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What is the number needed to treat (NNT)?

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Sometimes statistics are  like a sly old fox. They can be used malevolently to persuade members of the public about things they don’t know much about.

The pros and cons of breast cancer screening is in the news yet again today.

Probably every woman should look into this in depth but to help you first before you do, it is necessary to know the meaning of the Number Needed to Treat (NNT). Unless this is understood, people with a vested interest might run rings round you and you won’t know what to believe or worse still will believe the wrong thing.

Here is a brief account of NNT

COUNTRY: UK

This problem – and major problem it is – of not knowing who will benefit, and for that matter who will be harmed also lies at the heart of the screening debate, which has once again been re-ignited by a ‘new’ report on the benefits and harms of breast cancer screening, ‘new’ being qualified because, though the report is new, the data it is based on is old. The arguments for and against screening symptom free women of a certain age for breast cancer have gone up and down like a tired see-saw for decades.

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Reye’s Syndrome

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OK, it’s only a photo. These pills are yellow and aspirin is usually white. However, it is as well to remember as you travel around the world that some medications that don’t look like aspirin contain it as a component and unless you read the label carefully this could pass you by.

Why be concerned about aspirin? Introduced as an analgesic (painkiller), an antipyretic (ability to bring down fever), and an anti-inflammatory agent in 1897, it is one of the oldest drugs. It must have been a godsend for those suffering from toothache and other common aches and pains over a century ago. Aspirins’s chemical name is acetylsalicylic acid and it breaks down in the body to form salicylic acid.

It is an important drug in other ways and its benefits are today, over a century later, still being investigated.

However it also has side effects, the best known is that it can precipitate stomach bleeding.

There is also another rare but important side effect mainly affecting children. This has resulted in a change of advice to parents on how to treat a child with fever. In granny’s day it was normally advised to give a child half an aspirin to bring down temperature, however this is contrary to modern advice because of the possible risk of precipitating Reye’s Syndrome. Although this condition is rare, its seriousness is such that the risk of taking aspirin well outweighs any benefit in a child with pyrexia.

NATIONAL REYES SYNDROME FOUNDATION UK

COUNTRY : UK

What is Reye’s Syndrome

Reye’s syndrome is an acute disorder which affects children when they seem to be recovering from a viral illness like ‘flu’, chickenpox or diarrhoea. The child has a change in his/her personality or becomes drowsy and develops frequent or persistent vomiting. Unless diagnosed and treated successfully, death or severe disability may result.

Abnormal accumulations of fat develop in the liver and some other organs of the body. There is swelling of the brain which can cause it injury. The disease affects children from infancy onwards, including teenagers and has been reported, albeit rarely, in adults. Children of both sexes and all races can be affected.


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“My friend with cancer”

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Should the label “cancer “ become obsolete?

Should the full medical terminology be used instead and be used only by a few?

Cancer is after all a whole spectrum of diseases, some completely curable, some aggressive and everything in between.  Some cancers are quite slow growing, even when spread to other parts of the body, especially with present day treatment. It should not be assumed that the patient, even with advanced cancer, will soon be pushing up the daisies.

Cancer patients may live a long time and become ill with unrelated conditions that require treatment.

Should people be open about the fact they have ever been diagnosed with cancer?

Or should they take the view that their health is nobodies business but their own and the medical staff treating them?

Should medical history be exempt from todays fashionable “tell all” transparency culture, and revert to what is becoming the now “old fashioned” patient confidentiality?

My view is that patient confidentiality should be conserved at all costs but in many small ways it appears there is a movement away from this.

This article is rather worrying and I fear may be the way things often are.

THE UNSPOKEN SENTIMENT TOWARDS PATIENTS WITH ADVANCED CANCER

COUNTRY: USA

“Do you know my breast cancer friend, X?”

