Study reveals disturbing rate of failure among some surgeons

Thousands of patients are being forced to go under the knife for a second time because as many as half the operations carried out by some NHS surgeons end in failure.Study reveals disturbing rate of failure among some surgeonsThe disturbing finding comes from a study of bowel surgery, one of the commonest operations carried out on the NHS.

Patients whose bowel operations fail and have to be redone – usually because of bleeding, infection or leakage from the gut – face a four-fold increased risk of dying from surgery – up from 2.9 per cent to 11.9 per cent – and spend more than twice as long in hospital (27 days compared with 11).

There is growing concern in the NHS over variations in the quality of care between NHS trusts and individual surgical teams and about how to improve the outcomes of the poorest performers.

Researchers from Imperial College, London, investigated re-operation rates following bowel surgery to discover how wide the variation was and what might be done to boost performance. They examined almost 250,000 bowel operations conducted between 2000 and 2008 in England.

Predictably, the results showed that the trusts performing the most operations had the best results. But even among these there were wide variations, with re-operation rates ranging from 3.7 per cent to 11.5 per cent.

Overall almost 16,000 patients required further surgery to correct something that had gone wrong – one in every 15 procedures.

The study is published in the British Medical Journal. The worst-performing trusts and surgical teams are not named in the report, but an earlier study last April identified Burton Hospitals NHS Foundation Trust in Derbyshire as having the highest death rate following surgery for bowel cancer at 15.7 per cent, or one death in every 6.3 operations.

Omar Faiz, consultant colorectal surgeon and lead author of the study, said re-operation rates should be used with death rates to measure the quality of care in the NHS across a range of operations, provided the data was proved to be accurate.

Re-operation rates of 50 per cent were rare and reflected very unusual circumstances, such as when non-specialist surgeons were required to operate in emergencies.

“If there really are differences in performance that can’t be explained then the professional organisations will have to look at that,” he said.

Professor Norman Williams, president of the Royal College of Surgeons said the overall re-operation rate (6.5 per cent) was “quite impressive” and compared well with other countries. “We shouldn’t be complacent. If some surgeons truly have a 50 per cent re-operation rate it is extremely worrying.”

The college had said specialist surgery should be centralised in fewer hospitals and had encouraged surgeons to monitor performance.

Katherine Murphy of the Patients Association said: “We are supposed to have an NHS with patients at the centre, but it is still far from a patient-led service. They might get a choice of hospital but they are never given details of individual consultant performance, except in cardiac surgery. If they can do it in cardiac surgery why can’t we have it right across the NHS?

“These findings also emphasise the need for consultants to have regular tests [“revalidation”] by the General Medical Council to ensure they are up to date – but we are still waiting for it to be introduced,” she added.


15 minute daily exercise is bare minimum for health

Just 15 minutes of exercise a day can boost life expectancy by three years and cut death risk by 14%, new research suggests.15 minute daily exercise is bare minimum for healthExperts in The Lancet say this is the least amount of activity an adult can do to gain any health benefit.

This is about half the quantity currently recommended in the UK.

Meanwhile, work in the British Journal of Sports Medicine suggests a couch potato lifestyle with six hours of TV a day cuts lifespan by five years.

The UK government recently updated its exercise advice to have a more flexible approach, recommending adults get 150 minutes of activity a week.

This could be a couple of 10-minute bouts of activity every day or 30-minute exercise sessions, five times a week, for example.

“You can get good gains with relatively small amounts of physical activity. More is always better, but less is a good place to start” said Prof Stuart Biddle, an expert in exercise psychology at Loughborough University

The Lancet study, based on a review of more than 400,000 people in Taiwan, showed 15 minutes per day or 90 minutes per week of moderate exercise, such as brisk walking, can add three years to your life.

And people who start to do more exercise tend to get a taste for it and up their daily quota, the researchers from the National Health Research Institutes, Taiwan, and China Medical University Hospital found.

More exercise led to further life gains. Every additional 15 minutes of daily exercise further reduced all-cause death rates by 4%.

