By Dr. Ananya Mandal, MDMar 18 2019Around a fourth of cancer patients under the NHS have a worryingly long wait for their treatment to begin. This is a cause for significant concern say experts. The new figures from NHS England reveal that the health service has not been meeting targets of on-time health care delivery to cancer patients for over 1,000 days. Similar figures have emerged from the A&E department performance.The figures further show that after an urgent GP referral for a cancer patients, ideally the treatment should begin within 62 days. According to recommendations at least 85 percent of the patients should be seen during this time. January figures however reveal that only 76.2 percent of the patients are seen within this time frame.According to Dr Fran Woodard, executive director of policy and impact at Macmillan Cancer Support, “January 2019 marks five years since the 62-day cancer target was first missed and, despite the best efforts of hard working NHS staff, more than 127,000 people have been left waiting too long to start vital treatment throughout that time.” A spokeswoman from the NHS said in a statement, “More people than ever before are coming forward for cancer checks, with a quarter of a million more people getting checked for cancer this year and thousands more being treated within the two-month target. NHS England is investing an additional £10m this year to treat extra people and the NHS Long Term Plan sets out a range of ambitious measures to catch more cancers earlier, which will save thousands of lives every year.”Related StoriesTrends in colonoscopy rates not aligned with increase in early onset colorectal cancerStudy: Nearly a quarter of low-risk thyroid cancer patients receive more treatment than necessaryBacteria in the birth canal linked to lower risk of ovarian cancerWaiting time has not been looking good for the A&E department as well says the report. Only 84.2 percent of the patients are seen within the four hour target time. The recommended numbers of 95 percent have not been met since July 2015, says the report. An NHS spokeswoman said to this, “Despite significant increases in demand, almost a quarter of a million more people have been seen and treated within four hours in A&E this winter compared to last year. Ambulance services are responding to life threatening calls faster, with fewer ambulance handover delays at A&E, and significantly more people have got the support they needed to avoid a long stay in hospital.”The Royal College of Surgeons has issued a statement saying that 227,569 patients are kept waiting for over six months for a planned procedure. At present 4.16 million people are waiting to start on their treatment says the report. Professor Derek Alderson, president of the RCS, in a statement said, “The backlog of patients waiting to start treatment continues to grow. There are now over 100,000 more patients waiting longer than 18 weeks to start treatment when compared with the same time last year.”Labour’s shadow health secretary Jonathan Ashworth in a statement said, “Today’s statistics will do little to allay frontline concerns that targets will be changed not on the basis of clinical consensus, but because of political pressure from Tory ministers.” He called the situation “shameful”.
Source:https://ki.se/en/news/genetic-analysis-can-provide-better-dosage-of-antipsychotic-drugs Reviewed by James Ives, M.Psych. (Editor)Apr 16 2019An initial gene analysis may yield better outcomes when patients are treated with the antipsychotic drugs risperidone and aripiprazole. A novel study shows how the activity of a specific enzyme, which metabolizes the two drugs, affects the individual dose that should be given for optimal treatment. The study is published in The Lancet Psychiatry and has been conducted by researchers at Karolinska Institutet, in collaboration with the Diakonhjemmet Hospital in Oslo, Norway.The enzyme CYP2D6 metabolizes many different drugs in the body, including the antipsychotic drugs risperidone and aripiprazole. The activity of the enzyme differs widely in the population due to variations in the CYP2D6 gene.In collaboration with Espen Molden’s group at the Diakonhjemmet Hospital in Oslo, researchers at Karolinska Institutet have studied how CYP2D6 gene variants affect the treatment result in 2,622 patients with psychosis or schizophrenia receiving either risperidone or aripiprazole.Related StoriesGenetic contribution to distractibility helps explain procrastinationDoes genetic testing affect psychosocial health?Study: Treatment of psychosis can be targeted to specific genetic mutationThe results show that patients with low CYP2D6 enzyme activity were given the drugs at too high a dose, while patients with high enzyme activity were given the drugs at too low a dose. As a consequence, many of them switched medication.”In patients with too low or too high activity of the CYP2D6 enzyme, treatment failed to a larger extent, most likely due to side effects and lack of efficacy, respectively,” says Marin Jukic, researcher at the Department of Physiology and Pharmacology at Karolinska Institutet and the study’s first author.Compare dose changes”Interestingly, we found that without knowing which gene variant the patient had, the psychiatrists had in the main altered the dose based on the clinical outcome, and this correlated with the anticipated effects of the patient’s specific CYP2D6 genotype,” says Magnus Ingelman-Sundberg, Senior Professor at the same department at Karolinska Institutet and the study’s last author. “However, the dose changes were insufficient to avoid side effects or lack of effect. This is the first time we have been able to retrospectively compare dose changes during routine clinical treatment with the patient’s specific genotype.”The researchers believe that genotyping, i.e. the identification of the specific gene variant the patient carries, before initiation of risperidone or aripiprazole treatment, would result in much more effective treatment for millions of patients globally.”Further studies are now needed to test other psychoactive drugs in order to generate additional scientific evidence to support new recommendations in psychiatry,” says Magnus Ingelman-Sundberg. “Psychiatrists also need more education in this area.”In the early 1990s, Magnus Ingelman-Sundberg’s research group was the first in the world to show the presence of several variants of the CYP2D6 gene explaining why some people, the so-called ultra-rapid metabolizers, require higher drug doses than others.
