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Take a look at a selection of our recent media coverage:
6th September 2024
Following a cancer diagnosis, patients with heart failure with reduced ejection fraction (HFrEF) are less likely to continue or maintain the use of guideline-directed medical therapies (GDMTs), according to a new longitudinal study.
Researchers from University College London Hospitals NHS Foundation Trust analysed data from patients with heart failure in UK Clinical Practice Research Datalink between 2005 and 2021. Based on diagnostic and prescription records, patients with probable HFrEF were selected, and trends in the use and dosing of GDMTs before and after receiving a new cancer diagnosis were analysed.
The researchers matched 4,890 HFrEF patients with incident cancer to controls without cancer. The majority of the participants were male (73.9%), and the mean age was 75.7 years.
Patients with cancer were found to be 51% more likely to have poor adherence to renin-angiotensin-system inhibitors (RASIs), 22% more likely to have poor adherence to beta-blockers and 31% more likely to have poor adherence to mineralocorticoid receptor antagonists (MRAs) compared to non-cancer controls (RASIs: OR = 1.51, 95% CI = 1.35–1.68; beta-blockers: OR = 1.22, 95% CI = 1.08–1.37; MRAs: OR = 1.31, 95% CI = 1.08–1.59).
Cancer patients are also less likely to continue taking the GDMTs over time, with 104% more likely to stop taking RASIs, 35% more likely to stop taking beta-blockers and 49% more likely to stop taking MRAs than non-cancer controls.
Titration doses for RASIs and beta-blockers were more likely to be reduced after a cancer diagnosis (OR = 1.69, 95% CI = 1.40–2.04 and OR = 1.31, 95% CI = 1.05–1.62, respectively). None of the patients started new heart medications or had their medication doses increased after a cancer diagnosis, the researchers noted.
The reduction, interruption or cessation of heart failure treatments has a potentially negative impact on cardiovascular outcomes, the researchers said, adding that ‘this issue is even more concerning if the [heart failure] patient eventually needs cardiotoxic cancer treatments’.
Since heart failure leads to increased hospitalisation, and mortality is higher in patients with poor adherence or persistence to GDMTs, the researchers have called for better medical management of heart failure after a cancer diagnosis.
They also highlighted the need for further research, including targeted strategies for heart failure treatment optimisation, patient and clinician education at the time of cancer diagnosis, and an increase in multidisciplinary working between cardiologists, oncologists, general practitioners, pharmacists and specialist nurses.
Reference
Ju, C et al. Use of heart failure medical therapy before and after a cancer diagnosis: A longitudinal study, ESC Heart Failure 2024; Jul 23: doi.org/10.1002/ehf2.14981.
4th September 2024
Women with endometriosis are at higher risk of significant cardiac outcomes compared to women without the condition, according to a new study presented at the European Society of Cardiology (ESC) Congress 2024 in London.
The researchers highlighted the need to start routinely considering the risk of cardiovascular disease (CVD) in women with endometriosis after results showed these women have around a 20% greater risk of acute myocardial infarction or ischaemic stroke compared to women without endometriosis.
Using Danish nationwide registries of all women with a diagnosis of endometriosis between 1977 and 2021 (n=60,508), the researchers matched the cohort with women from the background population without endometriosis (n=242,032) in a 1:4 ratio based on year of birth. They were followed for a median of 16 years and a maximum of 45 years.
The primary outcome was a composite of acute myocardial infarction and ischaemic stroke, while the secondary outcomes included the individual components of the primary outcome, as well as arrhythmias, heart failure and mortality.
Women with endometriosis had around a 20% increased risk of the composite endpoint of acute myocardial infarction and ischaemic stroke compared with those without endometriosis (unadjusted hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.14−1.23; adjusted HR 1.15; 95% CI 1.11−1.20).
The 40-year cumulative incidence of the primary outcome was 17.5% (95% CI 16.6−18.2%) and 15.3% (95% CI 15.0−15.7%) in women with and without endometriosis, respectively (p<0.0001).
