Cancer tumour genetics reveal possible treatment revolution

Ian Sample. The Guardian Healthcare. Published online: 4th March 2016.

A landmark discovery into the genetic makeup of tumours has the potential to open a new front in the war on cancer, delivering potent therapies that are tailored to individual patients, scientists have said.

The breakthrough comes from research into the genetic complexity of lung and skin cancers which found that even as tumours grow and spread around the body, they carry with them a number of biological “flags” that the immune system can be primed to attack.

Because the flags, which appear as surface proteins, are found only on cancer cells, they provide what scientists described as “exquisite targets” for new therapies that draw on the power of the immune system to combat cancer.

Treatments that harness the immune system have shown great promise against some forms of cancer, such as melanoma, but they do not work in everyone. One approach releases the brakes on the immune system, unleashing the full force of killer T cells, which are otherwise dampened down by cancer cells. But to work, the patient’s immune system must first recognise the cancer as the enemy.

Read the full news article here

Discovering untapped relationship potential with patients in telehealth: a qualitative interview study

Heckemann, B. BMJ Open 2016;6:e009750

Objectives: To explore factors that influence relationship building between telehealth professionals and patients with chronic illness over a distance, from a telehealth professional’s perspective.

Design: 4 focus group interviews were conducted in June 2014. Digital recordings were transcribed verbatim and qualitative content analysis was performed using an iterative process of 3 coding rounds.

Participants: 20 telehealth professionals.

Setting: A telehealth service centre in the south of Germany that provided care for 12 000 patients with chronic heart failure across Germany.

Results: Non-video telehealth technology creates an atmosphere that fosters sharing of personal information and a non-judgemental attitude. This facilitates the delivery of fair and equal healthcare. A combination of a protocol-driven service structure along with shared team and organisational values provide a basis for establishing long-term healthcare relationships. However, each contact between a telehealth professional and a patient has an uncertain outcome and requires skilful negotiation of the relationship. Although care provision was personalised, there was scope to include the patients as ‘experts on their own illness’ to a greater extent as advocated by person-centred care. Currently, provision of person-centred care is not sufficiently addressed in telehealth professional training.

Conclusions: Telehealth offers a viable environment for the delivery of person-centred care for patients with long-standing disease. Current telehealth training programmes may be enhanced by teaching person-centred care skills.

Read the full article here

 

Language spoken at home and the association between ethnicity and doctor–patient communication in primary care

Brodie, K. et al. BMJ Open 2016;6:e010042

 

 

Objectives: To investigate if language spoken at home mediates the relationship between ethnicity and doctor–patient communication for South Asian and White British patients.

Methods: We conducted secondary analysis of patient experience survey data collected from 5870 patients across 25 English general practices. Mixed effect linear regression estimated the difference in composite general practitioner–patient communication scores between White British and South Asian patients, controlling for practice, patient demographics and patient language.

Results: There was strong evidence of an association between doctor–patient communication scores and ethnicity. South Asian patients reported scores averaging 3.0 percentage points lower (scale of 0–100) than White British patients (95% CI −4.9 to −1.1, p=0.002). This difference reduced to 1.4 points (95% CI −3.1 to 0.4) after accounting for speaking a non-English language at home; respondents who spoke a non-English language at home reported lower scores than English-speakers (adjusted difference 3.3 points, 95% CI −6.4 to −0.2).

Conclusions: South Asian patients rate communication lower than White British patients within the same practices and with similar demographics. Our analysis further shows that this disparity is largely mediated by language.

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Financial performance of the NHS in England.

A perfect storm: an impossible climate for NHS providers’ finances? 

An analysis of NHS finances and factors associated with financial performance. The Health Foundation.

This report looks at the financial performance of the NHS in England. The main focus is on the finances of NHS providers and the financial position of the commissioners of care (NHS England and clinical commissioning groups).

 

 

 

The report examines commissioners’ budgets and how spending has changed by type of provider, as well as the specific issues facing NHS providers. It also includes the findings of a statistical analysis that set out to identify factors that are most strongly associated with an acute or specialist provider’s deficit.

deficit

Image source: http://www.health.org.uk/

 

Public health nursing

The Royal College of Nursing has published The Value and Contribution of Nursing to Public Health in the UK: Final report.