I have come to realize that while the use of a cancer diagnosis to describe a patient is common, it can also trigger assumptions that may not be correct, which may result in terrible consequences. Beyond the care and compassion rendered in oncology practices throughout the world, there may be an unspoken sentiment within society and within other realms of medicine that treats patients with advanced (or chronic) disease as “hopeless” or “terminal,” regardless of where they are in their disease state.

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Storing medications safely away from children

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I have some awful recollections as a junior doctor of small children being brought into hospital suffering from overdoses of medications prescribed to their parents, grandparents or other adults in the family. Some of these children died. Indeed I remember when toddler twins both died from an overdose of aspirin within hours of each other.

Attempts were tried by pharmacists to dispense medicines in small bottles with lids that were difficult to open. The trouble was that some adults felt them difficult to open too and consequently, sometimes the “difficult” lid was discarded and the small bottles plugged with cotton wool.

Nowadays blister packs are more common but they might present as an interesting challenge to the older toddler although some perseverance would be required to remove large numbers of tablets. Nevertheless more adults receive medications than ever before and there is always a hazard in visiting friends and relatives even if your own home is safe enough.

I know someone who keeps all his tablets, bottles, inhalers and insulin injections piled up on the kitchen table. They take up about one third of the space there. He says he needs to have them in front of him so he won’t forget to take them. No doubt he is some child’s grandfather and the parents will need to be extra vigilant when they visit because he is so set in his ways he will never change. No doubt he drops tablets on their floor beneath him from time to time.

However, most parents would want to ensure that their own house is safe for their own and visiting children. A locked medicine cupboard out of the reach of young children is the answer. Indeed I think all new houses should be built nowadays with one of these wall mounted medicine cabinets and several other locked cupboards too especially the ones below the sink.

A study in Michigan demonstrated recently demonstrated some disconcerting findings on this matter:

NEARLY I IN 4 GRANDPARENTS STORE PRESCRIPTION MEDICINES WHERE CHILDREN CAN EASILY FIND THEM

COUNTRY : USA

“Unintentional poisonings from medicines cause more emergency room visits for young children each year than do car accidents. One key reason may be that nearly 1 of every 4 grandparents says that they store prescription medicines in easy-access ways, according to a new poll.”

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More on sleepless babies

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Well, this baby is dressed up to face the day  but is sound asleep. At his age it’s likely he won’t sleep through the night.

Its also likely that his parents are feeling pretty exhausted from time to time. They might even feel exhausted all of the time, especially if soon after his birth there has been an influx of daily visitors bringing gifts and good wishes.

It’s probably best for new parents to consider sleepless nights are the norm at least for a while. It’s best too, not to be be put off or develop guilt feelings when the parents of other infants proclaim their babies are great sleepers – sometimes the implication being that they are better at parenting than you are!

All babies are different just as you yourself are like no-one else in the world.

But somehow or another, get rest yourself so that you feel refreshed and able to care for the new baby. If visitors deprive you of rest in the early days, thank them for their gifts, tell them to wait a while, make their own tea or coffee, and if they are well known to you and reliable, tell them your glad they came because  now you would like to go to bed and grab some sleep while they are cooing over the baby. They will be happy to do something to help. On the other hand, they might not come back!

The Mayo Clinic offers some help – things you can try to help you to get a reasonable nights sleep as soon as possible. Some of the advice they give may work for you and your baby, but others won’t. It is all worth a try. You may discover some little tricks of your own that might help in your situation.

BABY SLEEP : HELPING BABY SLEEP DURING THE NIGHT

COUNTRY : USA

Keeping it in perspective

Getting your baby to sleep through the night is a worthy goal, but it’s not a measure of your parenting skills. Take time to understand your baby’s habits and ways of communicating so that you can help him or her become a better sleeper. If you continue to have concerns, consult your baby’s doctor for additional suggestions.

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Crying, Sleepless babies

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This little fellow is just born and is already giving two fingers to the world.

It is likely that very soon his parents will experience sleepless nights because it is normal for a young baby to need fed during the night. When babies are hungry they cry, and cry and cry. After all, how else can they communicate?

