What is consent?

 

This is probably one of the most fundamental laws involved with medicine, stating that no treatment can be carried without the consent of that patient. It means that before any examination or treatment of a competent adult, the medical professional must first seek their consent. This law protects the patient’s ability to make their own decisions and therefore means nothing that they don’t want to happen will happen. Although maybe frustrating for the doctor, a patient can refuse treatment even if it was in their best interests to pursue the treatment.

This consent can be oral, written or of a different form and once given, provides the professional with the ability to further the process of treatment. It must be noted however that to get to the stage where consent is given, the patient must be given all the information about what is going to happen. Failure to provide sufficient evidence could provide the patient with leverage in court to sue the professional. It is key that the patient is provided with all the information as it is likely that their opinion of what they want to happen next will incorporate a multitude of factors.

There are, however, several situations that come to affect the rule of consent. Firstly, if an individual is under the age of 16 then they are not able to consent to any treatment. Once they turn 16 they are seen to have the capacity to be able to decide and consent for themselves. There is also a further consideration that the person that is giving consent must have the cognitive capacity to be able to consent. This means that if a patient has a condition that affects their ability to process information then they cannot form a decision for themselves then they cannot consent. This does pose some questions as to whether it is correct that a person, no matter the relation, can decide what happens next in that person’s treatment.

For the patient to be able to consent for themselves they must first satisfy the following:

  • The patient must understand the information given to them and have the capacity to really understand what is meant.
  • The patient should then further retain the information for a prolonged time and then use it in order to make their final decision.
  • The patient must also have the capacity to consider both the positives and the negatives of the treatment in order to reach a conclusion
  • Finally, the patient must be able in some way to communicate the information.

Consent is one of the most important things that a doctor can obtain to treat a patient. Failure to seek consent, however, breaks the law and can result in serious consequences.

Aspirin ‘major bleed’ warning for over-75s

 

To begin with, what is aspirin? Aspirin is a drug that is most commonly used in the average household for pain relief from headaches to cold and flu symptoms. However, it is not this property which is its main property. If taken at low doses over a period of time, it has anticoagulant properties which basically work to prevent the blood clotting as readily. Aspirin is especially used after a person has had a stroke or heart attack, as at that point they are at a vulnerable time and further clotting could cause a hypoxia to that area, resulting in further complications.

New research in the Lancet has now shown that people over 75 who take the aspirin tablets are at a higher risk of stomach bleeds, which can in cases result in death.

Previously research showed that the risk of stomach bleeds within this age group was low. But with around half the people on lifelong aspirin in the UK now over 75, researchers at Oxford University decided to find out whether the benefits still outweigh the risks in this group.

Tests were conducted on 3,166 patients, whom have had strokes or heart attacks recently and were taking anticoagulant drugs daily. They found that, for patients aged under 65, the annual rate of disabling or fatal bleeds was less than 0.5% (around one person in every 200 people taking the medication). Meanwhile, for people aged 75 to 84, this rose to three people having major bleeds in every 200. This may not seem very significant but when it is considered the number of people annually having surgery for the conditions previously then it does become a fairly major problem. Further to the increase in the number of bleeds, the severity of the bleed also increased with age, with over 75s more likely to have a fatal or disabling bleed.

These findings have lead the questioning of whether aspirin is worth the risk for patients in this age range. It has also been suggested that PPI drugs (prevent stomach bleeds) should be also prescribed when aspirin is prescribed. It must also be known that in the majority of cases aspirin is extremely useful, however, it must be recognised that there are some isolated cases that must be taken into consideration. In my opinion, an assessment of the risk of stomach bleeds within a patient before administrating aspirin could help prevent the stomach bleeds.

For the full story as well as answers to common questions around the subject can be found here:

http://www.bbc.co.uk/news/health-40262771

Can we override the power to sleep?

 

It has long been known that sleep deprivation is very unhealthy for the body. Research has shown that a lack of sleep can cause impulsive behaviour, depression, paranoia and suicidal thoughts. It has even been shown that it can increase the chances of type 2 diabetes and even affect growth in adolescence.

Currently, in the US around 1/3 of the population suffer from a lack of sleep. However, Caltech researchers have identified a neural circuit in the brain that controls wakefulness. The findings have implications for treating insomnia, oversleeping, and sleep disturbances that accompany other neuropsychiatric disorders, such as depression.

