Hepatitis C - Irish Success!

The Irish Haemophilia Society has announced the effective eradication of Hepatitis C in people with haemophilia in Ireland.

All people with haemophilia who required treatment for Hepatitis C have now been offered treatment, with excellent success rates. A small number of people in the country decided not to take treatment because of their age or for other reasons.
From the 1970s to 1991, a total of 240 people with haemophilia were infected with Hepatitis C by blood products, used for the treatment of haemophilia.
Of these individuals 105 were also infected with HIV.
To date, 112 people have died of either HIV or Hepatitis C.

"This was the largest medical disaster in the history of the State and it devastated the entire haemophilia community", said Brian O'Mahony, Chief Executive of the Irish Haemophilia Society.
He said that thousands of people in the country still suffer from the disease and there is a plan to eradicate Hepatitis C in the country over the next number of years.



This led to the establishment of the Lindsay Tribunal of Inquiry in 2001.
People with haemophilia who were infected with Hepatitis C were supported by the society, as they sought and underwent treatment over the past number of years.
Treatment uptake among people with haemophilia was strong, despite the harsh side effects and long duration of previous treatments.
By 2015, all but 37 people had successfully cleared the virus through treatment.
The availability of the new generation of direct acting antivirals in 2015 provided an opportunity for successfully treating the virus with a less harsh regime and a much shorter duration of treatment.
The society advocated strongly for the availability of these treatments for people with haemophilia and in July 2015.
It received an assurance from the Department of Health that all State infected patients, including people with haemophilia, would be treated no later than the end of 2017. That target has now been exceeded.
All people with haemophilia have now been offered treatment.
The majority have now completed treatment with a small number currently undergoing treatment.
The success rates to date have been in excess of 90%.
For those who have cleared this virus, their future risk of serious liver disease or liver cancer has been very significantly reduced.

New MS drug a 'landmark development'
Doctors and charities have described a new drug to treat multiple sclerosis as a "landmark development".
The European Medicines Agency and the US Food and Drug Administration are reviewing whether to licence the drug, Ocrelizumab.
The results of three trials involving more than 2,000 people, published in the New England Journal of Medicine, show it slows both the primary progressive and relapsing-remitting forms of the disease.
Support groups said the findings offer a lot of hope to patients.

Cork Clinical Trial - Results!

Around 30 patients suffering from advanced melanoma cancer are being enrolled in a clinical trial in Cork, with early results indicating improved survival rates.

The trial involves a combination of two existing treatments.
Doctors are being encouraged to refer suitable patients for inclusion in the clinical trial which is being offered by Cork Cancer Research Centre at Cork University Hospital.
Scientists believe that by delivering an electrical impulse or shock directly to the tumour along with an immunotherapy drug called IPI and low dose chemotherapy survival rates will improve for advanced melanoma patients.
Doctors involved in the clinical trial believe the new treatment will be widely adopted and have described it as one of the first of it's kind in the world.

Health Service and Superbugs

Antibiotic resistance is one of the greatest challenges facing health services around the world, numerous reports have told us over the past year.

 

Currently, 700,000 people a year die because their conditions are resistant to the antibiotics traditionally administered to tackle them, and this figure will rise to 10 million within decades unless a solution is found.

 

Studies suggest CPE kills about 40 per cent of those
who become infected, especially older, frail patients.

 

In Ireland, progress has been made in reducing the level of infections caused by organisms that were a significant concern a decade ago. Superbugs such as MRSA haven’t gone away, but the number of patients infected during hospital stays has declined steadily.

However, the ground on which the battle against antibiotic resistance is fought constantly changes, and so new organisms have emerged to create problems in the overcrowded, overstretched Irish health system.

Worryingly, the threat they pose is ever greater, because many of them are resistant to all but the most potent antibiotics and they are difficult, if not impossible, to eradicate.

Of particular concern is the emergence of what is termed carbapenemase-producing Enterobacteriaceae (CPE), which results in some cases of bacteria being resistant to all conventionally-used antibiotics. The carbapenemases are enzymes that work by inactivating antibiotics.

