Inside Health

Inside Health

United Kingdom

Dr Mark Porter demystifies health issues, separating fact from fiction and bringing clarity to conflicting health advice, with the help of regular contributor GP Margaret McCartney


Dying at Home, Familial Hypercholesterolaemia FH, Delirium  

Most of us say we'd like to die at home but few of us actually achieve this wish - something the NHS is keen to change. An award-winning GP surgery in Lancaster, The King Street and University Medical Practice, has transformed the way they care for patients reaching the end of their life, twice winning the Gold Standards Framework Quality Hallmark Award. Dr Nour Ghazal tells Dr Mark Porter what they've done to ensure their patients have a say in how and where they would like to die and Inside Health's Dr Margaret McCartney describes how important it is to broach that most difficult of subjects. Familial Hypercholesterolaemia, also known as FH means that you have inherited high cholesterol levels and the consequences of this, if you don't know about it, can be deadly. Over half of men with FH will have a heart attack before they are 55, a third of women with FH before they're 60. But a simple genetic test can identify the condition and with a good diet, exercise and lipid lowering drugs like statins, people can live long and healthy lives. Steve Humphries, Professor of Cardiovascular Genetics at University College London tells Mark that only 15,000 people in the UK have a diagnosis of FH but it's thought that almost a quarter of a million people could in fact have the condition. So the race is on to identify and diagnose the thousands who don't know that they're carrying the suspect genes. Lorraine Priestley-Barnham, an FH clinical nurse specialist at Harefield Hospital in Middlesex describes the cascade testing being rolled out across the country in a programme supported by the British Heart Foundation. And three generations of the same family, father Chris, daughter Joanne and grandson, six year old Alfie, tell Inside Health how they found out they have FH. Delirium - an acute confused state with hallucinations and psychosis - is incredibly common in hospitals. One in five patients can experience it, many more in intensive care. Fiona tells Mark about her own experience in ICU after major surgery last year, when she believed she was being held prisoner and experimented on. She tried to escape from the ward and her daughter, Catherine, describes how distressing it was to witness her mother in such a terrified state. Julie Darbyshire, Critical Care Research Manager at the University of Oxford has done some of the first research into patients' experience of delirium and ICU consultant pharmacist, Mark Borthwick, who has a special interest in the condition, tells Mark about the different types of delirium.

Meningitis ACWY vaccine, Testosterone for women, Allotments on prescription, Heart failure and iron  

The Meningitis ACWY Vaccine was introduced last year to protect teenagers from year 9 in school to those starting university or college. But there seems to be confusion about how to get the jab and many parents remain unaware of the threat posed by Meningitis W. Inside Health's resident GP, Dr Margaret McCartney takes a closer look at headlines reporting that women should be given testosterone for low sex drive. Plus, half of all people with heart failure also have iron deficiency so might iron be a clue to a new type of treatment? And Mark Porter visits his local patch in Gloucestershire where doctors are offering allotments on prescription.

Ministrokes, Midwife study, Cyclic vomiting syndrome, Noise in intensive care  

Several decades ago, if you had a mini stroke or a transient ischaemic attack, it wasn't unusual for your doctor to tell you to rest in bed with the reassuring words that you'd been lucky. Follow up was casual to say the least, because it was thought that your chances of having a major stroke within the month was negligible. Dr Mark Porter talks to Peter Rothwell, Professor of Clinical Neurology at the University of Oxford, whose research transformed the way mini strokes are treated. TIAs are now seen as medical emergencies requiring urgent treatment. Taking aspirin straight after a TIA, his team's research also showed, could reduce the chance of a major stroke over the next few days by a staggering 80%. Headlines this week from a New Zealand study suggested midwife-led births mean worse outcomes for babies compared with doctor-led care - contradicting other research in the area. Inside Health's Dr Margaret McCartney assesses the new study and concludes the evidence still points to midwife-led care providing reassuringly good outcomes for low risk pregnancies. Imagine being sick for hours, days at a time, recovering for a few weeks, only for the whole cycle to start again as regular as clockwork. Roger McCleery has Cyclic Vomiting Syndrome and every couple of months he's so sick he ends up in hospital, from where he told Mark about the life-changing nature of this unpleasant condition. Consultant paediatric gastroenterologist, Sonny Chong from St Helier Hospital in Surrey who has a special interest in CVS, outlines the possible causes and treatments. Hospitals are getting noisier but in intensive and critical care, 24 hour operations, the noise can be intense, as loud as a busy restaurant with peaks of sound as loud as a pneumatic drill. Researcher Julie Darbyshire, critical care research programme manager at the Kadoorie Centre for Critical Care at the Nuffield Department of Clinical Neurosciences, has been involved in efforts at intensive care units across the Thames Valley to identify excess noise and take steps to muffle it. Peter Edmonds tells Mark how much sleep he missed being in ICU when he was a patient and Matron and Clinical Director at Oxford University Hospitals NHS Foundation Trust, Matt Holdaway, outlines how staff have embraced efforts to cut noise levels.

