Friday, 31 May 2013

Homes to be built on former Rushden hospital site

Homes to be built on former Rushden hospital site:
More than 100 homes will be built on the site of the former Rushden Hospital later this year, prompting a mixed reaction from residents. Evening Telegraph

Corby care home resident pushed by his head

Corby care home resident pushed by his head:
A former care worker at a Corby residential home pushed a resident with mental health problems into his room by his head as he lay on the floor, a court heard. Evening Telegraph

Stress-busting NHS staff scheme expands

Stress-busting NHS staff scheme expands:
 The scheme is meant to help foster a culture of compassionate patient care among NHS staff
Health & Social Care news from Public Service

An NHS for the digital generation

An NHS for the digital generation:
In the West, we have become used to improved living standards for the past fifty or more years. But there are concerns that the cost of healthcare is becoming unaffordable. EHI News

Social media in education and research

Social media in education and research:
The information in this document may be particularly helpful for both NHS and university staff involved in formulating local learning development agreements. NHS Networks

Physical activity: brief advice for adults in primary care

Physical activity: brief advice for adults in primary care:
This guidance aims to support routine provision of brief advice on physical activity in primary care practice. The recommendations include: identifying adults who are inactive; delivering and following up on brief advice; and incorporating advice in commissioning. It is aimed at commissioners of health services and anyone working in primary care whose remit includes offering lifestyle advice. Kings Fund Blogs

High-dose painkiller heart risk: small but significant

High-dose painkiller heart risk: small but significant:

"Study links painkillers to increased risk of heart attack," The Independent reports. This major study found that high doses of the non-steroidal anti-inflammatory drugs (NSAIDs) type of painkiller increased the risk of serious conditions such as heart attacks.
NSAIDs, such as ibuprofen, diclofenac, naproxen and coxibs, are widely used to relieve pain and inflammation.
Many people with painful long-term conditions, such as rheumatoid arthritis, are prescribed high doses of NSAIDs on a long-term basis. It is thought that these people have an increased risk of serious heart conditions compared with those who just take an occasional low-dose ibuprofen pill for a headache.

This new review of hundreds of studies found that coxibs and diclofenac increased the risk of major vascular events – mainly heart attacks – by a third, while ibuprofen was also associated with a greater risk of heart attack. High-dose naproxen did not affect the risk of heart attack.
The actual risk to individuals is small. For example, this study found that for every 1,000 patients taking a high dose of coxib or diclofenac for a year, three more had a major vascular event, one of which was fatal, compared with placebo.
Every treatment comes with both benefits and risks. Your doctor can provide you with information to allow you to make an informed choice and can help you to weigh the benefits of these painkillers against this small risk of a serious side effect.

Where did the story come from?

The study was carried out by researchers from the University of Oxford and was funded by the UK Medical Research Council and the British Heart Foundation. It was published in the peer-reviewed medical journal The Lancet.
It was widely reported in the UK media, and the quality of the reporting was generally of a high standard. Unlike in previous ‘drug-scare’ stories most media sources put the individual risk in its proper context, explaining that it is very small. They also reported the comments made by the researchers that people taking the occasional low dose of an NSAID are unlikely to be at risk.

What kind of research was this?

This research involved meta-analyses of randomised controlled trials (RCTs), including nearly 354,000 participants. The study looked at the risks of NSAIDs compared with placebo treatment and the comparable risks of different NSAIDs. Popular NSAIDs include the older types – ibuprofen, diclofenac, naproxen – and newer cox-II inhibitors (coxibs). Coxibs include celecoxib, etoricoxib and rofecoxib (rofecoxib was withdrawn from the market in 2004 because of concerns over an increased risk of heart attack and stroke).
The researchers were particularly interested in the risk of major cardiovascular events and gastrointestinal complications. They point out that previous research has found that both older and newer types of NSAIDs have a risk of vascular events, while the newer coxib-type NSAIDs are thought to have fewer gastrointestinal effects than older NSAIDs.
This review aimed to provide more accurate estimates of the size, timing and severity of the risk, among different types of patients.

What did the research involve?