When it came to the secondary endpoints, women with endometriosis had around a 20% increased risk of ischaemic stroke (adjusted HR 1.18; 95% CI 1.12−1.23) and around 35% increased risk of acute myocardial infarction (adjusted HR 1.35; 95% CI 1.31−1.40) compared to those without endometriosis.
Women with endometriosis also had increased risk of arrhythmias (adjusted HR 1.21; 95% CI 1.17−1.25) and heart failure (adjusted HR 1.11; 95% CI 1.05−1.18) compared to those without the condition.
Commenting on the results, lead study author Dr Eva Havers-Borgersen, a medical doctor and PhD fellow in cardiology at Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark, said: ‘Although the absolute differences were small, the relative differences were 20%, and with the high prevalence of endometriosis, these results provide more evidence that female-specific risk factors and CVD in women need greater attention.’
The researchers have called for women with endometriosis to undergo CVD risk assessment, with Dr Havers-Borgersen adding, ‘it is now time for female-specific risk factors – such as endometriosis, but also gestational diabetes and pre-eclampsia – to be considered in cardiovascular risk prediction models’.
They also highlight the need for further research to confirm their findings and support the integration of these factors into effective risk prediction models, as well as increasing awareness to ensure that risk factors and symptoms of CVD in women are recognised and reported.
The abstract ‘Endometriosis, a prevalent disease, is associated with significant cardiac disease‘ was presented at ESC Congress 2024 during the Cardiovascular disease in women (5) session on 2 September at 9am BST.
2nd September 2024
Professor Andy Bush has been at the forefront of paediatric respiratory medicine and research for over three decades. Most recently, he was awarded the Royal College of Paediatrics and Child Health’s highest honour – the James Spence medal – for his outstanding contribution to the field. He spoke to Julie Penfold about his career highlights, his passion for improving children’s respiratory health and campaigning to ban the promotion of e-cigarettes to young people, and his research into the early origins of asthma.
At the outset of his career in respiratory medicine, Professor Andy Bush initially worked in adult medicine as a trainee chest physician. At the time, he didn’t have any intention of going into paediatrics.
What changed the course of his career was working in a research role in the physiology laboratory led by the late Professor David Denison in the field of pulmonary circulatory physiology. He credits the nearly five years he worked with Professor Denison as being one of his standout career highlights.
‘David Denison was undoubtedly one of the main influences on my career. He was a brilliant respiratory physiologist. At the time, he was collaborating with Dr Elliot Shinebourne who was a great paediatric cardiologist, and I got involved with their research,’ explains Professor Bush.
‘As the research became more and more paediatric, I decided to dip my toe in the water and take on a paediatric job. I went to University College Hospital in London, UK, where I worked as a very junior trainee in the neonatal intensive care unity headed by the legendary Professor Os Reynolds. The job nearly killed me, but it was terrific, and I’ve been in paediatrics ever since.’
Indeed, Professor Bush has been a consultant paediatric chest physician at the Royal Brompton Hospital in London for more than 30 years. He is also professor of paediatrics and paediatric respirology at Imperial College London.
Recently, he was ‘immensely surprised and thrilled’ to learn he had been awarded the Royal College of Paediatrics and Child Health’s (RCPCH) highest honour, the James Spence Medal, for 2024, alongside an honorary fellowship. This highly prestigious medal is awarded by the RCPCH for outstanding contributions to the advancement of knowledge and understanding in paediatrics and child health. But he says it’s an award for his whole team.
‘I had no idea anyone had nominated me for it,’ he says. ‘I’m part of an incredibly brilliant team that also includes nurses, physiotherapists, pharmacists, psychologists and dietitians. If you’re going to look after a child who has a complex condition properly, no one person can do it flying solo.’
Campaigning on public health issues is something that’s very important to Professor Bush. ‘As clinicians, we see the consequences, we read the scientific literature, we see the studies and we can actually produce the evidence,’ he explains. ‘We can and should use this to convince the policy makers that, actually, something needs to be done.’
Professor Bush has had longstanding involvement in a campaign to introduce legislation to stop the advertising and promotion of e-cigarettes to young children, based on a concern that ‘nobody actually knows what they contain’.
