Sunday, December 16, 2007

Level 4: INSIGHT by Dr. Liz Miller

There is another level of insight, beyond seeing the effect of your behaviour on other people. It may go alongside but maybe at a higher level. Seeing yourself in other people, seeing their effect on other people, seeing how you might also have that effect and then making similar adjustments 

For example, you might be a very forthright individual. Level 1 you know you are forthright, Level 2 you know people see you as forthright, Level 3 you know the effect of forthrightness on the people around you, Level 4 you see forthrightness in other people, you see the effect it has on people around you and you modify your own forthrightness in the light of that effect. 

It might also be 'anxiety'. Level 1 You know you are anxious. Level 2 You understand that other people see you as anxious Level 3 You understand the effect of your anxiety on the people around you - either they also get anxious, or they get irritated by your obsession with details. Level 4 you see other anxious people and see the effect they have on the people around them and modify your own behaviour accordingly 

Level 4 is the start of rounded behaviour - the ability to see all sides of the problem, to understand how you relate to the people around, how you affect them and how they affect you. And to modify your behaviour accordingly...... 

With the mastery of  levels, comes transcendency 





Copyright (c) Dr. Liz Miller


Thursday, November 22, 2007

NHS database 'could be targeted'

 
Computer
Checks on data-sharing must be "robust", MPs heard
The man in charge of setting up the NHS medical records database has admitted that "you cannot stop the wicked doing wicked things" with information.
 
Richard Jeavons, director of IT implementation at the Department of Health, said there were instances where staff "abuse their privileges".
These had to be "pursued", he told the Commons home affairs committee.
 
The plan to put 50 million patients' records on the database is part of a £12bn NHS IT overhaul.
The scheme has raised concerns over cost and the security of information.
 
A poll for the Guardian suggests that 59% of GPs in England are unwilling to upload any record onto the database without the patient's specific consent.
 
Three quarters of more than 1,000 doctors questioned believed medical details would become less secure when they are put on a database that will eventually be used by the NHS and social services.
 
'Misuse'
Mr Jeavons, who was appointed in May, said the Department of Health did not itself hold many people's personal records but added that it provided guidance to NHS trusts on how to handle data.
At a committee hearing, Labour MP Margaret Moran said to him: "Even if we get the technology right, the problem is abuse by people or misuse of data.
 
"How confident are you that there won't be problems over data and privacy?"
 
If we can avoid setting up large-scale citizens' databases, that would be a wise thing to do
John Suffolk
Chief information officer
Mr Jeavons replied: "You cannot stop the wicked doing wicked things with information and patient data...
 
"Of course, we have examples where staff do abuse their privileges and have to be pursued through disciplinary procedures."
 
He added that the government had to "make sure" that people who abused the system knew they were "going to get caught".
 
The NHS scheme is intended to "modernise" the service.
By 2014, 30,000 GPs in England will be linked up to nearly 300 hospitals giving the NHS a "21st century" computer network.
 
It involves an online booking system, Choose and Book, a centralised medical records system, e-prescriptions and fast computer network links between NHS organisations.
 
It is said to be the most ambitious computer project in the world and represents the largest single investment in IT in the UK.
 
'Surveillance'
Opponents say it is too expensive and will compromise the confidentiality of records.
 
The home affairs committee is looking at whether the UK has become a "surveillance society".
 
In its hearing, it senior civil servants working in the education, transport and justice fields were also questioned.
 
The MPs were told different departments could not share information without legal guidelines being followed and rights of access clarified.
 
Clare Moriarty, constitution director at the Ministry of Justice, said efforts to make data protection as "robust" as possible were essential.
 
Questioned as to whether information had sometimes gone between departments unofficially, she replied: "I'm not aware of any department sharing data by stealth."
 
'Foolhardy'
Government chief information officer John Suffolk told the MPs that setting up a nationwide database going across Whitehall departments and other government agencies would create more problems.
 
He said: "When you work at a national scale, to continue to put more eggs in a single basket is a foolhardy approach."
 
Mr Suffolk added: "The more and more you put it into a large database, with more and more people having access, it becomes more complex...
"If we can avoid setting up large-scale citizens' databases, that would be a wise thing to do."
 
The Information commissioner last year warned the UK risked "sleep-walking into a surveillance society".
 
The committee's inquiry will include the impact of identity cards, the expansion of the DNA database and the rise in the use of CCTV cameras.

Monday, November 19, 2007

Monday, November 12, 2007

The Cult Called A.A.

by Paul Roasberry

Reprinted from Matrix, Denver Mensa, Janet Roder, Editor

When we think of cults, we usually think of bizarre religious sects, armed compounds, mind control and eccentric leaders. Most of us do not think of Alcoholics Anonymous (A.A.) as a cult, but I do.

Three years ago, I was in the grips of a serious drinking problem. Like most alcoholics, I rationalized my drinking, citing the many terrible circumstances in my life. Then, almost three years ago, I stopped drinking. Period. By myself.

Oh, I attended a half dozen or so A.A. meetings at the time, upon the advice of someone recommended by a friend. The woman who suggested A.A. to me was a licensed psychologist. She was a "recovered alcoholic" and was very active in A.A.

What I found at the meetings was a weird mixture of the deplorable and the laughable. It didn"t take long to notice that something was not quite level with this organization.
I was tipped off to A.A.'s strong cult qualities when the lady psychologist made a somewhat curious remark during the first week or two of my sobriety.

I had an uncle then (he died this past January) who had been an alcoholic prior to 1960. Uncle Ralph consumed, by his own subsequent admission, about a quart of whiskey a day. He stopped drinking without the assistance of A.A. when he met my aunt. It was a condition of their marriage that he stop drinking, and he did.

I remember my Uncle Ralph as a sweet, generous man during the thirty-odd years he was married to my aunt. He was not abusive or cruel, he worked hard, and made an excellent stepfather to my three girl cousins. When I mentioned Uncle Ralph to the lady psychologist, stating that he'd quit drinking on his own, she immediately dismissed my observation with, "Oh, well, he's just a dry drunk." She of course had never met my uncle Ralph, knew positively nothing about his character and yet claimed to be able to diagnose him as a "dry drunk" strictly on the information that he hadn't progressed through the A.A.'s widely touted "twelve step program." Bear in mind, this was a licensed psychologist making an incredibly spurious, rash judgment.

