Friday, 8 June 2012
The family and friends test: will hospitals raise their game? | Jocelyn Cornwell
The family and friends test: will hospitals raise their game? | Jocelyn Cornwell: From April 2013, every NHS hospital will be required to ask patients in A&E and on the wards whether they would want a friend or relative to be treated there. But will this drive hospitals to raise their game? (Blog, 7 Jun 2012) Kings Fund
The 15 Steps Challenge: Quality from a patient’s perspective
The 15 Steps Challenge: Quality from a patient’s perspective:
The 15 Steps Challenge encourages patients and staff to work together to identify improvements which may enhance the patient experience, highlighting what is working well and what might be done to increase patient confidence. NHS Networks
The 15 Steps Challenge encourages patients and staff to work together to identify improvements which may enhance the patient experience, highlighting what is working well and what might be done to increase patient confidence. NHS Networks
CCGs seek clarity about commissioning support
CCGs seek clarity about commissioning support: As authorisation begins, Marina Soteriou looks at clinical commissioning groups' (CCGs') next steps. GP Online
An atlas of variations in social care: an analysis of the quality of social care services in England
An atlas of variations in social care: an analysis of the quality of social care services in England:
This report reveals the financial and personal costs of variations in social care provision. It uncovers that £115 million of Government expenditure earmarked as ‘additional’ in 2011/12, and to be transferred from the NHS to local authorities for improving social care, is being used by commissioners to prop up eligibility criteria for existing services. Eligibility criteria are the indicators and measurements used to assess people’s social care needs and the services they should be able to access.
This report reveals the financial and personal costs of variations in social care provision. It uncovers that £115 million of Government expenditure earmarked as ‘additional’ in 2011/12, and to be transferred from the NHS to local authorities for improving social care, is being used by commissioners to prop up eligibility criteria for existing services. Eligibility criteria are the indicators and measurements used to assess people’s social care needs and the services they should be able to access.
Celebrating early implementer achievements - one year on: 150 years of health visiting services (1862-2012)
Celebrating early implementer achievements - one year on: 150 years of health visiting services (1862-2012):
This report provides more detail about the outcomes of the heath visitor early implementer sites’ (EIS) activities. It is a ‘one stop’ access point to the main elements of learning that came from the initial group of early implementers . It will be used to inform a second wave of service roll out, enabling to further improvement and development of local services. The twenty six case studies (one from each EIS), reflects learning and development stemming from the first wave of implementation and is aimed at the health visitor workforce, clinical leaders and commissioners.
This report provides more detail about the outcomes of the heath visitor early implementer sites’ (EIS) activities. It is a ‘one stop’ access point to the main elements of learning that came from the initial group of early implementers . It will be used to inform a second wave of service roll out, enabling to further improvement and development of local services. The twenty six case studies (one from each EIS), reflects learning and development stemming from the first wave of implementation and is aimed at the health visitor workforce, clinical leaders and commissioners.
NHS bursary scheme rules
NHS bursary scheme rules:
This document outlines the new rules which are applicable for students who started courses on or after 1st September 2012. The rules for students who started their courses before this date are set out in the thirteenth edition of the NHS bursary scheme rules.
This document outlines the new rules which are applicable for students who started courses on or after 1st September 2012. The rules for students who started their courses before this date are set out in the thirteenth edition of the NHS bursary scheme rules.
NHS millions used to 'prop up crumbling care system', report shows
NHS millions used to 'prop up crumbling care system', report shows: More than £100 million of taxpayers money set aside to improve care for the elderly and disabled has been spent by councils simply propping up the existing system, a report shows. The Daily Telegraph
NHS compensation to misdiagnosed patients rises to £98 million
NHS compensation to misdiagnosed patients rises to £98 million: Payouts to misdiagnosed patients increases by three-quarters in the last year to nearly £100 million.
The Daily Telegraph
The Daily Telegraph
New information measures published today about GP practices in England
New information measures published today about GP practices in England: Twenty new information measures about GP practices in England have been published today by the Health and Social Care Information Centre (HSCIC).
CT scans 'linked to brain cancer risk'
CT scans 'linked to brain cancer risk':
“CT scans can triple the risk of children developing leukaemia and brain cancer,” The Independent has today reported. Computerised tomography, or CT, is a technique that uses advanced X-ray technology to build up a detailed picture of a patient’s insides. Like regular X-rays, CT exposes patients to radiation that could potentially increase the risk of cancer.
Today’s news is based on a 24-year study that investigated whether or not children and adolescents given CT scans had an increased risk of brain tumours and leukaemia in the years that followed. The research compared the risk among children who were exposed to high doses of radiation during the scans with that of children who were exposed to the lowest dose of radiation. They found that the risk of developing leukaemia or a brain tumour increased as radiation exposure went up. Children who were exposed to a dose of radiation equivalent to two-to-three CT scans were at nearly three times the risk of developing a brain tumour in the next 10 years compared with children with the lowestexposure. Those who had been exposed to a dose equal to 5-10 scans had approximately three times the risk of developing leukaemia compared with those who received the lowest dose. However, it should be noted that the total number of cancer cases was low, and the overall risk of developing either a brain tumour or leukaemia remained well below 1%.