I am sorry to keep quoting people but I believe this perfectly explains what the research involves:

“We decided to examine a region of the brain, called the dorsal raphe nucleus, where there are an under-studied group of dopamine neurones called dorsal raphe nucleus neurones, or DRNDA neurones,” says Gradinaru. “People who have damage in this part of their brain have been shown to experience excessive daytime sleepiness, but there was not a good understanding of the exact role of these neurones in the sleep/wake cycle and whether they react to internal or external stimuli to influence arousal.”

Mice are used as models of the human brain, studying the DRNDA has provided scientists with information into the working of the brain. First, the team measured DRNDA activity while the animals encountered stimuli like the arrival of a potential mating partner, or a sudden unpleasant sensation, or food. The DRNDA neurones were highly active during these events, which led the researchers to then believe that the neurones send signals of arousal in these encounters, which can then modulate the state of sleep or wakefulness.

Further research showed that these neurones were least active during sleep in the mice. It was then shown that stimulating these neurones whilst the mouse slept caused the mice to wake up, showing a clear correlation between the neurones and sleep. Finally, the researchers examined the role of these neurones in waking the mice up due to external stimuli. The neurones’ activity was silenced with optogenetics, and a loud noise was played while the animals were asleep. Whereas control mice often woke up, the mice with blocked DRNDA often ignored the sound and remained asleep. This is a useful aspect of the neurones that could help patients with insomnia and other sleep deprivation.

“These experiments showed us that DRNDA cells are necessary for full wakefulness in the face of important stimuli in mice,” Gradinaru says. “DRNDA neurons are found analogously in humans, and while they have not been studied in depth, their degeneration has been correlated with excessive daytime sleepiness in patients with neurodegenerative disorders such as multiple systems atrophy and Lewy body dementia. Further work is necessary to establish causation in humans and to test the potential of the DRNDA as a therapeutic target for insomnia or oversleeping, and for sleep disturbances that accompany other psychiatric disorders such as depression, bipolar disorder, and schizophrenia.”

https://www.sciencedaily.com/releases/2017/06/170608123641.htm

Sleep loss can increase chances of obesity

 

A lack of sleep has been shown to increase weight gain sue to its effects on energy metabolism.

In the modern world, it is extremely hard to balance a sleep schedule with completing work and other factors. The underlying cause of increased obesity risk from sleep disruption is unclear but may relate to changes in appetite, metabolism, motivation, physical activity or a combination of factors. There have been studies it appears there is a correlation between lack of sleep and increased weight gain.

‘Dr Christian Benedict from Uppsala University, Sweden and his group have conducted a number of human studies to investigate how sleep loss may affect energy metabolism. These human studies have measured and imaged behavioural, physiological and biochemical responses to food following acute sleep deprivation. The behavioural data reveal that metabolically healthy, sleep-deprived human subjects prefer larger food portions, seek more calories, exhibit signs of increased food-related impulsivity, experience more pleasure from food, and expend less energy.’

Their studies have shown that certain hormones that increase hunger are produced more in sleep deprived individuals. Sleep restriction also increased levels of endocannabinoids, which is known to have appetite-promoting effects. Further work from Dr Benedict’s team shows that acute sleep loss alters the balance of gut bacteria, which has been widely implicated as key for maintaining a healthy metabolism.

Dr Christian Benedict remarks, “Since perturbed sleep is such a common feature of modern life, these studies show it is no surprise that metabolic disorders, such as obesity are also on the rise.”

There is no long-term data on the effect of sleep deprivation on weight gain but it is estimated that it will have a similar effect over prolonged periods of time.

Dr Christian Benedict says, “My studies suggest that sleep loss favours weight gain in humans. It may also be concluded that improving sleep could be a promising lifestyle intervention to reduce the risk of future weight gain.”

Apologies for the short post but I have had exams recently and more exams to come so I am a bit tied up with revision 🙁

Volunteering – what to expect and my experience so far.

 

I have recently managed to secure a place volunteering in a care home very close to where I live. The process of trying to get a place volunteering has probably taken me around 3 months since the initial email with myself visiting about twice a week in order to try and spur them on. Although it has been a pain to organise, I have enjoyed every aspect of the care home and it has provided me with a first-hand insight into the level of care that all workers there have to provide.

Currently, I am doing a few hours a week with the intent of moving up to around 5 hours in the summer holidays. Before this, I had never worked or even been a care home, with both grandparents being completely independent. Due to this, I had no real idea what to expect and I was completely reliant on the experiences of those around me to guide me. Beginning work in the care home, for me anyway, was very daunting, I entered the front door and was greeted with a vast array of names of job roles to learn. However, soon my nerves dissolved as those around me were extremely welcoming and very friendly.

