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8th November 2024
Adding in just five minutes of vigorous exercise to a daily routine can help lower blood pressure, a large study has concluded.
Analysis of data from more than 14,700 people across five countries found that short periods of exercise that increases heart rate, such as cycling and climbing stairs, had a measurable benefit.
Using fitness tracker data, the UK and Australian researchers also calculated that as little as 20 additional minutes of exercise per day could lead to clinically meaningful cardiovascular risk reduction at the population level.
Writing in the journal Circulation they said walking was not enough and it had to be more vigorous exercise, including short bursts of running, to have an impact.
To look at the relationship between movement and blood pressure, they split the data into categories of sedentary behaviour, such as sitting, as well as slow walking, fast walking, standing and more vigorous exercise.
An average 24-hour day was made up of around seven hours of sleep, 10 hours of sedentary behaviour, three hours of standing, one hour of slow walking, one hour of fast walking, and just 16 minutes of exercise activities such as running and cycling.
Looking at the impact of replacing one type of activity with another, they found switching any less active behaviour with more vigorous exercise could lower systolic blood pressure by 0.68 mmHg and diastolic blood pressure by 0.54 mmHg.
To put this in context, at a population level, a 2 mmHg reduction in systolic blood pressure and a 1 mmHg reduction in diastolic blood pressure is equivalent to around a 10% reduction in cardiovascular disease risk, they said.
They estimated this could be achieved with around 20 minutes of exercise a day.
Study lead Dr Jo Blodgett, a senior research fellow at University College London, said for most people, exercise is key to reducing blood pressure, rather than less strenuous forms of movement such as walking.
‘The good news is that whatever your physical ability, it doesn’t take long to have a positive effect on blood pressure.
‘What’s unique about our exercise variable is that it includes all exercise-like activities, from climbing the stairs to a short cycling errand, many of which can be integrated into daily routines.’
Among those who do not do a lot of exercise, walking did still have some positive benefits for blood pressure, she added.
‘But if you want to change your blood pressure, putting more demand on the cardiovascular system through exercise will have the greatest effect,’ she said.
Professor Emmanuel Stamatakis, joint senior author and professor of physical activity, lifestyle, and population health at the University of Sydney, said despite high blood pressure being one of the biggest health issues globally, there may be relatively accessible ways to tackle the problem in addition to medication.
‘The finding that doing as little as five extra minutes of exercise or vigorous incidental activities per day could be associated with measurably lower blood pressure readings emphasises how powerful short bouts of higher intensity movement could be for blood pressure management.’
In May, research showed that even light physical activity in children can mitigate the ‘ticking time bomb’ of cardiac health in later life.
A version of this article was originally published by our sister publication Pulse.
A new iPhone app and device are to be piloted across the UK‘s West Midlands to help patients detect and rule out suspected throat cancer.
The adapter device is a 32mm lens which, when paired with an accompanying app, can turn an iPhone into a portable diagnostic gadget, according to NHS England.
The device can capture live endoscopy examinations of the throat in high definition, which can be instantly shared with specialists via a secure data cloud. The consultant can then review the video to detect any traces of cancer.
Developed by Endoscope-i Ltd, the device is one of 14 projects to have received a share of £25m as part of the NHS Cancer Programme Innovation Open Call.
NHS England said the device could be used in ‘any NHS setting’ such as diagnostic centres and community settings, meaning people can be tested closer to home.
An initial trial of the device, which was done on low-risk patients at North Midlands University Hospitals NHS Trust, found that no cancers were missed using the device and that patients received results within 23 hours of the tests taking place. Around one in 100 patients were discovered to have cancer within this group.
Dr Cally Palmer, NHS England national cancer director, said: ‘Detecting cancer early is key to providing treatment as soon as possible to help give patients the best chance of survival. For those needing tests to investigate suspected cancer, it can be an extremely worrying time and being able to rule out the disease sooner can make a huge difference for people and their families.
‘While staff have been working hard to see and treat more people with cancer than ever before, we know that some people are still waiting too long to receive a diagnosis or the all-clear.
‘The NHS continues to adopt the latest technologies with the potential to benefit patients, and through pioneering new innovations like this iPhone device which could be used in any setting, we hope we’ll be able to detect many more cancers sooner and in ways that are more convenient and less invasive for patients.’
Health minister, Karin Smyth said: ‘This new technology is a shining example of how innovation and research can tackle waiting lists, improve patient experience and speed up diagnosis.
‘Using the app, patients can access a potentially lifesaving consultation. By catching cancer earlier and treating it faster, we can ensure more people survive this horrible disease.
‘Harnessing technology to support the NHS is a key part of our 10-Year Health Plan, and will shift the NHS from analogue to digital, equipping the health service with more cutting edge-technologies to catch cancers on time.’
Last month, a report into waiting times by the Nuffield Trust and Health Foundation found that those waiting for ear, nose and throat services were facing some of the longest waiting lists in the NHS system.
In the spring, NHS England announced a pilot project to help diagnose Barrett’s oesophagus using a capsule sponge test, which was part of the same NHS Cancer Programme Innovation Open Call. This freed up endoscopy capacity for higher risk patients and those referred for urgent tests for oesophageal cancer, helping to reduce waiting lists.
In September, research was published revealing that a new hand-held 3D photoacoustic scanner can produce detailed microvascular images in seconds, with the technology having the potential to assist with earlier detection of conditions such as cancer.
A version of this article was originally published by our sister publication Healthcare Leader.
Moving medical supplies via drone was once a farfetched idea, but there are now multiple projects working to make it a reality. Kathy Oxtoby considers five case studies from the UK and the Netherlands to determine the benefits for clinicians, patients and healthcare systems, as well as the remaining challenges and future potential of drone transportation within the healthcare landscape.
