Wednesday 20 June 2012
Less is more?
My new blog on The Lancet Student discusses the merits of minimally invasive surgery for oesophageal cancer. Have a read:
Thursday 22 March 2012
Digital Doctors
My new post on The Lancet Student discusses a new internet based therapy for chronic fatigue syndrome. Have a read:
http://www.thelancetstudent.com/blog/digital-doctors-can-internet-based-therapy-be-effective-chronic-fatigue-syndrome
http://www.thelancetstudent.com/blog/digital-doctors-can-internet-based-therapy-be-effective-chronic-fatigue-syndrome
Tuesday 13 March 2012
To prescribe or not to prescribe?
Looking
after the elderly, particularly in care homes, has been a hot topic recently as
we debate the future of our ageing population and reform of the NHS. Thus it
has become more important than ever that we provide a standard of care for the
elderly that is both effective in providing high- quality care and value for
money.
Many patients in care homes are
affected by dementia, which is not surprising since the onset is a direct
consequence of age. Non- pharmacological treatments are usually the first line
of treatment for patients with dementia, but often the symptoms are severe
enough to warrant treatment with anti- psychotics, and as a consequence around
one third of patients suffering from dementia in care homes are treated with
anti- psychotics.
But are we failing to provide an
acceptable standard of care by prescribing so many drugs? New research carried
out in the US suggests that this may be the case. Huybrechts et al utilised the Medicaid database (a database
of medical benefits) to examine the mortality rates of patients over 65
receiving anti- psychotic treatment for dementia in care homes between 2001 and
2005. They found that patients who were receiving treatment with haloperidol
had double the risk of morbidity compared with patients receiving although they
were less likely to exhibit psychiatric symptoms.
This paper appears to be making
an important point: that prescribing anti- psychotics to dementia patients is
actually detrimental to their health and is increasing mortality in care homes.
However, the research is crying out for a control that is not another anti-
psychotic treatment and that more closely resembles more conventional standards
of care. This paper can inform us of differences in the number fatalities
between different anti- psychotics, but lacks the design to tell us that
patients taking these drugs are worse off than those on other treatments (as
was claimed by the BBC).
This paper does send an
informative message- that prescribing already fragile elderly patients powerful
anti- psychotics with potentially debilitating side effects is an ill-advised
strategy in many cases. However, we need further research with study designs
that are able to show us the bigger picture, as well as research into a
legitimate alternative to taking anti- psychotics before we can make decisive
changes in policy. Sadly, this prospect
is probably further off than we think.
original paper (open access):
Tuesday 28 February 2012
Healing a broken heart
Continuing my series of articles breaking down articles published in The Lancet, here is a look at new research which shows promising results for stem cell treatment post- heart attack. Check it out here:
http://www.thelancetstudent.com/blog/healing-broken-heart
http://www.thelancetstudent.com/blog/healing-broken-heart
Wednesday 8 February 2012
Beating Stress
Everybody experiences stress, from the
small things, such as missing the train to work, to rather more difficult
situations, such as dealing with a car crash. The way that we deal and respond
to stress however, can vary from person to person. It is estimated that 10% of
people in the UK will experience Anxiety and Mixed Depressive Disorder at some
point in their lives. So why is it that our responses to stress can be so
different?
Anxiety disorders (such as
post-traumatic stress disorder, amongst others) can be exceptionally
debilitating in everyday life. People with anxiety disorders are also thought
to pay more attention towards negative or threatening things in the environment
around them and have been linked with a variation in the Serotonin Re-uptake
Transporter Gene (5-HTTLPR).
Serotonin (also known as 5-HT) is a
common and important neurotransmitter in the brain that is strongly linked with
mood. The short version (s allele) of the 5-HTTLPR gene causes lower production
of the Serotonin Transporter, which removes serotonin molecules from the
synapses between nerve cells after they have been used for signalling. Thus,
having the s allele will cause increased levels of serotonin in the synapse,
due to slower re-uptake.
 |
| Serotonin is a monoamine neurotransmitter. |
A study published last month, has looked into effects of the s allele on attention bias. They split their participants into two groups, with roughly a 50/50 split of people with the s allele and the long (l) allele. The groups were then subjected to an attention bias test, before undergoing attention bias modification (ABM). ABM is an experimental technique that is used to alter a person’s attention bias, either more positively or negatively, reflecting encounters with positive and negative stimuli in our everyday lives.
Participants with the s allele were
more sensitive to ABM, scoring higher in both positive and negative attention
bias tests after the ABM, but were especially sensitive to negative stimuli.
This result suggests a role for 5-HTTLPR as an ‘adaptability gene’, ie, not a
gene that would affect us all the time, but given the right stimuli,
could be responsible for changes in the way our brain works that would affect
our response. In practical terms this shows that people with anxiety disorders
may be predisposed to dealing poorly with stressful life events, but that they
may also thrive in an environment that is supportive.
It also shows the possible importance
of Gene/ Environment interactions (GxE). This is an area for debate in current
research but it seems clear that in some cases it is not simply the genes you
possess that is the most important factor, but how they interact with the
external stimuli that we encounter.
This paper suggests the possibility of
serotonin- reducing drugs possibly being effective in an anti- anxiety setting.
Clearly we will need further research to find an effective treatment.
Comment:
Free PubMed Article:
Picture, Wikipedia.org
http://www.google.co.uk/imgres?q=serotonin&hl=en&safe=off&sa=X&biw=1366&bih=667&tbm=isch&prmd=imvns&tbnid=0LoxSnjszNZUyM:&imgrefurl=http://en.wikipedia.org/wiki/File:Serotonin-3D.png&docid=uRd9BEu4ZdfrfM&imgurl=http://upload.wikimedia.org/wikipedia/commons/5/53/Serotonin-3D.png&w=2331&h=2016&ei=jwsXT6S7EYPoOZ3VmYcE&zoom=1&iact=hc&vpx=984&vpy=362&dur=3105&hovh=209&hovw=241&tx=135&ty=120&sig=115565233929553937633&page=1&tbnh=137&tbnw=165&start=0&ndsp=21&ved=1t:429,r:19,s:0
Thursday 2 February 2012
Suicide rates in England and Wales
I have another blog on The Lancet Student on a study showing that recent changes in mental healthcare in England and Wales has brought about a decline in suicides. A topical paper given the threat of cuts and reform to the NHS. Enjoy.
my blog:
the paper:
a comment in The Lancet:
this paper is in the news:
http://www.bbc.co.uk/news/science-environment-16816344
Wednesday 25 January 2012
Getting better: how do we test new cancer treatments?
Another blog on The Lancet Student. Check it out.
http://www.thelancetstudent.com/blog/getting-better-how-do-we-test-new-cancer-treatments
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