And research from Australia on health risks linked to TV viewing suggest too much time sat in front of the box can shorten life expectancy, presumably because viewers who watch a lot of telly do little or no exercise.

UK exercise recommendations

  • Under-fives (once walking independently): three hours every day
  • Five to 18-year-olds: at least an hour a day of moderate to vigorous intensity physical activity, plus muscle strengthening activities three times a week
  • Adults (including over 65s): 150 minutes a week of moderate to vigorous intensity physical activity, plus muscle strengthening activities twice a week

She added: “We hope these studies will help more people realise that there are many ways to get exercise, activities like walking at a good pace or digging the garden over can count too.”

Prof Stuart Biddle, an expert in exercise psychology at Loughborough University, said a lot of people in the UK now fall into the category of inactive or sedentary.

He said that aiming for 30 minutes of exercise a day on pretty much every day of the week might seem too challenging for some, but starting low and building up could be achievable.

“You can get good gains with relatively small amounts of physical activity. More is always better, but less is a good place to start.”


Caffeine in sunscreen could protect against skin cancer

Putting caffeine in sunscreen could provide greater protection against skin cancer new research suggests.Caffeine in sunscreen could protect against skin cancerScientists believe the chemical found in coffee absorbs ultraviolet radiation when applied to the skin and prevents tumours after exposure to sunlight.

They found in experiments that mice were slower to develop skin cancer if they were genetically engineered to suppress a particular enzyme, as caffeine does.

Writing in the Proceedings of the National Academy of Sciences, the academics say their findings suggest that the protective effects of sunscreen could be enhanced by adding caffeine.

“Combined with the extensive epidemiologic data linking caffeine intake with decreased skin cancer development, these findings suggest the possibility that topical caffeine application could be useful in preventing UV-induced skin cancers.

“An additional appealing aspect of topical application of caffeine is that it directly absorbs UV and thus also acts as a sunscreen, potentiating the efficacy of topical UV protection.”

Commenting on the research, Prof Dot Bennett, Professor of Cell Biology at St George’s, University of London, said the team had made “interesting progress” but went on: “The authors suggest adding caffeine or related molecules to sunscreens. First one might want to check there is no adverse effect of caffeine on the incidence of other cancers, especially melanoma (pigmented skin cancer), which kills over four times as many people as squamous cell carcinoma. But caffeine lotion might promote tanning a little, since this family of molecules stimulates pigment cells to make more pigment.”

Previous research has suggested that drinking coffee could reduce risk of developing skin cancer, as caffeine appears to kill off cells that have been damaged by ultraviolet radiation from the sun before they become cancerous.

In the new experiment, researchers at Rutgers University in the US genetically engineered mice to have a reduced function of ATR, an enzyme that “rescues” damaged cells. Caffeine is known to suppress ATR, causing the damaged cells to die rather than turn cancerous, so the mice were mimicking its effect.

When the mice were exposed to UV light, the modified ones developed tumours three weeks later than unmodified ones.  After 19 weeks, the subject mice had 69 per cent fewer tumours than the unmodified ones.


Every hour of TV watching shortens life by 22 minutes

Every hour spent watching television shortens the viewer’s life by 22 minutes, academics warn.Every hour of TV watching shortens life by 22 minutesAnyone who spends six hours a day in front of the goggle box is at risk of dying five years sooner than those who enjoy more active pastimes, it is claimed.

Researchers say that watching too much TV is as dangerous as smoking or being overweight, and that the “ubiquitous sedentary behaviour” should be seen as a “public health problem”.

Experts from the University of Queensland, Australia, write: “TV viewing time may have adverse health consequences that rival those of lack of physical activity, obesity and smoking; every single hour of TV viewed may shorten life by as much as 22 minutes.”

Referring to Australian and American guidelines that suggest children should spend no more than two hours a day in front of a screen, the academics conclude: “With further corroborative evidence, a public health case could be made that adults also need to limit the time spent watching TV.”

Although health campaigners – and parents – have long warned of the dangers of watching too much television, its effects on life expectancy have never before been calculated.

