GSK replace Serevent CFC-containing inhaler with CFC-free Serevent Evohaler
Fri, 23 Dec 2005 00:00 - NeLM Headline News
GlaxoSmithKline have distributed a letter to healthcare professionals informing them that the CFC free version of Serevent (salmeterol) – Serevent Evohaler™ will be introduced from January 2006. Distribution of CFC-containing Serevent will be stopped at the same time. The letter notes that Serevent Evohaler is equivalent to Serevent inhaler in terms of dose, efficacy, safety and price. The CFC free inhaler is also the same size, shape and colour as the CFC-containing inhaler. However, patients may notice a difference in the taste, sound or feel of the Evohaler. The letter is attached below for information.

Pfizer's smoking cessation drug (varenicline tartrate) gets priority review in the US
Fri, 23 Dec 2005 00:00 - NeLM Headline News
According to Pharmatimes, the US Food and Drug Administration (FDA) will give a priority review to Pfizer's anti-smoking drug Champix™ (varenicline tartrate). A priority review means that the usual 10-12 month review period is reduced to six months. However, this does not mean that the FDA will reach a decision within 6 months from now, as the Champix filing will only move forward once the FDA formally determines the application is sufficiently complete for review. Champix is the first non-nicotinic drug specifically developed for use in smoking cessation and works by easing the symptoms of smoking withdrawal by activating the same brain receptor stimulated by nicotine from a cigarette. According to World Health Organisation figures, every eight seconds a person dies of a smoking-related disease, and less than 7% who try to quit on their own manage to abstain for more than one year, with most relapsing after just a few days.

Sanofi Aventis to replace CFC-containing Tilade inhaler and discontinue Intal inhaler
Fri, 23 Dec 2005 00:00 - NeLM Headline News
Sanofi Aventis have distributed a letter to healthcare professionals informing them of the following: • The current CFC containing version of Tilade™ (nedocromil sodium) is being discontinued and replaced with a CFC free inhaler. This change will happen in December 2005. The company add that one important difference is that patients clean their inhalers following instructions in the patient information leaflet. If it is not cleaned regularly, it will become blocked. • The CFC containing Intal™ inhaler (sodium cromoglycate) will be discontinued

250,000 Brits to call on NHS this Christmas
Fri, 23 Dec 2005 00:00 - NeLM Headline News
Net Doctor reports that over 250,000 people could use the NHS' out-of-hours services this festive season for cough, cold and contraceptive advice. Britons are being reminded that they can now 'get the right treatment' from a full range of healthcare help and advice services, such as pharmacies, NHS Direct (both telephone and online advice), NHS walk-in centres or minor injury units. The Department of Health is forecasting the busiest year ever for the growing range of NHS out-of-hours services this Christmas. The predictions for this year are based on an England-wide survey of visits to walk-in centres last Christmas Day and hits and calls to over the last festive period. Speaking on a visit to a walk-in centre in Lewisham, south London, public health minister Caroline Flint pointed out that some people may run out of regular medication over the four-day festive bank holiday this year and warned patients to be prepared by visiting their GP or pharmacist and stocking up. The government is launching a new “Get the Treatment” campaign aimed at persuading people to seek the right health professional to suit their needs.