Breast cancer, Alcoholism, CRPS, Generics  

Breast Cancer and Bisphosphonates; an old drug for treating weak bones can reduce the risk of breast cancer spreading, but many post menopausal women are missing out. Why? Alcoholism and Baclofen; another old drug with a new use, this time a muscle relaxant to help people with an alcohol problem and news of three new trials recently presented in Germany. Complex Regional Pain Syndrome, a rare condition that often occurs after an injury or surgery and results in life changing pain. And why are some generic, non-branded medicines so expensive?

Welsh patient power, Liquid biopsies, Food allergies, Dosing errors  

A new medical movement in Wales is urging patients to take more control of the decisions about the care and treatment they receive. Called Choosing Wisely, it calls for a more equal doctor-patient relationship, an end to "doctor knows best". Dr Paul Myers, chair of the Academy of Medical Royal Colleges in Wales discusses the initiative with Dr Mark Porter and with Inside Health contributor, Dr Margaret McCartney. A new way of tracking cancer, through the blood, not from a biopsy of the tumour, is exciting oncologists worldwide. A liquid biopsy, a simple blood test, is proving to be a hugely promising development in cancer treatment. Circulating tumour DNA is measured in the blood, giving doctors the chance to target new treatments for the particular type of cancer. Dr Mark Porter talks to one of the pioneers in this field, Dr Nick Turner at The Royal Marsden Hospital and team leader at the Institute of Cancer Research about what liquid biopsies could, in the future, mean for cancer care. Traditional advice to parents has been to delay the introduction of foods like peanuts and eggs when they wean their babies onto solid food, in order to reduce the risk of food allergies later in life. But conventional wisdom has been turned on its head with a new body of evidence suggesting the opposite is true. In a new survey of the latest data, the Director of Imperial College's Paediatric Research Unit, Dr Robert Boyle, tells Mark that the two most common childhood food allergies, to peanuts and eggs, may be prevented by introducing them early. How accurate are parents when they're measuring out liquid medicine for their children? Not at all, according to a new study. Dr Margaret McCartney discusses the findings that 84% of the 2,000 or so volunteer parents made at least one error, and 20% made a big error. Scary stuff. But there's advice on how to avoid giving your sick child the wrong dose.

Obesity and smoking, Blood pressure, ADHD  

Is it useful as a public health message to compare obesity and smoking? Controversy in Rome behind a new trial that suggested Blood Pressure targets should get lower. And after a rise of medicating for ADHD over 25 years, the numbers of prescriptions for children has now plateaued. Is this a good news story or is there something more complicated behind the change in trend?

Why Becomea doctor? 3. A Matter of Life and Death  

Kevin Fong explores how doctors cope when things go wrong

Why Become a Doctor? 2. All Work and No Play?  

The real lives of junior doctors today.

Why Become a Doctor? 1. The Golden Age  

Was there ever a golden age in which to train to be a doctor?

Junior Doctors - The Golden Age?  

Was there ever a golden age for training to be a doctor ?

Personalised Medicine: Dose By Design  

Vivienne Parry asks if the NHS can deliver the benefits of genomic medicine for all

Zika in UK, Hip arthroscopy, Limits of cancer treatment  

With over 50 confirmed cases of people in the UK with the Zika, Dr Margaret McCartney reviews the latest advice for people worried about the virus. Keyhole surgery for the hip. Dr Mark Porter finds out how hip arthroscopy is increasingly being used to treat problems caused by hip impingement. Sion Glyn Jones, Professor of Orthopaedic Surgery at the University of Oxford and consultant orthopaedic surgeon at the Nuffield Orthopaedic Centre describes which groups appear to benefit most from hip arthroscopy, and Amanda, who had to wait 8 years before keyhole surgery on one of her painful hips, tells Mark about the transformation the operation made to her life. Mark and Margaret discuss the benefits of the "yellow card" system, which allows patients and health professionals to report side effects of drugs. And, as more and more people in the UK are surviving, or living with cancer, thanks to recent advances in treatment, choosing the best approach when faced with a life-limiting disease can be difficult. When cure rates approach 100% for early bowel cancer, advising a patient to have surgery is much easier than recommending aggressive chemotherapy for a hard-to-treat tumour when there's only a slim chance of a cure. Consultant oncologist Sam Guglani, from Cheltenham General Hospital, discusses with Mark the different factors that can influence and impact on the unique relationship between doctor and patient when faced with such choices.