Due to my age, I am not allowed to get involved in the personal care of any residents; nor can I help them get up or sit down due to the varying condition of the residents and certain restrictions that inhibit me doing so. My job is to make cups of tea, talk with the residents, observe medical rounds, ensure everyone has what they need. My favourite job to do is to take the blood pressures, pulses and the oxygen saturation of the residents (A senior care member is always present and all measurements are electronic due time constraints). This, in particular, has been the most valuable part of the job as it involves me having to adapt to each of the residents’ needs, whether it be they are deaf or blind, I have to inform them of what I need them to do. This really allows me to work first-hand with people of varying cognitive and physical abilities. Although at times this can be challenging due to certain residents’ conditions, I thoroughly enjoy the chance to work with residents and make sure they feel comfortable while I take the readings.

I think one of the big stigmas that people have towards care homes is that many believe they are quite lonely and dull places. However, one thing that has really struck me is that, although many of the residents are old and have many medical conditions, they all still have smiles on their faces and happiness still exists within. Another one of my favourite jobs is just sitting down and talking to one of the residents. This always puts a smile on my face as many delve into their pasts and tell me the stories of their childhood and all their happy memories. They also ask me how my life is and I always get asked how school is and if I am well behaved at school. What I love the most about these conversations is the sheer gratitude that the residents have that I have taken the time to speak to them, it is experiences like this which really brighten my day and make me love volunteering. I have learned from these experiences to cherish the good things in life so that further on in life I can think back to all the good times.

The care home I volunteer at has both residential and nursing home residents. This means that within the care home there is a wide range of conditions with residents at varying stages of illnesses. Although I have had experience of observing patients with Alzheimer’s disease, I had never experienced the level of care required to treat someone with Alzheimer’s. It pains me to see the decline in cognitive function of that the residents have undergone but I feel it has provided me with invaluable experience of how damaging the disease is. In care homes, it is expected that residents will come and go. This has taught me to show compassion without developing any emotional attachment to the resident, which is proving quite hard. It has further shown me the importance of improving the lives of those in the care home, even if only marginally, as at certain stages the quality of their life is more important than how much longer they do live. One resident that has really stuck with me is a patient that is completely immobile, blind, almost entirely deaf and has severe dementia. The reason she has stuck with me is that she showed me how destructive these diseases can be, which really spurred my inspiration to become a doctor and maybe prevent such conditions by diagnosis and early treatment.

Through the care home, i have learned how to adapt to different scenarios and the how much of an affect many of the conditions, mentioned previously, have on a person’s quality of life. I am thoroughly enjoying my time volunteering and always look forward to going there after school. Most of all it has further inspired and fueled my desire to study medicine.

I would definitely recommend volunteering in a care home or with the elderly to anyone as I have seen how beneficial it is to those that receive the help and attention.

Dangers of UV light.

 

As many of you will not be aware, May is ultraviolet awareness month. This is to try and make people conscious to the risk that UV light rays pose to your eyes. UV light increases your risk of cataracts and cancers of the eye especially in high-risk patients.

Ultraviolet radiation, such as sunlight, is absorbed by the lens of the eye. It can cause chemicals called free radicals to form inside the lens. Over time, free radicals may damage the lens. This can cause cataracts.

The human eye is constantly exposed to sunlight and artificial lighting. Light transmission through the eye is fundamental and required for it to focus. However, exposure to the intense ambient radiation can pose a hazard particularly if the subjects is over 40 years of age. This radiation exposure can lead to impaired vision and short-term or permanent blindness. Ultraviolet light induces cataract formation and are not necessary for sight. Ultraviolet radiation is also a risk factor for damage to the retinas of children. The removal of these wavelengths from the spectrum will greatly reduce the risk of early cataract and retinal damage. One way this may be easily done is by wearing sunglasses that block wavelengths below 400 nm (marked 400 on the glasses). These glasses have to be 100% UV absorbent to both UV-A and UV-B and also be a certain shape to prevent any reflected rays entering the eye. It must also be noted that it is best to avoid any un-necessary exposure to UV such as tanning beds.

If you would like to learn more about the month then see the link below:

http://everharteyes.com/disordereyecare/eye-calendar/1027-healthy-vision-and-ultraviolet-awareness-month.html

Barium sulphate in medicine

 

Barium sulphate is an inorganic compound with the chemical formula BaSO4. It is completely soluble in water, which is a very useful property of the compound. It is also white crystalline solid that is odourless. The white opaque appearance and its high density are exploited in its main applications.