The researchers carried out searches of randomised controlled trials that either compared the risks of NSAIDs with placebo treatment or compared the risk of one NSAID with another. The main risks they looked at were of major vascular and coronary events (heart attack, coronary death, stroke, death from any of these and heart failure) and of gastrointestinal complications (perforation of the stomach lining, obstruction or bleeding).
They searched various electronic databases, clinical trial registers, reference lists of relevant papers and also made contact with pharmaceutical companies. Trials (up to 2011) were eligible if they were properly randomised, lasted at least four weeks and compared an NSAID with either a placebo (or open control) or another NSAID.
All trials were reviewed for their eligibility by two researchers, who recorded the key characteristics of the trials that might affect the risk of bias (such as method of randomisation). Where possible, the researchers used data on individual participants or aggregate data (a standard format of results provided by the original researchers). They used standard meta-analytical techniques to give estimates of the risks.

What were the basic results?

The researchers included 639 trials in their analysis. Almost all trials involved a coxib or a high-dose NSAID (diclofenac 150mg daily, ibuprofen 2,400mg daily, naproxen 1,000mg daily).
  • Coxibs and diclofenac increased the risk of a major vascular event by about a third (coxibs rate ratio (RR) 1.37, 95% confidence interval (CI) 1.14–1.66; diclofenac RR 1.41, CI 1.12–1.78). Most of this increased risk was due to an increase in major coronary events such as heart attack.
  • Ibuprofen also significantly increased major coronary events (RR 2.22, CI 1.10–4.48), but not major vascular events, such as stroke.
  • Of 1,000 patients allocated to a coxib or diclofenac for a year, three more had major vascular events (one of which was fatal) compared with placebo.
  • Naproxen did not significantly increase major vascular events (RR 0.93, CI 0.69–1.27).
  • The risk of death from a vascular event was increased significantly by coxibs (RR 1.58, 99% CI 1.00–2.49) and diclofenac (RR 1.65, CI 0.95–2.85), but the increase seen with ibuprofen (RR 1.90, CI 0.56–6.41) and naproxen (RR 1.08, 0.48–2.47, p=0.80) was not significant.
  • Heart failure risk was roughly doubled by all NSAIDs.
All NSAIDs increased upper gastrointestinal complications:
  • naproxen RR 4.22, CI 2.71–6.56
  • ibuprofen RR 3.97, CI 2.22–7.10
  • diclofenac RR 1.89, CI 1.16–3.09
  • coxibs RR 1.81, CI 1.17–2.81
A further hypothetical analysis by the researchers indicated that the increased risk of heart attacks is highest in those with a previous history of heart disease or risk factors such as high cholesterol.

How did the researchers interpret the results?

The researchers say that the vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs.
Although NSAIDs increase vascular and gastrointestinal risks, they say that the size of these risks can be predicted, which could help guide doctors making decisions on medications for their patients.


This large review adds to, and expands on, the current evidence on the risks of vascular disease and gastrointestinal complications for different NSAIDs. It largely concentrates on trials of high doses of NSAIDs that can only be prescribed by a doctor. It is unclear from this study whether there is any risk from taking lower doses available over the counter. While most experts advise that low-dose NSAIDs, taken occasionally, are safe for most people, an accompanying editorial points out that there are still “large gaps” in evidence on the risks with lower doses of NSAIDs.
While the risk to individuals is small, it is important to remember that high doses of NSAIDs are used by millions of people worldwide to manage chronic pain, for example from arthritis.  Even a one in 1,000 risk of NSAID-associated death would amount to 1,000 deaths in a population of 1 million. Such risks are worth bearing in mind when deciding on treatment with your doctor.
This means that any evidence that improves the safety of prescribing of this kind of medication is vital. The evidence presented in this study is likely to be of particular interest to organisations that advise doctors on which drugs to prescribe, such as NICE (the National Institute for Health and Care Excellence).
As an accompanying editorial argues, “identification of safe and effective strategies for chronic pain is sorely needed. In the meantime, long-term use of high dose NSAIDs should be reserved for those who receive considerable symptomatic benefit from the treatment and understand the risks”.
Anyone concerned about using NSAIDs on a long-term basis should seek the advice of their GP or the doctor in charge of their care.