Statins in the media, Unusual neurological itch, The hunger hormone, Viagra  

Has media coverage of statins caused people to come off the drugs? An unusual neurological itch on the arms or back that is often misdiagnosed. Plus Ghrelin, the hormone that makes your tummy rumble and an unexpected surgical side effect that may help in the quest for people to lose weight. And the story of how Viagra was discovered.

Braintraining and dementia; Cluster headaches; Cancer rehab; #hellomynameis  

Every three minutes somebody in the UK develops dementia, so when it's claimed that tailored computer brain training can reduce cases of dementia and cognitive decline by a third over a decade, people sit up and take notice. The research claiming the 33% reduction for the group of people whose "processing function" was targeted for brain training, hasn't yet been published - so isn't peer-reviewed - but the preliminary data by a US team was presented to the Alzheimer's Association International Conference in Toronto this week. Dr Doug Brown, Director of R&D at the UK's Alzheimer's Society speaks from the Canadian conference to Dr Mark Porter and says there's widespread excitement about the potential of brain training to protect against dementia. Dr Margaret McCartney urges caution, warning it's too early to make claims before the full data is available. James is a young man with a high pressure sales job, but every year in the summer months he is crippled by agonising headaches. He's one of the 100,000 people in the UK who suffers from cluster headaches, so called because they come in disabling bouts, lasting for 4-6 weeks at a time. Inside Health visits a new one-stop multidisciplinary rapid-access headache clinic at St Thomas's Hospital in London, where James is getting treatment. Dr Giorgio Lambru, who heads the new service, tells Mark why it's so vital that patients with cluster headaches have to be seen, diagnosed and treated quickly. Years after cardiac rehabilitation became a standard part of therapy for heart attacks, the same post-treatment care still isn't routinely available for people who've had cancer, despite decade-old guidance from NICE suggesting that it should be. The UK's first clinical trial to measure holistic cancer care is hoping to provide the evidence that will demonstrate the type of support and rehabilitation that really works. Professor of Nursing Annie Young from Warwick Medical School and University Hospitals Coventry and Warwickshire NHS Trust tells Mark that after treatment, patients can feel abandoned and vulnerable. #hellomynameis is a hugely successful social media campaign which highlights the importance of healthcare staff introducing themselves to patients. It was launched by Dr Kate Granger after her experience of being in hospital. Kate died at the weekend from cancer, aged just 34. Dr Margaret McCartney describes the enormous impact of Kate's campaign throughout the NHS.

Papilloedema; Cardiac death in sport; Diagnosing early miscarriage; Warfarin  

What is Papilloedema? The condition has been in the headlines as an optometrist was found guilty of manslaughter after missing abnormalities in the eyes of an eight year old child. Plus, Margaret McCartney debates the accuracy of screening young people for Sudden Cardiac Death in Sport. How to diagnose early miscarriage in women who are bleeding in early pregnancy? And the serendipitous story of how the anti-clotting agent warfarin was first discovered., Asthma, Acne rosacea, Pacemakers, the scheme to build an enormous database containing the medical records of all English patients has been scrapped. Dr Mark Porter investigates the fall-out following the cancellation of this expensive programme, which foundered on concerns about confidentiality and public and professional trust. Chair of the national EMIS user group and Sheffield GP Dr Geoff Schrecker and GP Dr Margaret McCartney discuss the scale of the failure of the programme and outline what needs to happen in the future if valuable patient data is to be used for the public good. Twelve hundred adults and children die every year in the UK from asthma attacks, and these grim statistics have remained stubbornly consistent for decades. But there is light on the horizon as researchers in the field begin to stratify the disease; identifying patients with different types of asthma and treating them accordingly. Mark visits the Churchill Hospital in Oxford where some pioneering work has taken place to develop new diagnostic tests and new treatments. Ian Pavord, Professor of Respiratory Medicine at the Nuffield Department of Medicine, shows Mark the new FENO breath test for nitric oxide to test inflammation - soon to be available for use in general practice. Acne Rosacea is a debilitating and painful condition. It's characterised by redness, spots and inflammation on the face and affects both sexes but mainly women. Dr Bav Shergill of the British Association of Dermatologists discusses latest treatments. And the first in a new series dedicated to happy accidents that have altered modern medicine. First off, the pacemaker. Dr Margaret McCartney and Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford, tell the remarkable story of the serendipitous discovery of this life-saving device.