Of course, all cults have this in common: they reject and label as untouchables any who do not embrace their particular version of "Truth." To died-in-the-wool communists, non-believers are "bootlickers of the capitalists," or "counter-revolutionary hooligans." To the born again fundamentalist Christian, non-believers are "agents of Satan." To Moslems, Christians are "devils," and to Nazis, Jews are "swine." To the Alcoholics Anonymous membership, anyone who stops drinking without chanting the mantras of cult founder Bill W. are "dry drunks," pure and simple. You don't even need to know anything more about the self-quitters -- the fact that they quit drinking without A.A. makes them dry drunks, a priori.

Don't get me wrong. I do not advocate suppressing A.A. or any other cult. I simply want you to know, in case you are a problem drinker and are toying around with the idea of quitting, that it's O.K. to develop your own solution to your own problem. The last thing you need when you undertake a major, radical transformation in your life is to be accused by a bunch of self-righteous fanatics of being "a dry drunk," whatever the hell that is.

The whole A.A. program hinges upon the alcoholic's acceptance of what A.A. calls a "higher power." Conversely, adherents to the twelve-step program are expected to renounce any personal responsibility for, or control over, their problem. This blatant renunciation of the concept of free will is also a characteristic of every single other cult I can think of -- the individual counts for nothing, while the non-existent, the illusory, the hypothetical, is all. Self-respecting, proud, analytical achievers do not make good cult members. A cult follower must be stripped of his sense of individual worth -- in many sects, he is humiliated sexually, deprived of sensory stimuli, sequestered from the larger community, or otherwise manipulated to look upon himself as degraded and worthless. In A.A., you are plopped in a ring of cultists every evening and pressured to place your entire destiny in the hands of some "higher power."

When I began to ask hard questions about the nature of this "higher power," half expecting to hear some gibberish about "god," I learned (no kidding!) that one member even had his motorcycle represent his "higher power." What form of silliness is this that empowers motorcycles to cure us of alcoholism, I wondered.

At A.A. meetings, everyone sits around in a big circle. There are readings from "the Big Book," a not-very-well-written compendium of home-spun philosophy and anecdote authored by Bill W. and his colleagues some decades ago. Every cult needs its sacred writings, its revealed word. Members start talking about themselves and their alcoholism, and oddly, this sounds more like "self-criticism" under Mao's cultural revolution than anything therapeutic. In fact, it's all directed toward precisely the same end as "confession" in the Catholic church and Maoist "self-criticism" -- de-emphasis of the individual and a concomitant glorification of the ethereal, the other-worldly, the imaginary.

At some point, if you begin to question this "program" of A.A.'s, the talk gets tough and they start to lean on you. You are told that you can never recover on your own, that you are doomed to lapse over and over again into drinking binges, or at best, become a "dry drunk." (This is supposedly someone who has stopped drinking but still manifests all the unconscionable traits of a drunk: all the sociopathy, all the abusiveness, all the manipulative behaviors.)

The more you try to trot out examples of persons who have transformed their own lives under their own steam, the more the party line is thrown back at you: you are powerless against drink. Powerless. Any so-called examples of alcoholics who quit drinking without the twelve steps are in reality only examples of "dry drunks."

When I left A.A., I made the comment to someone that if I were indeed "powerless," I might as well commit suicide, because a life without any control over my destiny would be pointless and absurd. I stated again my conviction that I did not regard myself as powerless, and I went about my recovery in the most sensible way I could imagine. I removed alcohol from my home, I found some healthy pastimes to pursue (mountain climbing, writing, and painting) and, in the whirlwind breakup of my marriage, I devoted myself to staying afloat financially, making my new company prosper, and seeking out some like-minded companionship -- that was when I re-joined Mensa.

So, if you are determined to quit drinking, you can save yourself about three hundred sixty-five hours a year, plus travel time.

Try the "one-step" program, instead: just stop drinking. Believe me: you can do it.

I did.

Saturday, October 27, 2007

Medical matters dominate papers

Medical Matrix
 
Daily newspapers
Medical stories are a dominant theme across Saturday's papers. In particular, much attention is given to new plans to allow nurses to decide over resuscitating patients.
 
The front pages of the Daily Mail, the Times and the Daily Telegraph all go with the news that nurses will be able to decide whether to resuscitate patients.
The idea is anathema to the Daily Mail. It reports the views of one patients' group under the headline, "Nurses to have the power to end a life".
 
The Times is in favour, noting that nurses are closer to patients than doctors.
 
In the Telegraph, a Christian Medical Fellowship spokesman says it is unfair to place the responsibility on nurses.
 
Together in death
There are more medical matters in the Sun, one of many papers to relate the demise of Lionel and Rosemary Owen.
 
The elderly couple's daughter claims they both died from Clostridium Difficile at the Royal Devon and Exeter Hospital, only a few minutes apart.
 
Nina Griffith tells the Sun the hospital knew her mother had the superbug but allowed her to visit for treatment, and she gave it to her husband.
 
She tells the Daily Express her mother believed in the NHS but it failed her.
 
The hospital tells the Sun it is investigating the "complex" circumstances surrounding the deaths.
 
Brain injury fear
A Guardian exclusive reveals the Ministry of Defence is holding a major study into brain injuries in troops returning from Iraq and Afghanistan.
 
The report says the soldiers may have suffered the injuries after being exposed to high-powered bomb blasts.
 
Troops are at risk due to increased use of road-side bombs, the paper explains, and even the most advanced helmets cannot protect the brain from the shock waves.
 
Victims suffer symptoms such as acute memory loss and flashbacks, it says.
 
Galloping prices
The Financial Times is preoccupied with the price of oil. It says the price of crude has hit a new record, jumping above 92 dollars for the first time.
 
According to one futures trader quoted in the paper momentum in the oil market is like "riding on a galloping horse".
 
"Scotland-10, England-nil", reads the inflammatory headline on the front of the Independent.
 