He says: ‘There’s a statement that they are 95% safer than cigarettes and it’s based on no evidence whatsoever. What we do know is if you inhale e-cigarettes, you can get an acute lung injury and end up in intensive care.
‘For young people to be inhaling these toxic chemicals into their lungs is really frightening, particularly since there’s evidence of vulnerability. There’s enough animal data to make me really worried about the safety of e-cigarettes. It’s a subject I feel very strongly about.’
In 2024, the UK Government confirmed the marketing, sale and supply of disposable vapes will be banned in the UK from 1 April 2025.
While this is welcome news, Professor Bush feels enforcement is needed to really make the ban work, which is also something a British Medical Association report recently championed.
There are plenty of opportunities to make a difference to children and young people’s health in terms of the range of treatments clinicians in the UK can now offer. However, prohibitive costs for some of these is creating barriers to treatment.
‘Basic science is delivering us the most fantastic new treatments such as the new medications for cystic fibrosis such as Kaftrio, Symkevi and Orkambi. These are absolute game changers as these modulator drugs work by correcting basic defects and making the abnormal proteins work. It’s really fantastic science. But one of the challenges of offering these treatments is the cost as the NHS spends around £1bn annually on them,’ Professor Bush explains.
‘Another example is a promising treatment for the rare condition spinal muscular atrophy. In its most severe form, a baby will never sit up or walk independently, but this now seems to be curable with gene therapy,’ he continues. ‘But a single injection of gene therapy costs the NHS £1.7m. In this country, we are getting a lot of these expensive medications, but across the world, there are places that just simply can’t afford them, so cost is a big challenge.’
Professor Bush’s research interests include the invasive and non-invasive assessment and measurement of airway inflammation in asthma and cystic fibrosis. This includes the use of endobronchial biopsy in the management of severe asthma, and also respiratory mass spectrometry.
He and his team are currently focused on researching the early origins of asthma. ‘There is a lot of evidence that if as a baby you are in an environment of high bacterial diversity, such as on a farm, you are less likely to develop asthma,’ Professor Bush explains.
‘Collaboration with a team led by Professors Saglani and Lloyd at Imperial College has led to beginning to unpick how specific environmental bacteria suppress the development of allergic disease in babies, and the next step after understanding the pathways to allergy and asthma is to design treatments to prevent it – not all babies are going to be brought up on a farm!’
As such, with support from the Wellcome Foundation, his team has recruited a birth cohort of over a thousand mothers and their babies. Samples, such as brushings from the inside of the lung and nose, are taken in the first two weeks of life, analysed for infection and then followed up as they get older.
‘What we’re learning is when you look at a child when they’re first born, those who are going to go on to have asthma will have reduced lung function compared to normal,’ Professor Bush explains. ‘Over the first five or six years of their life, they lose more lung function. They go through a phase of routine viral colds with wheezing and not much in the way of allergy to then developing allergic asthma. But what drives that? If we could find a pathway to stop a child going down the route to develop asthma, it would be such a major thing to do.’
Similar research was undertaken by the Tucson research group in which they followed up 849 of the 1,246 newborn babies who were enrolled in their original children’s respiratory study. They found for some participants the onset of asthma started from their mid-teens to early 20s. Yet this wasn’t a new onset as these individuals had previously experienced asthma symptoms such as wheezing and airway obstruction when they were aged four to six years.
‘What drives those who go into remission and stay in remission is fascinating. If we could switch someone to go into remission who would otherwise go on to have asthma, it would be really exciting,’ Professor Bush adds.
On the horizon, Professor Bush sees more care and monitoring taking place in a patient’s home so regular trips to hospital can be phased out. For conditions such as bronchiolitis, his team is currently looking to find subgroups with particular problems so they can devise a targeted therapy. ‘I also think, increasingly, we will see a move to personalising medicine rather than having a one-size-fits-all approach,’ he says.
Training the next generation of paediatricians is also important to Professor Bush. He has co-supervised more than 50 doctoral students, and more than 100 of his trainees now occupy senior clinical and academic positions.
‘What you really want to do is train people up to be much brighter than you and that, I think I can say without fear of contradiction, I’ve managed to do,’ he says. ‘I’ve been lucky in my career to work some very bright young people who are absolutely soaring ahead in their careers now which is brilliant.’