New Anatomy / Physiology, App

An Irish developed app has been listed by Apple as one of the 16 most innovative apps and games for 2016

Complete Anatomy, designed by Dublin-based 3D4Medical, beat competition from two million other apps that were published in Apple's App Store this year.
The app gives people learning anatomy or physiology a 3D view of the body, layer by layer, and allows the user to zoom, rotate, cut through structures and see behind layers.
Recordings can also be made for educational purposes, and content can be shared via the cloud.
The App Store Best of 2016 shortlist was picked by Apple's Editorial Team.

A screenshot of the 3D4Medical app from Apple

Last year Complete Anatomy received the Apple Design Award for its technical excellence and outstanding design and innovation, and was also featured on stage by Apple during a high-profile iPad product launch.
The app has reached the top of the app store medical charts in 148 countries, and the overall charts in the online shop in 52 states.
At the start of this year, 3D4Medical announced it was taking on 70 new staff as it bolstered its product development line and grew sales overseas.

Medical Research - Limerick

Medical technology company Becton Dickinson and Company is to establish a new research and development centre in Limerick, which will bring an additional 100 jobs.

Becton Dickinson and Company, or BD as it is known, employs 600 people in Ireland at sites in Dún Laoghaire and Drogheda, and 100 employees already in Limerick.
It is a global company involved in medical technology, diagnostics, medical research and health care management.



A new Research and Development centre of excellence is being established by the company in Limerick as part of a €21 million investment which will drive its international growth.

It will concentrate on product and software development, clinical research instrumentation, and prototype development primarily for its life sciences business.
The company said this will require significant hiring of R&D staff, collaboration with local universities and the development of new technical capabilities.
An extensive renovation of the former Unigolf premises at Plassy technological park at Castletroy in Limerick will be required which will house its current 100 employees in Limerick, and a further 100 workers as a result of today's expansion announcement.

Medical Ethics - Cryonics

Freezing a body immediately following death so that one day, through the miracle of science, it might be resurrected seems outlandish, bordering on delusional.
Yet to some, it’s what keeps them strong.
Unnerved by the thought of death, of burial, of being cremated, it offers a glimmer of hope that perhaps one day, their life could resume. Finality would no longer be, well, final.
One might even argue that it is an alternative to religion, for those who like the idea of, but do not believe in an afterlife.

Except in the case of cryonics, there are many ethical, moral and scientific dilemmas apparent in the current life, which must be dealt with in the here and now.
Issues which have been thrown into the spotlight by the recent tragic case of a 14-year-old girl in Britain.
“JS”, as she is known, sought High Court help in ensuring her mother had the sole right to decide to send her body to cryonic storage following her death from cancer – in line with her wishes.
Rather than being a case about the right to use cryonic services, in fact the case was effectively a family law issue.



The court was simply asked to mediate in a dispute between JS’s mother and her estranged husband, who was concerned about JS’s wish to be frozen in time.
Inevitably, however, the media attention and public interest surrounding the court action has focused less on the actual issue in the case, and instead spawned a debate about the use of cryonics.
It should, of course, be remembered that cryonics isn’t new.
The first human to be cryo-preserved was Californian psychology professor James Bedford, who was frozen following his death in 1967.
However, the theory and discussion underpinning it dates back decades earlier.
Indeed, it might come as a surprise to many people that a whole industry has now built up around the process, with several companies in the US and Russia offering cryonic services for as little as $25,000.
And while the numbers aren't huge, people are using the service - including some in Ireland according to one US provider.
But while the process and access to such services has developed, the fundamental ethical and moral questions remain the same.
First, and most fundamentally, apart from hope, what exactly are people buying?
Right now, scientists can’t even cryopreserve healthy organs and bring them back to life again properly for transplantation, let alone seriously diseased or worn ones.
So to project ahead to a time when it is possible to freeze a healthy or even damaged dead body and then successfully thaw it back into life is something of a giant leap.