NHS Choices 

Links To The Headlines

Study links painkillers to increased risk of heart attack. The Independent, May 30 2013
Painkiller taken for arthritis is heart risk. The Daily Telegraph, May 30 2013
Painkillers taken by millions could increase heart risk: Prolonged use 'leads to significant danger'. Daily Mail, May 30 2013
Common painkillers 'pose heart risk'. BBC News, May 30 2013
Painkillers may increase risk of heart attacks, strokes and death. Metro, May 30 2013
Painkillers 'could increase risk' of heart problems. ITV News, May 30 2013

Links To Science

Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. The Lancet. Published online May 30 2013

World Health Organisation warns against 'threat to the entire world' from new Sars-like virus

World Health Organisation warns against 'threat to the entire world' from new Sars-like virus:
A new Sars-like virus discovered in humans could pose “a threat to the entire world”, the World Health Organisation warned this week. Independent

Hospital admissions linked to alcohol rise to more than a million in year

Hospital admissions linked to alcohol rise to more than a million in year:
Doctors repeat call for alcohol pricing rule to deter heavy drinkers as Alcohol Concern warns of lack of help for addiction
An estimated 1.22m hospital admissions in England were linked to drinking too much alcohol in 2011-12, according to NHS figures – a 51% rise over the past nine years.
Drug prescriptions to treat alcohol dependency outside hospital are also continuing to go up. Nearly 180,000 prescriptions were dispensed by doctors, nurses and pharmacists in 2012, 6% up in a year and nearly 75% more than in 2003.
Hospital admissions for which drink was the main cause rose to 200,900 in 2011-12, 1% more than the previous year, and more than 40% up on 2002-03.
Men accounted for three in five of the patients whose alcohol consumption was the main reason for admission. Admission rates were highest in north-west England and lowest in the east.
The bleak figures prompted doctors to call again for minimum alcohol pricing, which is the subject of a legal battle between the drinks industry and the Scottish government and is still formally under consideration in England although there is little ministerial appetite for it.
Nick Sheron, adviser on alcohol at the Royal College of Physicians, said the rise in prescriptions of drugs indicated "the huge strain alcohol abuse puts on our society" but focused on the admissions.
He added: "Today's statistics show that in 2012, hospitals in England admitted 200,900 cases where the main reason for admission was an alcohol-related condition.
"The rise in alcohol addiction is being driven by cheap alcohol. A minimum unit price for alcohol would effectively tackle this problem. In Canada, a 10% increase in minimum unit price caused a 32% reduction in deaths.
"Our own research in Southampton shows that a minimum unit price of 50p would, on average, cost patients with alcohol dependency and cirrhosis an additional £36 a week.
"The impact on moderate drinkers was less than 30p a week, because these patients simply do not drink the ultra-cheap, ultra-strong booze. Minimum unit pricing is targeted at very heavy drinkers whose families are devastated by the impact that drinking has on their lives."
Emily Robinson, director of campaigns at the charity Alcohol Concern, said that the government "must get a grip and implement measures that will prevent this urgent situation from getting worse … The real issue is the vast numbers of people who are not getting help for their alcohol addiction. We estimate that only one in 16 people with alcohol problems is receiving specialist help as there is just not enough treatment available."
A Department of Health spokesman said the figures proved alcohol was causing harm to the health of hundreds of thousands of people.
"That is why we are already improving prevention by funding alcohol risk assessments at GPs and encouraging increased access to alcohol liaison nurses in hospitals.
"The alcohol industry has also pledged to take one billion units out of the market by 2015 and we have consulted on a range of options to tackle irresponsible practices and strengthen local licensing powers."
A British Beer and Pub Association spokesman said: "Alcohol misuse remains a problem for a minority and is something we must all work to tackle. Nevertheless, key trends are moving in the right direction."

New Cochrane review finds that NRT, bupropion and varenicline are effective treatments for smoking cessation

New Cochrane review finds that NRT, bupropion and varenicline are effective treatments for smoking cessation: Smoking is the main preventable cause of premature illness and death worldwide. Approximately 20% of deaths in men and 5% in woman over 30 can be attributed to smoking. The World Health Organization (WHO) estimates that 6 million people die from smoking related disease each year, with tobacco being the number one risk factor for [read the full story...] Mental Elf

No proof coffee causes obesity and diabetes - NHS Choices

No proof coffee causes obesity and diabetes - NHS Choices:

NHS Choices
Go to NHS Choices homepage Your health, your choices. Information navigation. Search entire site. Enter a search term: Main navigation. Health A-Z. Hundreds of conditions explained; Arthritis information; Asthma information; Back pain information ...

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