X-rays are very useful within modern medicine to identify broken bones and to diagnose a multitude of conditions. Bones absorb more X-rays than soft tissue because of the Calcium in the bones. The high atomic number of Calcium (20), dramatically increases the photoelectric effect, which is the main mechanism of X-ray absorption by bones. This means that X-rays are not very useful for soft tissue as they don’t absorb many X-ray photons. Therefore, Barium sulphate is used. Barium sulphate is very dense and opaque to X-rays, meaning that the X-rays are absorbed by it. This means that on X-rays they show very clearly on the X-ray.

Barium sulphate is used to help doctors examine the oesophagus, stomach, and intestine using x-rays or computed tomography (CAT scan, CT scan. Barium sulphate is in a class of medications called radiopaque contrast media. It works by coating the oesophagus, stomach, or intestine with a material that is not absorbed into the body so that diseased or damaged areas can be clearly seen by x-ray examination or CT scan. This is where another property of barium sulphate helps it excel in its function. As barium sulphate is completely insoluble in water it will not be dissolved within the human body, meaning that it can coat the entire oesophagus ready for X-ray without having inaccurate areas where it has been dissolved. Barium sulphate is toxic but it is safe to use because it is insoluble (does not dissolve). This prevents it from entering the blood.

Barium sulphate can come as a powder to be mixed with water, a suspension (liquid), a paste, and a tablet. The powder, water mixture and the suspension may be taken by mouth or may be given as an enema (liquid that is instilled into the rectum but must be done by a medical professional). However, the paste and tablet are only taken by mouth. Normally barium sulphate is taken 1 to 2 times before the scan within 2 hours of the scan.

Although very useful, barium sulphate does come with a range of side effects, including:

  • severe stomach pain;
  • severe cramping, diarrhoea, or constipation;
  • sweating;
  • ringing in your ears;
  • confusion, fast heart rate; or
  • pale skin, weakness.

Common side effects may include:

  • mild stomach cramps;
  • nausea, vomiting;
  • loose stools or mild constipation.

Scientists find a new mechanism that causes cancer cells to self-destruct

 

Cancer is the single name assigned to more than 100 diseases. It is the result of abnormal cells that multiply and spread out of control, damaging healthy cells along the way. Most cancers result in tumors but those that affect the blood do not. Many cancer patients struggle with the adverse effects of chemotherapy, still the most prescribed cancer treatment. These effects include hair loss, vomiting, fatigue and anaemia. However, in some ways, this is an improvement to patients with cancers that can’t be treated.

A newly-discovered mechanism involves the modification of specific proteins that affect the construction and stability of the spindle, the microtubular structure that prepares duplicated chromosomes for segregation into “daughter” cells during cell division.

The researchers found that certain compounds called Phenanthridine derivatives were able to diminish the activity of these proteins, which can distort the spindle structure and prevent the segregation of chromosomes. Once the proteins were modified, the cell was prevented from splitting, and this induced the cell’s rapid self-destruction.

“The mechanism we identified during the mitosis of cancer cells is specifically targeted by the Phenanthridine derivatives we tested,” Prof. Cohen-Armon stated. “However, a variety of additional drugs that also modify these specific proteins may now be developed for cancer cell self-destruction during cell division. The faster the cancer cells proliferate, the more quickly they are expected to die.”

Research was conducted using both cancer cell cultures and mice transplanted with human cancer cells. Furthermore, mice transplanted with triple negative treat cancer cells, currently resistant to available therapies, revealed the arrest of tumor growth.

“Identifying the mechanism and showing its relevance in treating developed tumors opens new avenues for the eradication of rapidly developing aggressive cancers without damaging healthy tissues,” said Prof. Cohen-Armon.

Current research is being carried out with Phenanthridine to see if it has any effect against two forms of aggressive cancer.

This research holds a lot of promise in looking for an alternative method to treating cancer, which is far less damaging than chemotherapy.

Prof. Cohen-Armon has said that “the discovery of an exclusive mechanism that kills cancer cells without impairing healthy cells, and the fact that this mechanism works on a variety of rapidly proliferating human cancer cells, is very exciting,”

He further states “According to the mechanism we discovered, the faster cancer cells proliferate, the faster and more efficiently they will be eradicated. The mechanism unleashed during mitosis may be suitable for treating aggressive cancers that are unaffected by traditional chemotherapy.”

