Risk of dying of unnatural death for people with epilepsy slightly higher than the rest of population

University of Manchester | April 2018 | Increased risk of unnatural death to people with epilepsy found

Scientists at Manchester and Swansea University have discovered that people with epilepsy are at a slightly increased risk of dying an unnatural death compared to the rest of the population.  They analysed data from electronic primary care data sets linked to hospitalisation and mortality record for  individuals with epilepsy in England and Wales and compared these to individuals without (via University of Manchester).

The analysis shows that compared to people without epilepsy, people with epilepsy are specifically:

• Twice as likely to die by suicide
• Three times more likely to die accidentally
• Five times more likely to die specifically by accidental medication poisoning
• Three and a half times as likely to die by intentional medication poisoning

The researchers recommend consider the toxicity of concomitant medication when prescribing drugs for people with epilepsy.

Dr Hayley Gorton said: “Because of these risks, it’s important that people with epilepsy are adequately warned so they can take measures to prevent accidents.

“We urge clinicians to advise their patients about unintentional injury prevention and monitor them for suicidal thoughts and behaviour.

“We would also advise doctors to assess suitability and toxicity of medication when prescribing medicines for other associated conditions to these individuals.

Abstract

Importance  People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported.

Objective  To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths.

Design, Setting, and Participants  This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014).
Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017.

Exposures  People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.

Main Outcomes and Measures  Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.

Results  In total, 44 678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort.
Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.

Conclusions and Relevance  Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.

The research has been published  in the JAMA Neurology, Rotherham NHS staff may request it here

Repeat prescriptions are expensive and time consuming – it’s time for an NHS rethink

NIHR | April 2018 | Repeat prescriptions are expensive and time consuming – it’s time for an NHS rethink

Writing on the NIHR’s blog Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care at Bristol  and  Céline Miani, Junior research group leader, Social epidemiology consider the relative advantages and disadvantages of short repeat prescriptions. While these prescriptions offer convenience for patients who do not require further appointments,  and reduce medication waste they also have a number of downsides.  They cite the time and effort pharmacies spend dispensing pills is also considerable, and potentially an inefficient use of pharmacists’ skills.  These type of  prescriptions can also increase the workload for GPs as they still require authorisation.

Payne’s recent research into longer duration prescriptions showed an association with better adherence by patients in taking their medications.  Payne calls for a clinical trial to determine if there is a correlation between the two.

 The full blog post can be read at NIHR

 Research article:Miani C, Martin A, Exley J, Doble B, Wilson E, Payne R, et al | Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling | Health Technol Assess | 2017 | 21 | 78

The paper can be read here 

Reported assaults on NHS staff increase

Unison | April 2018 | Steep rise in reported assaults against NHS staff, says UNISON 

Unison has published figures which show an increase in the number of assaults on NHS staff. The biggest rise is the incidence in acute care where it increased by a fifth (21 per cent) in hospitals with an A&E department (via Unison).

Responses were received from 181 organisations and these reported physical assaults on staff of  56,435 in 2016/17, which is a 9.7% increase on the 2016/16 data (51,447).

There were 18,720 assaults in this period in the acute trusts who responded to  HSJ’s enquiry for information on behalf of Unison.  Unison have  extrapolated these figures and say this rate is equal to 200 assualts on NHS staff every day.

Other parts of the NHS showing an increase in attacks on staff higher than the national average of 9.7% were:

·     Community trusts – up 21.5% in the trusts responding to the survey (860 in 2016/17, up from 708 in 2015/16)

·     Ambulance trusts saw 2,330 violent incidents in 2016/17, up from 2,036 the previous year (a 14.5% increase)

·     Trusts employing more than 7,000 staff reported a 15.5% increase on 2015/16, compared to a 8.3% rise in the number of assaults in organisations employing less than 3,000.

Full details are available from Unison 

In the media:

The Independent Violence against NHS staff rockets as cuts cause ‘hostile’ environment, warns

Guardian Rise in attacks on NHS workers blamed on lack of staff and delays

 

How digital innovators are transforming the NHS

Public | April 2018 | The promise of Healthtech: How digital innovators are transforming the NHS 

Innovations such as cloud computing,  VR, 3D printing, genomics and artificial intelligence all provide opportunities for the NHS to sustainably relieve the
demographic and financial pressures it faces. Public, an organisation that helps startups to support the public sector, cautions that “without major reform, the NHS may see a £30 billion funding gap open up over the next three years alone.”

