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Drs John Coffin and David Acorn NEWS PAGE |
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Drs John Coffin and David Acorn NEWS PAGE |
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New Guidelines for Treatment of High Blood PressureThe new guidelines issued by NICE are a result of research published last year and we have already considered this when starting people on treatment of blood pressure for the first time. Beta blockers used to be recommended as a first choice, but because other treatments such as ACE inhibitors and calcium antagonists are more effective, they have been relegated to last place. It's important to realise that beta blockers aren't dangerous, but other treatments may be better. It is very important that you don't stop beta blockers suddenly as this can be dangerous, and for some people beta blockers are essential. Beta blockers are recommended for those who have had heart attacks, where they can save lives, and for those with angina or palpitations. If you are concerned, come and see us before considering any changes. Not everyone can tolerate the other kinds of blood pressure medication and this is another reason for taking beta blockers. New telephone numberWe have changed our telephone number to an 0844 number. Calls are charged at the standard BT rate for a local day time call. Mobile phone customers will also pay their usual daytime local call rate. We generate some income from this. This is used to offset the substantial cost of leasing an advanced telephone system. We hope that you will find that you can access the surgery a lot more easily than before. There is a queuing system that informs you where you are in the queue. A simple menu allows you to choose whether you want to request an appointment or find out the result of your tests. In a medical emergency your call will bypass the queue if you use the appropriate menu option. (We hope patients will use this facility thoughtfully). It was with much soul-searching that we chose this system but we really believe that it will offer a much better service than before. Waist to hip ratio is better than weight and height as a predictor of risk of heart diseaseA study published in the Lancet on 4th November 2005 confirms previous research about the importance of the ratio between waist and hip measurements as a predictor of the risk of heart disease. 27,000 people in 52 different countries were studied. The measurements of people who had had heart attacks was compared with those of people who hadn't had heart attacks. There was a strong relationship between the ratio of hip to waist measurement and heart disease whatever country the person came from, whether they were Asian, African or Caucasian. This makes sense because it seems that fat stored in the abdominal cavity is responsible for the changes in metabolism that make a person more at risk of heart disease. So someone with a big tummy but who was otherwise built like a bean pole would be more at risk, despite his low weight in proportion to his height. A 14 stone rugby player however, would be heavy for his height but have a small waist in comparison with his hip size. This would give him a low waist to hip ratio and a low risk of heart disease. Try our waist to hip ratio calculator and see what your risk is. Exercise helps you sleepThree studies have shown some evidence that exercise can help you sleep better. One randomly selected 43 people with sleep problems to either join an exercise programme or remain "couch potatoes". Those who exercised began to get to sleep more quickly and sleep for longer. Read more on Bandolier's website Choose and BookA new system for making referrals to hospital specialists is due to start soon. When your doctor wants to refer you to hospital for an out patient appointment you will be able to choose from up to five different places. You will be given the necessary information to help you decide such as length of waiting list, quality indicators etc. We haven't decided exactly how to implement the system yet, we may suggest that you phone the Choose and Book service yourself when you get home if possible, though we would offer help to anyone who has trouble doing this for themselves. Alternatively we may book your hospital appointment online at the surgery before you go home. Read more on the Choose and Book website More encouraging news on the MMR vaccineA Japanese study in Yokohama looked at the incidence of new cases of autism during the years when MMR vaccine was being used and in the years after it was replaced by the single vaccines. 17,704 children were given the MMR vaccination until it was discontinued in 1993. 13,722 children born after this date received the individual vaccines. The incidence of autistic spectrum disorder continued to rise after the MMR was stopped. It is not known why more children are being diagnosed with autistic spectrum disorder, but it seems very unlikely now that MMR vaccine is the cause. Read more about it in the Guardian website. Good news for victims of breast cancerThe British Medical Journal reported two studies this January, that are encouraging for those women suffering from breast cancer. Bandonna and colleagues followed the progress of women treated with chemotherapy for 28 years afterwards. The women had cancer that was suitable for surgery, and were treated with a combination of cyclophosphamide, methotrexate and fluorouracil (CMF). Those treated with CMF and surgery did better than those treated by surgery alone, even after 30 years. The addition of chemotherapy reduced the chance of dying by 35%. It is reassuring that the benefit of this regime of chemotherapy was still seen such a long time after it was given. The newer chemotherapy regimes seem to be even more effective, but haven't been around long enough to confirm that their benefits are long lasting. If the newer treatments stand the test of time that will be even more encouraging. A second paper, from Denmark, measured the effect of their breast cancer screening programme. Their programme is similar to ours. Women are given mammograms every two years (in Britain the interval is three yearly), between the ages of 50 and 69. Screening was started in 1991, and it seems to have reduced the number of deaths from breast cancer by a quarter. Estimates of the benefits of screening in this country are also favourable. For every 500 women screened one life is saved. See NHS breast cancer screening website for more information. New cervical screening programmeThe Minister for Public Health has announced the following changes to the cervical smear programme.