*Note: Phenanthridine is a nitrogen heterocyclic compound that is the basis of DNA-binding fluorescent dyesthrough intercalation.*

My experience of vasectomies

 

Last Tuesday I was lucky enough to gain some valuable work experience by shadowing a local GP at their vasectomy clinic. I therefore saw it very fitting to make a post about vasectomies and what I saw.

First of all, what is a vasectomy? A vasectomy is a surgical operation intended to sterilise a man. This is achieved by cutting the tubes which carry the sperm to the sex fluid to make semen. This prevents the sperm reaching the female’s egg cells during intercourse and therefore prevents fertilisation.

info-diagram

The vasectomies I witnessed did not involve the use of scalpels, which I was not aware were available. Instead of the use of the scalpel, an instrument it is used which essentially burns its way through the skin. In doing so it also cauterises any small blood vessels and prevents any bleeding.

The patient is initially administered a local anaesthetic into the operation area, which as I was told is the only painful part of the operation but I’m sure a couple of the patients will disagree with me.

During a no-scalpel vasectomy, the doctor will feel the vas deferens underneath the skin of your scrotum and then hold them in place using a small clamp.

The scalpel alternative is then used to make a tiny puncture hole in the skin of the scrotum. A small pair of forceps is used to open up the hole, allowing the surgeon to access the vas deferens without needing to cut the skin with a scalpel. The tubes are then closed in the same way as in a conventional vasectomy, either by being tied or sealed.

What also surprised me during the operation was the fact that no stitches were needed and once the vas deferent were cut and cauterised the operation was pretty much over. Further to this, what really struck me was how calm the theatre was and how the doctor was able to maintain a flowing conversation with the patient. This taught me the importance of communication with the patient, not only to inform them of what happens but also in order to keep their mind off what is happening.

Overall, this was a very interesting operation to watch and I am very grateful for the opportunity to watch it. On the other hand, I did find myself grimacing at some points when, being male myself, I thought about how it was in the patient’s shoes.

If you would like to learn more then the link below is a good place to start.

http://www.nhs.uk/Conditions/contraception-guide/pages/vasectomy-male-sterilisation.aspx#No-scalpel

Alzheimer’s and stem cells.

 

Alzheimer’s disease is the most common cause of dementia. The initial effects of Alzheimer’s often include lapses in memory or the inability to say the right words. Over time, symptoms such as confusion, mood swings or memory loss develop and become increasingly severe.

The cause of the disease is still very cloudy, but researchers have found that people affected by Alzheimer’s have an abnormal build-up of certain proteins in the brain. One of these proteins, called amyloid beta, clumps together to form ‘plaques’.

Below you can see an image that I copied from http://www.alz.org/facts/ . Although it may be hard to read, I am sure you will be able to make out some of the key facts and figures.

2017-facts2017_infographic2

Currently, there is no cure for Alzheimer’s, however, there are a range of medicines available that can prevent the progress of Alzheimer’s through the body. Most of these drugs belong to a class called cholinesterase inhibitors. They can help prevent the breakdown of a natural substance in the brain called acetylcholine, which carries signals between neurones.

A lot of money is being invested into the research of Alzheimer’s and the next big step towards its treatment lies in the use of stem cells. The hope is that neural stem cells will be able to be transplanted into the brain of Alzheimer’s sufferers, in an attempt to replenish the neurones in the brain. Although many remain speculative, recent research has shown that the human brain may be more malleable than previously thought.

Another possible approach to stem cell therapies might be to use certain types of stem cells to deliver proteins called neurotrophins to the brain. Neutrophin levels are normally low within Alzheimer’s patients and this does not encourage the growth and survival of healthy neurones.

At present, research is using a certain type of stem cells called induced pluripotent stem (iPS) cells (more can be found about these by clicking the hyperlink). These are created by using already specialised cells and almost ‘reprogramming’ them into other, more useful, cells. This ultimately has the potential to act as a source of cells that are otherwise difficult to obtain, such as the neurons found in the brain. 

So far, scientists have managed to use iPS technology to take skin cells from an Alzheimer’s patient and use them to grow neurones. The lab-grown neurons release the beta amyloid protein that forms plaques in patients’ brains. Furthermore, scientists have used iPS neurones to study the build up of tau protein, which forms the tangles in patients’ brains in Alzheimer’s Disease. Overall, this provides scientists to study and conduct tests on the neurones and gain a greater understanding of how to treat Alzheimer’s.

To conclude, the use if iPS stem cells holds great promise for the future development of preventative treatment of Alzheimer’s. Although there may be no treatment available using stem cells for Alzheimer’s, their use has already provided invaluable information and continues to be a useful resource.