The paper looks at how life has changed for Scots since devolution, and concludes that they have never had it so good.

Friday, October 26, 2007

Doctors 'misused figures to back abortions'

By Gordon Rayner

Doctors may have misled the Government in order to keep the 24-week abortion limit, it has been claimed.
  • Your View: Should the 24-week abortion limit be lowered?




    The Tory MP Nadine Dorries said yesterday that the Royal College of Obstetricians and Gynaecologists (RCOG) had submitted evidence to ministers showing the survival rate at 23 weeks was just 10-15 per cent, when some hospitals recorded survival rates of 40 per cent at 23 weeks and 66 per cent at 24 weeks.
  • Mrs Dorries also criticised the British Medical Association (BMA) for "working it" so that only pro-abortion motions were discussed at its annual conference.
    Her allegations came before Dawn Primarolo, the minister for public health, appeared before a parliamentary science and technology committee inquiry into abortion.
    Miss Primarolo told the committee that the Government did not believe there was enough evidence to reduce the upper abortion limit, citing the low survival rate.
    But Mrs Dorries challenged her, saying there were units where the rates were much higher. She asked: "Do you still feel 24 weeks is the right limit?"
    Miss Primarolo said: "The [scientific] consensus is still clear with regard to survival rates under 24 weeks. There are improvements in care but the advice is still the same in terms of survival rates."
    The minister said the Department of Health had been given evidence by a range of organisations, including the RCOG and the BMA.
    On her internet blog, Mrs Dorries claimed the RCOG had quoted an average UK figure, omitting figures showing that at "good neonatal units" a high proportion of 23-week babies would live.
    An RCOG spokesman strongly denied misleading the committee. He said: "What we have provided is scientific evidence, which the committee will look at. [Mrs Dorries], on the other hand, has just provided her own opinion."
    Mrs Dorries argued that Hope Hospital in Salford and University College Hospital in London had survival rates of 42 per cent at 22 weeks and 66 per cent at 24 weeks.
    However, a consultant at the UCH neonatal unit later told The Daily Telegraph that the figures did not apply to all births at the hospital — only those admitted to intensive care. The number of extremely early babies was very small, making percentages very unreliable.
    The inquiry paves the way for the Human Tissues and Embryos Act, expected next month, at which both sides of the abortion debate will attempt to amend the 1967 Abortion Act.

    Flu vaccines are not helping elderly patients

    Picture of a patient getting a flu jab
    The Flu jab
     
    Flu vaccines are not helping elderly patients and, despite vaccination programmes, the number of hospital admissions due to flu is not being reduced, reported The Times and other newspapers. The study by the Health Protection Agency "will fuel doubts over the effectiveness of the vaccine in older people" the newspaper said, and although the researchers are not recommending an end to the vaccination programme, they suggest other measures should be considered which might reduce hospital admissions such as treating chest infections, improving housing and promoting giving up smoking.
     
    This story is based on a study that suggests the influenza vaccination programme in the elderly should be an area for further research. However, this study looked only at people who were already ill, and at the current time there is insufficient evidence from this study alone to conclude that influenza vaccinations are unnecessary for a vulnerable group of the population during the winter period.
     
    Where did the story come from? The research was carried out by Dr Rachel Jordan of the Health Protection Research and Development Unit of the Health Protection Agency (based at the University of Birmingham) and other colleagues from the HPA and at Universities and hospitals in Birmingham, Nottingham Derby, and Aberdeen. The main sponsor of the study was the British Lung Foundation. It was published in the peer-reviewed medical journal Vaccine.
     
    What kind of scientific study was this? This was a case-control study of sick, elderly people, which aimed to compare those who were admitted to hospital with an acute respiratory illness (cases) with those that presented to the GP with an acute respiratory illness but did not require hospital admission (controls). The participants were part of a larger study that was examining the risk factors for winter hospital admissions due to respiratory illness.
     
    The researchers used a group of elderly people aged between 65 and 89 years old who went to the GP with an acute respiratory illness (or acute worsening of a pre-existing condition) between October 2003 and March 2004. The researchers selected six controls for each hospitalised case and these were matched as closely as possible in terms of sex, age and date of GP consultation. They examined GP records to obtain information about medical diagnoses, pneumococcal vaccinations, and whether the patient had received the recommended influenza vaccination for that winter in the three weeks prior to the start of the study.

    These results do not "negate the need for influenza vaccine". Rachel Jordan, lead author
    All patients included in the study were invited for interview with a nurse to look at social, medical and lifestyle factors. The study excluded patients with dementia and those who were unable to take part in the interview. Of the potential 3,970 people included in the original group, 157 cases and 639 controls were interviewed and included in the study analysis.
     
    What were the results of the study? The researchers found there to be no difference in the rates of vaccination between those who were hospitalised for their illnesses and those who weren't; 74.5% of the hospitalised patients had been vaccinated compared with a vaccination rate of 74.2% in patients who weren't hospitalised. The difference remained non-significant even when adjusting for potential contributing factors such as chronic obstructive pulmonary disease (COPD), other medical illnesses, smoking and age.
     
    What interpretations did the researchers draw from these results? The researchers conclude that in ill people, influenza vaccine did not reduce the number of hospital admissions due to respiratory illness during a typical winter.
     
    What does the NHS Knowledge Service make of this study?
    Although this study can provide some data on the effect of flu vaccination on the numbers of hospital admissions due to a respiratory illness over a winter period, several points must be kept in mind when interpreting the study. Newspaper headlines such as "flu jabs fail to cut illnesses" may lead you to believe that this study was looking at whether the vaccination could prevent infection with the influenza virus, which is not the case.
    • The study only enrolled people who had presented to their GPs with "an acute episode of respiratory infection or acute exacerbation of pre-existing disease", i.e. people who were already sick. As such, it was designed to answer a very specific question about whether the influenza vaccination reduces "respiratory admissions" (which could include flu or not) to hospitals in those who are ill. The study could not and did not intend to determine whether the influenza vaccination can prevent infection.
     