In a paper published in the British Journal of Sports Medicine, Dr J Lennert Veerman and colleagues looked at the results of a survey of 11,247 Australians taken in 1999-2000, which asked about time spent watching TV, and also mortality figures for the country.

They constructed a model in which they compared life expectancy for adults who watch TV to those who did not, and worked out that every hour spent glued to the screen shortened life by 21.8 minutes.

For those in the top 1 per cent of the population who watch six hours of programmes a day, they “can expect to live 4.8 years less than a person who does not watch TV”.

The researchers say that watching TV is among the most common forms of sedentary behaviour, along with sitting in cars.

“Because TV viewing is a ubiquitous behaviour that occupies significant portions of adults’ leisure time, its effects are significant for overall population health.”

England’s Chief Medical Officer, Sally Davies, said: “Physical activity offers huge benefits and these studies back what we already know – that doing a little bit of physical activity each day brings health benefits and a sedentary lifestyle carries additional risks.

“That’s why the UK’s Chief Medical Officers recently updated their advice on physical activity to be more flexible, right from babyhood to adult life.  Adults, for example, can get their 150 minutes of activity a week in sessions of 10 minutes or more and for the first time we have provided guidelines on reducing sedentary time.”

“We hope these studies will help more people realise that there are many ways to get exercise – activities like walking at a good pace or digging the garden over can count too.”

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, said: “Sedentary behaviour such as vegging in front of the TV is practically a cultural institution these days and it’s good to relax for a while, but this study supports the view that too much of it can be bad for our health.

“Many of us make a conscious decision not to smoke because we know it’s bad for us, and this study suggests that more of us should make the same kind of pledge about lounging around and watching lots of TV.

“Introducing more activity to our daily lives, whether it’s walking to the shops instead of taking the bus, using the stairs instead of the lift or taking up active hobbies like sport or gardening mean we won’t spend as much time in front of the TV where we’re likely to pile on the pounds.”


Cancer discovery offers hope of tackling spread of disease

Scientists have discovered how cancerous cells can grow their way out of tumours, offering clues for new drugs to prevent cancers spreading.Cancer discovery offers hope of tackling spread of diseaseThey say they have identified a protein called JAK which helps cancerous cells generate the force needed to move.

Writing in Cancer Cell, they say the cells contract like muscle to force their way out and around the body.

Cancer Research UK said the study provided fresh understanding of ways to stop cancer spreading.

When cancers spread, a process known as metastasis, they become more difficult to treat, as secondary tumours tend to be more aggressive. It is thought that 90% of cancer-related deaths occur after metastasis.

Scientists at the Institute of Cancer Research, who investigated the chemicals involved in cell migration in melanoma – skin cancer – say cancerous cells can move in two ways.

They can “elbow” their way out of a tumour or the tumour itself can form corridors down which the cells can escape.

Lead researcher Professor Chris Marshall said both processes were being controlled by the same chemical.

“There is a common theme of using force, force generated by the same mechanism – the same molecule, called JAK,” he said.

JAK is not a new culprit in cancer. It has been linked to leukaemia, so some drugs are already being developed which target the protein.

“Our new study suggests that such drugs may also stop the spread of cancer,” Professor Marshall said.

“The test will be when we start to see whether any of these agents will stop the spread. We’re thinking of clinical trials in the next few years.”

Dr Lesley Walker, Cancer Research UK’s director of cancer information, said: “A huge challenge in successfully treating cancer is stopping it from spreading around the body, and keeping cancer that has already spread at bay.

“Discovering how cancer cells can funnel grooves though tissues, to squeeze away from primary tumours and spread to new sites, gives scientists fresh understanding of ways to stop cancer spread – literally in its tracks.”


Beware- how a sun and sea holiday will shrink your brain power

According to research, taking a holiday– particularly a sunny one – can lower your IQ.Beware- how a sun and sea holiday will shrink your brain powerA Health warning- two weeks’ holiday could reduce your IQ by as much as 20 points, but, fortunately, the effect is only temporary.