With rising waiting lists, ongoing staff shortages and mounting pressure on hospital teams, it is increasingly vital that care is delivered faster and more efficiently to patients. Greener, more sustainable care is also a priority, with the drive to achieve a net zero NHS by 2040.
One approach that has the benefits of both faster delivery and sustainability is the use of drones – also known as unmanned arial vehicles or UAVS. Drones are already transporting medicines to remote areas in such countries as Rwanda, the United States, Australia and India.
In recent years, the NHS has been trialling the use of drones for a variety of purposes, including delivering medical supplies of blood packs and chemotherapy, transporting lab specimens, and more.
For Professor Claire Anderson, Royal Pharmaceutical Society president, the Covid-19 pandemic and recent advancements in technology have made the drone transportation of medical supplies eminently possible, and the benefits are clear.
‘Drones offer timely access to medicines, especially in remote areas, and the pandemic highlighted their potential for safe, contactless delivery of essential supplies,’ she says.
‘It can reduce costs and travel time, improve access to healthcare for patients in rural or hard to reach areas, and free up staff time for direct patient care. Drones are also more environmentally sustainable, emitting less carbon dioxide than cars or trucks.’
For patients with chronic conditions, using drones to deliver critical medicines can ‘help reduce waiting times and ensure more consistent access to healthcare’ and ‘alleviate some of the pressures caused by long waiting lists’, she adds.
However, in their current form, there are some inevitable drawbacks. Drones can only carry light items – typically around two to four kilograms – which limits their use for transporting a wide range of items. Additionally, they have limited range and battery life, which affects the numbers of deliveries that can be made on one flight.
In addition, some medicines need to be stored in specific conditions, such as controlled temperatures and multilayer packaging, which must also be taken into consideration. ‘Regulations require these conditions to be met throughout transport to ensure the product is safe to use,’ says Professor Anderson.
As the need and momentum for the use of drones in healthcare builds, the list of projects assessing the benefits, challenges and future potential of drone transportation is growing.
So what projects are currently underway, and what insights are they giving into this innovative movement of medical supplies?
The weather and geography of Cornwall, southwest England, present unique challenges when it comes to the collection and delivery of pathology samples and time-critical medicines, particularly on the Isles of Scilly – 28 miles off the coast.
Poor weather conditions mean flights to and from the islands can be grounded for two to three days, delaying transit of crucial items.
The Open Skies Cornwall project is a consortium of technology providers and end users. It includes exploring conceptual use cases involving the transport of pathology samples and blood products, point of care equipment and consumables, and Royal Cornwall Hospital Pharmacy service provision via drones.
‘We wanted to level up the provision of care and build a reliable and robust service for the island community,’ says Jo Walsh, pathology optimisation project lead at Royal Cornwall Hospitals NHS Trust.
Samples can be adversely affected by the time it takes to transport them, and often repeat testing is required as a result. ‘We’re looking to prevent any repeated testing and provide timely and accurate results for clinicians, that are not adversely affected by transport delays,’ says Ms Walsh.
‘We also want to enable patients to receive treatment at home, rather than having to travel to the main hospital – a journey that is especially problematic for those living off the mainland, as they have to travel by plane.’
As well as focusing on island healthcare connectivity, the Open Skies Cornwall project also involves working with Falmouth Harbour to integrate autonomous drone solutions and enable infrastructure for ship-to-shore delivery, remote healthcare, telemedicine and flying defibrillator applications to support residents and maritime visitors.
Lisa Vipond, pathology services manager at the Trust says that the team sees ‘this project as a complimentary element to our courier system, assisting their challenges.’
A key part of the project is looking at maintaining the validity of samples, and the impact of environmental factors, such as heat, cold, pressure and vibrations on samples transported by drone.
There are plans to do testing flights at the end of this year, but ‘we need to ensure the regulatory and legislative requirements are all in place ahead of this’, says Ms Vipond.
Ms Walsh believes many other areas of the NHS could benefit from drones, including emergency care.
‘Working in the NHS, patient care is at the centre of what you do,’ says Ms Walsh. ‘When you see a solution to gaps in service provision due to elements beyond your control – such as geographical and weather limitations – you want to push that solution forward.
‘We can’t just use this project as a “proof of concept”. We need to embed drone transport within our infrastructure long-term.’
Project CAELUS (Care & Equity – Healthcare Logistics UAS Scotland), aims to develop and trial the UK’s first national distribution network using drones to transport essential medicines, blood, organs and other medical supplies throughout Scotland to eliminate land transport issues.
Led by AGS Airports, it brings together 16 partners, including NHS Scotland and is funded by the UK Research and Innovation Future Flight Challenge and other partners. The consortium has developed a virtual model, or digital twin, of the proposed delivery network, which connects hospitals, pathology laboratories, distribution centres and GP surgeries across the country.
A number of live flight trials are taking place across the country as part of the project. For example, this August, laboratory specimens were flown between NHS Lothian and NHS Borders by drone.
In October, drone technology was used to connect the island community of Arran with the mainland. Further trials are planned in the NHS Highland and NHS Grampian areas of Scotland later in the year.
And the Scottish Ambulance Service has also researched whether a drone could transport defibrillators to the location of a cardiac arrest faster than an ambulance.
Dr Jamie Hogg, clinical lead for Project CALEUS for the north of Scotland and a retired GP, says the team hopes that the use of drones to transport medicines, blood samples and equipment will enable patients living in more rural areas to be ‘treated closer to home and more quickly’.
Requesting quick deliveries of medicines for patients via a drone network would have significant benefit, he says, however, a change in regulations to allow the move from the currently segregated to integrated airspace will be key.