There are three factors driving this change, they are  the growing, ageing populations who are net consumers of public services, especially health care.  The rise in long-term, chronic conditions evident across all age groups.  The compounding effect of higher demand for health services and higher expectations for those health services as, in many cases, more expensive treatments become standard.  The report includes a feature on ‘Healthtech 27’ which are the most promising startups in healthcare.
Nicola Blackwood, the author of this report and former Health Innovation Minister,
argues that the NHS is still ‘risk averse’.  As part of this research, Public surveyed a number of health startups- they also spoke to NHS professionals, interviewing key decision-makers across the health and care landscape-to explore some of the barriers to innovation.

These interviews revealed:

• Lack of clarity about evidence 
• Regulation of digital health products is fast evolving
  
• Slow procurement
  
• Partial interoperability 
  
• Unclear data security standards 
• Limited change management and digital skills

 

Image source: public.io

Alongside this, Healthtech also predicts 9 areas of opportunity for the future

1. Procurement and productivity 
2. Recruitment and training 
3. Prevention
4. Winter pressures and supported self-care
5. AI in Pathology and Radiology
6. Patient safety
7. Mental health
8. Social care
9. Research 

Mortality in the UK

There has been a long-term downward trend in the number of deaths, but since 2011 
the number of deaths and the crude death rate have increased. The number of deaths has increased more than the crude death rate, as some of the increase in the number of deaths was due to population growth. Improvements to life expectancy have slowed in recent years for both men and women, but estimates of life expectancy have not fallen compared with earlier periods. (House of Commons Library)

The briefing can be downloaded from The House of Commons Library 

World Haemophilia Day

NIHR | April 2018 | Local patient praises NHS research on World Haemophilia Day

To mark World World Haemophilia Day 2018, which is today 17 April,  NIHR have published the experience of  a patient with haemophilia, who participated in a  clinical trial to help find a cure for the condition.

The patient, Darren has haemophilia A, a rare condition affecting approximately one in every 5,000 males.  With those affected living either partly or completely without the essential blood clotting protein VIII, the condition has serious side effects and can cause excessive bleeding episodes.

At the moment treatment for haemophilia involves injections of a drug to replace the clotting protein, but now a new trial has found that gene therapy was effective in helping 85 per cent of participants achieve sustained normal levels of the blood clotting protein.

Darren, who participated in the study to support research looking for a cure.  He said:  “I’ve had haemophilia all my life, I grew up with it just being there- I didn’t know any different. And now, I didn’t realise the effect it had on my life before. Simple things like taking the medication, being very conscious about what you’re doing.”

The full story can be read at NIHR 

The results of the trial have been published in The New England Journal of Medicine 

Abstract

BACKGROUND

Patients with hemophilia A rely on exogenous factor VIII to prevent bleeding in joints, soft tissue, and the central nervous system. Although successful gene transfer has been reported in patients with hemophilia B, the large size of the factor VIII coding region has precluded improved outcomes with gene therapy in patients with hemophilia A.

METHODS

We infused a single intravenous dose of a codon-optimized adeno-associated virus serotype 5 (AAV5) vector encoding a B-domain–deleted human factor VIII (AAV5-hFVIII-SQ) in nine men with severe hemophilia A. Participants were enrolled sequentially into one of three dose cohorts (low dose [one participant], intermediate dose [one participant], and high dose [seven participants]) and were followed through 52 weeks.

RESULTS

Factor VIII activity levels remained at 3 IU or less per deciliter in the recipients of the low or intermediate dose. In the high-dose cohort, the factor VIII activity level was more than 5 IU per deciliter between weeks 2 and 9 after gene transfer in all seven participants, and the level in six participants increased to a normal value (more than 50 IU per deciliter) that was maintained at 1 year after receipt of the dose. In the high-dose cohort, the median annualized bleeding rate among participants who had previously received prophylactic therapy decreased from 16 events before the study to 1 event after gene transfer, and factor VIII use for participant-reported bleeding ceased in all the participants in this cohort by week 22. The primary adverse event was an elevation in the serum alanine aminotransferase level to 1.5 times the upper limit of the normal range or less. Progression of preexisting chronic arthropathy in one participant was the only serious adverse event. No neutralizing antibodies to factor VIII were detected.

