Cancer vaccine plan needs nurses

Thursday May 15th, 2008

A lack of resources means that government plans to vaccinate all girls in England against cervical cancer might fail, it has been claimed.

The department of health aims to give all 12-13 year olds girls a set of three injections to vaccinate them against infection with the human papillomavirus (HPV), thought to cause nearly all cases of cervical cancer.

Last week, the chief nursing officer Christine Beasley wrote a letter to primary care trusts saying they are responsible for carrying out the programme. But Nursing Standard reports that many school nurses fear the scheme is unworkable.

They say that the department of health's promise of an average of 55,000 UK pounds for each PCT may not be enough to cover the cost of extra staffing, storage and paperwork. The resource problems are likely to be compounded by a proposed two-year catch-up campaign for girls aged up to 18.

One school nurse from East Lancashire, Vanessa Woodall, told the magazine: "To do this work in schools, each PCT will need upwards of ten staff managing the programme, vaccinating and looking after children who faint. You cannot just turn up with one or two people."

She believes that specialist immunisation nurses should cover this, and other vaccination programmes.

Ros Godson, professional officer for school health and public health at Amicus/Unite, agrees that PCTs should set up specialist teams to help nurses.

"School nurses cannot carry out this programme by themselves. They would spend the whole year not being able to do any other work," she said.

Fiona Smith of the Royal College of Nursing is also calling for a realistic long-term plan to cope with the programme.

Air pollution linked to blood clots

Wednesday May 14th, 2008

Long-term exposure to air pollution may raise the risk of dangerous blood clots, according to new findings.

Dr Andrea Baccarelli of the Harvard School of Public Health, Boston, and colleagues say that exposure to very small particles of chemicals in the air, that come from burning fossil fuels and other sources, have been linked to death from heart disease and stroke. This link may be due to increased blood clotting, so they set out to examine the effects on deep vein thrombosis.

They took data from 870 deep vein thrombosis patients and 1,210 similar healthy adults, living in different areas of the Lombardy region in Italy. Pollution from small particles (less than ten micrometers in diameter) was measured in each region.

In the Archives of Internal Medicine, the team report that deep vein thrombosis patients "tended to have a higher exposure to particulate air pollution in the year before diagnosis than controls".

They calculate that for every increase in pollution of ten micrograms per square meter, the risk of deep vein thrombosis in the coming year increases by 70 per cent. Furthermore, in tests, the blood of participants in both groups with higher levels of exposure took less time to clot.

The authors write: "Long-term exposure to particulate air pollution is associated with altered coagulation function and DVT risk."

However, the link was slightly weaker for women, particularly those using oral contraceptives or hormone therapy. "Such hormone therapies are independent risk factors for deep vein thrombosis, which is also confirmed in this study by the higher prevalence of oral contraceptive and hormone use in the cases compared with the controls," they conclude.

Baccarelli, A. et al. Exposure to Particulate Air Pollution and Risk of Deep Vein Thrombosis. Archives of Internal Medicine, Vol. 168, May 12, 2008, pp. 920-27.

Cannulae prescriptions "eliminate" MRSA

Tuesday May 13th, 2008

A hospital group claims to have eliminated MRSA bloodstream infections by cracking down on the use of cannulae.

Staff who want to use a cannula for drugs or fluids now have to get a "prescription" at the Winchester and Eastleigh Healthcare NHS Trust, Hampshire.

The trust took action after experiencing some 11 MRSA bloodstream infections. Four of them were related directly to the use of cannula.

Under the new scheme agreement to use a cannula has to be signed by a doctor and the device inserted by a specialist.

The cannula is flushed with a saline solution, once inserted, and then inspected daily. A scorecard is used to report irregularities or signs of infection.

Consultant physician Dr Chris Gordon said: "It is well known that cannulae can cause bloodstream infections, such as MRSA, which is why we were so keen to make these changes.

"If we can prevent these, then we can reduce our MRSA bloodstream cases by a third. If all trusts did this just imagine what the national picture would be."

And a nurse who worked with him, Sister Rachel Wright, said: "We always try to follow best practice but with this, I think it is fair to say we have gone one better. It just illustrates that simple measures, when strictly followed, can work."

Sport may boost female health

Tuesday May 13th, 2008

Sport and other leisure activity seem to help protect women against breast cancer, researchers reported today.

"Recreational" activity is more effective at reducing the risk of cancer than holding down an active job or being busy at housework, according to a new study.

Researchers in Alberta, Canada, analysed 62 pieces of research about lifestyle and the risk of breast cancer.

They found that all physical activity helped reduce risk - as did staying lean.

They also found that taking up sport and exercise later in life was very effective at staving off disease.

Writing on-line in the British Journal of Sports Medicine, researcher Dr Christine Friedenreich concludes that lean women who undertake sport or other activity in their spare time had the lowest risk of developing breast cancer.

In a second study, reported on-line today in the Annals of Rheumatic Diseases, researchers say that mothers who breast-feed their babies help to reduce their risk of developing rheumatoid arthritis.

The study of some 700 women concludes that those who breast-fed for at least 13 months faced half the risk of developing the disease of those who never breast-fed.

Researchers at Malmo University Hospital, Sweden, also found no evidence that taking contraceptive pills could protect against rheumatoid arthritis.

Researcher Dr Mitra Pikwer states: "It was difficult to say whether there was a connection between higher rates of breast feeding and a corresponding fall in the number of women affected by rheumatoid arthritis, but the results of the study provided yet another reason why women should continue breast feeding."

British Journal of Sports Medicine 2008; doi:10.1136/bjsm.2006.029132

Books on Women's Health

Elderly neglected - doctors

Monday May 12th, 2008

Doctors want more cash spent on care of the elderly, according to a survey published today.

Residential and care homes fail to provide activities to maintain mental and physical agility, doctors said.

In one area elderly patients have been told they will have to manage with one bath a week.

Problems with dementia services and podiatry were also identified by participants in the British Medical Association survey.

Some 500 doctors took part in the survey, including GPs, consultants and staff grade doctors.

Just 8.1 per cent felt services in care homes were adequate while some two thirds complained that residential and nursing homes had inadequate staffing levels.

Some 60 per cent said continuity of care between health and social services was not good enough - but 41 per cent said they had continuous access to physiotherapy services for patients.

Wiltshire GP Dr Helena McKeown, who chairs the BMA's community care committee, said: "It's disgraceful that care services are so chronically under-funded. For example, cutbacks in my area meant I heard of elderly patients having their bathing reduced from twice a week to once a week, something which they found very distressing and dehumanising.

"We no longer have an attached social worker, a community physiotherapist or a dedicated community psychiatric nurse so it's very difficult to give our patients the sort of joined-up care they need. It?s incredibly frustrating for everyone involved - all we want to do is help our patients and we can't."

She added: "The funding of community services has not kept up with society's desire for people to stay in their homes for as long as possible.

"People deserve to have an old age that is fulfilling and dignified, at the moment I don't feel a lot of them are getting that."

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