30th August 2024
The British Medical Association (BMA) has urged the Government to ban all disposable and non-tobacco flavoured vapes in a bid to stop the ‘epidemic’ of vaping.
A new report by the doctors’ union has set out a series of ‘bold actions’ for the Government to take to ‘stem the trend of increased vaping’, particularly among children and young people.
The new Labour Government confirmed last month that it will introduce laws to clamp down on vaping with a commitment to carry forward the Tobacco and Vapes Bill, which originated during Rishi Sunak’s time as Prime Minister.
Under the new legislation there would be ‘limits’ on the sale and marketing of vapes, including a restriction on vape flavours, packaging and points of sale.
However, the BMA said that this bill had not been ‘carried forward into the new parliamentary session’ and that ‘so far there are no details of any measures that will be taken’.
The BMA’s tobacco report therefore sets out a ‘blueprint for what legislation should include to tackle rising vape use’, and it suggests that ‘one of the most dominant factors influencing this rise is the widespread availability of disposable vapes’.
According to the charity Action on Smoking and Health, 7.6% of 11- to 17-year-olds are now vaping regularly or occasionally, compared to 1.3% in 2014.
The doctors’ union called on the Government to ban disposable vapes ‘on the grounds of disproportionate and harmful use by children and young people and their adverse impact on the environment’.
Other recommendations set out in the report included:
The report recognised that vapes can be useful for people trying to quit smoking cigarettes, but pointed out that they are a ‘less dangerous rather than risk-free alternative’.
Nicotine addiction caused by vaping could lead to health problems such as high blood pressure and increased risk of COPD, according to the report.
BMA public health medicine committee chair Dr Penelope Toff said the new Government ‘must now ensure’ the measures in the Tobacco and Vapes Bill are ‘carried through into legislation’, and ‘would do well to go even further’.
She continued: ‘While this Government has rightly pledged to tackle smoking and vaping, the test will be in how it acts.
‘As we await details, we have put together this blueprint of the actions that are crucial right now to stop this serious public health threat in its tracks.’
Professor David Strain, chair of the BMA’s board of science, said vape usage has ‘risen hugely in the last decade’ and there is now a ‘vaping epidemic’.
He said: ‘As a doctor, I understand the role vapes can play in helping people to stop smoking, but they have no rightful place in our children and young people’s lives and when it comes to protecting their health, we cannot afford to gamble.
‘An industry so obviously targeting children with colours, flavours and branding, to push a product that can lead to nicotine addiction and potential further harms cannot be allowed to happen any longer.’
In response to the report, a spokesperson for the Department of Health and Social Care said that the marketing of vapes to children is ‘utterly unacceptable’.
They continued: ‘Vapes can be an effective way for adult smokers to quit, but we have always been clear that children and adult non-smokers should never vape.
‘The Tobacco and Vapes Bill will stop vapes from deliberately being branded and advertised to appeal to children, including by regulating flavours, packaging and changing how and where they are displayed in shops.’
A version of this article was originally published by our sister publication Pulse.
28th August 2024
Electronic prescribing and medicines administration (EPMA) could reduce the likelihood of a small number of low-harm and moderate-harm medication-related incidents, according to a team from the University of Nottingham and Nottingham University Hospital NHS Trust, UK.
By analysing the frequency of the different types of medication-related incidents that caused patient harm, the researchers found that more than half of the incidents (n=243, 62.8%) could not be mitigated by any use of EPMA, even with further development, but EPMA could reduce the likelihood of a small number of the least harmful incidents.
The research team, which included hospital pharmacy and medical staff, conducted a retrospective review of harmful incidents (n=387) for medication-related reports at a major UK teaching hospital between September 2020 and August 2021 and the frequency of different types of incidents were collated. DATIX reports and investigation results were reviewed to determine whether EPMA could have prevented the harmful incidents.
Administration errors were found to cause the largest proportion of harmful medication incidents (n=215, 55.6%), followed by incidents classified as ‘other’ (n=102, 26.4%) and ‘prescribing’ (n=46, 11.9%). The majority of incidents were classified as ‘low harm’ (n=321, 83.0%).