The project ends in December, and then there will be ‘a period of reflection to take in everything that’s been done and decide on next steps’, Dr Hogg explains.
Blood packs have been successfully flown by drone in a series of ‘beyond visual line of sight’ flights, for the first time in the UK.
In a research study to check the viability of flying blood via drone, run jointly by NHS Blood and Transplant (NHSBT) and the medical logistics company Apian, 10 units of packed blood cells were transported on a 68km journey across Northumbria’s skies, while an identical 10 packs were transported concurrently by road.
After assessment, results showed both sets remained viable, with no significant difference in the biochemical or haematological profiles of the blood, which determine if it has maintained quality and can be used for clinical purposes.
‘We’re proud to drive innovation that could improve patient outcomes, and this trial could do exactly that,’ says Mike Wiltshire, component development laboratory manager at NHS Blood and Transplant.
‘Drone travel would be especially useful in transporting items – whether blood packs, blood samples or other – to more remote locations, or via routes that normally suffer from traffic congestion, meaning the products are available for patients faster than they would be by road and ensuring patients are treated as quickly as possible.’
If drones are able to deliver blood products faster, then ‘more patients will be able to be treated or receive results the same day’ than at present, which ‘may reduce patients having to return to the hospital at a different time, should the medicine or test results not be available same day’, Mr Wiltshire adds.
The UK has clear guidelines on the transport of blood components and maintenance of product temperature. ‘We needed to source a suitably sized and specified transport container, along with cool packs, to ensure the temperature of the blood was maintained as required,’ explains Mr Wiltshire.
The number of items and weight that can be transported at any one time is limited by the drone load capacity. Drone operators are therefore exploring different types of drone to determine the best one for the transportation of blood, which may in turn be dependent on the specific requirements of the transport route.
The flying of drones like those used in this study is currently ‘very tightly regulated’ meaning that drones cannot simply fly directly between any given two points – permission must be granted, which may not be guaranteed, depending on the locations in question. ‘Drone operators are looking to overcome this significant challenge for the use of drones for this and many other uses,’ he says.
NHSBT is currently in discussions around a similar trial for platelets, to understand how platelets for transfusion will react to drone transportation and whether their use will be viable in the NHS for this purpose.
The Welsh Blood Service (WBS) is interested in exploring what role drones might play in enabling efficient, sustainable transport of blood products between north and south Wales as well as faster, on-demand delivery of blood products and other medical supplies in rural Wales.
The organisations involved in the Welsh Health Drone Innovation Partnership are the WBS – part of Velindre University NHS Trust –the Welsh Ambulance Service University NHS Trust, Snowdonia Aerospace Centre and the technology company Slink-Tech.
Currently, the partnership is undertaking a foundation study for drone-based blood delivery service between WBS stock holding units at Talbot Green in the south and Wrexham in the north to establish its potential for supporting the Welsh NHS, including specific use cases for the WBS, and to test the basic premise with the Civil Aviation Authority.
‘Drone-based infrastructure has the benefit of not being tied to pre-existing infrastructure on land, which due to geographical constraints has often unintentionally left rural communities underserved,’ says a spokesperson for Velindre University NHS Trust.
‘Drone technology provides the opportunity to tackle inequalities by improving accessibility to communities and regions which may be left behind by traditional logistic infrastructure.’
The primary challenge is to establish ‘a robust business case for early deployment of drone technology to improve the quality and resilience of health and care services in Wales’, the spokesperson adds.
Alan Prosser, the director of the WBS, says: ‘Technology is advancing at pace in this area, and we acknowledge that drone capability still needs to mature in terms of carrying capacity and battery payload before this becomes a viable option for our service.’
The UK isn’t the only country trialling the use of drones to transport medical supplies. In the Netherlands, researchers have investigated the impact of medical drone transport on the stability of monoclonal antibodies (mAbs).
The study findings revealed ‘no significant differences between car and drone transport’, indicating that the stability of mAbs in both vials and infusion bags was adequately maintained during transportation regardless of the mode.
As such, medical drones are ‘a viable and reliable means for the inter-hospital transport of mAbs, paving the way for more efficient and predictable logistics in healthcare delivery’, the authors say.
In fact, the researchers concluded that the integration of drone technology into healthcare logistics ‘has the potential to significantly enhance’ the crucial transport of this treatment type.
With so many ongoing trials and success stories demonstrating the benefits of drone technology in healthcare, the future looks bright, and Professor Anderson says it really does have ‘the potential to ‘revolutionise the way we deliver medical supplies, especially in remote or hard-to-reach areas’.
She is keen to point out, however, that ‘as with any transport around medicines, safety and security must remain a priority’.
The use of drones will ‘undoubtedly increase over the next five to 10 years, for a variety of applications,’ according to Mr Wiltshire. ‘However, there are challenges to overcome – such as restrictions on airspace – before this use is widespread’.
In the meantime, Dr Hogg is encouraging healthcare professionals to ‘think about what they could do if they had drones available to them’ to support patients in accessing vital medical supplies.
‘We are getting to the point where drone transport for medical products could become a reality,’ he says. ‘In three- or four-years’ time, we could be saying to a [resident] doctor: “Can you “drone” this down to Aberdeen?”, and the answer will be: “Yes, sure.”’
7th November 2024
An ‘early warning system’ for future pandemics is to be rolled out in the UK to monitor threats, prevent disease and protect the public, the Department of Health and Social Care (DHSC) has announced.
The surveillance system will be created via the expansion of NHS England’s respiratory metagenomics programme, led by Guys and St Thomas’ NHS Foundation Trust. It uses technology created by life sciences company Oxford Nanopore to analyse genes and pathogens to rapidly diagnose cancers and rare and infectious diseases and match patients with the right treatments within six hours.
