Saturday, September 12, 2015

Friday, September 4, 2015

Medical students with mental health problems do not feel adequately supported

Survey provides a snapshot of mental health problems among medical students in the UK
Over 80% of medical students with mental health issues feel they receive poor or only moderately adequate support from their medical schools, finds a small online survey published in Student BMJ today.
Of the 1,122 UK respondents, 30% (343) said they had experienced or received treatment for a mental health condition, and almost 15% (167) revealed that they had considered committing suicide while studying at medical school.
"The number of students reporting mental illness or considering suicide is shocking," says Twishaa Sheth, chair of the BMA’s student’s welfare committee, adding that "what is more concerning is the lack of independent support available for students."
Student BMJ invited its readers to take part in a survey on the health of medical students. The number of respondents represents around 2% of medical students.
The survey also asked questions about smoking, drinking and alcohol use. In total, 15.8% (177) of respondents claimed they smoked, one quarter reported binge drinking each week, and 10.9% (123) said they had taken illegal drugs more than once.
Furthermore, 8.3% (94) claimed to have tried a legal high, and the same number had used cognitive enhancing drugs to help with revision.
Reasons behind the high rates of mental health problems among medical students are "complex", writes Matthew Billingsley, Editor of the Student BMJ.
"Students often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards," he says, adding that "the demands of the course can cause an over competitive environment that can have a detrimental effect on the health of students."
Deborah Cohen, senior medical research fellow at the University of Cardiff, describes Student BMJ’s results as "concerning," but that they are in line with previous research.
A study she carried out found that 15% of 557 respondents from two large UK medical schools had substantial levels of depression and 52% reported substantial levels of anxiety.
Earlier this year, Student BMJ reported that there was not a clear separation between medical school staff with pastoral roles and those who rule on fitness to practice disciplinary issues. This raised concerns about students being able to report a problem without it affecting their final result.
In July, the General Medical Council and the Medical Schools Council issued new guidelines to clarify that teaching and pastoral roles should be separate.
Iain Cameron, chair of the MSC, says "Medical schools take the mental wellbeing of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously."
"It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support."
He adds that the MSC would like to work with Student BMJ and colleagues across the sector to promote the new guidelines and other initiatives on student mental health.
Link to research

Concern over inappropriate use of psychotropic drugs in people with intellectual disability

Over 70% of prescriptions are given to those without a record of mental illness
The proportion of people with intellectual disability in the UK who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness, finds a study published by The BMJ today.
This suggests that, in some cases, these drugs are being used to manage challenging behaviour rather than for mental illness, say the researchers. They call for changes in the prescribing of psychotropic drugs for people with intellectual disability as well as more evidence on their safety in this group.
People with intellectual disability develop severe mental illness at higher rates than do the general population and may show challenging behaviour.
Concern has existed for many years that psychotropic drugs in general - and antipsychotics in particular (mainly used to treat schizophrenia and bipolar disorder) - are overused in people with intellectual disability, but accurate estimates have been difficult to obtain.
So a team of researchers based at University College London set out to describe rates of recorded mental illness, challenging behaviour, and use of psychotropic drugs in people with intellectual disability in UK primary care.
They analysed data from 571 UK general practices using the The Health Improvement Network (THIN), a large database of electronic health records, and identified 33,016 people with a record of intellectual disability. Average age at study entry was 36 years and average follow-up was five and a half years.
Of 9,135 participants treated with antipsychotic drugs by the end of the study period, 6,503 (71%) did not have a record of severe mental illness.
Of the 11,915 with a record of challenging behaviour, 5,562 (47%) had received antipsychotic drugs, whereas only 1,421 (12%) had a record of severe mental illness.
And of those with a record of prescription of antipsychotics, 26% did not have a record of severe mental illness or challenging behaviour.
New prescriptions for antipsychotics were significantly more common in older people and in those with a record of challenging behaviour, severe mental illness, depression, anxiety, autism, dementia, and epilepsy.
People with a record of challenging behaviour were more than twice as likely to receive a prescription for antipsychotics compared with those without a record of challenging behaviour, say the authors.
Prescription of antipsychotic drugs is disproportionate to the level of recorded severe mental illness and is associated with the presence of challenging behaviour, older age, and diagnoses of autism and dementia, they add.
"Inappropriate use of drug treatment has implications for the individual and for healthcare systems," they warn. "These findings highlight the need for an improved evidence base for use of drugs and optimisation of drug treatment in people with intellectual disability."
Link to article

Wednesday, September 2, 2015


Give your Diagnosis?? and comment on X ray, microbiology  and Treatment.

GSK’s malaria candidate vaccine, Mosquirix™ (RTS,S), receives positive opinion from European regulators for the prevention of malaria in young children in sub-Saharan Africa