Oseltamivir resistance in avian flu a cause for concern
Thu, 22 Dec 2005 00:00 - NeLM Headline News
A case report in today's NEJM describes a patient with influenza A (H5N1) virus ('avian flu') infection who initially responded to oseltamivir but subsequently deteriorated and died. Analysis of virus samples from the patient found infection with a strain resistant to oseltamivir due to a single mutation in the neuraminidase gene. The patient described was a 13-year old Vietnamese girl who was admitted to hospital with a history suggestive of influenza infection; her mother had died the day before of confirmed avian flu infection after a single day's oseltamivir treatment. The patient was started immediately on oseltamivir at recommended doses for her age. She remained stable for three days, but on the fourth day she started to deteriorate and she died three days later. Analysis of virus samples from throat swabs taken on day four revealed infection with a mutant virus with high-level resistance to oseltamivir, with small numbers of a sensitive (wild-type) population present. Samples from other patients of the same hospital who had proven influenza A (H5N1) virus infection were analysed. This found that in those who survived there was a rapid decline in viral load to undetectable levels, whereas in those who died the virus was still detectable after oseltamivir treatment. Where analysis of admission samples was possible, only wild-type virus was found, however the resistant strain was shown to have been present at the end of treatment in at least one. The authors conclude that they isolated influenza A (H5N1) virus with a single-point mutation conferring high-level resistance to oseltamivir from two patients, both of whom died. They note that the patient described was treated with a relatively high dose for her weight, and that treatment started during the optimum time period for success. Her treatment course suggests that the development of viral resistance during treatment contributed to failure of therapy and her death. They discuss the implications of their findings and suggest that in some patients at least, recommended doses of oseltamivir are inadequate to suppress viral replication completely. Such incomplete suppression not only allows the infection to proceed, but also encourages the development of resistance. New treatment strategies aimed at increasing anti-viral efficacy are needed. Two accompanying Perspective articles discuss issues around the use of oseltamivir for avian flu. One considers the direct implications of the case report. The author discusses the mechanism of resistance to oseltamivir, and notes that zanamivir is not affected by the particular mutation described due to its molecular structure. She notes that there is now particular concern over individual stockpiling of oseltamivir, as this is more likely to lead to inappropriate use and inadequate dosing; there is also concern that patients will not complete appropriately prescribed courses with similar results. There is also a question over the whether current doses and treatment duration are sufficiently effective against this virus. She concludes that this case report confirms oseltamivir resistance as a reality, and that strategies against a potential pandemic must take this into account so as to minimise the risk of selecting for resistant strains. The second Perspective discusses the dilemma presented by the patient who requests a prescription for oseltamivir as a precaution. Based on existing information and knowledge, the author concludes that physicians have no obligation as individual patient basis to prescribe the drug under such circumstances as the chance of individual benefit is small. When examined from a public health perspective, personal stockpiling gives no overall benefit and is likely to result in overall harm. This is because such activity diverts supplies from where they are most needed, and leads to a high risk of chaotic and ineffective use with consequent encouragement of the development of resistant strains. On pub

Long distance travel and DVT risk- report by Dept of Transport
Thu, 22 Dec 2005 00:00 - NeLM Headline News
According to research funded by the Department for Transport, the Department of Health and the EC, and carried out under the auspices of the WHO, long-distance travel does lead to increased risk of DVT. The research found that: • All forms of transport involving a journey of four hours or more leads to an increase in the risk of DVTs. • In a study of air passengers of working age, 1 case of DVT was found for every 6000 journeys that lasted 4 hours or more. According to the Transport Minister: • Every year, DVT occurs in about 1-3 per 1000 people in the general population, ranging from fewer than 1 in 3000 in people under the age of 40 up to 1 in 500 in those over 80. • In all incidences of DVT, only 1% of cases prove to be fatal. • Incidences of DVT are generally low, but long journeys were found to increase the risk approximately three-fold (comparable to the risk of DVT during pregnancy). • People who are at higher risk, include older people, those with hereditary blood conditions, users of oral contraception, those on journeys of more than 12 hours and very tall people. The Minister recommended that all travellers refer to the Department of Health's advice on this subject, available from link above.

Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer
Thu, 22 Dec 2005 00:00 - NeLM Headline News
According to a report in the Journal of Clinical Endocrinology and Metabolism, men with prostate cancer on androgen deprivation therapy (ADT) have a 5- to 10-fold increased loss of bone density at multiple skeletal sites, compared with those not on ADT or healthy controls. These findings come from a 12-month prospective study at an American medical centre, involving 152 men with prostate cancer (30 with acute ADT, < 6 months; 50 with chronic ADT, 6 months or more; and 72 with no ADT), and 43 healthy age-matched controls. The main outcome measures were bone mineral density (BMD) of the hip, wrist, total body, and spine; body composition; and markers of bone turnover. After 12 months: • Those on acute ADT had a mean reduction in BMD of 2.5% at the total hip, 2.4% at the trochanter, 2.6% at the total radius, 3.3% at the total body, and 4% at the posteroanterior spine (all p < 0.05). • Men with chronic ADT had a 2.0% reduction in BMD at the total radius (p < 0.05). • Healthy controls and men with prostate cancer not on ADT had no significant reduction in BMD. • Both use and duration of ADT were associated with change in bone mass at the hip (p < 0.05). • Men on acute ADT had a 10.4% increase in total body fat and a 3.5% reduction in total body lean mass at 12 months, whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls (p < 0.05). • Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls (p < 0.05). • Men in the highest tertile of bone turnover markers at 6 months had the greatest loss of bone density at 12 months. The researchers conclude from these findings that use of ADT in prostate cancer patients is linked to a 5- to 10-fold increased loss of bone density at multiple skeletal sites, compared with controls, placing them at increased risk of fracture. They add that as bone loss is maximal in the first year after initiation of ADT, the use of early preventative therapy should be considered.