The expansion of the programme will also allow potential outbreaks of bacterial or viral diseases to be monitored across the country, alongside antimicrobial resistance.
The technology was initially piloted at St Thomas’ hospital and will be rolled out across 30 NHS sites. Data will be given to the UK Health and Security Agency to allow for quicker detection and action on emerging infectious diseases.
The programme is a partnership between the government, Genomics England, UK Biobank, NHS England and Oxford Nanopore.
Health secretary Wes Streeting said: ‘If we fail to prepare, we should prepare to fail. Our NHS was already on its knees when the pandemic struck, and it was hit harder than any other comparable healthcare system.
‘We cannot let history repeat itself. That’s why this historic partnership with Oxford Nanopore will ensure our world-leading scientists have the latest information on emerging threats at their fingertips.’
Professor Dame Sue Hill, chief scientific officer for England, said: ‘This strategic partnership will build upon our expertise in infectious disease genomics, representing a significant leap forward in our ability to protect public health and save lives.
‘By integrating cutting-edge technology into 30 NHS sites across the country, we are not only enhancing our capacity to rapidly diagnose and treat severe respiratory infections, but also creating a crucial early warning system for new and emerging infectious diseases.’
Professor Susan Hopkins, chief medical advisor at the UK Health Security Agency, said: ‘Enhancing the capacity for the NHS to determine new and emerging pathogens causing severe acute respiratory infections will improve the detection and emergence of infections.
‘As part of the 100 days mission, this will enable the development of effective diagnostics for novel pathogens and enhance our pandemic preparedness.‘
Professor Ian Abbs, chief executive of Guy’s and St Thomas’ NHS Foundation Trust, said: ‘We’ve been working on the respiratory metagenomics programme for over four years and have clearly seen the benefit to our patients. It’s a momentous day now that we can ensure other hospitals, and more patients, can also benefit from faster and more accurate treatment for severe respiratory conditions thanks to new genomic technology.’
A version of this article was originally published by our sister title Healthcare Leader.
6th November 2024
The Royal College of Paediatrics and Child Health’s new ‘landmark’ blueprint is shining a light on what can be done to improve the provision of child health services both on the frontline and with support from the Government. Saša Janković investigates.
Earlier this year, The Academy of Medical Sciences described what it called ‘a crisis in child health’, with the UK ‘failing too many of its children’. And The Children’s Commissioner for England noted that access to children and young people’s healthcare services is a ‘postcode lottery’. Yet while the need for care is rising, the capacity for, and quality of, care is not always keeping up.
NHS Providers points to evidence suggesting children and young people’s services are ‘recovering at a slower rate post Covid-19, in comparison to adult services, impacting on waiting lists and the availability and accessibility of services’.
According to NHS Provider’s ‘Forgotten Generation’ report, in May 2024, 356,200 children and young people were waiting for planned acute care – an increase of 110,000 in just three years. A further 282,000 children and young people were on the community health services waiting list, with 88,900 of this group waiting over 52 weeks.
The latest data for mental health services also paints a concerning picture. The Care Quality Commission’s ‘Monitoring the Mental Health Act in 2022/2023’ report highlights that almost half a million children and young people were waiting for mental health services in November 2023 – a record number that the CQC says had increased by almost 20,000 by January 2024.
The Royal College of Paediatrics and Child Health (RCPCH) has gone further in stating that we are ‘failing a generation of young people’ through a lack of dedicated focus and attention, blaming ‘a decade of chronic underinvestment and lack of national prioritisation in children’s health’.
According to the RCPCH, over three-quarters of respondents to a snapshot poll of its members reported regularly seeing children who have waited over 18 weeks for an appointment, with 83% saying there is not ‘an appropriate level’ of capacity locally to meet demand.
‘The impacts of long waits are as devastating as they are far-reaching,’ says Dr Ronny Cheung, consultant general paediatrician at Evelina London Children’s Hospital, and RCPCH officer for health services. ‘Children and their families are denied child disability payments until seen by a paediatrician. Mild symptoms progressing into much more complicated conditions and a reduced quality of life, school exclusions and wider family stress are impacts that will have life-long consequences and, tragically, are repeated hundreds of thousands of times across the UK.’
In a bid to tackle these issues, the RCPCH’s newly published policy report, entitled ‘From left behind to leading the way: a blueprint for transforming child health services in England’, highlights how the lack of investment in children’s health is having severe consequences. It provides a blueprint which, if taken forward, the Royal College says leaves it ‘hopeful for change’.
The blueprint makes a series of evidence-based recommendations to the new UK Government for change across seven key areas of child health services in funding, workforce, integration, data and digital innovation, urgent and emergency care, community services and primary care. It urges key actions to address the longstanding underinvestment in children’s health services in England built on four national foundations: fair funding, workforce sustainability, improved data systems and prioritisation of children within integrated care systems (ICSs).
Suggestions include developing a child health workforce strategy, introducing a children and young people specific waiting times standard for ICSs, prioritising the development of a digital child health record, and adequately investing in community paediatrics and health visiting and school nursing services.
It also calls for a Children’s Health Investment Standard to address the disparity in funding between adult and child health services and recommends expanding paediatric training posts to ensure a sustainable child health workforce.
One major recommendation in the blueprint is to reduce pressure on urgent and emergency care by embedding paediatric-specific advice and assessment services within NHS 111 – known as Paediatric Clinical Assessment Services. The report says this model has shown significant potential to manage cases earlier, increase self-care rates and reduce emergency department attendances.
Dr Helen Stewart is the RCPCH’s officer for health improvement, as well as a consultant in paediatric emergency medicine at Sheffield Children’s Hospital NHS Foundation Trust, which is one of only three dedicated children’s hospital Trusts in the UK. She says reducing pressure on urgent and emergency care requires properly funded and staffed community services.