Holidays, it seems – particularly to sweltering destinations – can impair mental functioning.

The problems begin when you book your holiday online, particularly if this entails a lengthy email exchange. According to a 2005 study by psychologist Glenn Wilson, visiting professor at Gresham College, London, email “bombardment” can reduce IQ by up to 10 points – more than double the effect of smoking a considerable amount of cannabis.

Prof Wilson has labelled the condition “infomania”. Concentration is impaired as sufferers’ minds remain fixed in an almost permanent state of readiness to react to potential incoming messages, as opposed to focusing on tasks in hand.

Even on a good day, the human brain finds it hard to cope with juggling multiple tasks simultaneously, so the email overload further reduces its effectiveness.

Then you actually have to get to your holiday resort.

The stress of modern travel – worries over airport strikes, volcanic ash or whether you’re in the right queue for priority boarding – can increase levels of cortisol, the stress hormone.

This risks damaging cells in part of the brain called the hippocampus, which in turn adversely affects short-term memory and concentration.

Add a restorative drink while airborne and, depending on the beverage, you could drop another 10 to 20 IQ points, according to Alcohol Concern. And you haven’t even checked into your hotel yet.

It is at this point that phrenic Armageddon really kicks in. Research by Professor Siegfried Lehrl of the University of Erlangen in Germany, a specialist in mental performance, suggests that sunbathing and relaxation cause one’s frontal lobes literally to shrivel.

Prof Lehrl says that inactivity reduces oxygen to the brain, which causes the dendrites and axons (parts of the nerve cells involved in sending electrical impulses) to degrade. Add dehydration caused by excess heat, alcohol, or both, and brain cell volume may decrease by up to 15 per cent.

“Fourteen days of complete rest can be enough to bring your IQ down by 20 points – more than the difference between a bright and an average student,” says Prof Lehrl. “Vocabulary shrinks, and we even detect personality changes.”

For men, this loss of intelligence may well be exacerbated by the vision of the opposite sex in bikinis. A 2008 study for The Journal of Consumer Research concluded that merely looking at women in beach garb “instigates generalised impatience in intertemporal choice”.

In layman’s terms, men’s judgment and self-critical faculties are compromised, and, in worst-case scenarios, they will propose to (or proposition) the first girl who winks at them.

At this point, you might be tempted to down a cold beer or a Gin and Tonic at the poolside bar. Don’t!

Researchers at Bristol University discovered that drinking anything overly cold reduces brain power by as much as 10 IQ points, as energy and blood are diverted from the brain to the stomach, to balance the drop in temperature.

So how can you negate the nightmare effects of your dream vacation?

According to Prof Lehrl, you should exercise your brain on holiday for at least 10 minutes a day by playing an intellectually stimulating game (chess or Scrabble, for instance), mitigate inactivity with regular long walks, rehydrate constantly – and chew lots of gum.

Gum? “The part of the brainstem that keeps us alert is constantly stimulated by chewing, as a result of which the attention level rises, as does the flow of blood to the brain.”

If you lack the willpower to follow the professor’s advice, the good news is that, unless you did propose to the first girl who winked at you (and she accepted), the consequences of a vacation are temporary. Four days later, your IQ usually returns to normal.

So next time you see raucous holidaymakers necking beers and mooning passers-by, try not to be too judgmental: they are probably email-overloaded nuclear safety engineers who have neglected to chew gum. Hopefully, they will leave a sensible interval between returning to work and installing their reactor’s control rods.


NHS hospitals needed £200 million in bailouts and loans

England’s NHS hospitals needed at least £200 million in bailouts and loans as they struggled to balance their books while also meeting tough savings targets, according to a spending watchdog.NHS hospitals needed £200 million in bailouts and loansThe Audit Commission said nine NHS trusts “failed to achieve financial balance” and many more applied for extra funding from managers and the Government, although overall performance “continues to be good”.

Health bodies spent £289m on redundancy payments but the number of staff employed in hospitals actually rose by almost 8,000.