Excess risk of fatal CHD associated with diabetes: a meta-analysis
Thu, 22 Dec 2005 00:00 - NeLM Headline News
A meta-analysis published early online in the BMJ has attempted to estimate the relative risk (RR) for fatal CHD associated with diabetes in men and women. The analysis included 37 studies published between 1966 and March 2005, of type 2 diabetes and fatal CHD among 447,064 patients. The following findings are reported: • Rate of fatal CHD was higher in patients with diabetes than in those without (5.4 v 1.6%); overall summary RR for fatal CHD in patients with diabetes vs no diabetes was greater among women than among men (3.50, 95% CI, 2.70 to 4.53 v 2.06, 1.81 to 2.34). • After exclusion of 8 studies that had adjusted only for age, the difference in risk between the sexes was reduced: pooled ratio of the RR (women: men) from the 29 studies with multiple adjusted estimates was 1.46 (1.14 to 1.88). The researchers conclude that “the RR for fatal CHD associated with diabetes is 50% higher in women than it is in men. This greater excess coronary risk may be explained by more adverse cardiovascular risk profiles among women with diabetes, combined with possible disparities in treatment that favour men.”

Judge orders Swindon PCT to fund trastuzumab (Herceptin) in early breast cancer pending full court hearing
Thu, 22 Dec 2005 00:00 - NeLM Headline News
Reuters has reported that a British High Court judge has instructed Swindon PCT to fund Roche's Herceptin™ (trastuzumab) for a woman with early stage breast cancer, pending a full court hearing. In a statement, the PCT's Director of Public Health who denied that the decision had been taken on the basis of cost alone, said “at present the available evidence of the efficacy and safety of the treatment for early stage breast cancer is insufficient to make reliable judgements. We await advice on prescribing of Herceptin from NICE. Until this time, in accordance with many other PCTs, we will continue to review every request for Herceptin on a case by case basis taking into account the individual circumstances of each patient.”

HPA National Influenza Report: 12/12/05-18/12/05 (Week 50/05)
Thu, 22 Dec 2005 00:00 - NeLM Headline News
The Health Protection Agency has issued the weekly national influenza report for week 50, which can be accessed via the link above. It notes that influenza activity in the UK remained within baseline levels during this period.

Dept Health issues guidance on cosmetic surgery and non-surgical cosmetic treatments
Thu, 22 Dec 2005 00:00 - NeLM Headline News
The Dept Health has issued guidance on cosmetic surgery and non-surgical cosmetic treatments, to help patients make an informed decision about whether or not to these treatments. The guidance has been compiled to meet the requirements of the Report of the Expert Group on the Regulation of Cosmetic Surgery. The following subjects are covered: • Considering a surgical or non-surgical procedure? • A - Z list of cosmetic procedures • Qualifications - what they mean • When the results of your surgery are not what you expected • Cosmetic surgery useful links • What do we mean by “cosmetic surgery” and “non-surgical cosmetic treatments”?

HTA publication: Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis
Wed, 21 Dec 2005 00:00 - NeLM Headline News
A systematic review published by the NHS Health Technology Assessment Programme has assessed the benefits in terms of reductions in the risks of deep vein thrombosis (DVT) and of pulmonary embolism (PE), and hazards in terms of major bleeding (in surgical and medical patients), of: • mechanical compression • oral anticoagulants • dextran • regional anaesthesia (as an alternative to general anaesthesia) The authors made the following concluding statement: “In the absence of a clear contraindication (such as severe peripheral arterial disease), patients undergoing a surgical procedure would be expected to derive net benefit from a mechanical compression method of thromboprophylaxis (such as graduated compression stockings), irrespective of their absolute risk of venous thromboembolism. Patients who are considered to be at particularly high risk of venous thromboembolism may also benefit from a pharmacological thromboprophylactic agent, but since oral anticoagulant and dextran regimens appear less effective at preventing DVT than standard low-dose unfractionated heparin or low molecular weight heparin regimens, they may be less suitable for patients at high risk of venous thromboembolism, even though they are associated with less bleeding. Whenever feasible, the use of regional anaesthesia as an alternative to general anaesthesia may also provide additional protection against venous thromboembolism. There is little information on the prevention of venous thromboembolism among high-risk medical patients (such as those with stroke), so further randomised trials in this area would be helpful.”