‘We get a number of families attending who say they can’t get a GP appointment, and we know primary care is overwhelmed, but there has been a reduction in health visitor numbers as well, so families don’t have anywhere to turn when they are worried and come to the emergency department as a last resort,’ she explains. ‘Then there are young people waiting years for assessments for ADHD across the country and families struggling to access mental health services and so they present to [the emergency department] in crisis.’
A key focus of the RCPCH 2024 blueprint is significant concern around respiratory services, particularly childhood asthma, where the UK has some of the highest emergency admission and death rates in Europe.
To address these issues, the blueprint recommends several key actions, including the expansion of structured asthma care reviews delivered in both primary and secondary care settings, to ensure every child has a personalised asthma action plan and access to specialist support when needed.
Additionally, the report stresses the importance of improving the availability of community-based asthma management services, which can reduce pressure on emergency departments. Another key recommendation is to standardise the approach to early intervention, particularly in schools and community settings, to identify and manage early signs of poorly controlled asthma, thus preventing avoidable flare-ups and hospital visits.
To this end, Amanda Allard, co-chair of the Children and Young People’s Health Policy Influencing Group and director of the Council for Disabled Children, says improvements in information sharing across agencies – for example schools, children’s social care services and the health system – have proven to be ‘essential’ to safeguard children’s health outcomes, wellbeing and safety, but more work needs to be done to optimise this.
‘At the moment, little communication between these services often means not all necessary information is shared about a child who then may not get the care they require,’ she says. ‘More information sharing, as well as using a single child identifier – such as a child’s NHS number – across agencies will significantly improve health outcomes for children and young people, as well as have other positive effects on other aspects of their care and wellbeing. And we also need to improve the quality of the data that we are sharing [otherwise] commissioners don’t have a complete picture of need when they are planning services.’
On the subject of cross-sector integration, Ms Allard adds: ‘We would like to see health professionals working more closely with colleagues in primary care and other agencies such as education and social care to support those colleagues in meeting lower-level needs without the need for referral to secondary care. There are some brilliant examples of this happening such as the Balanced System and Connecting Care for Children. We need these to become universally available.’
NHS Providers is also calling for a cross-government plan to improve the wellbeing of children and young people, with its outgoing CEO Sir Julian Hartley saying that Trusts are ‘ready to play their part in making things better for children and young people’.
But he also stresses that ‘it will require concerted, joined-up working between Trusts, Government, NHS England and local partners including councils, schools and the voluntary sector.’
From Ms Allard’s perspective, ‘the Darzi review acknowledges that “the patient voice is simply not loud enough”, so more must be done to listen to the voices of children, young people and their families, for example by including them in the co-production of guidelines and policies.’
Since most change is reliant on Government funding and top-down approaches, the RCPCH report says if the new UK Government is serious about improving the health of children and young people to raise the healthiest generation of children in our history, then the children’s health workforce needs ‘greater support and changes are needed at a national level to restore and improve health services for children’.
Until there’s movement on this, there are ways in which clinicians and other healthcare professionals in both secondary and primary care can bolster their support for children’s health. According to Dr Stewart, one such way to achieve this is to hone in on ‘the approach that every contact counts’. This, she says, is particularly important as ‘it can be hard for families, especially those in difficult socioeconomic circumstances, to access healthcare – for instance if they are in insecure employment, it’s hard to take a day off work.’
As such, making every contact count can streamline access to healthcare information and make a positive difference to children and their families. ‘If healthcare professionals were able to signpost to relevant services and address other things in their consultations that would be very helpful – such as are vaccinations up to date, healthy eating advice, mental health support – a lot of these only take a very short conversation and some information about where they can access support,’ Dr Stewart says. ‘It can be hard to do when you are really busy but each time we do it, [we] might be helping a family in an important way.’
4th November 2024
The initiation of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) among patients with newly diagnosed rheumatoid arthritis varies widely with age and ethnicity, researchers have found.
In a new study in England and Wales led by King’s College London (KCL), older patients and patients with Asian heritage were found to be missing out on effective treatments.
The researchers showed that patients over 65 years of age were 60% less likely to be given highly effective biological and targeted synthetic DMARDs to treat symptoms compared to patients aged under 40. Asian women were also less likely to be prescribed these drugs than Asian men and white men.
Socioeconomic status, other health conditions, or the response to conventional treatments did not explain the differences, the researchers said.
Using data from the National Early Inflammatory Arthritis Audit (NEIAA), the researchers identified 6,098 patients enrolled in the audit between May 2018 and April 2022 who had rheumatoid arthritis and 12-month follow-up data available.
Statistical methods were used to examine whether factors such as age, sex, ethnicity, health and economic status were associated with the initiation of biological and targeted synthetic DMARDs within 12 months of initial rheumatology assessment.
The mean age of the patients was 59.2 years, and just under two-thirds were women. The majority of the participants were white (86.2%), 2.5% were Black, 7.9% were Asian and 3.3% were mixed or other ethnicities.
Within 12 months of initial diagnosis, 8.3% of patients started biological and targeted synthetic DMARDs. Patients under 40 were nearly two and half times more likely to start treatment than patients who were over 65 (multivariable-adjusted risk ratio 2.41 [95% CI 1.83–3.19]; p<0.0001), and Asian women were about half as likely to start treatment than white individuals (0.52 [0.36–0.76]; p=0.0007).
The study also found that Black individuals were more likely to be started on biological and targeted synthetic DMARDs than white individuals (1.54 [1.10–2.16]; p=0.012), which was at least partly explained by worse disease severity at diagnosis in these individuals.