This study suggests that children who are exposed to higher levels of radiation during a CT scan may have an increased risk of developing certain types of cancer. This increase in risk is small in real terms, but should still be weighed up alongside the benefits of a scan. It’s important to note that these risks don’t apply to MRI scans, which are alternative scans that don’t use the ionising radiation of X-rays. However, MRI scans don’t always provide the same detail as CT scans and are therefore not always the most appropriate scanning method.
The study was published in the peer-reviewed medical journal The Lancet.
The media reported the story accurately, with most news outlets emphasising that the “absolute risk” of developing cancer remained quite low even after repeated CT scans. “Absolute risk” presents a person’s overall risk of developing a condition, rather than how much a person’s risk is raised by an event such as a CT scan. News coverage also reported that the benefits of scans generally outweigh the risks.
CT scans are used to create images of the body that are much more detailed than those obtained by a typical X-ray. CT scans are usually used to diagnose a number of conditions, including cancers, and bleeding or swelling in the brain. They may be used after serious accidents in order to determine whether or not there are serious internal injuries. The amount of radiation absorbed during a CT scan depends on various factors including the body part scanned, the tissue or organ of interest, the age of the scanning technology used and the patient’s age and sex. The researchers took these factors into consideration in order to estimate the amount of radiation each patient was exposed to.
This was a large, long-running retrospective cohort study. A study of this type can establish the association between exposure to CT radiation and cancer risk, but can’t conclusively show that one causes the other.
They then determined how many of the patients went on to develop a brain tumour or leukaemia (a type of blood cancer) and determined the risk of developing one of these cancers over an average of 10 years based on radiation dose. The researchers then compared the risk of developing one of these cancers in the higher radiation-dose groups with the risk in the lowest-dose group.
Compared with patients exposed to the lowest dose of radiation:
CT scans (like many other scans such as X-rays) expose the body to doses of ionising radiation, although it is not entirely definite that this exposure increases leukaemia or brain tumour risk. However, as the researchers have rightly pointed out, when considering whether or not to conduct a CT scan doctors should weigh up the benefits of the scan against its small increase in brain tumour and leukaemia risk. Like any other test or treatment, doctors must consider whether a CT scan is the best option for the patient and what the overall balance of benefits and harms is.
The researchers added that the radiation doses of CT scans should be kept as low as possible, and that CT should only be used once other diagnostic tests with lower or zero radiation doses (such as ultrasound or MRI scans) have already been used or ruled out.
It is important to remember that the three-fold risk increases covered in the media headlines are relative increases, and that the absolute risk increase of developing a brain tumour or leukaemia following childhood CT scans is well below 1%.
UK regulations already state that CT scans should only be used when clinically justified, and the UK is reported to have lower levels of CT scanning compared with other countries. CT scans are an invaluable diagnostic tool in many medical situations, and although this research does suggest a potential link with brain cancers and leukaemia, the benefits of this accurate and fast test appear to outweigh the risks associated with radiation exposure.
Analysis by Bazian
CT scans could triple risk of a brain tumour in children. The Daily Telegraph, June 7 2012
CT scans 'triple risk of children getting cancer'. The Independent, June 7 2012
Child's risk of brain cancer triples after just two CT scans. Daily Mail, June 7 2012
Related editorial
Einstein AJ. Beyond the bombs: cancer risks of low-dose medical radiation. The Lancet, Early Online Publication, June 7 2012
NHS Choices
Today’s news is based on a 24-year study that investigated whether or not children and adolescents given CT scans had an increased risk of brain tumours and leukaemia in the years that followed. The research compared the risk among children who were exposed to high doses of radiation during the scans with that of children who were exposed to the lowest dose of radiation. They found that the risk of developing leukaemia or a brain tumour increased as radiation exposure went up. Children who were exposed to a dose of radiation equivalent to two-to-three CT scans were at nearly three times the risk of developing a brain tumour in the next 10 years compared with children with the lowestexposure. Those who had been exposed to a dose equal to 5-10 scans had approximately three times the risk of developing leukaemia compared with those who received the lowest dose. However, it should be noted that the total number of cancer cases was low, and the overall risk of developing either a brain tumour or leukaemia remained well below 1%.
This study suggests that children who are exposed to higher levels of radiation during a CT scan may have an increased risk of developing certain types of cancer. This increase in risk is small in real terms, but should still be weighed up alongside the benefits of a scan. It’s important to note that these risks don’t apply to MRI scans, which are alternative scans that don’t use the ionising radiation of X-rays. However, MRI scans don’t always provide the same detail as CT scans and are therefore not always the most appropriate scanning method.