    • Grouping people under a broad definition of presentation – "acute respiratory illness or acute exacerbation of a pre-existing respiratory disease" – means that those with a wide variety of both viral and bacterial infections such as upper respiratory tract infections (coughs, colds, sore throats), influenza, acute bronchitis, infective exacerbations of COPD, and pneumonia would have been included. Through this method, it isn't possible to separate those patients who were admitted specifically for influenza. As the researchers conclude, their study shows that "influenza is not the sole driver of winter respiratory admissions".
     
    • There are different types of influenza infection. Influenza is a virus, and different strains circulate during different seasons. Vaccinations are prepared before the flu season starts and are designed to protect against the strains that are predicted to be predominant. It is not always possible to get this 100% correct and the vaccination is always more effective in seasons where it matches well with the strains of virus that are causing infection. The researchers themselves note that "in the 2003–2004 season, the circulating virus showed antigenic drift compared with the vaccine strain". This means that the vaccine would not offer full protection against flu that season. This study cannot be generalised to predict what happens in seasons where the vaccine is fully matched to the viruses that are causing infection in the population.
     
    • Controls were matched for age, sex and date of consultation but there are many other factors that could impact upon whether hospitalisation could be required for a respiratory illness, such as presence of asthma, COPD, or having a series of repeated infections.
    This study suggests that influenza is not the "sole driver" of admissions to hospital for respiratory infections and that relying on a vaccine to prevent flu in order to reduce the winter bed pressures in hospitals is not sufficient.
     
    This study was not set up to determine whether the vaccination works to prevent influenza infection in the elderly. The researchers themselves say that their results do not "negate the need for influenza vaccine, as other studies show small but demonstrable benefits in reducing both infection (an outcome this study did not look at) and subsequent morbidity and mortality in the elderly, particularly in a season where the vaccine is well-matched and there is high viral circulation". The efficacy of the vaccination in preventing infection is a separate issue and we support the call for further well-designed research to answer this question once and for all. The elderly should continue to be vaccinated against flu while this research is being conducted.
     
    Sir Muir Gray adds... Hospital admission is determined by many factors, of which the incidence and severity of disease are but two. This does not mean that immunisation should be stopped; if you are offered an immunisation this study should not influence your decision, immunisation does much more good than harm and is still to be recommended.

    Links to the headlines

    Flu jab 'failing to save the elderly'. The Times, October 24 2007
    Flu jabs 'fail to cut illnesses'. The Daily Telegraph, October 24 2007
    Flu jab is 'no use' for the old. The Sun, October 24 2007

    Links to the science

    Further reading Rivetti D, Jefferson T, Thomas R, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2006, Issue 3
    Analysis by Bazian source image
    Edited by NHS Choices
    Latest Headlines

    Friday, October 12, 2007




    MEDICAL MATRIX is part of RED CUBE MEDIA LIMITED © 2007, All Rights Reserved. Company No.: 6309631 VAT No.: GB 863 7338 95.

    Sunday, September 30, 2007

    The epidemiology of depressive disorders








    Recently, the issue of whether depression is overdiagnosed has been discussed, by two leading Australian authorities, in the British Medical Journal 1,2,. This timely debate has reignited the controversy about how depressive disorders are diagnosed, and whether the diagnostic criteria are sufficiently accurate, robust and reliable. Few reading this article have not suffered unhappiness at some time. Often such emotional discomfort can be a normal "physiological response" to major stresses and life events. The invisible line, beyond which such sadness becomes pathological, is notoriously difficult to identify. This article considers the arguments for and against the proposition that depression is over diagnosed.




    Diagnostic precision may be possible in other branches of medicine; however defining mental ill health continues to pose challenges. Sophisticated investigations, relying on imaging or assays, do not have a role in diagnosing depressive illnesses. The diagnostic and statistical manual (DSM-III), published by the American Psychiatric Association, provides the basis for diagnosis in modern clinical psychiatry. DSM-III lists inclusion and exclusion criteria for the diagnosis of mental health disorders. Such a checklist approach, familiar to readers of "pop medical" questionnaires, may be based upon assumptions, and the reliability of DSM-III has been challenged 3, 4।





    Over diagnosis risks exposing those who are unhappy to potentially harmful effects of antidepressants, psychotherapy and electroconvulsive therapy1.




    Hickie argues that depression is not over diagnosed and that evidence suggests that prompt intervention can reduce the incidence of suicide 5, whilst proving cost-effective6, 7. Therapeutic intervention relies on diagnostic tools with high degrees of specificity and sensitivity. "Tightening" diagnostic criteria, may appeal to epidemiologists and clinical scientists, however it risks denying treatment to the marginalised, who's suffering does not fulfil rigid tick box diagnostic criteria. Hickie cites evidence that increased diagnosis has improved treatment outcomes, leading to improved physical health, social functioning and employability with reduced levels of substance misuse). More widespread recognition of depressive illness may improve understanding about depression, helping to destigmatising mental illness8.




    Summary




    There can be no doubt that depression can be incorrectly diagnosed; conversely, there are many in whom depressive disorders continue to elude health professionals. The pharmaceutical industry will seek to promote new therapeutic agents in their quest to maximise profits. Meanwhile, governments struggle to contain the rising costs of healthcare, and rationing decisions are becoming more explicit. In many nations, as few as 10% of those suffering from depression ever receive treatment9. It is critical that we remember that this debate is about real people who are suffering. The government have identified mental health a key priority; mental health has been a Cinderella service for too long. It is essential that the NHS continues to fund treatment for those who may benefit from treatment.