EPMA would not have been able to reduce the likelihood of the incident in 62.8% of all incidents where harm was identified due to issues where the software has no impact such as lack of communication, distractions or staff shortages.
However, the researchers found that implementation of EPMA could potentially reduce the likelihood of all incidents which caused harm by 18.6% (n=72) without any software configuration, and by an additional 7.5% (n=29) if configurations were made.
For the low harm incidents (n=59) and moderate harm incidents (n=13), EPMA could reduce the incident likelihood by 18.4% and 20.3% respectively without configuration.
EPMA also has the potential to reduce medication errors caused by illegibility, multiple drug charts or missing drug charts, the researchers said.
The study shows that EPMA can lead to a reduction of harmful incidents in hospitals, particularly with targeted configuration and development of software and the researchers suggest the findings can be used by hospitals to optimise their EPMA systems.
Reference
Cattell M et al. Retrospective review of medication-related incidents at a major teaching hospital and the potential mitigation of these incidents with electronic prescribing and medicines administration. European Journal of Hospital Pharmacy 2024; Jun 21: doi.org/10.1136/ejhpharm-2022-003515.
21st August 2024
A new international protocol to support the structured and optimal transition of children with chronic intestinal failure on home parenteral nutrition from paediatric to adult care has been published based on a consensus of specialist healthcare advice from experts across Europe and North America.
The new practical guidance is designed to be used by clinicians as a formal checklist that can be placed in the patient’s chart to review and track the transition process by chronic intestinal failure multidisciplinary team members.
While the outlook and life expectancy for children with chronic intestinal failure on home parenteral nutrition have improved dramatically, and there is a need to bridge the gap between paediatric and adult healthcare for these patients, the research team said.
Members of the Intestinal Failure working group of the European Reference Network for Rare Inherited Congenital (gastrointestinal and digestive) Anomalies and the European Society for Paediatric Gastroenterology Hepatology and Nutrition’s Network of Intestinal Failure and Intestinal Transplant in Europe group were sent a survey to analyse 20 interventions for transition.
Alongside this, the experts were given an open-ended question to fill in any other suggestion regarding the most effective intervention they had experience with.
Interventions that scored over 80% by all participants were automatically added to the new protocol. These included interventions such as ‘paediatric physician initiates discussion about transfer of care to patients and parents’ and ‘paediatric physician assesses the patient’s understanding of the current health situation’, which scored 95% and 93%, respectively.
Interventions scoring below 50% were excluded, while those scoring between 50 and 80% were discussed in a consensus meeting of experts and patient representatives and included if a unanimous agreement was met. Those discussed at the consensus meeting included interventions such as ‘paediatric physician directs all questions and explanations to patient instead of the parents/caregivers’.
The primary interventions in the final protocol include the assessment of the patient’s transition readiness, provision of knowledge to the patient by the paediatric team, involvement of parents in the transition process and collaboration between the paediatric and adult teams.
The researchers advise that preparation for the transition from paediatric to adult care for children with chronic intestinal failure on home parenteral nutrition should begin one to two years before transition and that the process should be tailored to the individual patient.
They also suggest that future research investigating transition readiness of chronic intestinal failure patients is needed.
Reference
Demirok, A et al. Transition from pediatric to adult care in patients with chronic intestinal failure on home parenteral nutrition: How to do it right? Clinical Nutrition 2024; Jun 20: doi.org/10.1016/j.clnu.2024.06.019.
19th August 2024
A study by German researchers shows that despite differences in healthcare systems in Europe, strategies that address everyday external stressors in emergency departments (EDs) can improve working conditions and increase sustainability.
The European Society for Emergency Medicine (EUSEM)-initiated, Europe-wide consensus survey sought to identify unequivocal major factors for good and poor working conditions in EDs and determine their retrospective effects on healthcare providers. The findings provide a scientific framework for future interventions to improve ED provider work lives.