Healthcare agencies urge the NHS to step up measures to minimise risk of patients contracting Clostridium difficile
Wed, 21 Dec 2005 00:00 - NeLM Headline News
The Health Protection Agency and the Healthcare Commission have urged the health service to do more to minimise the risk to patients of Clostridium difficile (C. difficile). The request comes following interim findings of a joint survey which revealed that over a third of trusts surveyed do not routinely follow government guidelines on the management of C. difficile infection in their hospitals. The two organisations make the following recommendations for trusts: • “Ensure that their policies on antibiotic prescribing are informed by current guidelines on best practice, and that these policies are properly monitored. Current guidance states that trusts should have up-to-date guidelines for treating specific infections, policies to reduce inappropriate administration of broad-spectrum antibiotics, and regularly monitor antibiotic usage through audit and feedback to prescribers. • Review their procedures and capacity to isolate patients with C. difficile. The isolation of patients is an effective method of rapidly controlling the spread of infection. • Ensure that they understand the criteria for testing and reporting samples of C. difficile, and that they comply with the scheme for mandatory surveillance introduced last year. This requires that all NHS trusts report to the HPA the number of cases of infection caused by C. difficile diagnosed in patients 65 years of age and older”. Some of the results reported showed: • “Thirty eight per cent of trusts surveyed said they do not have restrictions in place to prevent the inappropriate use of antibiotics, which would help to minimise the risk of C. difficile infection • Over a third of respondents reported that they are unable to routinely isolate patients with C.difficile infection. Only 11% of trusts said they have a ward that can be used for isolating patients with C. difficile. • Less than half of trusts surveyed use the same recognised definition of an outbreak. Forty percent reported that, in the event of an outbreak, they do not routinely follow guidance, which recommends that they should inform the consultant in communicable disease control. • Most of the trusts surveyed also reported that they do not routinely inform the relevant authority that is responsible for monitoring their performance i.e. the strategic health authority, or Monitor in the case of NHS foundation trusts. • Two-thirds of respondents felt that the reported incidence of C. difficile infection has increased in their trust during the past three years. • A quarter of trusts reported they had closed wards in the past 12 months due to cases of C. difficile • Over two thirds of trusts thought that the prescribing of antibiotics and the lack of facilities for isolation represented the greatest challenges to controlling infection. • Sixty-five per cent of trusts reported that they do not routinely record information on deaths from C. difficile.” The Healthcare Commission and the Health Protection Agency will incorporate learning from these interim findings, and the final report, into their respective programmes of work.

CMO and CNO issue letter regarding C-difficile infection control
Wed, 21 Dec 2005 00:00 - NeLM Headline News
The Chief Medical Officer and Chief Nursing Officer have issued a letter to NHS Trust Chief Executives to remind them of: • the requirements of the mandatory surveillance scheme operated on behalf of the Department of Health by the Health Protection Agency (HPA) • recommendations for microbiological investigation of outbreaks • the need for policies and procedures to be in place to minimise the risk of C. difficile infection and implement control policies when cases occur.

Flu vaccine not as effective as studies suggest, say researchers
Wed, 21 Dec 2005 00:00 - NeLM Headline News
According to an article published in The Guardian, a report published in the International Journal of Epidemiology suggests that there is evidence of serious bias in most studies investigating the flu vaccine. According to the authors of the report, most studies did not take into account the fact that healthier elderly people, who were less at risk of dying, were more likely to be vaccinated. The research did however point out that this did not mean the vaccine was ineffective, only that "...other methods for evaluations of influenza vaccine effectiveness should be further explored".