The findings highlight the problems of a ‘one-size-fits-all’ approach to treatment and the need for personalised information to be considered. The researchers say equitable access to biological and targeted synthetic DMARDs and quality care for underserved groups is needed.
Lead author Dr Mark Russell, NIHR clinical lecturer in rheumatology at King’s College London, said: ‘Rheumatoid arthritis is a progressive, debilitating condition with no cure. This study highlights marked differences in who gets started on advanced therapies for rheumatoid arthritis.
‘Access to these drugs in England and Wales is defined by need. Despite this, we found that Asian women and older adults were far less likely to be initiated on these treatments. Biologics are incredibly effective at improving quality of life and preventing complications from rheumatoid arthritis.
‘It is therefore crucial to develop a better understanding of what underlies these disparities if we are to ensure all patient groups receive equitable access to the best available care.’
Reference
Russell, M et al. Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study. The Lancet Rheumatology 2024; Oct 15: DOI: 10.1016/ S2665-9913(24)00221-2.
1st November 2024
Artificial intelligence (AI)-enabled electrocardiography (ECG) can accurately predict an individual patient’s risk of future cardiovascular events as well as their short and long-term risk of dying, a study finds.
Existing AI-enabled ECG could predict disease and mortality but could not give sufficient information to guide clinical decisions for individual patients and were not adopted into practice, UK researchers wrote in The Lancet Digital Health.
To address the limitations of previous AI models, the team from Imperial College London and Imperial College Healthcare NHS Trust developed the AI-ECG risk estimator (AIRE) platform using data from a secondary care dataset of 1,163,401 ECGs taken from 189,539 patients.
Using a deep learning and a discrete-time survival model, researchers were able to create a patient-specific survival curve with a single ECG, allowing the AIRE platform to predict not only risk of mortality but also time-to-mortality.
The platform was validated in five diverse, transnational cohorts from the USA, Brazil, and the UK, including volunteers, primary care patients, and secondary care patients.
Researchers found the model was able to identify the risk of death in the ten years following the ECG (from high to low) in 78% of cases, and was also able to predict future ventricular arrhythmia, future atherosclerotic cardiovascular disease, and future heart failure.
‘Through phenome-wide and genome-wide association studies, we also identified candidate biological pathways for the prediction of increased risk, including changes in cardiac structure and function, and genes associated with cardiac structure, biological ageing, and metabolic syndrome,’ they wrote.
They concluded that clinicians could act on AIRE’s predictions to provide targeted, personalised and earlier intervention.
‘AIRE is an actionable, explainable, and biologically plausible AI-ECG risk estimation platform that has the potential for use worldwide across a wide range of clinical contexts for short-term and long-term risk estimation,’ they said.
Lead author Dr Arunashis Sau, an Academic Clinical Lecturer at Imperial College London’s National Heart and Lung Institute, and cardiology registrar at Imperial College Healthcare NHS Trust, said compared with cardiologists the AI model could detect more subtle detail in the ECGs.
‘It can ‘spot’ problems in ECGs that would appear normal to us, and potentially long before the disease develops fully,’ he said.
‘Our analysis shows that the AI can tell us a lot about not only about the heart but also what is going on elsewhere in the body and may be able to detect accelerated ageing.’
Dr Sau acknowledged it was necessary to see how the model performed in the healthcare system, but suggested it was possible that in the future, the technology could be used in a wearable device that provided doctors with continuous remote monitoring and a potential alert system.
Senior study author Dr Fu Siong Ng, Reader in Cardiac Electrophysiology at the National Heart & Lung Institute at Imperial College London, said the work had shown the AI model was a credible and reliable tool that could, in future, be programmed for use in different areas of the NHS to provide doctors with relevant risk information.
‘This could have a positive impact on how patients are treated, and ultimately improve patient longevity and quality of life, he said.
Dr Ng, who is also a consultant cardiologist at Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust, said the technology could also reduce waiting lists and allow more efficient allocation of resources.
Trials of the model are planned to start by mid-2025 in hospitals across Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust.
Participants are set to be recruited from outpatient clinics and from inpatient medical wards.
31st October 2024
The use of low frequency ventilation (LFV) during cardiopulmonary bypass (CPB) for patients undergoing valvular surgery is feasible and safe, a new study has concluded.
LFV led to better postoperative lung function and improved exercise ability in patients undergoing surgery for heart valve disorders.
Researchers randomly assigned 63 patients with severe mitral or aortic valve disease undergoing surgery to LFV or usual care (33 LFV vs 30 usual care). The mean age of patients was 66.8 years and 30% were female.
Patients were assessed for generic inflammatory and vascular biomarkers and the lung‐specific biomarker soluble receptor for advanced glycation end-products (sRAGE) up to 24 hours after surgery. They then undertook pulmonary function tests and six‐minute walking tests up to eight weeks after discharge.
Overall, patients who received LFV showed better preservation of lung function and respiratory health, the researchers said.
Some 10 minutes after surgery, patients who received LFV showed elevated sRAGE levels, approximately three times above base level (geometric mean ratio, 3.05; [95% CI, 1.13– 8.24], suggesting damage to the lungs.
However, sRAGE levels gradually reduced over 24 hours, with measurements of 1.07, 0.84, 0.67 and 0.62 at two, four, six, 12 and 24 hours post-CPB, respectively, showing an overall reduction in lung injury and recovery over time. All results had a confidence level of 95%. The researchers observed no changes for any of the generic biomarkers tested.
Lung function tests highlighted significant improvement in lung function in patients who had LFV. The mean difference in FEV1/FVC ratio (forced expiratory volume in 1 second/forced vital capacity ratio) was improved by 0.050 six to eight weeks post-surgery for the LFV group, and forced vital capacity was also better preserved in the LFV group, with patients able to walk 63.2 metres further than those in the control group.