An overview of previously reported ED working conditions and improvement interventions across Europe was attained from a literature search and informed a two-round mixed-method Delphi survey, covering key factors for ED providers’ work life, wellbeing, and associated patient care outcomes. The researchers surveyed 18 clinicians with emergency medicine leadership roles across large (>600 beds), middle-sized (200–600 beds) and small hospitals (<200 beds) in six European countries: Belgium, Finland, Germany, Italy, Romania and the UK.
There was almost unanimous consensus amongst the participants on four categories of working conditions in EDs. These categories included both positive aspects, such as ‘job challenges’, encompassing variation and interdisciplinary interaction, which had an average rating of 4.7/5 in the survey response and 100% consensus, ‘job intellectuality’ (mean = 4.6, 94%) and ‘job control’ (mean = 4.4, 100%), which included participation in decision-making.
The highest ratings for negative conditions were for ‘overcrowding’ (mean = 4.7, 94%), ‘workflow interruptions and/or multitasking’ (mean = 4.6, 94%), ‘time pressure and/or lack of breaks’ (mean = 4.4, 89%), and ‘employee turnover and understaffing’ (mean = 4.4, 83%). Additionally, ‘medical errors’ (mean = 4.1, 83%) were deemed to be highly relevant among clinicians.
The highest-rated work-life improvement practice was ‘emergency care as autonomous specialty’ (mean = 4.4, 94%), while skills training, debriefings after critical events and regular feedback from mentors were also deemed crucial at a team level.
Whilst the positive aspects of ED life were attributed to personality aspects, such as high individual motivation and team orientation, the negative effects were shown to depend on external and structural factors caused by the healthcare system. The authors noted that the latter can lead to exhaustion and burnout and are ubiquitous across European healthcare systems.
The authors hope the findings can help decision-makers develop targeted strategies to improve working conditions in the field of emergency medicine, as well as laying the ‘scientific groundwork for future intervention studies at the local and systemic levels to improve ED provider work life’.
Weigl, M et al. Key factors for sustainable working conditions in emergency departments: an EUSEM-initiated, Europe-wide consensus survey. European Journal of Emergency Medicine 2024; Jul 19: DOI: 10.1097/MEJ.0000000000001159.
16th August 2024
Updated guidance advising clinicians to be aware of and prepare for a new and more fatal variant of mpox, currently spreading in parts of central and east Africa, has been issued by the UK Health Security Agency (UKHSA).
A UKHSA warning, issued on 15 August, comes a day after the World Health Organization (WHO) declared the current mpox outbreak a global public health emergency.
There are particular concerns over the new Clade I variant of the disease (Clade I MPXV) that has a high fatality rate.
The UKHSA is therefore urging all NHS primary care, urgent care, sexual health services, paediatrics, obstetrics and emergency departments to ensure the latest guidance is understood and actioned.
UK clinicians should be aware of the risk of mpox exposure where there is a travel history to Democratic Republic of the Congo (DRC), Republic of the Congo, Central African Republic, Burundi, Rwanda, Uganda, Kenya, Cameroon and Gabon, UKHSA said.
There may also be a risk associated with Angola, South Sudan, Tanzania and Zambia.
All laboratory-confirmed Clade I MPXV cases should be managed as a high consequence infectious disease (HCID), it added.
WHO director-general Dr Tedros Adhanom Ghebreyesus said that an upsurge of mpox in the DRC and a growing number of countries in Africa ‘constitutes a public health emergency of international concern’.
The announcement came after an emergency committee met to review data from affected countries and concluded it could spread to further countries in Africa as well as outside the continent.
‘A co-ordinated international response is essential to stop this outbreak and save lives,’ Dr Tedros said.
The previous mpox outbreak in 2022 was caused by a milder version of the infection – known as Clade II. The current concern is over the spread of Clade I or, more specifically, a variant called Clade Ib, which was first noted in September and has spread rapidly.
Since the start of the year, there have been more than 15,600 cases of mpox in the DRC, with at least 537 deaths, WHO said.
In the past month, over 100 laboratory-confirmed cases of Clade Ib have also been reported in Burundi, Kenya, Rwanda and Uganda for the first time.
So far, no case of the new variant has been detected in the UK, but Sweden reported the first case in Europe on 15 August in a patient who had travelled from the affected region. This is the first case to have been detected outside Africa.