No difference in total treatment costs when comparing starting treatment with older conventional antipsychotics and starting treatment with olanzapine for schizophrenia?
Wed, 21 Dec 2005 00:00 - NeLM Headline News
BioSpace has reported that according to a study published in the journal Value in Health, requiring people with schizophrenia to first fail on an older, inexpensive generic antipsychotic before allowing them to switch to the newer antipsychotic Zyprexa (olanzapine) may not result in cost savings overall. According to the authors of the study, data showed that despite higher medication costs of olanzapine, the difference in one-year direct total costs between olanzapine as initial (first-line) treatment, and conventional antipsychotics as first line treatment, was small and not statistically significant, and findings indicated that any savings on medication costs were offset by the increased costs of other services associated with treatment with conventional antipsychotics, including hospitalisations, crisis interventions and emergency room visits. Researchers in this study also compared the cost-effectiveness of olanzapine (mean modal dose 13.49 mg/day) and risperidone (mean modal dose 4.95 mg/day) as first-line treatment for schizophrenia and found the total costs associated with the two medications to be similar and not significantly different from each other. The 1 year, multi-centre, open-label study involved 664 patients with schizophrenia who were randomised to receive either olanzapine as first-line treatment (n=229), first-line treatment with conventional antipsychotics such as perphenazine, loxapine, haloperidol, thiothixene, fluphenazine (maximum of two consecutive agents before a possible switch to Zyprexa, n=214), or risperidone as first-line treatment (n=221). Barring any clinically significant adverse events, all patients were to remain on their randomised treatment regimen for at least eight weeks, but could continue on their initial treatment regimen for as long as clinically indicated during the one-year trial. Results were analysed from the perspective of the public payer health care system and included total direct treatment costs and the treatment effectiveness for patients with schizophrenia, measured in both clinical and social terms. Total direct costs reflected resources considered to be "mental health" or "psychiatric" (e.g., antipsychotic/psychotropic medications, psychiatric hospitalisations, outpatient visits to psychiatrists, etc.), as well as resources considered to be "non-psychiatric" (e.g., non-psychotropic medications, hospitalisations for physical illnesses, primary care physician visits, etc.). Clinical effectiveness was measured using the Brief Psychiatric Rating Scale (BPRS) and social effectiveness was measured using the Lehman Quality of Life Scale (LQLI) social relations scores. The study was designed to compare the clinical and social effectiveness and total direct costs of treatment with different antipsychotics.. Researchers reported the following results: • Total one-year mean direct costs were $20,891 for olanzapine, $21,283 for conventional antipsychotics, and $21,347 for risperidone (the differences were not statistically significant). • Approximately half of patients who began the study on conventional antipsychotics switched to an atypical antipsychotic, and rates of switching from the initial antipsychotic were significantly lower for olanzapine than for the conventional antipsychotics (14% vs. 53%, p < 0.001) or risperidone (14% vs. 31%, p < 0.001). • For patients who required a switch from their initial antipsychotic to another, there was a saving of $195 in yearly medication costs but, this was offset by an additional $3,741 needed for other services of which more than 70% were for acute inpatient/outpatient services such as hospitalisations, partial hospitalisations, crisis interventions and emergency room visits. • Olanzapine was significantly more effective than conventional antipsychotics on both clinical symptoms (BPRS) (p=0.025) and social relations (LQLI) (p=0.043), and compared to risperidone on social relations (p=0.002).

Bee-sting therapy shown ineffective in MS
Wed, 21 Dec 2005 00:00 - NeLM Headline News
A small controlled crossover study has found that bee-sting therapy, a popular alternative treatment for multiple sclerosis (MS), had no objective or subjective benefits over a 24-week period. The trial included 26 patients with relapsing-remitting or relapsing secondary progressive MS, who were randomised to treatment with 24 weeks of bee-sting therapy under medical supervision or 24 weeks no treatment. Bee-sting therapy was given three times a week, and patients received gradually increasing numbers of stings up to 20 per session. All were monitored for the development of allergic reactions. At the end of each period, patients crossed over into the other group. Primary outcome was the cumulative number of new gadolinium-enhancing lesions on T1-weighted brain MRI; secondary outcomes measured were lesion load on T2*-weighted MRI, relapse rate, and disability, fatigue, and health-related quality of life measured using standard techniques. The results showed no significant differences between the two treatment periods in either the primary outcome or in any of the secondary outcomes. Treatment was, however, well tolerated and there were no serious adverse events. The authors conclude that in their trial “treatment with bee venom in patients with relapsing multiple sclerosis did not reduce disease activity, disability, or fatigue and did not improve quality of life.” As a result, patients should be advised to refrain from using it unless better evidence for benefit becomes available. They note that although the trial was small, the measurement technique used - serial T1 weighted gadolinium-enhanced MRI - is a sensitive and reliable tool for detecting disease activity in MS.