Sometimes the crying and the night wakening can go on until they are much older so it’s as well to try to get into some sort of a bed-time routine as soon as possible so that bad habits don’t set in. This is not always easy to do since babies are all different as are domestic circumstances.

There is a charity called Cry-sis that offers help for the parents of crying babies. At the time of writing this post they also offer a helpline from 9.0am to 10.0pm seven days a week.

The link below gives some advice on how to cope if your baby is crying right now:

CRYING BABIES

COUNTRY : UK

N.B. While much of the advice given in the “Cry-sis” website is helpful, I would disagree completely with some statements relating to (1) consulting a homeopath or (2) consulting a cranial osteopath whether or not they have paediatric experience. Most medical practitioners would agree this is contrary to good medical practice and such “alternative medical treatment” is without any evidence base whatsoever.

Another link gives some more advice on the routines that might help a baby and toddler sleep through the night:

SLEEPLESS BABIES

COUNTRY : UK

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Migraine

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A bad migraine is pretty horrible and can be very incapacitating. Unfortunately it is a common condition although there is marked variation in both intensity and frequency.

I suffered from migraines as a teenager and always had the feeling that they were precipitated by working in fluorescent light but never really went to the bother of proving this to myself. Fortunately for me, though, the visual aura was the worst part of it and the headache that followed was always tolerable. Fortunately too, they disappeared completely in my twenties, never to return.

MIGRAINE

COUNTRY : UK

Stages of migraine

There are five distinct stages to a migraine, although not everyone goes through all the stages:

1. ‘Prodromal’ (pre-headache) stage. Some people experience changes in mood, energy levels, behaviour and appetite, and sometimes aches and pains several hours or days before an attack.

2. Aura. Some people experience a sensation, or aura, just before their migraine starts. Symptoms of aura include flashes of light or blind spots, difficulty focusing, and seeing things as if you are looking through a broken mirror. This stage normally lasts around 15 minutes to an hour.

3. Headache stage. This is usually a pulsating or throbbing pain on one side of the head. You usually have nausea or vomiting, and extreme sensitivity to bright light and loud sounds, with a strong desire to lie down in a darkened room. This stage lasts for four to 72 hours.

4. Resolution stage. Most attacks gradually fade away. Some people find the headache stops suddenly after they have been sick. Sleep often relieves the symptoms.

5. ‘Postdromal’ or recovery phase. There may be a stage of exhaustion and weakness afterwards.

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Pregnancy : pre-eclampsia

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Pre-eclampsia is common in pregnancy and certain groups of patients are more at risk that others. This condition is one of the reasons why a close watch is kept on blood pressure and routine checks are made for ankle swelling and protein in the urine. If present, these can be the warning signs of pre-eclampsia and the mother is then watched more carefully to ensure the condition does not progress to the much more dangerous condition – eclampsia. Pre-eclampsia settles once the baby is born. If symptoms are becoming severe, the birth may be induced before term.

The link below gives information on the symptoms, causes, diagnosis, treatment and complications of pre-eclampsia.

PRE-ECLAMPSIA

COUNTRY : UK

Pre-eclampsia is a condition that affects some pregnant women during the second half of pregnancy (from around week 20) or immediately after delivery of their baby.
Women with pre-eclampsia have high blood pressure, fluid retention (oedema) and protein in the urine (proteinuria). If it’s not treated, it can lead to serious complications.
In the unborn baby, pre-eclampsia can cause growth problems.

Some factors have been identified that could increase your chance of developing pre-eclampsia. These are listed below.

WHO IS MOST AT RISK OF PRE-ECLAMPSIA?

It is your first pregnancy. Pre-eclampsia is more likely to happen during the first pregnancy than during any subsequent pregnancies.

It has been at least 10 years since your last pregnancy.

You have a family history of the condition. For example, your mother or sister has had pre-eclampsia.