The changes were made for the following reasons
How to live an extra 10 years50 years ago Richard Doll published the results of research that showed that smokers were more likely to get cancer of the lung. He asked 30,000 male doctors about their smoking habits, and then waited to see what happened to them. Periodically he checked if they were still alive and if not, what they had died from. He published the results of 50 years of observation of these doctors in the British Medical Journal, were you can read the study. The results were
Men who smoked died earlier because of lung cancer, cancers of the mouth and gullet, chest disease such as chronic bronchitis, heart disease and strokes. We realise how difficult it is to stop smoking, so if you would like help read more about our smoking cessation programme. Sedentary life style is a 'health time-bomb' for the 21st Century“The lack of physical activity is a major
underlying cause of death, disease and disability. Preliminary data from a
WHO study on risk factors suggest that a sedentary lifestyle is one of the
ten leading global causes of death and disability. More than two million
deaths each year are attributable to physical inactivity.”
In 2001 the National Travel Survey found that in the last 10 years the number of primary school children walking to school had fallen from 62% to 56% and only 2% of secondary school children cycled to school compared with five percent in 1989/91. Adults haven't been doing very well either, sedentary behaviour, that is being "active" less than once a week is on the increase, women are worse, with 41% being sedentary in 1998 compared with 35% of men. All this is happening despite the fact that being inactive doubles your chance of a heart disease, possibly trebles your chance of a stroke and may increase your risk of bowel cancer by 40%. The list of other ailments caused by being a couch potato is almost endless, including greater risk of diabetes, high blood pressure, obesity, osteoporosis, depression, and even falls in older people. HRT and risk of breast cancerThe new research concerning hormone replacement therapy and breast cancer was the "Million Women Study". This was actually performed on 800,000 women. 200,000 had to be excluded after initial screening to make sure only women who had had the menopause were included. The women were aged 50 to 64 and they all attended the normal breast screening programme. Half of them had taken HRT. Those taking the combined form of HRT (the sort given to those who still have a womb), had double the risk of breast cancer compared with those who hadn't taken HRT. Women using the oestrogen only form of HRT, as given to those who have had a hysterectomy, were about a third more likely to get breast cancer. It is estimated that if 1000 women take the combined form of HRT for 10 years, 19 of them get breast cancer because of the HRT. An extra 5 breast cancers are likely to be caused in a 1000 women taking the oestrogen only HRT for 10 years. This isn't entirely new knowledge, but until now we thought that the number of cases of breast cancer caused by HRT was smaller (see last year's news item). The main benefits of HRT seem to be in reducing hot flushes, and relief of other unpleasant symptoms of the menopause. Risks and benefits vary according to your current and past health and that of your parents. Because everyone is different, advice about taking HRT has to be tailored to the individual. You may want to discuss this with us at a routine appointment. Read the Guardian article here The PolypillThe Polypill hasn't been made yet. It is a proposed combination of three blood pressure pills (at lower than usual doses), the vitamin called folic acid, aspirin, and a cholesterol lowering drug. The research workers looked at the results of research on all these individual drugs. They knew from this how much these drugs reduce the risk of heart disease, and then estimated the likely benefit of combining them in one pill. It has to be emphasised that the Polypill only exists as a theoretical combination of drugs. Until long-term trials are performed comparing it with a dummy pill we won't know for sure how much good (and harm) it would do. Until then, there is a lot that can be done. Look at the Keeping Healthy section on this site, and also visit the British Heart Foundation website. For more information about the Polypill read the summary on the National Electronic Library of Health, or read the original paper in the British Medical Journal. HRT patches for prostate cancerA recent pilot study reported that men with advanced prostate cancer seemed to benefit from hormone replacement patches (as used to treat women going through the menopause). An improvement in quality of life was noted and any osteoporosis began to get better. However this is only a pilot study, on 20 men, and further research is needed. Ibuprofen may cancel out the benefits of aspirinRecent research published in The Lancet revealed that ibuprofen, an anti-inflammatory drug used for pain relief and arthritis, may cancel out the benefits of aspirin in reducing the risk of heart disease. The research compared people taking aspirin by itself, ibuprofen with aspirin, diclofenac and aspirin, and other anti-inflammatory drugs and aspirin. They had all been in hospital. The patients that had been in hospital had heart disease such as angina or had had a heart attack. Others had diseases of blood vessels such as blocked arteries in the legs or had had a stroke. Normally aspirin reduces the risk of dying in this group of people. Unfortunately taking ibuprofen with aspirin seemed to cancel out this benefit. The other drug combinations didn't appear to have an effect. New Danish Study on MMR and AutismAll Danish children born between 1st January 1991 and 31st December 1999 were studied (a total of 537,303 children). Out of the total of 537,303 children, 440,655 received the MMR vaccine. 