Dozens were found at fault with the “value for money” they offer and a fifth of all NHS bodies failed to meet their savings targets despite cutting back on staff and the number of patients they treat.

The Audit Commission, the public spending watchdog that is being scrapped, warned that health service providers face even tougher times ahead as savings become harder to find and Government spending increases dry up.

Andy McKeon, managing director for health at the Audit Commission, said: “It is impressive that the NHS overall performed so well financially last year, even if some organisations struggled.

“But there is no room for complacency. Tighter funding, and the need to continue to improve services and implement reforms, will make the next three years much tougher.  NHS organisations will need to make a determined effort to find further recurrent savings while continuing to deliver high quality services.”

The watchdog looked at the 2010-11 accounts for Primary Care Trusts, which pay for treatment; hospitals not including the semi-independent Foundation Trusts; and the regional Strategic Health Authorities.

It found that they were running a £1.5 billion surplus and had actually underspent by £272 millon on the £2.95 billion in capital expenditure they were given by the Department of Health, twice as much as recorded the previous year.

But seven hospitals and two PCTs failed to break even, one fewer than in 2009-10, with the biggest deficit of £41m recorded by South London Healthcare NHS Trust.

At least 16 NHS organisations needed additional financial support from PCTs which is never paid back “thereby obscuring their real financial health”.

Managers gave out £90 million to hospitals, while the Department of Health issued loans totalling £34 million to four hospitals and also gave £76 million to two trusts which did not even have enough money to pay back loans.

Ministers want to cut management costs by 45 per cent at SHAs and PCTs, which are being restructured, and they did let 5,713 people go with average pay-offs of £40,000 each.

But the headcount at hospitals actually rose by 7,616 and only fell by 27 in the 10 SHAs.

The Audit Commission did not find any NHS body’s accounts were not “true and fair”, but it did issue “qualified Value For Money conclusions” for 27 hospitals and 18 PCTs, suggesting they had problems with “financial resilience” or “economy, efficiency and effectiveness”.

The Audit Commission warns next year will be “a more financially challenging year” as there will be no “significant real-terms increase” in the central budget, so trusts will require “determined effort and strong leadership”.


St John Ambulance abandoning volunteers over restructuring

St John Ambulance, the charity, has been accused of abandoning its volunteers as it attempts a widespread restructuring project.St John Ambulance abandoning volunteers over restructuringThe first aid organisation has announced plans to streamline its management amid financial woes.

It is set to embark on a major restructuring exercise to rebalance its books, which includes setting up eight regional boards and merging offices in 41 regions.

But the charity, which has recorded operating losses seven years in a row, is accused of “kicking volunteers in the teeth” by those who regularly help out.

They claim that disillusioned volunteers will no longer want to raise money if the cash goes in a central pot rather than helping local projects.

“All counties work in their own particular way according to their local people and in a way that can only be done by them,” one senior volunteer said.

“If the structure is changed … what incentive is there for local people to volunteer and raise money?”

A former chairman of a county division claimed the changes would lead to “financial ruin”.

“We are absolutely horrified because we feel that this restructure is doing away with the strong volunteer ethos of St John’s. It’s like kicking volunteers in the teeth” she said.

Under the plans eight regional directors will be created on salaries of £80,000 a year plus benefits to represent London, the south east, south west, East Midlands, West Midlands, East of England, North-West and North East.

Officials admitted that “financial” pressures were partly behind the new structure as well as “increasing regulation”. It denied it was in “imminent financial crisis”.

While the service claimed there would be no redundancies the charity admitted “some roles have been placed at risk and are therefore undergoing consultation”. It would not provide further details.

The charity, founded in 1877, currently employs about 1600 staff across the country and has more than 40,000 volunteers on its books.

It trains more than half a million people a year and has more than 1000 ambulances that provide support to NHS trusts. The Duke of Gloucester is the service’s Grand Prior of the Order.

In a letter sent to volunteers around the country, Rodney Green, the charity’s Prior and chairman of board of trustees, admitted the organisation faced a “number of difficult challenges in the years ahead”.