CONCLUSIONS

The infusion of AAV5-hFVIII-SQ was associated with the sustained normalization of factor VIII activity level over a period of 1 year in six of seven participants who received a high dose, with stabilization of hemostasis and a profound reduction in factor VIII use in all seven participants. In this small study, no safety events were noted, but no safety conclusions can be drawn. (Funded by BioMarin Pharmaceutical; ClinicalTrials.gov number, NCT02576795; EudraCT number, 2014-003880-38.)

Rotherham NHS staff can request the article here

Full reference: Rangarajan, S., Walsh, L., Lester, W., Perry, D., Madan, B., Laffan, M., & Pasi, K. J | 2017 | AAV5–factor VIII gene transfer in severe hemophilia |  A. New England Journal of Medicine |  377 | Vol. 26 |P. 2519-2530.

Parliamentary and Health Service Ombudsman business plan 2018-19

Parliamentary and Health Service Ombudsman |April 2018  | PHSO
business plan 2018-19

The Parliamentary and Health Service Ombudsman has released the business plan for 2018-19. The focus of the plan is on transformation activity to facilitate the delivery of the strategy. The strategy has 3 key objectives, they are listed below:

Objective 1
To improve the quality of our service, whilst remaining independent, impartial and fair

For  the Parliamentary and Health Service Ombudsman the main focus in the first year of this strategy is to complete the work they have already started to improve their service

Objective 2
To increase the transparency and impact of our casework 

They will we will begin to look at how they can publish more casework and they will start a project to look more closely at the enablers for greater transparency

Objective 3
To work in partnership to improve public services, especially frontline complaint handling

Image source: ombudsman.org.uk

The Parliamentary and Health Service Ombudsman have set out a number of activities to collaborate more with other ombudsman services and strengthen external relationships.

In addition to the objectives, there are also a number of business critical enablers which can be found in the business plan.

The business plan can be accessed from the Parliamentary and Health Service Ombudsman

Raw fruit and veg boosts mental health, finds study

Researchers at a New Zealand University investigated the differences between consumption of raw fruit and vegetables compared to processed (cooked or canned) fruits and vegetables, and mental health in people between 18 and 25 . They surveyed more than 400 young adults in the US and New Zealand asking them about their eating habits and preferences towards raw or cooked and their mental health.

The investigators found that intake of raw fruit and vegetable  (FVI) predicted reduced depressive symptoms and higher positive mood, life satisfaction, and flourishing; whereas  processed FVI only predicted higher positive mood. They identified 10 raw foods that were associated with improved mental health such dark leafy greens, citrus fruits, fresh berries, kiwi fruit, apples and bananas and cucumbers. The study suggests that eating required intake of fruit and vegetables raw to maximise mental health benefits via Science Daily. 

Abstract

Background: Higher intakes of fruits and vegetables, rich in micronutrients, have been associated with better mental health. However, cooking or processing may reduce the availability of these important micronutrients. This study investigated the differential associations between intake of raw fruits and vegetables, compared to processed (cooked or canned) fruits and vegetables, and mental health in young adults.

Methods: In a cross-sectional survey design, 422 young adults ages 18–25 (66.1% female) living in New Zealand and the United States completed an online survey that assessed typical consumption of raw vs. cooked/canned/processed fruits and vegetables, negative and positive mental health (depressive symptoms, anxiety, negative mood, positive mood, life satisfaction, and flourishing), and covariates (including socio-economic status, body mass index, sleep, physical activity, smoking, and alcohol use).

Results: Controlling for covariates, raw fruit and vegetable intake (FVI) predicted reduced depressive symptoms and higher positive mood, life satisfaction, and flourishing; processed FVI only predicted higher positive mood. The top 10 raw foods related to better mental health were carrots, bananas, apples, dark leafy greens like spinach, grapefruit, lettuce, citrus fruits, fresh berries, cucumber, and kiwifruit.

Conclusions: Raw FVI, but not processed FVI, significantly predicted higher mental health outcomes when controlling for the covariates. Applications include recommending the consumption of raw fruits and vegetables to maximize mental health benefits.

The full article is available to read at Frontiers in Psychology here

Full reference:

Brookie, K.L.,  Best, G., I.  Conner, T., S. | 2018 | Intake of Raw Fruits and Vegetables Is Associated With Better Mental Health Than Intake of Processed Fruits and Vegetables|  Frontiers in Psychology| Vol. 9   DOI: 10.3389/fpsyg.2018.00487