    Web resources












    References




    1. Parker G. Is depression overdiagnosed? Yes. BMJ 2007;335:328


    2. Hickie I. Is depression overdiagnosed? No. BMJ 2007;335:329


    3. Kirk SA, Kutchins H. The selling of DSM. The rhetoric of science in psychiatry. New York: Aldine De Gruyter, 1992.


    4. Parker G. Beyond major depression. Psychol Med 2005;35:467-74


    5. Ludwig J, Marcotte D. Anti-depressants, suicide, and drug regulation. J Policy Analysis Manage 2005;24:249-72


    6. Simon G, Revicki D, Heiligenstein M, Grothaus L, Von Korff M, Katon, et al. Recovery from depression, work productivity and health care costs among primary care patients. Gen Hosp Psychiatry 2000;22:153-62


    7. Sanderson K, Andrews G, Corry J, Lapsley H. Reducing the burden of affective disorders: is evidence-based health care affordable? J Affect Disord 2003;77:109-25


    8. Pirkis J, Hickie I, Young L, Burns J, Highet N, Davenport T. An evaluation of beyondblue Int J Mental Health Promotion, Australia's national depression initiative


    9. Lee S, Fung SC, Tsang A, Zhang MY, Huang YQ, He YL, et al. Delay in initial treatment contact after first onset of mental disorders in metropolitan China. Acta Psychiatr Scand 2007;116:10-6

    Monday, September 24, 2007

    Australian has 'world-first' conscious brain surgery

    Mon Sep 24, 5:20 AM ET
     
    An Australian man was conscious and spoke to his medical team during life-saving brain surgery in what doctors are claiming as a world-first procedure with cutting-edge technology.
     
    John James said it was a strange experience to hear the doctors and nurses talking to each other as he lay on the operating table with a 1.5-centimetre (half-an-inch) hole in his head.
    But he said he was confident throughout the April surgery to remove an aneurysm from his brain, which threatened to burst and kill him.
     
    "The nurses looking after me, they were talking to me," the retired bus driver told a press conference in Canberra. "I could only see bits because I couldn't move my head at all."
    "I wasn't worried whatsoever.... I was quite confident all the way through."
     
    Doctors asked James to read the words and numbers on flashcards shown to him during the surgery so they knew they were not affecting his vision.
     
    The team believes the combination of the technology and the small size of the hole in James's head, as well as the fact he was conscious throughout the operation, makes it a world first.
     
    "As far as I'm aware reading the literature, this kind of thing done as a package has never been done before," Canberra Hospital neurosurgeon Vini Khurana said.
    "So we were pleased. The result was obviously very good."
     
    Virtual reality software, which created a three-dimensional image of James's brain, was used to allow the team to rehearse the operation to drain the blood from the aneurysm.
     
    During the surgery, Khurana had a 3-D image of the brain projected onto one side of his eyepiece. On the other side he could see a close-up view of the brain through a microscope.
     
    An ultrasound probe was also used to ensure that no more blood was flowing through the aneurysm after the drainage was completed.
     
    "The technology we used was quite extraordinary," Khurana said.
     
    "It's like GPS navigation that you use in the car being injected into your sunglasses as you drive."
     
    James, who has since turned 78, initially went to the doctor because of problems with his vision and dizzy spells and scans revealed the potentially deadly aneurysm.
     
    Surgery was required but because the aneurysm was behind his right eye the operation could have blinded him, which is why the doctors wanted him awake during the procedure.
     
    The great-grandfather, who was sent home two days after the operation, said he felt fine after the surgery.
     
    "I had to sit for an hour to make sure everything was alright," he said. "I just came back to normal after that."

    Sunday, September 23, 2007

    PM in pledge to beat hospital bugs

     
    Press Assoc. - Sunday, September 23 06:02 am
     
    Gordon Brown has set the stage for his first Labour Party conference as leader with a pledge that every hospital in the country will undergo a ward-by-ward "deep clean" in a bid to drive out superbugs from the NHS.
    A buoyant Prime Minister arrived in Bournemouth on Saturday amid a swirl of speculation that he will capitalise on his opinion poll lead to call a snap general election this autumn.
     
    That speculation was intensified by an ICM poll for the Sunday Mirror which put Labour on 39%, six points ahead of the Tories on 33%, with the Liberal Democrats on 19%.
     
    The findings suggest that Labour has emerged from the Northern Rock crisis with its reputation for economic competence intact.
     
    Chancellor Alistair Darling will tell the conference that through its "strength of purpose" the Government has built "one of the strongest economies in the world".
     
    The confidence coursing through the party was graphically illustrated by Foreign Secretary David Miliband, who suggested that it was now looking forward to a second decade in power.
     
    "We didn't solve all the problems of the world in 10 years in government. Well, this is a party that is planning how it is going to use the next 10 years to go further towards solving them," he told The Observer.
     
    The Prime Minister refused to be drawn on whether he intended to go to the country this autumn, telling The Sunday Times: "My focus is and will remain on the work that needs to be done".
     
    He was, however, swift to launch his first policy initiative, promising that over the next 12 months all hospitals would be restored to a pristine state of cleanliness to rid them of MRSA and C-difficile.
     
    Officials said that it would be up to individual NHS trusts to decide how the cleaning programme was implemented. However, it is thought wards could be closed for a week at a time while they are systematically cleansed.

    Friday, September 07, 2007

    MEDICAL MATRIX readers can you assist with TV documentary?



    Tiger Aspect productions are one of the UK's leading independent television production companies, responsible for respected and varied factual output (the Monastery, Seaside Parish, Diet Doctors and more).

    We are currently focusing on a feature dealing with people who suffer from excess sweating (hyperhidrosis). We are looking for case studies who would be willing to discuss with us the issues they have faced and the treatments they have used to combat the problem. We are looking for a variety of experiences. If you suffer from the problem or have a story relating to excess sweating we would love to hear from you.

    Of course we understand that this is a delicate subject and we can confirm that any contact with ourselves is in strict confidence, there is no obligation to be part of the program and no information will be shared or broadcast without permission from the case study.

    Please email - duncanthompson@tigeraspect.co.uk

    Alternativly please call Duncan Tompson on: 0207 434 6909

    Knife crime-an emerging public health issue


    Report by Dr. Tom Fitzgerald - for Medical Matrix
     
    According to a recent study, published by the Centre for Crime and Justice Studies, recorded muggings, involving the use of knives, have increased from 25,500 in 2004-5 to 64,000 in the year to April 2007. This reflects 175 victims every day, compared to just 69 in 2004-5.
     
    Every day, between 1997 and 2005, 13 people required hospital admission for treatment following stab injuries 1. Knife-related injuries are a major public health issue and treating victims of knife crime places a massive strain on our already overstretched NHS.
     
