Genome editing is the act of modifying a cell’s DNA by removing, adding or substituting genes. This, in turn, will alter the characteristics of the cell. The development of CRISPR was a major advancement in gene editing as it meant that parts of the gene sequence could be specifically targeted, with the new technology allowing it to be more precise than previous techniques.
Germline gene editing is the use of genome editing in embryos or the gametes. This can be used to edit mutations in the gene sequence that could cause a genetic disease. This form of gene therapy is not currently legal in the UK due to the risks outweighing the benefits. However, there is still a lot of debate as to whether it should be legalised. Some people argue that germline gene therapy ‘enables the correction of disease-causing mutations that are certain to be passed on from generation to generation, sparing future generations from suffering from the disease’. On the other hand, some people argue that this form of gene editing has ‘unpredictable’ effects and ‘other mutations’ could be introduced.
There are also many ethical debates as to whether germline gene therapy is acceptable in today’s society. The Gene Therapy Advisory Committee (GTAC) has to approve new gene therapy techniques before they can be introduced and prevent gene editing being used to create designer babies. There are many ethical issues against germline gene therapy, for example, it could be misused to ‘improve’ the population by selecting favourable characteristics to be developed. Also, as germline therapy became more common, it could create discriminatory behaviour against people with disabilities or genetic disorders.
Personally, I think that, at present, it is sensible to strictly regulate the use of gene editing as it could easily be abused and used for reasons other than to reduce the occurrence of genetic disorders. I think that more research needs to be conducted into this field to reduce the potential risks as it is not currently safe enough to introduce to the public. I also think that, as gene therapy becomes more commonly used in the future, it should continue to be closely regulated to make sure the technology isn’t extorted for individuals’ personal gain, aside from health benefits.
During May half term I decided to organise a work experience placement at a local pharmacy. I initially experienced several draw backs as the first few pharmacies I contacted weren’t offering placements. Through persistence I was able to secure a placement at a pharmacy who were enthusiastic and more than willing to offer me work experience.
I found the placement gave me an invaluable insight into daily outpatient care. I worked on the front desk which allowed me to work directly with members of the public. This involved taking in and handing out prescriptions, carrying out necessary personal checks. I also, using my own knowledge and judgement, advised patients to the best of my ability.
I also grasped a basic knowledge of the database systems used by the pharmacy through recording ‘minor ailment’ cases and registering new patients onto the system.
As I progressed through the week, I also made up prescriptions for patients. This involved familiarising myself with the format of prescriptions and the lay out of the pharmacy. This was both interesting and tasking as I began to form an understanding of common medicines and their uses. This also required a high attention to detail as it was easy to make a mistake and pick up a drug with a similar name or dosage.
Overall, I enjoyed my time at the pharmacy and I feel that I worked hard to learn and develop new skills to aid me in pursuing a career in medicine.
Chalmers University of Technology in Sweden has published research regarding the use of graphene spikes to kill bacteria and prevent infections from implants. The idea of using graphene to prevent implant infections is not a new discovery, but the recent research published has been the greatest development towards this theory becoming a reality.
The research suggested that placing the graphene spikes in a vertical orientation could be pivotal in killing the bacteria on the implant. This is because the graphene flakes prevent the bacteria from attaching to the implant by slicing the bacteria, subsequently killing them.
This means that the graphene flakes can ‘help protect the patient against infection, eliminate the need for antibiotic treatment, and reduce the risk of implant rejection.’
Human cells are 25 micrometres in size and are significantly bigger than bacterium which measure only 1 micrometre. Therefore, the graphene does not harm any human cells because it merely scratches their surface, but is able to slice the bacterium – destroying it completely.
In the earlier stages of this research, the results were conflicting. Some tests showed positive results, as the graphene killed the bacteria; however, others showed the graphene had no effect. Ivan Mijakovic, Professor at the Department of Biology and Biological Engineering, explained these results by saying, “We discovered that the key parameter is to orient the graphene vertically. If it is horizontal, the bacteria are not harmed”.
Graphene flakes need to undergo more testing before they are granted safe to use on humans, but the results so far have been encouraging.
Personally, I think that this is a great medical advancement as implant rejection is a major concern after surgery. Reducing the chance of infection will make implant surgeries safer for patients. This could mean that more people in need of implant surgeries would chose to have them, as graphene flakes could reduce a major risk of having the surgery.
In the Teddy Bear Clinic this week we wanted to teach the children how to use bandages. We decided that this would be an important lesson as young children often fall and cut themselves.
To start the session we gathered the children on the floor in a circle and sat down with them. This reduced the level of intimidation as it made the atmosphere more casual and also ensured that they all had a clear view of the demonstration.