And even then, bringing back a body is one thing, but bringing back a functioning brain with a fully conscious mind is quite another.
Perhaps as machine learning, artificial intelligence and neurological monitoring technology progresses, it might in time become feasible to download and then upload the contents of a brain.
But that won’t happen today, or tomorrow.
Aside from the practicalities of it all, there are also many questions around ethics.
For starters, informed consent is the key to any medical procedure.
But if you don’t know much about what you are consenting to, how can you give that informed consent?
For example, anyone signing up for cryopreservation doesn’t know how long they will be frozen for.
Nor do they know under what circumstances they will come back to life.
And as for who will make that decision in hundreds of years’ time – well that is anyone’s guess.
Is it right to sell a dream to someone, when you have no inkling whatsoever about how the reality will turn out?
Who will be there when they are woken up? What kind of state will they and the world around them be in?

Will there even be someone to wake them up?
One early cryonics attempt at Chatsworth in the US failed when those behind it ran out of money and left the bodies to decompose, for example.
There’s also the even more sinister danger of cryonics potentially being used as a means of prematurely euthanising someone.
Of course science has an on-going uncanny ability to confound our expectations, upend our understanding of what is normal.
After all, if it didn’t, then what would be the point of research?
But what’s clear is that right now, cryonics poses many threats and challenges and offers few definitive answers.
The need for regulation is, therefore, growing so that people can’t be exploited, expectations can’t be falsely raised and scientific fact can’t be undermined.

Excessive Drug Pricing - UK

Drug firms Pfizer and Flynn Pharma have been fined nearly £90 million (€105.6m) for "excessive and unfair" pricing to the NHS after hiking the cost of an anti-epilepsy drug by up to 2,600% overnight.

The Competition and Markets Authority (CMA) said drug maker Pfizer and distributor Flynn Pharma broke competition law when they increased the cost of a medicine used by around 48,000 patients in the UK.
The watchdog said their moves saw the cost to the NHS of phenytoin sodium capsules rocket from around £2 million a year in 2012 to about £50 million in 2013 - far more than Pfizer was charging in any other European country.



Pfizer was handed a record £84.2 million fine, while Flynn Pharma was fined £5.2 million.
The CMA has also ordered both firms to reduce their prices for the anti-epilepsy drug.

Body Fat Storage - Diabetes

 Inability to Store Fat Safely Increases Diabetes Risk

A study of 200,000 people showed that those with a variation in their genetic make-up were less likely to deposit fat under the skin in the lower body.
This can lead the body to become resistant to the hormone insulin.
The scientists said their findings explain why even slim people who eat too much and are inactive are at risk.
And they added that a healthy diet and physical exercise is important, regardless of body weight.



Genetic Link

Insulin is a hormone that controls levels of blood sugar.
When the body becomes resistant to it, levels of blood sugars and lipids rise, increasing the risk of diabetes and heart disease - but no-one is sure why insulin resistance happens and why some people become resistant when overweight, and others do not.
International figures show that 43% of people who develop type 2 diabetes are obese, 43% are overweight and 14% have a healthy weight.
The Cambridge study, published in Nature Genetics, found that a large proportion of the population has inherited some of 53 separate genetic variants that inhibit the storage of fat safely under the skin, particularly in the lower half of the body.
Their fat is more likely to end up in the bloodstream or stored in and around the body's central organs.
The study said people who have more of this genetic material are at much greater risk of type 2 diabetes - no matter what their BMI (body mass index) is.

Fat location

In the 20% of the population with the highest number of these genetic variants, their risk of diabetes rose by 39% compared to the 20% of the population with the lowest genetic risk.

People with fat storage problems can end up with fat accumulating in and around the liver, pancreas and muscles - where it causes insulin resistance and eventually type 2 diabetes.

Dr Luca Lotta, from the Medical Research Council epidemiology unit at the University of Cambridge, said that fat stored in the arms, legs and under the skin played an important role.
"Our results highlight the important biological role of peripheral fat tissue as a deposit of the surplus of energy due to overeating and lack of physical exercise."

Australian Schoolboys - Create Justice

The man who sparked outrage last year by hiking the price of a life-saving drug may have met his match in some Australian schoolboys.