    Injuries caused by knives can have a devastating effect on victims and their loved ones. According to Home Office figures, between 1995-200, 37.9% of homicide victims were the victims of stabbings-the commonest cause of death. A similar study in Scotland revealed an even more alarming picture, with the homicide rate for stabbing-related assaults increasing 164% between 1981 and 20032. An audit of forensic knife injuries at one East London hospital revealed 309 injuries over a 2 year period, of which 259 victims required admission, 184 required surgery and 8 died of their injuries 3. This audit suggested that the injuries were becoming more serious. In an editorial in the BMJ in 2005, a team of emergency physicians called for a ban on pointed-tip kitchen knives of the dagger variety, which anecdotally are thought tobe used in a significant proportion of forensic knife injuries 4.
     
    There are no reliable statistics on the incidence of knife carrying. With the rise in gang culture, many young people carry knives because of peer pressure or for protection against assailants. This creates a vicious cycle and evidence suggests that young people carrying knives are themselves more likely to be victims of knife-inflicted injuries. Evidence from the British Crime Survey 2005-6 suggests that young men, those from minority ethnic communities and the poor are most likely to be victims of violent crime 5.
     
    Tackling the rise in knife crime will require an integrated approach, involving a number of government departments and other agencies. This must include action to address the root causes of violent crime as well as robust measures to deter young people from carrying knives. Further research will be required to evaluate various interventions to reduce knife-inflicted injuries. Steps need to be taken to reduce poverty, unemployment and social deprivation-all factors known to predispose young people to commit violent acts. Young people need positive role models, together with training opportunities if they are to turn their backs on the sub-culture of violence and knife carrying. Educational strategies will be required to provide young people with information about the consequences of knife injuries. High profile knife amnesties, such as the 2006 amnesty which saw 90,000 knives surrendered, are only part of the solution. The Violent Crime Reduction Act 2006 gave teachers tough powers to search pupils, suspected of  carrying weapons. The Act also raises the age at which young people are allowed to purchase knives from 16 to 18. Currently, those prosecuted for carrying knives illegally may be imprisoned for up to 2 years, yet custodial sentences are rarely handed down. This is an ineffective deterrent and tougher penalties, together with robust enforcement have a vital role in preventing the increase in knife crime.
     
    Web resources:
     
     
     
     
    References:
    1.      Maxwell, R., Trotter, C., Verne, J., Brown, P., Gunnell, D. (2007). Trends in admissions to hospital involving an assault using a knife or other sharp instrument, England, 1997-2005. J Public Health (Oxf) 29: 186-190
    2.      Leyland, A. H. (2006). Homicides involving knives and other sharp objects in Scotland, 1981-2003. J Public Health (Oxf) 28: 145-147
    3.      Konig, T., Knowles, C. H, West, A., Wilson, A., Cross, F. (2006). Stabbing: data support public perception. BMJ 333: 652-652
    4.      Hern E, Glazebrook W, Beckett M. Reducing knife crime. BMJ 2005;330: 1221-2
    5.      British Crime survey 2005/06 Home Office

    Friday, August 24, 2007

    anti-euthanasia talk

      SPUC  Kensington & Chelsea  Branch
     
    Dear  Medical Matrix readers,
     
    You  are all very  welcome  to  hear  Miss  Teresa  Lynch,  founding  Chair,  talk  about  the  aims & achievements  of  'Nurses  opposed  to  euthanasia'.  The  group  supports  nurses  and  other  medical  professionals  threatened  with  having  to  let  patients  die  in  hospitals  today ~ http://www.spuc.org.uk/about/noe/   I  enclose  the  aims  of  NoE
              7.30p.m,  Tues.  25th  Sept,
                  24  Smith  Terrace,
               LONDON,  SW3  4DL
            (All welcome;  Admission  free  of  course)
    The  nearest  tube  is  Sloane  Square & walk  down  the  King's  Road,  left  into  Smith  Street,  right  into  Smith  Terrace;  there  is  free  meter & single-yellow  line  car  parking  around  Smith  Terrace  after  6.30pm.
     
    Here  are  some  relevant  links  http://www.spuc.org.uk/ethics/euthanasia/
     
    SPUC's  free  Pro-Life  Times  ( http://www.spuc.org.uk/pro-life-times/  &  prolifetimes@blueyonder.co.uk )  constantly  opposes  euthanasia.  Might  you  be  interested  in  submitting  an  article  about  euthanasia-related  matters ?  I  trust  you  are  aware  of  our  division  'No less Human'  for  those  with  disabilities  http://www.spuc.org.uk/about/no-less-human/
     
    See  also  http://www.spuc.org.uk/about/pfn/  (we  can  provide  100s  of  leaflets  about  'Patients First'  if  you  know  of  those  interested),  and  links  to  relevant  books  at  http://www.chninternational.com/no_water_no_life_bk_by_g_craig.html  and  http://www.argospress.com/Resources/medical/book-0253205174.htm
     
    All  kind  regards.
    In  defence  of  life,
     
    William Jolliffe  (Branch  Secretary), 
     
    24  Smith  Terrace,  LONDON,  SW3  4DL;  Tel. 020 - 7352 - 7212 / Mobile 07973 - 510 - 144
    williamhmjolliffe@yahoo.co.uk
    www.jolliffephotos.com



    Wednesday, August 15, 2007

    The Ethics of Cosmetic Surgery

     
     
    Advances in plastic and reconstructive surgery have revolutionised the management of patients suffering from disfiguring congenital abnormalities, burns and skin cancers. Aesthetic (or cosmetic) surgery refers to plastic surgery performed to improve physical appearance in the absence of pathology. The demand for aesthetic surgery has increased in recent years as our culture has become more concerned with image and appearance.
     
    Many regard aesthetic surgery as a panacea for their personal and relationship difficulties. This may reflect modern image-obsessed popular culture, but it can be due to deep-rooted insecurities. Body Dysmorphic Disorder (BDB) is a psychiatric syndrome, characterised by a pre-occupation with a non-existent or minimal cosmetic "defect" associated with persistent attempts to have the defect surgically corrected. BDB is increasingly recognised, and may be becoming more prevalent.
     