In new strengthened guidance to NHS providers, the UKHSA has now urged providers ‘to ensure there is a clinical pathway for isolation and management of suspected Clade I MPXV cases within their setting’.
The UKHSA update said: ‘Individuals with clinically suspected mpox presenting to acute care settings who meet the case definition for possible Clade I MPXV infection should be isolated and managed as a HCID as outlined in the National Infection Prevention and Control Manual.’
Providers of NHS services are also advised to ‘ensure that they have adequate stocks of appropriate personal protective equipment (PPE)’ and that ‘relevant staff are trained in its use for the assessment and treatment of patients presenting with suspected MPXV infection’.
‘Clinicians should be alert to the possibility of Clade I MPXV infection in patients presenting with suspected mpox where there is a link to the specified countries in the African region,’ the DHSC said.
‘Healthcare professionals should remain vigilant for Clade I MPXV, including in sexually acquired mpox cases, and should obtain comprehensive travel histories from patients,’ the guidance said.
The previous mpox outbreak in the UK in 2022 saw more than 3,700 confirmed cases in the UK. Vaccination was offered to gay, bisexual and other men who have sex with men (GBMSM) who were at the highest risk of infection.
Dr Meera Chand, deputy director at UKHSA, said: ‘The risk to the UK population is currently considered low.
‘However, planning is underway to prepare for any cases that we might see in the UK.
‘This includes ensuring that clinicians are aware and able to recognise cases promptly, that rapid testing is available, and that protocols are developed for the safe clinical care of people who have the infection and the prevention of onward transmission.’
Dr Brian Ferguson, associate professor of immunology at the University of Cambridge, said: ‘The situation is concerning because of the spread of the Clade Ib virus, which is considered to cause more severe disease, and because there are many children being infected in DRC during this new outbreak. 40% of cases are in children under five years old.’
He added that even though there are existing effective vaccines, there are not enough doses and they are not being getting to where they are needed.
‘The WHO is attempting to address these issues, but this requires greater international effort to produce and deliver vaccines,’ he said.
Earlier this year, the UKHSA brought attention to rising pertussis cases after repeated warnings from public health officials about falling uptake of maternal pertussis vaccination.
And in June, public health officials warned that cases of dengue fever in Europe were continuing to rise as climate change creates favourable conditions for invasive mosquitoes.
A version of this article was originally published by our sister publication Pulse.
15th August 2024
A research team from the Netherlands has found that the stability of monoclonal antibodies (mAbs) is unaffected by the use of drone transportation when compared with traditional car transport for inter-hospital transportation.
They found the stability of mAbs in both vials and infusion bags was adequately maintained during drone transport, indicating that medical drones are a viable and reliable transportation method.
The current reliance on cars to deliver mAbs is compromised by the unpredictable nature of traffic and infrastructure, which leads to unreliable transport times. Drone transport could therefore offer health systems a more efficient and predictable transportation system for mAbs, the authors said.
The researchers assessed the efficacy and safety of medical drone transportation on the stability of mAbs transported in vials and ready-to-administer infusion bags with blinatumomab, tocilizumab and daratumumab. These were Blincyto 38.5 μg concentrate after reconstitution, RoActemra 20 mg/mL concentrate for infusion and Darzalex 20 mg/mL concentrate for infusion, respectively.
These mAbs were chosen as blinatumomab represents a low-concentrate protein drug, tocilizumab represents a drug that may be necessary in emergency settings, and daratumumab is a viable option for home treatment of patients.
Using a VTOL fixed-wing drone, temperature recorders and impact indicators estimated mechanical stress during the flight. Four flights carrying vials and five flights carrying IV bags were performed at a field lab in the Netherlands with an average flight length of eight kilometres and eight minutes of flight time.
Control high-performance size-exclusion chromatography (HP-SEC), dynamic light scattering (DLS), light obscuration (LO), micro-flow imaging (MFI) and nanoparticle tracking analysis (NTA) and absence of visible particles (VI) were employed to assess the presence of aggregates and particle formation in car, drone and control conditions.