You had pre-eclampsia in a previous pregnancy. There is an approximately 20% chance that you will develop the condition again in later pregnancies.

You are a teenager or are over 40.

You have an existing medical problem, for example, diabetes, kidney disease, migraines or high blood pressure.

You were obese at the start of your pregnancy (you had a body mass index of 30 or more).

You are expecting multiple babies, such as twins or triplets (this places more strain on the placenta).

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Eclampsia

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The reality of pregnancy is that it is not a cuddly, twee phenomenon.  Mothers nowadays should be relaxed about their pregnancy, delivery and post partum days because the chances are that everything will go well for mother and baby. However, there are many potential dangers associated with pregnancy and delivery. Although most mothers and babies are delivered uneventfully, when things go wrong in pregnancy they often do so quickly, dramatically and at times unexpectedly.

My view (and the view of most doctors I know) is that there is no place for a home delivery in modern society where maternity units are available for all women. I will probably repeat this time and again in this blog even although many might disagree.

One of the most serious complications of pregnancy is a poorly understood condition known as eclampsia. This can threaten the lives of both baby and mother. Fortunately, with proper antenatal care clampsia is rare, however the forerunner, pre-eclampsia is very common and when detected, treatment can usually prevent progression to the full blown and much more dangerous eclampsia.

ECLAMPSIA

COUNTRY : USA

Treatment
If you have preeclampsia your health care provider should carefully monitor you for signs of worsening and potential eclampsia. Delivery is the treatment of choice for severe preeclampsia in an attempt to prevent eclampsia. Delivering the baby relieves the condition. Prolonging the pregnancy can be dangerous to both you and your infant.

With careful monitoring, the goal is to manage severe cases until 32 – 34 weeks into the pregnancy, and mild cases until 36 – 37 weeks have passed. This helps reduce complications from premature delivery.

You may be given medicine to prevent seizures (anticonvulsant). Magnesium sulfate is a safe drug for both you and your baby. Your doctor may prescribe medication to lower high blood pressure, but you may have to deliver if your blood pressure stays high, even with medication.

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Norovirus: vomiting and diarrhoea

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Norovirus, sometimes called Norwalk virus or small round structured virus causes winter vomiting disease. Although commoner in the winter months, it can occur at any time of the year. It is the commonest cause of vomiting and diarrhoea in the UK and is highly infectious. Indeed if it appears in the hospital setting it frequently leads to ward closure since this is often the only way to contain the infection.

Hand-washing alone often is not enough to contain the virus. It is not, however, a hospital acquired infection as such and is brought in by a member of staff, visitor or patient who has acquired it in the community. It is important, therefore not to visit patients if you have recently suffered from a brief episode of diarrhoea because of the havoc this virus can cause to the everyday running of a hospital. Usually you are no longer infectious after being symptom free for 48 hours.

Norovirus is transmitted very easily in the following ways:

Not washing hands after using the toilet

Being exposed to the virus when cleaning up vomit or diarrhoea of infected person

By breathing in virus from the air e.g. after projectile vomiting

Touching surfaces that have virus on them eg toilet seats, furniture, door handles, keyboards etc.

By eating contaminated food eg oysters contaminated from sewage in sea water

Here are some commonly asked questions regarding Norovirus infection:

NOROVIRUS : FREQUENTLY ASKED QUESTIONS

COUNTRY : ENGLAND

What are the symptoms?

The most common symptoms are nausea, vomiting and diarrhoea. Symptoms often start with the sudden onset of nausea followed by projectile vomiting and watery diarrhoea. However, not all of those infected will experience all of the symptoms. Some people may also have a raised temperature, headaches and aching limbs.

Symptoms usually begin around 12 to 48 hours after becoming infected. The illness is self-limiting and the symptoms will last for 12 to 60 hours. Most people make a full recovery within 1-2 days, however some people (usually the very young or elderly) may become very dehydrated and require hospital treatment.

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