US executive Martin Shkreli became a symbol of greed, when he raised the price of a tablet of Daraprim from $13.50 (£11) to $750.
Now, Sydney school students have recreated the drug's key ingredient for just $20.
Daraprim is an anti-parasitic drug used by malaria and Aids patients.
Martin Shkreli: 'The most hated man in America'

The Sydney Grammar boys, all 17, synthesised the active ingredient, pyrimethamine, in their school science laboratory.
"It wasn't terribly hard but that's really the point, I think, because we're high school students," one boy, Charles Jameson, told the BBC.
The students produced 3.7 grams of pyrimethamine for $20. In the US, the same quantity would cost up to $110,000.
In most countries, including Australia and Britain, the drug retails for less than $1.50 per pill.

                           

The Sydney students at work

in their high school laboratory

The boys said they conducted the year-long experiment to highlight the drug's inflated cost in the US.
"It seems totally unjustified and ethically wrong," student James Wood said. "It's a life-saving drug and so many people can't afford it."
Supervising teacher Dr Malcolm Binns said: "Everyone is very happy and pleased with the result. All the boys think it's the most amazing thing."
Developed in the 1950s, Daraprim is the best treatment for a relatively rare parasitic infection called toxoplasmosis.
Mr Shkreli, also known as "Pharma Bro", was chief executive of Turing Pharmaceuticals when it acquired exclusive rights to Daraprim.
Its decision to increase the cost by more than 5,000% in August last year drew international condemnation. Mr Shkreli has argued the Daraprim price increase was warranted because the drug is highly specialised.
But the firm eventually agreed to lower the price to something more affordable.

'Real monetary value'

Dr Alice Williamson, a University of Sydney research chemist, supported the boys' project through online platform - Open Source Malaria.
"They've transformed starter material that's worth pennies into something that has a real monetary value in the States," she told the BBC.

"If you can obtain it cheaply in schools, then there's no excuse for charging that much money for a drug. Especially from people that really need it and probably can't afford to pay for it."
Dr Williamson called the pricing in the US "ludicrous".
Mr Shkreli was arrested in December on allegations of securities fraud. He subsequently stepped down as the head of Turing. His trial is set for 26 June, 2017.

Irish Healthcare - Overview

Health Service Executive Director General Tony O'Brien has told the Committee on the Future of Healthcare that 80% of Ireland's health services are of a very high standard, but that this is overshadowed by the 20% of services that are not delivered as they should be.

He said despite resource restraints over the past six years of austerity, there have been numerous improvements, including stroke care, where Ireland is now placed in the top three in Europe.
However, Mr O’Brien said treating an older population is costly and getting more costly, and unless this is planned for significant difficulties will emerge in future.
He said the HSE is already seeing the effect on bed capacity.
More emergency work and less elective work is being carried out each year, and if these trends continue the HSE will be unable to accommodate elective work in the future, he said.
Mr O’Brien said the HSE was created with a big bang and was not well thought through, saying it is not possible to manage all staff from one central location.
He said seven hospital groups have been established and should now be allowed time to bed in, adding that a rethink is needed of existing policies and capital expenditure.
Healthcare planning is tied to the electoral cycle, he said, as well as a 12-month economic cycle, which hampers rather than facilitates reform.
Mr O'Brien said Ireland needs to build consensus on health spending and how much taxpayers are willing to hand over for the health service they want.

Tony O'Brien, HSE said treating an older

population is costly and getting more costly

Committee chairperson Róisín Shortall questioned whether Mr O'Brien meant that the taxpayer should spend more on healthcare, considering Ireland's spend is close to the top of the OECD at the moment.

Mr O'Brien clarified, saying Ireland is spending a very substantial sum on healthcare, and there is an opportunity to spend that funding better.

Liam Woods, Interim Acting Director of Acute Services, said the HSE reduced agency staff costs by €38 million last year, but there was still a high level of such agency staff.

New Treatment - Lung Disease

Scientists in Ireland are developing a new treatment for lung diseases, including cystic fibrosis and asthma, as part of an €8.8m international project.