“This would be true regardless of race or ethnicity, so we might expect to see menthol flavoring making it more difficult for everyone to quit. The fact that we didn’t find consistency across racial and ethnic groups, we think, might point to the causal role of social influences like tobacco marketing,” he added.Related StoriesTelomere shortening in adulthood is not caused by smoking, say researchersCollege affirmative action bans may increase smoking rates among minority high school studentsStudy reveals how habitual smoking may contribute to development of hypertensionBig Tobacco’s marketing efforts have included heavier advertising of menthols on billboards in predominantly African American neighborhoods, and ads in African American-centric magazines, compared to white communities and periodicals.In addition, the industry has provided philanthropic support to organizations such as the National Association for the Advancement of Colored People and the National Urban League, Giovino added.A recent study by Giovino and colleagues suggests that tobacco companies are holding onto the menthol market better than non-menthol cigarettes. “Less quitting by menthol smokers is part of the reason why,” he said.Smokers’ inaccurate perceptions of menthol cigarettes have further compounded cessation efforts, Giovino says.”Some people believe they are less dangerous, even though they are, in epidemiological studies, found to be at least as dangerous as non-mentholated cigarettes,” he said. “Menthol is a topical anesthetic that numbs the respiratory tract. People inhale them more easily, which gives the perception of safety.”The idea for the study stemmed from a conversation between Smith and study co-author Biruktawit Assefa, now with Yale University School of Public Health, who worked with Smith when she was an undergraduate intern at Yale.”We wanted to more conclusively look at whether there are racial differences in how menthol flavoring may impede smoking cessation, across studies published on the topic,” Smith said.Essentially, it’s about social injustice, said Smith, who wants to use research “to give power back to communities from which power has been taken.””It all comes down to power and who has more of it and who has less of it, and why,” Smith added. Banning menthol from tobacco products — which the study recommends — might help shift the power, he said.”Such a policy might effectively take some power away from the tobacco industry and give it back to blacks and African Americans in the U.S.,” Smith said. Source:University at BuffaloJournal reference:Smith, P.H. et al. (2019) Use of Mentholated Cigarettes and Likelihood of Smoking Cessation in the United States: A Meta-Analysis. Nicotine & Tobacco Research. doi.org/10.1093/ntr/ntz067. Much of the rationale for why menthol flavoring might impede cessation has to do with how menthol flavoring might make the nicotine in cigarettes more reinforcing.” Philip Smith, study’s lead author Reviewed by Kate Anderton, B.Sc. (Editor)Jun 17 2019For decades, Big Tobacco has sold African American smokers on menthol-flavored cigarettes through targeted marketing campaigns. That’s among the reasons why, in the U.S., black smokers who prefer menthols are 12% less likely to quit smoking compared to non-menthol users, according to the results of a newly published study.The findings, reported today in the journal Nicotine & Tobacco Research, underscore the role that mentholated cigarettes play in smoking cessation efforts, particularly among African American tobacco users, says the study’s lead author, Philip Smith, an assistant professor in the Department of Kinesiology and Health at Miami University (OH).Menthol cigarettes were first sold in the 1920s. The tobacco industry began targeting African Americans in the 1940s and menthol use grew along with the belief that menthols were less dangerous, according to Gary Giovino, the study’s senior author and a professor of community health and health behavior at the University at Buffalo who has extensively studied the marketing and use of menthol cigarettes.The study — a meta-analysis of 19 studies plucked from a review of more than 400 abstracts — looks at the association between menthol use and smoking cessation.The finding that menthol flavoring was associated with less success in quitting smoking among African Americans wasn’t surprising, Smith said. The lack of association for white smokers, however, was.