316 of all the children were diagnosed with Autism 422 of all the children were diagnosed with another autistic-spectrum disorder. There was no increased risk of these disorders in the group that were immunised compared with the group that were not. This was a good quality study using information from the Danish Psychiatric Central Register which collects statistics on diagnoses of autism etc made throughout the country in hospitals, outpatient clinics and psychiatric departments. Read an abstract of the original research in the New England Journal of Medicine Doubt about the effect of screening for prostate cancerResearch published in the British Medical Journal on 5th October failed to show any benefit from the PSA test for early prostate cancer. Two groups of men, about 95,000 in Seattle-Puget Sound and 120,000 in Connecticut, aged 65-79 were followed up for 11 years. In both areas the death rate from prostate cancer was almost the same before the period of observation. When PSA testing was introduced the Seattle area was more intensively screened than Connecticut. About 2/3 of the men in the Seattle area had a PSA at least once in 5 years (about 5 times as many men as were screened in Connecticut). In addition the Seattle men were treated more radically. At the end of 11 years follow up there was no difference in the number of men dying from prostate cancer, between the two groups. There are technical problems with this kind of study, but it does seem to indicate that PSA testing is not very effective at saving lives. More research is needed. Read the article in the British Medical Journal Aspirin and diabetes, guidelines from Diabetes UKDiabetes UK has suggested guidelines for the use of aspirin in people with diabetes. Heart disease is a major risk of diabetes. Using aspirin can help reduce that risk. However not everyone can take aspirin safely on a regular basis, so check with a health professional first. Besides aspirin, regular exercise, controlling weight, healthy eating and stopping smoking can all help reduce the risk of heart disease. See the guidelines on the Diabetes UK website Hormone Replacement Therapy (HRT) linked to breast cancer (July 2002)It has been known for a long time that there is an increased risk of breast cancer from taking HRT. The results of new research published in the Journal of the American Medical Association (JAMA) provide further evidence. The trial was performed on 16,608 women aged 50-79 using a form of HRT not available in this country called Prempro. This form of HRT is similar to Premique which contains the same amount of the hormone oestrogen but twice as much progesterone. The trial was stopped after 5 years because the researchers felt that the risks of the treatment were greater than the benefits. Many of the Newspapers reported the percentage increase in risk, but it is more useful to look at the absolute risk (the actual numbers of extra cases of breast cancer etc caused by the drug). The absolute risks of harm from Prempro were as follows For every 10,000 women taking the drug, there were
The benefits were
Overall there was no increase in the number of people dying in the group of women taking Prempro, but this may be because these women have only been followed up for five years which may not be long enough to show up any increase. The risks of harm are still relatively small, and many women find that HRT increases their quality of life and may decide that the benefits for them make the risks worthwhile. Other evidence suggests that the risk of breast cancer increases the longer that HRT is taken so some women may want to consider stopping it after five years. The decision to take HRT is best made on an individual basis in discussion with your doctor. It is important to note that the results apply to one form of HRT only and we do not know for certain that women on other types would be similarly affected. The women taking oestrogen only HRT, the kind given to those who have had a hysterectomy, are still taking part in the American trial, researchers have not had to stop their contribution to the trial because the same levels of increased risk have not been found so far.
New advice on Benecol and Flora Pro-Activ from the British Heart Foundation (BHF)The addition of naturally occurring plant sterols or stanols to margarine in Benecol and Flora Pro-Activ is known to reduce LDL cholesterol (this is the harmful form of cholesterol) by 9%-20%. This may well help to prevent heart disease and strokes. However so far, no long term tests of the safety of these products in a large number of people have been performed. They might prevent other beneficial nutrients in the diet from being absorbed. Unfortunately nobody knows yet if the long term benefits outweigh the harms of these margarines. For now the BHF advise that
See Five a Day and Healthy Eating on this site to find out more . . . New Surgery PlansOur current premises our bursting at the seams and we need
a bigger surgery. We have been trying to find a new site for a surgery
since the beginning of 1999. Why do we need to move?Have a look at the facts
and figures section on this site to see how much more chronic disease
we now deal with compared with 10 years ago. New workThe new National Service Framework for Coronary Heart
Disease (CHD) requires us to assess those in high risk groups for CHD and
help them to reduce their risks. More servicesWe also now have a counsellor and monthly chiropody
clinics. It is now very difficult to find space for everyone to work. In
addition these new services create extra administrative tasks which need
more office space for our staff. Closer team workWe will have a base for our district nurses and health visitor in the new premises, helping us to work more effectively as a team. Improved accessibilityAll consulting and treatment rooms will be on the ground floor making access easier for all our patients. Future proofingOur new premises will have enough capacity to cope with the likely increase in medical work that medical advances of the new century will bring |
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[ home ] [ site map ] [ search ] [ disclaimer ] [ feedback ] 0844 477 3088 Fax 0844 477 3089 Copyright© 2001-2008 John Coffin, Stock Surgery, Common Road, Stock, Essex CM4 9NF |