The first of its kind dry powder inhaler will deliver an innovative drug into the lungs in a way that is hoped will effectively break up thick sticky mucus, that can cause lung infections.
Cystic fibrosis is caused by a genetic anomaly that leads to the production of a thick sticky mucus in the lungs, which in turn can lead to serious infections.



Ireland has the highest incidence of cystic fibrosis in the world.

While there are therapies that can break up the mucus, there are a limited number of effective ones.
In fact there have been no new versions of these mucolytic therapies in the past 20 years, and only one in the past 50.
Scientists at the University of California and University College Dublin have developed a novel compound which shows great promise as a drug for breaking up mucus.

Professors John Fahy and Stefan Oscarson from those universities have secured €8.8m from the US National Institutes of Health (NIH) for two projects associated with the development of new lung disease treatments.
As part of one of these, scientists from the Science Foundation Ireland-funded AMBER and SSPC centres, led by Prof Anne-Marie Healy, head of the school of pharmacy at TCD have been awarded €600,000 to devise a new method of delivering the drug into the lungs.
They will develop a first of its kind dry powder inhaler that will enable the treatment to reach the mucus and break it up.
Professor Anne Marie Healy, Head of the School of Pharmacy and Pharmaceutical Sciences at Trinity, Investigator in AMBER and SSPC (The Synthesis and Solid State Pharmaceutical Centre, led by the University of Limerick) said,
"I am delighted to be part of a transnational NIH project, which aims to take the research from bench to bedside," said Prof Healy.
"Ireland has the highest incidence of cystic fibrosis in the world, with approximately 1 in 19 Irish people carrying one copy of the altered gene that causes the condition.
"In addition, Ireland has the fourth highest prevalence of asthma in the world, with almost 5,000 asthma admissions to hospital on average each year.
"Our proposed new treatment has the potential to greatly improve the respiratory function of these patients with lung disease, thus improving overall quality of life and reducing hospital admissions."
It is expected that within the five year lifetime of the project the new treatment will be clinically trialled on humans.

It is hoped that as well as being used for treating cystic fibrosis and asthma, the inhaler will also be useful for tackling other lung conditions, like chronic obstructive pulmonary disease.

Life - Course Criminology

The study of Life-Course Criminology seems far removed from the study of health care and medical topics.

Recently received title -
An Introduction to Life-Course Criminology by Carlsson and Sarnecki reviews the various features/theories associated with criminology and how criminal-careers might be predicted, and interventions introduced to provide the most appropriate impacts. The authors also provide examples from their work on the Stockholm Life-Course project.

This title is located at 364.3 CAR

 

 

A related topic to Criminology, the study of Forensic Medicine.
Titles on this subject are located at 614.1 - in particular

Simpson's Forensic Medicine - 614.1 PAY

 

 

 

Teamwork - Healthcare Delivery

Within recent decades healthcare delivery has become increasingly reliant on the principles, which support teamwork.

Educational studies have also focused on promoting the inter-professional practices associated with nurturing the teamwork aspects, required to deliver modern medical care.

A recent publication on this topic is now part of the James Hardiman collection:

Healthcare Teamwork (Inter-Professional Practice and Education)  by  T J K Drinka and P G Clark (2nd edition, 2016) is located at

362.1068 DRI

                   

 

Medicinal Cannabis - Review

Simon Harris pledges to take action on Medicinal Cannabis

Minister makes promise to mother of child, with catastrophic form of epilepsy.



The Minister made the promise to Vera Twomey after she embarked on a walk from County Cork to Leinster House, in order to draw attention to this issue.
Her six year old daughter, Ava Barry, has a catastrophic form of epilepsy but is now almost seizure free after she started taking two doses of Cannabis Oil a day.
Ava suffers from Dravet Syndrome and needed around - the - clock care before she started taking Cannabidiol Oil earlier this month. Ms. Twomey is calling for a change to Irish law to allow for Cannabis to be used for medicinal purposes.