Week 11Nov. 17at Lions1:00 p.m. SIGN UP to watch every NFL preseason and regular season game and RedZone during the 2019 season on DAZNAn expected contender in the NFC East with the Philadelphia Eagles, if the Cowboys can surpass the success of Carson Wentz and company, the NFC East could be looking at a deep run in the postseason.Key additionsRandall Cobb (WR), Robert Quinn (DE)Key lossesCole Beasley (WR), Terrance Williams (WR)Preseason scheduleWeekDateOpponentTime/Result Week 1Aug. 10at 49ers9:00 p.m. Week 10Nov. 10vs. Vikings8:20 p.m. Week 15Dec. 15vs. Rams4:25 p.m. Week 3Sept. 22vs. Dolphins1:00 p.m. Week 1Sept. 8vs. Giants4:25 p.m. What is the cost and how do I sign up for DAZN?You can sign up for a FREE trial of DAZN and subscribe for $20 CAD per month or $150 CAD per year by clicking here . What devices are supported by DAZN?DAZN has apps available for all of the following platforms: Apple TV, Chromecast, Amazon Fire TV, Amazon Fire Stick, Amazon Fire Tablet, Android Phone & Tablet, iPhone & iPad, Android TV, LG, Smart TV, Panasonic Smart TV, Samsung Smart TV, Sony Smart TV, SmartCast, Xbox One, Xbox One S, Xbox One X, PlayStation 4, PlayStation 3, PlayStation 4 Pro, and Roku.What other sports stream on DAZN?Besides streaming every NFL game and RedZone, DAZN airs every match from Europa League, Champions League and Premier League soccer. In addition, DAZN has the rights to stream MLS games in Canada, championship boxing and MMA events, ATP and WTA tour events and MLB Network. (All times Eastern)How to watch the Dallas Cowboys in Canada Every Dallas Cowboys game during the 2019 preseason, regular season and playoffs is streamed in high-definition on DAZN .DAZN Canada has also partnered with Bell, Rogers, Shaw, SaskTel and other cable/satellite providers to distribute NFL Sunday Ticket across Canada, for Sunday afternoon games.However, DAZN is the only place to watch every preseason, regular season (including Thursday night, Sunday night and Monday night games) and playoff games, plus exclusive access to RedZone.Each game is available LIVE and ON DEMAND.What is DAZN?DAZN is a global sports streaming service that offers exclusive coverage of every NFL game and RedZone in Canada, both LIVE and ON DEMAND.Football fans in Canada also can enjoy 24/7 streaming of the NFL Network on DAZN, which includes complete coverage of the NFL Draft, Scouting Combine and Free Agency. Week 4Aug 29vs. Buccaneers8:00 p.m. Week 16Dec. 22at Eagles4:25 p.m. Week 8Oct. 27– Week 4Sept. 29at Saints8:20 p.m. Week 7Oct. 20vs. Eagles8:20 p.m. Week 5Oct. 6vs. Packers4:25 p.m. Week 2Aug. 17at Rams10:00 p.m. Week 14Dec. 5 (Thurs.)at Bears8:20 p.m. Week 13Nov. 28 (Thurs.)vs Bills4:30 p.m. Week 12Nov. 24at Patriots4:25 p.m. Week 9Nov. 4 (Mon.)at Giants8:15 p.m. Week 6Oct. 13at Jets4:25 p.m. Week 3Aug. 24vs Texans7:00 p.m. Late-season success gave the Dallas Cowboys a fighting chance in the playoffs but they were sent packing in the second round against the Los Angeles Rams. The Amari Cooper-Dak Prescott connection got a lot of attention and success in the big moments late last season. If the passing game continues to improve, paired with star running back Ezekiel Elliott, the Cowboys could be dangerous again this fall.Defensively, there are big questions in Dallas; however, linebacker Leighton Vander Esch shined bright in the heart of the Cowboy’s defense last season. Many questioned his first-round selection initially, but after making the Pro Bowl in his first season, the doubters have been put to rest. Week 2Sept. 15at Redskins1:00 p.m. Week 17Dec. 29vs Redskins1:00 p.m. (All times Eastern)Game to watchWeek 7 vs Eagles: The Dallas Cowboys will square off against Philadelphia on Sunday Night Football once again this season and with the first meeting halfway through the schedule, a lot rides on the outcome. The Eagles and Cowboys could both have favorable records and division seeding might come down to head-to-head results in 2019.Regular season scheduleWEEKDATEOPPONENTTime/Result