The researchers concluded that the use of LFV led to a significant improvement in exercise capacity and overall physical recovery.
A more extensive phase III trial will take place across the UK to allow the researchers to investigate further.
Reference
Roger, C et al. Low Frequency Ventilation During Cardiopulmonary Bypass to Protect Postoperative Lung Function in Cardiac Valvular Surgery: The PROTECTION Phase II Randomized Trial. Journal of the American Heart Association 2024; Sept 30: DOI: 10.1161/JAHA.124.035011.
30th October 2024
With another successful ESC Congress under its belt, the European Society of Cardiology’s new president Professor Thomas Lüscher speaks to Helen Quinn about the current challenges and opportunities in European cardiology, his highlights from the congress and his thoughts on the future of cardiovascular care.
In September 2024, at the European Society of Cardiology (ESC) annual congress, delegates welcomed Professor Thomas F. Lüscher as their new president and it’s a role he is excited about taking on.
Professor Lüscher is a world-renowned cardiologist, ranking in the top 0.5% globally of most cited scientists and currently a consultant cardiologist and director of research, education and development at the Royal Brompton and Harefield hospitals in London and professor at King’s College London, UK.
Having been involved with the ESC for many years, Professor Lüscher has chaired various working groups, became vice president in 2003 and then editor-in-chief of the European Heart Journal in 2008 – a position he held for 11 years. He describes the society as ‘a fantastic success story’ that has evolved from ‘a small club of friends into the largest and most influential society in medicine’.
With seven associations, seven councils, 15 working groups, 57 national societies, 47 affiliated national societies, 17 journals, 18 textbooks, an annual congress and nine speciality congresses, the ESC works hard to improve cardiovascular care and patient outcomes throughout Europe.
‘[It’s] an institution that dominates the field in a positive manner by providing guidelines, education and registries to improve the burden of cardiovascular disease. So, it’s a really exciting position I have,’ Professor Lüscher says.
Cardiovascular disease is still the leading cause of morbidity and mortality in Europe, and there are significant challenges facing the field. In the past, support from the EU has favoured oncology over cardiovascular healthcare. To try to change this imbalance, the ESC has responded by putting together a cardiovascular health plan, which has been submitted to the EU Council of Health Ministers to raise the profile of research and increase the quality and equality of care patients receive.
‘We hope this will impact the support for cardiovascular science and education in the future,’ Professor Lüscher says. ‘Europe has had a fantastic history. Most of the interventions have been invented in Europe, starting with pacemakers, atrial fibrillation ablation, percutaneous coronary intervention, transcatheter aortic valve implantation and MitraClip. It’s quite an amazing story.’
Today, however, innovation and development are hampered by regulations, according to Professor Lüscher. At the same time, the Food and Drug Administration in the US has become more lenient and much quicker and effective in approving drugs and trials.
‘I’m concerned that the speed and impressive innovation we have delivered over the last 200 years may be fading a little bit. There has been a bit of a shift from Europe to the US. [There are] a lot of rules and regulations in the EU and the UK,’ explains Professor Lüscher.
A lack of centralised device regulation in Europe is also impeding developments in field. Consequently, the ESC is working constructively with the European Medicines Agency and the Notified Bodies to make Europe fitter for innovation.
For some patients, differences in access to care is one of the main barriers to improving cardiovascular health across the continent. Such inequalities are highlighted in the ESC’s publication ‘Atlas of Cardiology’, which gives a picture of the current state of cardiovascular across Europe and shows vast differences in modern management options for cardiovascular conditions in different countries.
Patients in countries like Germany, Switzerland, Scandinavia and the Netherlands have good access to the latest treatments and medications. In other European countries, access is much more difficult, with many patients – particularly those in Eastern Europe – missing out.
And in the UK, for example, there is a concern that lower social classes have limited access to the latest cardiovascular treatments, Professor Lüscher explains, with deprived areas experiencing worse levels of care and, in turn, worse outcomes.
‘If you have severe heart failure, you might need a left ventricular assist device and in many countries that’s not available. Also, some novel, more expensive drugs are not available in certain countries,’ Professor Lüscher says. ‘There’s a huge heterogeneity in access to treatment across European countries. These are ethical concerns for medicine that, by nature, is a humanistic profession. The ESC tried to address this problem.’
The European Union has tried to overcome these inequalities in care by putting pressure on the prices of medications. There is also pressure on patent durations to make generic therapies available more easily and earlier, which is beneficial in the short term, but it is something that Professor Lüscher worries will obstruct innovations in the long term.
‘In the end, this is an economic problem,’ Professor Lüscher says. ‘There’s a close correlation between gross national product and availability of medical services, and currently in Europe the economy is not doing well. In many countries, we have issues with the economy that reflect on the service for patients.’
There is, however, much to be excited about in the field of cardiology, with many innovations and new research shared at the ESC Congress 2024. For Professor Lüscher, two significant potential developments excited him the most.
The first is the development of genetic tools as therapeutic agents to treat and prevent cardiovascular disease. This cutting-edge approach focuses on the use of antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), which can block the production of certain proteins in the body and currently mainly target the liver.
‘The liver has specific receptors, in particular the asialoglycoprotein receptor, mainly expressed in hepatocytes. So, once linked with a GalNac residue, you can direct these double-stranded RNAs specifically to the hepatic cells. Then they bind to the RISC complex within the cell and inhibit the translation of a transcript to a protein over several months,’ Professor Lüscher explains.
This process enables a long-lasting therapeutic approach. There are now siRNAs for PCSK9, which lower low-density lipoprotein (LDL) plasma levels for six months, and others, including a new development for lipoprotein(a). In addition, siRNA therapies can target angiotensinogen to lower blood pressure for several months. Other siRNAs, like those that reduce transthyretin (TTR), help treat ATTR amyloidosis by preventing the formation of harmful amyloid deposits.