Where did the story come from?
The study was carried out by researchers from Newcastle University and other institutions throughout the UK, US and Canada. The research was funded by the UK Department of Health and the US National Cancer Institute.The study was published in the peer-reviewed medical journal The Lancet.
The media reported the story accurately, with most news outlets emphasising that the “absolute risk” of developing cancer remained quite low even after repeated CT scans. “Absolute risk” presents a person’s overall risk of developing a condition, rather than how much a person’s risk is raised by an event such as a CT scan. News coverage also reported that the benefits of scans generally outweigh the risks.
What kind of research was this?
This was a retrospective cohort study of children and adolescents that examined the association between estimated radiation exposure during a computed tomography (CT) scan and the risk of developing a brain tumour or leukaemia.CT scans are used to create images of the body that are much more detailed than those obtained by a typical X-ray. CT scans are usually used to diagnose a number of conditions, including cancers, and bleeding or swelling in the brain. They may be used after serious accidents in order to determine whether or not there are serious internal injuries. The amount of radiation absorbed during a CT scan depends on various factors including the body part scanned, the tissue or organ of interest, the age of the scanning technology used and the patient’s age and sex. The researchers took these factors into consideration in order to estimate the amount of radiation each patient was exposed to.
This was a large, long-running retrospective cohort study. A study of this type can establish the association between exposure to CT radiation and cancer risk, but can’t conclusively show that one causes the other.
What did the research involve?
The researchers examined the medical records of over 175,000 patients under the age of 22 years old who had undergone a CT scan between 1985 and 2001. The researchers estimated the amount of radiation that the patients were exposed to during these scans and grouped the patients based on this estimated dose.They then determined how many of the patients went on to develop a brain tumour or leukaemia (a type of blood cancer) and determined the risk of developing one of these cancers over an average of 10 years based on radiation dose. The researchers then compared the risk of developing one of these cancers in the higher radiation-dose groups with the risk in the lowest-dose group.
What were the basic results?
Among the 175,000 patients there were a total of 135 brain tumours and 74 cases of leukaemia diagnosed during the follow-up period. The researchers found that the risk of both of these cancers increased with higher radiation doses.Compared with patients exposed to the lowest dose of radiation:
- Patients exposed to a dose equivalent to two-to-three CT scans had over a three-fold increased risk of developing a brain tumour (relative risk [RR] 3.32, 95% CI 1.84 to 6.42).
- Patients exposed to a dose equivalent to 5-10 CT scans had over a three-fold increased risk of developing leukaemia (RR 3.18, 95% CI 1.46 to 6.94).
How did the researchers interpret the results?
The researchers concluded that, while the absolute increase in risk was low, “radiation doses from CT scans ought to be kept as low as possible.”Conclusion
This well-conducted research suggests that, among children, the risk of developing a brain tumour or leukaemia goes up as doses of radiation from CT scans increase. This absolute increase in risk, however, is quite small.CT scans (like many other scans such as X-rays) expose the body to doses of ionising radiation, although it is not entirely definite that this exposure increases leukaemia or brain tumour risk. However, as the researchers have rightly pointed out, when considering whether or not to conduct a CT scan doctors should weigh up the benefits of the scan against its small increase in brain tumour and leukaemia risk. Like any other test or treatment, doctors must consider whether a CT scan is the best option for the patient and what the overall balance of benefits and harms is.
The researchers added that the radiation doses of CT scans should be kept as low as possible, and that CT should only be used once other diagnostic tests with lower or zero radiation doses (such as ultrasound or MRI scans) have already been used or ruled out.
It is important to remember that the three-fold risk increases covered in the media headlines are relative increases, and that the absolute risk increase of developing a brain tumour or leukaemia following childhood CT scans is well below 1%.
UK regulations already state that CT scans should only be used when clinically justified, and the UK is reported to have lower levels of CT scanning compared with other countries. CT scans are an invaluable diagnostic tool in many medical situations, and although this research does suggest a potential link with brain cancers and leukaemia, the benefits of this accurate and fast test appear to outweigh the risks associated with radiation exposure.
Analysis by Bazian
Links To The Headlines
CT scans warning after study claims too many could lead to brain cancer. The Guardian, June 7 2012CT scans could triple risk of a brain tumour in children. The Daily Telegraph, June 7 2012
CT scans 'triple risk of children getting cancer'. The Independent, June 7 2012
Child's risk of brain cancer triples after just two CT scans. Daily Mail, June 7 2012
Links To Science
Pearce MS, Salotti JA, Little MP et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, Early Online Publication, 7 June 2012Related editorial
Einstein AJ. Beyond the bombs: cancer risks of low-dose medical radiation. The Lancet, Early Online Publication, June 7 2012
NHS Choices
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