Where there was enough quality data, statistical analysis of the vials revealed no significant differences between the control group and the drone-exposed mAbs. Similarly, there were no statistically significant differences between the control, the car and the drone groups for all the infusion bags. By way of example, the data for blinatumomab has been summarised in Table 1 below.
Table 1: Summary of the main results of infusion bag analysis
HP-SEC: mean percentage, DLS: mean particle size, LO and MFI: mean total particle concentration, VI: absence of visible particles.
The researchers concluded that integrating drone technology into healthcare logistics has the potential to significantly enhance the efficiency of inter-hospital transportation. Both commercial vials and ready-to-administer infusion bags of mAbs could be transported by drone without resulting in aggregate formation.
Güngören M et al. Investigating the Impact of Drone Transport on the Stability of Monoclonal Antibodies for Inter-Hospital Transportation. Journal of Pharmaceutical Sciences 2024; Apr 03: doi.org/10.1016/j.xphs.2024.04.002.
14th August 2024
Reducing child poverty between 2024 and 2033 would significantly improve child health and health inequalities, as well as reducing pressure on NHS secondary care services, a study has suggested.
Researchers from the University of Glasgow highlighted how meeting hypothetical future child poverty targets would cut infant deaths, reduce the number of children in care and decrease hospital admissions for children.
Reducing childhood poverty would particularly benefit children’s health in the most deprived regions, such as the North East, and would likely have beneficial knock-on effects on local authorities and health services, they said.
The findings, published in the Journal of Epidemiology & Community Health, demonstrate the importance of renewed policy efforts to reduce child poverty.
Child poverty is a crucial determinant of population health and health inequalities and is significantly influenced by Government policy. Experiencing childhood poverty is associated with worse outcomes across a wide range of early years health indicators, and the relationship is often causal. The impact of the Covid-19 pandemic and the ongoing cost-of-living crisis has heightened concerns about rising levels of child poverty in the UK.
Using local authority data, combined with published and newly created estimates of the association between childhood poverty and infant mortality, the researchers modelled the effects of different levels of child poverty reduction scenarios on population health and health inequalities in England between 2024 and 2033.
Four indicators of childhood poverty were measured in children under 16 years of age, including infant mortality per 1,000, the number of children in care, those hospitalised for nutritional anaemia and hospital admissions for all-cause emergencies.
The poverty indicators were modelled against three child poverty reduction scenarios between 2024 and 2033. These included low-ambition (15% reduction), medium-ambition (25% reduction) and high-ambition (35% reduction) and were compared with a baseline childhood poverty scenario (15% increase).
The impacts were assessed at national and regional levels to understand how different areas and social strata are affected and how health inequalities occur. Child poverty was defined as the proportion of children under 16 living in families with an income below 60% of the contemporary national average.
All three projected scenarios were shown to significantly improve child health, with the more ambitious targets corresponding to more significant benefits. The benefits associated with the high-ambition target were found to be approximately twice as large as the benefits of the low-ambition target across all four outcomes.
Meeting the high ambition target would be expected to cut the total number of infant deaths by 293, children entering care by 4,696, hospital admissions for nutritional anaemia by 458, and childhood emergency admissions by 32,650 over the next decade.
In comparison, the low ambition target would result in 155 fewer infant deaths, 2,483 fewer children entering care, 242 fewer hospital admissions for nutritional anaemia, and 17,266 fewer childhood emergency admissions.
The improvements would be higher in areas most affected by childhood poverty, the researchers found. In the North East of England, the total number of infant deaths would be projected to fall by 126, compared with a fall of 71 in the least deprived between 2024 and 2033.
The researchers suggested that Government policies should directly tackle childhood poverty to improve childhood health and health inequality. For example, removing the two-child limit on child benefits and targeted income supplementation, such as the Child Tax Credit, alongside other measures to improve early years services.
‘These reductions [in child poverty] would likely translate into significant savings for and relieve pressure on health services,’ the researchers said. ’We highlight that if policymakers were to set and achieve child poverty targets for England, this would likely improve child health, particularly among the most socioeconomically disadvantaged, and “level up“ regional inequalities. Other health impacts we have not been able to quantify are also likely.’
A version of this article was originally published by our sister publication Nursing in Practice.
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