In order the engage the children from the start and introduce them to the subject matter, we proceeded to ask them what they knew about bandages and when they should be used. We also placed emphasis on talking to them about cleaning the wound as this is an important stage in reducing the risk of infection.
We used the medic society’s teddy to demonstrate the practice of cleaning and bandaging a wound whilst continuing to ask the children questions to maintain their interest. This was important as young children have a shorter attention span and can easily get distracted and we wanted to ensure their continued involvement.
The next step was to split the children into smaller groups, each with one member of the medic society. This was when I could personally engage with the children individually as I had to discuss their teddies’ injuries and undergo the process of cleaning and bandaging the ‘wounds’. The children enjoyed this level of interaction as they proceeded to talk to me about their teddies with enthusiasm and excitement.
Our objective of this session was to ensure the children knew what to do if they needed to use a bandage, not necessarily for them to be able to attend to themselves, as this would clearly not be appropriate, but so they would know the process and why everything happens. This would reduce their panic should the situation arise. We fulfilled our objective as the children enjoyed the session and, by the end of the activity, could tell us what would need to happen should someone need to use a bandage.
A long running issue for the NHS is a mass shortage of beds. For years it has been urged that more beds are needed as these shortages are linked to higher infection rates in hospitals and longer waits in A&E. High bed occupancy is aimed to be avoided so that emergency patients can be admitted immediately.
When a hospital is overfull it also reduces the quality of care available to the patients. For example; patients may be admitted to wards that don’t meet their needs and diagnostic services are less available. This then increases the amount of time they need to stay in hospital which, in turn, further impacts the shortage of beds.
From 2011 to 2016 there was an 11% increase in the amount of people having to wait over 4 hours for a hospital bed. This leads to patients not receiving the immediate care and attention they require. This can cause patients to need additional care compared to what was originally necessary which puts more strain on other NHS resources.
Solutions to tackle this wide spread problem are to invest in health services outside of the hospital environment. This is because investing money into the hospitals will not benefit the current system. The money should instead be invested into out-of-hours services such as community nurses and social care. More access to GP appointments would also decrease the amount of cases reaching A&E.
If the money is invested into these services then it would reduce the amount of cases reaching the hospital and work to keep bed occupancy closer to the 85% recommended.
On 24th January we carried out our first Teddy Bear Clinic session. This session involved a ‘check up’ for the childrens’ teddies in which they told us their teddies’ maladies, to which we gave care instructions and preventative measures. We also carried out exams on the teddies, taking their weight and height to ensure the teddies’ health is monitored.
This session was an introduction to the Clinic in a hope to get the children involved. The aims of this session were to conquer fears of visiting the doctors as this is a common fear among young children. The Clinic was successful as all the children were excited and enthusiastic to get involved. We also sat on small chairs so that we were the same height as the children so as not to overpower and intimidate them.
This session also introduced us to the idea of working with young children, as this is a key skill that will be required of us when pursuing a career in medicine. I adopted an enthusiastic tone when interacting with the children and an open posture to encourage them to engage with me as children this age (3-5) can often be nervous when talking to new people.
At the end of the session we gave the children a ‘Draw your teddy’ sheet for them to complete for the next time we hold the Clinic in order to add to the teddies’ records.
We are holding the next Clinic session on the 7th February.
A trial has been carried out at John Hopkins University on 1005 patients whose cancer had already been diagnosed. The blood test achieved a 70% success rate in diagnosing the eight most common forms of cancer (breast, lung, ovary, liver, colon, oesophagus, stomach and pancreas).
The blood test works by detecting common genetic mutations in cancerous cells and proteins which are released by these cells. The test can also help to identify where in the body the cancer is growing because the proteins are released differently depending which part of the body they are being released from. If the test was made more sensitive to a larger range of gene mutations and proteins, the range of cancers that could be detected would increase.
This could prove to be extremely useful for early detection of these cancers as five of them don’t currently have any screening tests available. Also, pancreatic cancer shows so few symptoms in the early stages that four out of five patients who are diagnosed die within that same year. However, the blood test is still in the early stages of development and has not yet been proved to diagnose cancers in the early stages because there are much fewer symptoms and gene mutations at this point, proving detection unlikely. Further testing to see if it can diagnose early stages of cancer could take another “five to six years” said Professor Richard Marais from Cancer research UK.
Personally, I think that this is a revolutionary step in cancer treatment as it would mean that someone could have the blood test instead of having various different types of screening which should save both time and money.
Also, once further testing is conducted to determine whether it can diagnose early stages of cancer, a routine blood test could diagnose cancers before symptoms present themselves which should reduce the mortality rate of cancer massively. It would also reduce the amount of cancer treatments needed, such as chemotherapy, as the cancerous cells could be removed in surgery or killed using drugs before they spread further.
