. It is advised that patients should discuss the risks and benefits with their physicians.
Source: "Vaccine therapy with sipuleucel-T (Provenge) for prostate cancer". Maturitas 2011 Aug;69(4):296-303. Epub 2011 May 31
Chemotherapy and hormonal therapy are the usual treatment available to these patients, but many patients have progressed to castrate-resistant prostate cancer (CRPC) and chemotherapy has significant side effects.
A new study was published online in the journal Maturitas in May about a novel therapeutic cancer vaccine, Sipuleucel-T, or Provenge, produced by Dendreon Ltd, for the treatment of CRPC after randomized trials showed significant survival advantage compared to controls.
In April 2010, the US FDA approved the vaccine therapy for advanced prostate cancer that has failed to respond to hormone therapy. The therapy involves taking the patient's own immune cells, externally activated against prostate cancer antigen PAP and infuse back into the patient. The patient's own immune system will then create T-cells to attack these cells.
Provenge does not cure prostate cancer but trials show that it extends survival by 4 months or years for some patients. Phase I and Phase II trials show that the vaccine is safe but some patients suffer side effects such as fatigue, headache, back pain, joint pain etc. It is advised that patients should discuss the risks and benefits with their physicians.
Source: "Vaccine therapy with sipuleucel-T (Provenge) for prostate cancer". Maturitas 2011 Aug;69(4):296-303. Epub 2011 May 31
Thursday, July 07, 2011
sitting for long periods doubles risk of blood clots in the lungs
According to a new study published by the BMJ, women who sit for long period of time everyday are 2 to 3 times more likely to develop blood clot in their lungs than more active women. The study is the first to prove that a sedentary lifestyle increases the risk of developing a pulmonary embolism.
US researchers followed almost 70,000 female nurses for 18 years and collected information about their lifestyle through biennial questionnaires. They found that the risk of pulmonary embolism was more than twice higher in women who spent more than 41 hrs a week (outside work) sitting comapred with those who spent less than 10 hrs a week. The study also showed that physical inactivity correlated with heart disease and hypertension.
The authors concluded that physical inactivity is associated with pulmonary embolism in women and suggest that the incidence of pulmonary embolism could be redudced by discouraging physical inactivity among the general public.
Source: Physical inactivity and idiopathic pulmonary embolism in women: prospective study. BMJ 2011; 343:d3867 (Published 4 July 2011) Open access
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