    In the National Health Service (NHS), finite resources limit the availability of aesthetic surgery to those who suffer significant psychological distress due to their appearance. In the independent healthcare sector, aesthetic surgery has increased in popularity, reflecting increased consumer demand.
     
    In 1979, Beauchamp and Childress published Principles of Biomedical Ethics, in which they presented four "principles" that have since been adopted as the ethical basis for contemporary UK medical practice. They argued that these principles "bridged" high-level moral theory and what they described as "low-level common morality". These principles included: respect for autonomy, beneficience, non-maleficience and justice. Whilst these principles were developed to guide physicians treating those suffering ill health, they provide the ethical framework which underpins modern surgical practice.
     
    Respect for Patient autonomy
     
    In general, competent adults have the right to decide whether they wish to undergo a surgical procedure. Providing they are given sufficient information, on which to make an informed decision, patients' wishes must be respected. Information must include the risks of surgery together with alternative options. These principles still apply to aesthetic surgery where patients are not suffering from an "illness".
     
    Beneficience
     
    This principle requires medical practitioners to act in patients "best interests". Undertaking surgery to improve a patients self-image and esteem is acceptable. However, defining patients best interests can be very difficult. Many people experience real pain, discomfort, social handicap and suffering because they are self-conscious about their appearance. This group benefit from aesthetic surgery.
     
    Non-maleficience
     
    This principle ensures that doctors never act against patients' best interests or in a way that may harm a patient. Consultant plastic surgeons may decline to operate on patients if they do not believe that surgery is in patients' interests. Surgeons are reluctant to operate on those with unrealistic expectations, as the risks of surgery may outweigh any benefits. Patients with serious health problems are at increased risk of suffering complications under general anaesthesia, and again the risks may outweigh the benefits. All such assessments need to be made on an individual basis. In the past, there has been a perception that surgeons have a potential conflict of interest in the independent sector. No surgeon would ever proceed with an operation merely for personal pecuniary gain. All surgeons take their duty of care to their patients very seriously.
     
    Justice
     
    This principle requires doctors to ensure that medical care to available to all. Equitable access to healthcare is regarded as a basic human right. However, resources are limited and it is not possible for the National Health Service to provide aesthetic surgery for all those who would like it. "Rationing" takes place on the basis of clinical need. Inevitably, this introduces subjective judgments about whose need is greater. In the private sector, those who can afford to pay can undergo surgery.
     
     
     
    With appropriate patient selection, aesthetic surgery can offer excellent cosmetic results. Patients must undergo thorough pre-operative assessment and counseling before surgery. This may require expert psychological assessment. Surgeons must ensure that patients' expectations are realistic. Surgeons need to explain the likely benefits of surgery, alternative non-surgical options as well as the risks of surgery and anaesthesia. Patients need to make an informed choice regarding whether surgery is right for them. Consultant surgeons and consultant anaesthetists treating patients, undergoing cosmetic procedures, should be on the General Medical Councils' Specialist Register. Surgery should only be undertaken in premises that are fully-equipped, with resuscitation facilities and staff trained in advanced life support. Clinics and hospitals providing aesthetic surgery should be registered with the Healthcare Commission.
     
     
    For further information:
     
    The British Association of Aesthetic Plastic Surgeons
    This email address is being protected from spam bots, you need Javascript enabled to view it
    References
     
    Beauchamp and Childress, Principles of Biomedical Ethics, Fourth Edition.
    Oxford. 1979


    Tuesday, August 07, 2007

    Andrew Wakefield: Galileo or Shipman

    There is a free circus in town, or rather in the Coliseum, for the next month. Get your tickets at the GMC, and hear good doctors made fools of trying to defend an open mind.

    I spent the morning at the GMC, on Euston Rd, where they will decide whether Andrew Wakefield is a son of Satan or a misunderstood honest researcher doing his best to make sense of a complex topic. This morning's session was one of the supporting or warm-up acts, Richard Horton, Editor of the Lancet. Horton is one the few remaining voices for free medical thought, fewer since Richard Smith left the British Medical Journal.

    The first few hours raised the following questions

    The procedure - Can the GMC set the standard, prosecute offenders and judge the case? All in all, a bit like the Inquisition

    The GMC Panel - ? fit for purpose - too early to say - none of them said very much.

    The prosecution, 'Miss (married) Smith' more of an actress than a barrister - perfect pitch, excellent vocal modulation, and a full range of styles. She was able to encompass serious, pitiful, scathing, patronising and even attempt humour, using a wonderfully contrived Sloane-style diction, within one speech. RADA 1985?

    The defence, I warmed to the defence Barrister, sensible, down to earth and very aware of the size of the storm in the GMC teacup. Everyone should have one.

    The question to be decided Galileo or Shipman? - Not Shipman, as no patients have ever come to harm as a result of Dr Andrew Wakefields clinical activity. But you can't tell that from the size of the party.

    Galileo? Yes and No! This is not a big controversy, these are not ideas that will shake the universe. MMR and autism are they associated? the paper about which there is all the fuss, actually concluded that there was no evidence that they were.

    However, what did Galileo actually change? were his ideas earth shattering? not immediately but they opened the floodgates to allow scientific thought to think the unthinkable and unseat the Church from its position as the arbiter of knowledge.

    Wakefield is guilty of looking for a cause for autism. Autism, like Alzheimers, like Polycystic ovaries, like heart disease did not exist in Galileo's time. They are all conditions of which we do not know the cause. They are spreading faster than the plague in the middle ages. The plague left a third of the population dead. By contrast, these diseases are big business. The healthcare industry provides reliable growth, year on year. The economy of health would bankrupt America and most of the Western world.

    As doctors we are taught that we do not know the cause of these conditions. We tell you, our patients that we do not know the cause of these conditions but take these drugs, and it will all get better.

    But we know the cause of everything else, we know how computers work, how to get rockets in space, we know what caused the World Trade Center to collapse, we even know how to predict a hurricane. But we don't know the cause of diseases that are unheard of in the developing world, that people only get when they move to the West, diseases that are rising in incidence year on year, that even in the West occur more often with an unhealthy lifestyle than with an unhealthy lifestyle ??? has anyone in the audience got any ideas??