Hopefully, the blood test will prove effective in further trials so that it can be brought over to the UK and be made available to the general public.
As part of our sixth form medic society, to which I am a co-founder, we have planned a ‘Teddy Bear Clinic’ that we will run for the kindergarten class at my school.
The clinic will run once a fortnight on a Wednesday afternoon with the society splitting into two groups and alternating running the clinic.
To secure the idea of the clinic, myself and the other co-founder had to write a letter to the Head of the Prep Department. In this letter we explained what the clinic would involve and how it could benefit both us and the children. (Here you will find a copy of the letter) Teddy Bear Clinic Letter
The following day we received a letter from our correspondent, informing us that he thought our idea would be a great success and that he was impressed by our professionalism.
We then held a meeting with the medic society to finalise our ideas of what the sessions would involve and how we would go about conducting them.
All that is left to do now is to write a letter to the parents of the students explaining what the clinic is and requesting that they each bring in a teddy bear.
The clinic will start on the 24th January and I am excited for the new experiences this will give me.
A new study has been carried out by a team from the University of Leeds working with Karolinksa Institutet in Sweden that looks at the mortality rate of women compared to men during the year after having a STEMI heart attack. The study looked at data from Sweden’s online cardiac registry between 2003 and 2013.
A STEMI heart attack is caused by a blockage in the coronary artery, whereas a non-STEMI heart attack is caused by this artery being severely narrowed but not completely blocked. If a patient is having a STEMI heart attack then they have to undergo immediate treatment.
The study shows that there is a notable difference between the treatment given to patients depending on their gender. This is shown as 34% of women were less likely to undergo procedures to unblock arteries which would return the blood flow to the heart, such as stents and bypass surgery. If they received this treatment, the risk of having a STEMI heart attack would be reduced. Women were also 24% less likely to be prescribed statins after they had a heart attack, which would help to prevent them from having another. Aspirin was also 16% less likely to be prescribed to women, which helps to prevent blood clots in the arteries.
It is thought that the main reason for these gender inequalities is because of the common misconception that men are more likely to have heart attacks than women. This can be seen as previous research has also shown that women are 50% more likely to be misdiagnosed, meaning that it takes longer for them to be treated correctly.
Co-author of the study, Professor Chris Gale from the University of Leeds, said that this gender imbalance in care also occurs in the UK. He said this misdiagnosis “feeds the whole pathway of care”. He stated, “if you missed the first, earliest opportunity for care – you’re much more likely to miss the next point of contact – and it all adds up cumulatively and leads to a greater mortality.”
Personally, I think that hospitals should be made aware of this knowledge immediately and need to act upon it accordingly as this gender inequality cannot be allowed to continue. It is unacceptable that women should be treated any differently from men, especially as it is causing the unnecessary death of many women. I understand that it is easy to fall victim to the stereotypes that label us all but this is a factor that must be overlooked in order to deliver the best quality of care to the patients.
This will be the first high energy proton beam therapy centre to be built in the UK, with another being built at University College London Hospitals by 2020. The NHS has invested £250 million for these two centres to be built. The proton beam therapy will be placed into Christie Hospital, Manchester on 11th January 2018 with patients able to receive treatment from August 2018.
Proton beam therapy is considered safer for patients than the more common radiotherapy as it uses charged particles which directly target the cancer cells rather than a beam of high energy x-rays which are aimed at the area where the cancer can be found, which leads to healthy cells also being targeted by the x-rays. These means that radiotherapy can lead to many side-effects such as; tiredness, hair loss, nausea, diarrhoea, fertility issues, lymphoedema. This form of cancer treatment will be particularly used for children whose organs, if subjected to high energy x-rays, are at risk of lasting damage.
Last year, the NHS had to send patients abroad to receive proton beam therapy as no treatment was available for them within the UK. This meant a cost of around £114,000 for each patient. Hopefully this cost can be reduced now that the treatment will be available for the patients in the UK as 750 patients are hoped to be able to have the treatment centre at Christie’s from August 2018.
Although the funding of £250 million to build the centres has already been provided, the NHS hope to raise an extra £10 million for each of the centres in order for the centres to be fully equipped with specialist CT and MRI scanners and to build age appropriate facilities.
Personally, I think that this will aid the NHS greatly as it will reduce costs of having to send patients abroad to receive the treatment and this money can be used to fund the centres now being established in the UK. Also, it will benefit cancer patients massively as the proton beam therapy will be made available to many more people which will likely increase the recovery rates of cancer which can be treated this way and may also reduce the cases of recurring cancer as healthy cells are not subjected to the damaging x-rays.