This document presents the findings from a project to assess the value and contribution that nurses make to public health, in particular: the role of nursing and midwifery staff in public health; how nursing roles are valued; what and where the gaps are in nursing knowledge and education in relation to public health; and how nurses and other public health practitioners consider these gaps should be addressed.

Patient choice in the NHS: five key questions

Guardian Healthcare Network’s expert panel discussed the barriers and experiences of trying to include patients’ opinions in their care – here’s a debrief

  • What problems does the idea of choice create?

Jonathan Hearsey, extended scope practitioner, Sussex MSK Partnership:The confusion regarding what choice means in some clinical situations could break the valuable relationship between patient and clinician and, ultimately, [possibly affect] outcomes. In musculoskeletal medicine, it is common for patients with non-specific mechanical back pain to attempt to exercise choice in order to demand needless imaging or clinical tests like MRI scans or blood tests. In some instances it is perfectly correct to order tests but in the majority of cases MRI scans are unnecessary and lead to patient concern about normal changes in discs or joints.

patient choice

Image source: The Guardian

Natalie Koussa, programme lead, National Voices’ Wellbeing Our Way programme: People need to understand that patient control isn’t just about simple offers such Choose and Book for elective procedures, but around people taking control of the decisions which enable them to live in the ways which matter to them. End of life is an area in which we know that the vast majority of people would prefer to die at home, and yet are unable to. Charity Compassion in Dying found that 75% of service users who completed a written statement about their wishes for their end-of-life care – such as an advance decision or advance statement – stated they felt happier about the future or had greater peace of mind.

  • What are the main obstacles to patient choice?

Jacob Lant, head of policy and partnerships at patient advocacy organisation Healthwatch England: I think one of reasons choice doesn’t always work as intended is because of simplistic examples of villages with only a single GP practice with just one GP. The conversation often focuses on the fact the patient has no choice of which GP to go to in that situation. But there are lots of constructive conversations that could be had about how that single surgery offers a range of services. We shouldn’t let local variation in services prevent conversations about how choice can work.

Sean O’Sullivan, head of policy, Royal College of Midwives: I was struck in the Mid Staffs report by the weakness of the then patient organisations. This feels like a perennial issue since the demise of community health councils. For maternity services there are maternity services liaison committees, which can be effective and dynamic vehicles for user involvement where they work well, but this is not the case everywhere.

Frontline midwives have the information necessary to inform patients of their options, but they lack time. There are so many issues that midwives are expected to discuss with women at antenatal booking appointments – smoking, diet, nutrition, breastfeeding, FGM, domestic violence, immunisation etc – but the time available is finite and it can be hard to do more than what feels like a tick-box exercise rather than a genuine discussion.

Read the full debrief here

Blood pressure targets in primary care – BMJ Editorial

Muth, C. et al. BMJ 2016;352:i813

A balancing act between the certainty of evidence and the messier reality of everyday practice

NHS RefreshManagement of high blood pressure is crucial, to forestall end organ damage, disability, and death and to reduce societal costs from cardiovascular disease. Good management is particularly important in general practice, where most patient care occurs. Recent clinical practice guidelines recommend treatment to systolic blood pressure (SBP) targets of <140 mm Hg, but for patients at high risk, such as those with previous stroke, many guidelines recommend lower targets.

Is a lower SBP target feasible in general practice? The linked randomised controlled trial by Mant and colleagues (doi:10.1136/bmj.i708) investigated the effects of an SBP target of below 130 mm Hg or a reduction in SBP of at least 10 mm Hg to reduce the recurrence of cerebrovascular events among adults with a history of previous stroke or transient ischaemic attack.7 Control participants had an SBP target of below 140 mm Hg. Participants in both groups had their blood pressure checked quarterly by a practice nurse (or monthly if SBP was above target) and were treated at their general practitioner’s discretion, supported by a guideline based computerised algorithm. Use of the more intensive target led to a statistically significant but modest difference of about 3 mm Hg in SBP between groups (16.1 mm Hg reduction for intervention versus 12.8 for control), at the expense of more changes of antihypertensive drugs in the intervention group, a higher dropout rate (20% v 12%), and an increase in the workload of general practitioners and nurses. These results raise several questions about the application, feasibility, and desirability in practice of lower blood pressure targets recommended by evidence based guidelines.