Cannabis for medicinal purposes is legal in a number of countries including The Netherlands, The Czech Republic, Canada, Australia, Malta, Croatia and some US states. It is usually made available on prescription from doctors and supplied in a standardised form through pharmacies.
Mr. Harris said that the government had ordered a review of the Republic's policy on Medicinal Cannabis.

Fingerprints reveal Lifestyle

Traces of skin, oil and grime left on your phone, can reveal a lot about your lifestyle, and may some day serve as a "fingerprint" in criminal investigations, researchers have said.

The study involved 39 volunteers who allowed scientists to swab their smart phones - and right hands - in several places.
Researchers found a bounty of chemical information left behind on the devices.
These included anti-inflammatory and anti-fungal skin creams, hair loss treatments, anti-depressants and eye drops, according to the study in the Proceedings of the National Academy of Sciences.
They also found food molecules from citrus, caffeine, herbs and spices.
Sunscreen ingredients and DEET mosquito repellent were detected months after they had last been used by the phone owners.

Researchers found lots of chemical information

left behind on mobile devices

"By analysing the molecules they've left behind on their phones, we could tell if a person is likely female, uses high-end cosmetics, dyes her hair, drinks coffee, prefers beer over wine, likes spicy food, is being treated for depression, wears sunscreen and bug spray - and therefore likely spends a lot of time outdoors - all kinds of things," said study co-author Amina Bouslimani of the University of California, San Diego.
"This is the kind of information that could help an investigator narrow down the search for an object's owner."
Other applications could include criminal profiling, airport screening, medication adherence monitoring and environmental exposure studies.
"You can imagine a scenario where a crime scene investigator comes across a personal object - like a phone, pen or key - without fingerprints or DNA, or with prints or DNA not found in the database," said senior author Pieter Dorrestein, of the San Diego School of Medicine and Skaggs School of Pharmacy and Pharmaceutical Sciences.
"They would have nothing to go on to determine who that belongs to. So we thought, what if we take advantage of left-behind skin chemistry to tell us what kind of lifestyle this person has?"
The study was considered a "proof of concept" exercise, and more work is needed to refine the techniques for widespread use.
For now, the approach can only provide a general profile of person's lifestyle, not a one-to-one match.

Medico-Legal Issue - Case Study

A 14-year-old girl who died of cancer has been cryogenically frozen in the hope that she can be "woken up" and cured in the future after winning a landmark court case in her final days.


Justice Peter Jackson 

The girl's divorced parents had disagreed over whether her wish to be frozen should be followed, so the girl, who cannot be named for legal reasons, asked a High Court judge to intervene.

In a letter to the court, she said: "I don't want to die but I know I am going to... I want to live longer... I want to have this chance."

The girl, known as JS, asked Mr Justice Peter Jackson to rule that her mother, who supported her desire to be cryogenically preserved, should be the only person allowed to make decisions about the disposal of her body. Shortly before her death in a London hospital on October 17, in what is believed to be a unique case, the judge granted JS her wish.

Her body was frozen and taken to a storage facility in the US. She is one of only 10 Britons to have been frozen, and the only British child.
She told a relation: "I'm dying, but I'm going to come back again in 200 years."

But after a decision that raises profound moral and ethical questions, the judge and the girl's doctors expressed serious misgivings about the process, which did not go entirely to plan.
Her mother spent the last hours of her daughter's life fretting about details of the freezing process, which was "disorganised" and caused "real concern" to hospital staff.

Mr Justice Jackson suggested that "proper regulation" of cryonic preservation should now be considered.
The case can only now be reported because the judge ruled that nothing could be published until one month after JS's death. He also ruled that her parents' names and other specific details should stay secret.

JS, who lived with her mother in London, was diagnosed with a rare form of cancer last year and by August this year she had been told it was terminal. She began researching cryonics online - a controversial and costly process that involves the freezing of a dead body in the hope that resuscitation and a cure may one day be possible - and decided she wanted to be frozen after her death.

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Legally, she had to have the permission of both of her parents, but her estranged father had disagreed, sparking the court battle. (© Daily Telegraph London)