    Are they
    1) - Visitations from outer space
    2) - Down to processed food, the way we live and what we do to ourselves
    3) - Caused by viruses at the neuromuscular junction *


    Even twenty years ago these diseases were rare, dementia in the under eighties was rare, so rare that if a 'youngster' became demented, they warranted a brain biopsy. Now dementia is so common patients rarely even get a CT Scan. Polycystic ovaries were called SteinLeventhal syndrome and went to a specialist clinic. And type II diabetes - there was no type II diabetes.

    Andrew Wakefield dared to ask what causes Autism. We live in a cause and effect universe, that is not an unreasonable question.

    So if you can think what might be causing the current epidemic of disease, from glaucoma to dementia, from diabetes to cancer - answers on a postcard please

    The first correct answer wins a cat and the editor's decision is final




    * Recent answer from a Teaching Hospital consultant when asked what he thought caused irritable bowel syndrome.


    Copyright (c) Dr. Liz Miller

    http://www.drlizmiller.co.uk

    Friday, August 03, 2007

    Just as you thought it was safe to go into hospital

    Finally, even the BBC has noticed that there will be no doctors on the hospital wards this week as doctors complete their biannual migration.

    Yes don't be ill - this month, or next month, or anytime before Christmas. If you want your doctors trained, I would recommend you time your illness for early January 2008. Just after the Christmas break. By then, the doctors will have been in the job for five months, and should know what they are doing.

    Research (I love that word, its covers more than Elizabeth Arden over 55s make-up) shows that in Industry it takes five to six months before a person has learnt their job well to be of value to their company. Which is almost exactly the time, when we get ready for the next round of medical chairs.

    This year there is a severe shortage of chairs, leaving approximately 10,000 doctors without a job. Many of these are top class graduates, not great at filling out forms and describing themselves in 100 words or less, but prize winners, first class students, able and willing.

    Political correctness has gone beserk. It is has been decreed that all doctors must compete on an equal footing. In order not to give bright hard working graduates an unfair advantage, they hvae not been allowed to mention their class of degree, their prizes or any other achievement gained during their student years. So the decision as to who to employ has been made largely on their ability to fill out a form. Bureaucracy begets bureaucracy!

    The bureaucrats are in the process of making medicine in their own image. Form filling rules. It no longer matters what happens to a patient, or what you learn from your experience only that you fill in the correct accident form to make sure you are 'covered'. This system will only work if doctors are selected from an early age, on their ability to fill out a form properly. This suits 'Sensitive-Individuals' that is fear-driven, task not people-focused individuals who are not fit to be let out on their own in a mortuary.

    It is amazing how much has been lost in the present sandstorm of confusion

    1)Modernising medical careers - a way to shorten and cheapen the way we train doctors
    2) An IT collapse and fiasco providing a diversion worthy of the French Resistance to make sure no one noticed exactly how many doctors would be unemployed.
    3)10,000 unemployed doctors
    4) Everyone swapping jobs August 1st - so just make sure you aren't ill.

    And now, as everyone is going on holiday, lets take our illnesses abroad.

    That comment is truer than I realised. I have had an interesting conversation with a Refugee liason worker, the days of medical tourism are over. Refugees now go to Italy and Germany for their medical care, rather than the UK. It may be easier to get treated here, but the quality is not what it was.

    That story reminds me of the time I had a suitcase stolen and lost half its contents. The other half were left with the case, round the corner. I couldn't bear to wear anything that had been left with the case - after all if it wasn't good enough to be stolen, it definitely wasn't good enough for me.

    So if our health care isn't good enough for an asylum seeker, why is it good enough for us?

    (c) Dr. Liz Miller

    http://www.drlizmiller.co.uk

    Thursday, August 02, 2007




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    Sunday, July 29, 2007

    Shopaholics need therapy

    By Emily Nash.
     
    Popping out for some retail therapy in the lunch-hour is a source of comfort for many stressed and depressed workers.
     
    But those who take it too far and become real shopaholics have a serious psychiatric disorder, experts said yesterday.
     
    Easy credit, advertising and the glamorous designer clothes featured on TV contribute to lavish spending, they claimed.
     
    Now compulsive shopping has finally been recognised as a unique condition and listed alongside addictions to gambling and alcohol in the official reference book for US psychiatrists, The Diagnostic and Statistical Manual of Mental Disorders.
     
    The inclusion is likely to be mirrored in its European equivalent.

    Researchers believe the disorder affects about one in ten people, with women nine times as likely as men to be hooked.
     
    The addiction is high profile — society girl Tara Palmer-Tompkinson famously sought help after spending £20,000 in a designer clothes spree.
     
    'You can't open your eyes, you can't eat your cereal without being persuaded to buy something,' said Dr Adrienne Baker, senior psychotherapy lecturer at Regent's College in London.
     
    'It is usually written off as affecting only bored, affluent, middle-aged women but it affects people from any background.'
     
    Robert Lefever, director of the Promis recovery centre in Kent, has treated the condition with group therapy for 17 years.
     
    One former patient was dubbed Anne of the 1,000 T-shirts. 'She didn't even unwrap the T-shirts, just piled them up to the point where she could not even get into her bedroom,' he added. 'But she's doing fine now.'

    Smoking marijuana increases the risk of schizophrenia

    Smoking marijuana increases the risk of schizophrenia

    A study from the Lancet has suggested that cannabis users have a 41 per cent increased risk of developing a psychotic illness such as schizophrenia.
     
    A team of researchers led by Dr Stanley Zammit from Bristol and Cardiff Universities undertook a meta-analysis of 35 studies. The researchers concluded that there is 'a consistent association between cannabis use and psychotic symptoms, including disabling psychotic disorders'.
     
    An accompanying editorial from two Danish researchers suggests that up to 800 schizophrenia cases each year in the UK can be linked to cannabis use.
     
    Although this study is one of the most comprehensive of its kind, the researchers emphasise that a randomised controlled trial with a long-term follow-up is required to investigate whether there is a direct link.
     
    Comment below and tell us what you think