Multi-morbidity, one-shot radiotherapy during surgery for early stage breast cancer  

David Haslam, chair of NICE, discusses with Mark Porter how doctors should treat patients with 'multi-morbidity', the millions of people receiving many different drugs for many different conditions. There's plenty of trial data for starting treatments, but a dearth of evidence for stopping them! And one-shot radiotherapy during surgery for breast cancer may help 20,000 women in the UK. Rather than daily hospital visits for radiotherapy over 5 weeks, a dose is given straight to the open wound during the operation. It is quicker, cheaper and much more convenient, so why isn't it more widely available?

Health checks, Fertility, Adjustment  

NHS health checks or 'mid-life MOTs' have hit the headlines as new research claims they are a success. The aim is prevention - of diabetes, heart attacks and strokes - but their introduction has been controversial amid criticism they are not evidence based or cost effective. Resident sceptic Dr Margaret McCartney debates the issues with National Clinical Advisor Dr Matt Kearney. And putting the family back into planning. As more couples leave it later before starting a family there is growing concern from fertility experts that many people don't know enough about when female fertility starts to decline. Professor Adam Balen and Professor Joyce Harper discuss the issues. And how accurate is the perception, often reported in the media, that fertility 'drops off a cliff' in the mid to late thirties? Professor Richard Anderson reviews the so called 'broken stick' study, a mathematical model which first defined the sharp drop off of female fertility. And another instalment of Inside Language where Dr Margaret McCartney and Professor Carl Heneghan examine the terms used in evidence based medicine and why they matter. This week, adjustment and how researchers allow for factors that might skew their findings.

Preventive HIV therapy, Sugar tax, Bowel cancer, Surgery  

The average five-year-old consumes their own body weight in sugar every year in this country - a scary illustration of the scale of the sugar problem. The new sugar tax is supposed to tackle this, but what's the evidence that a tax on sugary drinks alone will make a difference? Dr Margaret McCartney reviews the evidence from other countries, which have also used fiscal measures to nudge their populations into eating a healthy diet. PrEP - pre-exposure prophylaxis - is the latest advance in the ongoing battle against HIV. Studies show this preventive HIV therapy can reduce the risk of HIV infection by 86%. So the announcement by NHS England that it wasn't its responsibility to commission the drug has been met by shock and disappointment. Sexual Health and HIV consultant, Dr Jake Bayley, tells Mark that PrEP is a game changer in preventing HIV in high risk groups and the news that it won't be rolled out nationally, as expected, means the UK is falling behind in HIV prevention. "We don't like to talk about our bottoms", Maureen Williams tells Inside Health is one reason why take up of bowel cancer screening across the country is so patchy. Maureen was one of the first people to receive the faecal occult blood test ten years ago as part of the roll out of the bowel cancer screening programme and despite having no symptoms, they found early stage bowel cancer. Ten years later Maureen campaigns for people to complete and return the potentially life-saving test. The clinical head of the Scottish Bowel Cancer Screening Programme talks to Mark about the new, simpler screening test called FIT, the Faecal Immunochemical Test, due to be rolled out in Scotland, and perhaps soon in the rest of the UK as well. Researchers in Taiwan have concluded that most patients who undergo surgery can start showering 48 hours after an operation - a finding that flies in the face of traditional thinking that scars need to be kept dry and under a dressing for a week or more, before getting wet. Consultant Surgeon Nicholas Markham from North Devon District Hospital details the dramatic changes for patients undergoing surgery, including keyhole surgery, changes in the use of anaesthetic, access to food and water and bed rest.

Asthma, Visual snow, Confounding factors  

Why asthma is both over diagnosed and undertreated. Professor Mike Thomas and GP Dr Margaret McCartney discuss this apparent contradiction and look behind recent headlines that half a million children in the UK could be taking asthma medicines they don't need. A new study finds that putting doctors under pressure or being a difficult patient may backfire, inducing them to make diagnostic errors. With scarlet fever and measles in the news, Margaret McCartney gives a quick guide on the key symptoms as both diseases have a characteristic rash. A listener has emailed to ask about visual snow, a condition where your vision is like an untuned TV set. World expert, Professor Peter Goadsby explains the latest understanding of visual snow, and says that even 15 years ago it hadn't been universally accepted as a condition. Plus the first in the latest Inside Language series with Margaret and Dr Carl Heneghan of Oxford University. This week, they discuss confounding factors and why they matter to your health.

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