A briefing note sent to volunteers explaining the changes, said the organisation needed to increase its “charitable and community impact”.

“We need a greater consistency in our quality – so that we can meet more stringent regulatory requirements and also better support the front line,” stated the document, titled “Becoming ‘The Difference’: transforming St John Ambulance”.

“More urgently, we need to balance the books and achieve secure finances.  For seven years running, we have spent more than we earned and are set to make further losses this year. The charity cannot sustain this.”

Mr Green insisted the changes, signed off by the trustees last month following “rigorous analysis of the current structure”, would transform the organisation “so that we can save yet more lives”.


Ovarian cancer gene raises risk six fold

Researchers have found a gene which increases the chance of developing ovarian cancer six fold.Ovarian cancer gene raises risk six foldAbout one woman in 70 is at risk of developing ovarian cancer, which claims more than 4,200 lives a year.

However, for those with a faulty RAD15D gene, the risk is raised to one in 11.

The discovery was made by scientists at the Institute of Cancer Research, which is connected to The Royal Marsden hospital in London.

Professor Nazneen Rahman, head of genetics and epidemiology, said: “At this level of risk, women may wish to consider having their ovaries removed after having children, to prevent ovarian cancer occurring.”

At the moment the discovery, published in the journal Nature Genetics, is limited to the knowledge that faulty copies of this gene raise ovarian cancer risk.

But Prof Rahman said: “There is also real hope on the horizon that drugs specifically targeted to the gene will be available.”

The study was based on comparing the DNA of women from 911 families with ovarian and breast cancer, to that from 1,060 people in the general population.

Cancer Research UK, which helped fund the study, described it as “the most significant ovarian cancer gene discovery for more than a decade”.

Prof Nic Jones, the charity’s chief scientist, said: “It’s incredibly exciting to discover this high risk gene for ovarian cancer.

“It’s further evidence that a range of different high risk genes are causing the development of breast and ovarian cancer and we hope there are more waiting to be discovered in different cancers.

“We believe the results of this research will help inform personalised treatment approaches and give doctors better information about risks of cancer to tell patients.”

About 10 per cent of the 6,500 new cases of ovarian cancer every year are estimated to be in those with “a strong family history” of the disease, said Annwen Jones, chief executive of the charity Target Ovarian Cancer.

She said: “This new information, in the future, could help more women with a family history understand their personal risk of developing this disease.”

Survival rates for ovarian cancer remain poor compared to other types. While 92 per cent of breast cancer patients now survive for at least five year from diagnosis, for ovarian cancer only about four in 10 do.


Bupa calls for urgent action over care home crisis

Ray King, chief executive of medical group Bupa, has called for a “chronic underfunding” of the care homes system to be addressed “urgently”.Bupa calls for urgent action over care home crisisHe warned that the NHS may face a “bed blocking” crisis unless fees paid to care home operators such as Bupa rise.

Mr King said the number of care home places in the UK will fall unless operators get “fairer fees”.

His comments came as he unveiled a sharp rise in Bupa’s overall global profits, but a fall in the UK division.

About 70% of Bupa’s 18,000 care residents, in its more than 300 homes, are paid for by local authorities- and local authorities pay for well over half of England’s 390,000 care home residents.

But Mr King said operators are seeing a real terms fall in fees as authorities’ budgets come under pressure.

Bupa believes there could be a 100,000 care home bed shortfall within 10 years, if investment in the sector is not increased and current funds are not ring fenced.

This could put pressure on the NHS to take in people who would normally go into care homes.

Bupa, which is a provident company with no shareholders, said its global care services division lifted revenues by 1% to £589 million and profits by 2% to £67.7 million in the half year to June.

But the UK care arm saw a “marginal” fall in profits and occupancy, a situation that could worsen.

Mr King said: “We are calling for the chronic underfunding of the social care system to be urgently addressed. At the absolute minimum, there must be a real terms increase in funding for local authority purchased care home places over 2012-15.”