24 July 2015
Issued: London, UK
  • WHO will now assess how the world’s first malaria candidate vaccine might be used alongside other tools to prevent malaria
GSK announced today that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive scientific opinion for its malaria candidate vaccine MosquirixTM, also known as RTS,S, in children aged 6 weeks to 17 months. Following this decision, the World Health Organization (WHO) will now formulate a policy recommendation on use of the vaccine in national immunisation programmes once approved by national regulatory authorities.
RTS,S, which was developed in partnership with the PATH Malaria Vaccine Initiative (MVI), is the first candidate vaccine for the prevention of malaria to reach this milestone. While other vaccines tackle viruses or bacteria, RTS,S has been designed to prevent malaria caused by the Plasmodium falciparum parasite, which is most prevalent in sub-Saharan Africa (SSA). In 2013, there were an estimated 584,000 deaths from malaria with around 90% of these occurring in SSA, and 83% in children under the age of five in SSA.1
The CHMP scientific opinion is a key step in the regulatory process toward making RTS,S available alongside existing tools currently recommended for malaria prevention. The positive opinion for young children was based on the review of data assessing the candidate vaccine’s safety, efficacy and quality. Clinical data submitted for CHMP assessment were mainly from a phase III clinical trial programme involving more than 16,000 young children that was conducted by 13 African research centres in eight African countries (Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, Nigeria, and Tanzania).
Data from this trial programme demonstrate that over the first 18 months following three doses of RTS,S, malaria cases were reduced by almost half in children aged 5-17 months at the time of first vaccination and by 27% in infants aged 6-12 weeks. At study end, four doses of RTS,S reduced malaria cases by 39% over four years of follow-up in children, and by 27% over three years of follow-up in infants.2  In areas of the highest malaria burden, more than 6,000 clinical malaria cases were prevented over the study period for every 1,000 children vaccinated.2 The efficacy of RTS,S was evaluated in addition to existing malaria control measures, such as insecticide treated bed nets, which were used by approximately 80% of the children and infants in the trial.
Sir Andrew Witty, CEO of GSK said: “Today’s scientific opinion represents a further important step towards making available for young children the world's first malaria vaccine. While RTS,S on its own is not the complete answer to malaria, its use alongside those interventions currently available such as bed nets and insecticides, would provide a very meaningful contribution to controlling the impact of malaria on children in those African communities that need it the most. The work doesn’t stop here and GSK remains committed to investing in R&D for malaria vaccines and treatments to find more ways to tackle this devastating disease.”
Dr David C. Kaslow, Vice President of Product Development at PATH said: “Today marks a significant scientific milestone for the long-standing partnership to develop a vaccine, yet several more steps remain before a malaria vaccine might reach the young children in Africa who most need protection against this deadly human parasite. PATH will continue to work with GSK and other partners to ensure that the evidence is available, as soon as possible, to support informed decision-making on those remaining steps.”
GSK has committed to a not-for-profit price for RTS,S so that, if approved, the price of RTS,S would cover the cost of manufacturing the vaccine together with a small return of around five per cent that will be reinvested in research and development for second-generation malaria vaccines, or vaccines against other neglected tropical diseases.
Next steps
Following the CHMP positive scientific opinion, two of the WHO’s independent advisory groups, the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Committee (MPAC) will now jointly review the evidence base for RTS,S and make a joint policy recommendation for how it might be used alongside other tools to prevent malaria in the event the vaccine candidate is approved by national regulatory authorities in SSA. The WHO has indicated that such a policy recommendation may be possible by end of this year.
Following the WHO policy recommendation, GSK will also submit an application to the WHO for pre-qualification of RTS,S. WHO pre-qualification involves a scientific assessment of the quality, safety and efficacy of any new vaccine proposed for introduction in WHO Expanded Programme on Immunization. A pre-qualification decision is used by the United Nations agencies and other large scale public procurement agencies to help inform vaccine purchasing decisions.
Once a WHO pre-qualification is granted, GSK would then apply for marketing authorisation in countries in sub-Saharan Africa on a country-by-country basis. These regulatory and policy decisions would, if positive, enable countries to begin implementation of RTS,S through their universal immunisation programmes.
Both a WHO policy recommendation and WHO pre-qualification are requirements for Gavi, the Vaccine Alliance, to support eligible African countries introducing RTS,S into local immunisation programmes supported by UNICEF.
Notes to Editors
  • Mosquirix is the brand name given to this malaria candidate vaccine. Its scientific name, RTS,S, reflects the composition. RTS,S also contains the AS01 adjuvant system.[i]
  • RTS,S aims to trigger the body’s immune system to defend against the Plasmodium falciparum malaria parasite when it first enters the human host’s bloodstream and/or when the parasite infects liver cells. It is designed to prevent the parasite from infecting, maturing and multiplying in the liver, after which time the parasite would re-enter the bloodstream and infect red blood cells, leading to disease symptoms.
  • The safety and efficacy of RTS,S has been evaluated in a large-scale phase III trial, in which it was administered in three doses, one month apart, with an additional fourth dose given 18 months later. Results from this trial have consistently demonstrated that RTS,S can help to protect children against malaria in endemic countries, when used in addition to other malaria control measures such as bed nets.
  • RTS,S is the most advanced malaria vaccine candidate in development globally. It was created in 1987 by scientists working at GSK laboratories. Early clinical development was done in collaboration with the Walter Reed Army Institute for Research. In January 2001, GSK and PATH, with grant monies from the Bill & Melinda Gates Foundation to PATH, entered into a public-private partnership to develop an RTS,S-based vaccine for infants and young children living in malaria-endemic regions in sub-Saharan Africa.
  • GSK has invested more than $365 million to date and expects to invest a further $200 to $250 million until development is completed. Between 2001 and the end of 2014, the MVI, supported by grants from Bill & Melinda Gates Foundation, invested more than $200 million to advance the RTS,S project.
  • The EMA’s CHMP opinion is a final stage in the Article 58 procedure initiated in July 2014, by which the CHMP gives a scientific opinion, in co-operation with the World Health Organization (WHO), on a medicinal product for human use that is intended exclusively for markets outside of the European Union (EU). This assessment requires medicinal products to meet the same standards as those intended for use in the EU.

2.      RTS,S Clinical Trials Partnership, The Lancet. 2015; 386 (9988): 31–45.

Friday, August 28, 2015

BMJ comes out with review article on Febrile seizures

This clinical review summarises how to recognise a febrile seizure and rule out other underlying causes. How to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Comparative effectiveness and tolerance of treatments for H pylori

This network meta-analysis compares different eradication treatments forHelicobacter pylori.This showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, levofloxacin based triple treatment, hybrid treatment and sequential treatment might be most effective for eradicating H pylori.
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