Gene editing tools, such as CRISPR-Cas9, are also emerging, which can precisely modify nucleoid acid sequences in the DNA. In animal trials, this tool has been used to permanently block the production of PCSK9, preventing it from binding to LDL receptors and thus lowering cholesterol levels and potentially offering a one-off, lifelong treatment.
‘The long-term vision is that we cure rather than treat. These genetic tools are a completely new chapter in pharmacotherapy,’ Professor Lüscher says.
A second area of innovation that will continue to be incredibly influential in cardiovascular medicine is the development of artificial intelligence (AI) and machine learning. As part of his presidency, Professor Lüscher has set out his vision for the digital transformation of cardiology in Europe.
Beginning with online consultations, he believes AI has much to offer clinicians and patients. ‘With an algorithm, you can analyse the face of a person, see the pulse, see the wrinkles, see the amount of sweat, and you can make outcome predictions,’ he says.
‘AI analyses any sort of picture, not just faces, but echocardiograms, CT scans, MRIs, nuclear scans, pathology specimens, biopsies – anything that’s visual and can also diagnose patients,’ he adds.
Analysing the human voice is also possible using AI, which can be incredibly helpful for cardiovascular diagnosis by identifying atrial fibrillation and arrhythmias through variations heard in the vocal cords as well as congestion caused by heart failure.
Professor Lüscher believes AI algorithms will become important ‘co-pilots’ for clinicians, prompting them to think about diagnoses they may have missed. Other algorithms can read reports shared as part of a referral, giving summaries and analysing volumes from images in seconds that would otherwise take clinicians significant chunks of time.
‘It makes us faster and more precise, provided the algorithms are good,’ Professor Lüscher says. ‘Algorithms that are not good or false can potentially kill patients. These algorithms have to travel well and work in different geographical areas and countries, otherwise it’s not acceptable.’
As such, the ESC is involved in developing quality standards for algorithms across Europe and only uses algorithms that they can show are well-verified in independent cohorts.
Amidst the innovations and new pathways, there will inevitably be challenges ahead, but there is much to look forward to in cardiology as Professor Lüscher begins his two-year presidential journey.
29th October 2024
A study has identified subtle changes in how immune cells respond to different severe febrile illnesses in children, which could lead to improved treatments.
A range of pathogens and inflammatory triggers could cause severe febrile illnesses in children, researchers wrote in the journal Nature Communications, however it was difficult for clinicians to identify the exact cause as the illnesses tended to share clinical features.
Diagnosis required time-consuming microbiological testing, which could lead to delays in clinicians starting appropriate treatment, the UK research team said.
Using immunophenotyping with mass cytometry and cell stimulation experiments, they followed the path of immune dysfunction in a group of 128 children: 74 children with multi-system inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2, 30 with bacterial infection, 16 with viral infection, eight with Kawasaki disease and a further 42 controls.
They further explored the findings using gene expression data from whole blood RNA sequencing in a separate cohort of 500 children with these severe febrile illnesses and 134 healthy controls.
The study found that neutrophil activation and apoptosis were prominent in MIS-C, and that this was partially shared with bacterial infection.
In addition, memory T cells from patients with MIS-C and those with bacterial infection were exhausted.
In contrast, viral infection was characterised by a distinct signature of decreased interferon signalling and lower interferon receptor gene expression.
‘Our data support an important role for neutrophil and monocyte activation in the pathology of MIS-C and highlight T cell exhaustion upon presentation of MIS-C,’ the researchers concluded.
‘Neutrophil activation and features of T cell activation and exhaustion were shared with severe bacterial infection, while severe viral infection was characterised by downregulated STAT signalling pathways, highlighting shared and distinct features of immune dysregulation in these disparate severe febrile illnesses of childhood,’ they added.
Study co-author Professor Michael Levin, chair in paediatrics and international child health from the Department of Infectious Disease at Imperial College London, said: ‘For decades we have been working to unpick the granular detail of febrile illnesses, so we can improve treatments and reduce the impact these conditions have on children.
‘As clinicians, we may often see a child in the hospital or clinic with a fever and no other real defining symptoms, making an accurate diagnosis and targeted treatment difficult.’
By providing a clearer picture of the immune mechanisms in febrile illnesses, this study and others like it might ultimately help clinicians to diagnose and treat children earlier, he said.
The team was motivated to investigate immune dysfunction in febrile illnesses after an increase in the number of children being admitted to hospitals worldwide with MIS-C – a life-threatening condition following SARS-CoV-2 exposure characterised by symptoms including fevers, rash, conjunctival infection, severe cardiac dysfunction, multi-organ involvement and intense inflammation.
They noted that clinically MIS-C shared similarities with severe bacterial infection, including toxic shock syndrome and Kawasaki disease, adding that both MIS-C and Kawasaki disease could cause coronary artery aneurysms.
Study co-author Dr Michael Carter, from King’s College London and the Evelina London Children’s Hospital, said: ‘We saw that severe bacterial infection and MIS-C overlapped immunologically, although they are caused by very different things.
‘In the clinic currently, our treatments for dysfunctional immunity are poor and not targeted to individual children. Going forwards, by looking at the immune system in much more detail, we hope we’ll be able to develop therapies that can treat the immune response in a much more targeted way and improve outcomes for our patients.’
The latest findings build on related work led by Imperial College London researchers which aimed to develop a blood test to rapidly diagnose the cause of paediatric febrile illnesses by using the differences in the levels of expression of 161 genes in patients’ blood to distinguish between 18 infectious and inflammatory diseases.