Obesity linked to visible temptation
Tue, 20 Dec 2005 00:01 - Telegraph Health
Scientists have found that the more you see, the more you are likely to eat - and they have tempted women with chocolate to prove the point.

Further data presented for Gardasil HPV vaccine
Tue, 20 Dec 2005 00:00 - NeLM Headline News
Further data regarding the efficacy of Gardasil, a prophylactic quadrivalent human papillomavirus (HPV) vaccine, have been presented at the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy. This data covers the efficacy against types 6, 11, 16 and 18. Phase III results of the efficacy of Gardasil against types 16 and 18 were presented earlier on this year. According to the Reuters report, the data came from a randomised, double-blind, placebo-controlled trial of over 5,000 women aged 16-24 years, who were serological negative and HPV DNA negative at baseline. A total of 93% of the women received three vaccine doses over the course of a year. After seven months, the researchers noted that "there were no cases in the vaccine group of women developing any 6-, 11-, 16-, or 18-related cervical lesions, whereas there were 37 in the placebo group. This gives us a 100% efficacy with fairly narrow confidence intervals. For vulvar/vaginal lesions, there were 40 cases in the placebo group, and in the vaccine group - zero, again giving us 100% efficacy with very tight confidence intervals." When analysed on an intention-to-treat basis, the efficacy rate was 97% in preventing cervical intraepithelial neoplasia or cancer and 95% in preventing genital warts and vulvar or vaginal neoplasia. There was no further detailed statistical information presented in the abstract – the data was from a presentation only and has not been published.

Meta-analysis of cephalosporins versus penicillin for ‘strep throat’
Tue, 20 Dec 2005 00:00 - NeLM Headline News
The results of a meta-analysis looking at treatment of Group A streptococcal tonsillopharyngitis (GAST) have been reported in the news today. The results were presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington. The conclusion of the study was that bacterial failure is significantly less likely if an oral cephalosporin is prescribed (for 4-5 days or 10 days) versus 10 days of penicillin. A total of 47 trials (n=11,426) comparing penicillin and cephalosporin treatment of GAST were included in this analysis (25 US and 10 European trials of 10 days cephalosporin versus 10 days penicillin, 3 US and 9 European trials of 4-5 days cephalosporin versus 10 days of penicillin). The following results for bacterial cure rate were presented in abstract: • 10-day cephalosporin trials = odds ratio (OR)=2.70 (95% CI 2.15-3.37, p=0.0001) and 4.27 (3.13-5.83, p=0.0001) for US and European trials respectively • short-course cephalosporin trials = OR=2.41 (1.76-3.30, p=0.0001) and 1.30 (1.03-1.64, p=0.0001) for US and European trials, respectively As this research has been presented in abstract form only, further details on methodology and results are not available. According to a NetDoctor report on these findings, the researchers found that 18% who took amoxicillin needed further treatment within weeks while around 25% of those who were given penicillin also need other treatment. The team also noted that there was a higher failure rate when the first generation cephalosporins were administered versus newer generations (no detailed statistical data reported for these findings). According to a BBC report, Dr Robert George, director of the Respiratory and Systemic Infection Laboratory and a consultant medical microbiologist for the Health Protection Agency, said: "The World Health Organisation continues to recommend penicillin as the first line of treatment for strep throat and the Health Protection Agency guidance is in accordance with this." (see link above for HPA guidelines). He added: "Although prescribing cephalosporins might reduce a strep throat infection in a shorter time period, the effects of using a more potent antibiotic must be considered." He also warned of the increased risk of resistance if antibiotics were used more regularly for strep throat.

Health Select Committee report recommends wider ban on smoking
Tue, 20 Dec 2005 00:00 - NeLM Headline News
The Department of Health has issued a press release regarding the Health Select Committee's report on smoking in public places, which was published on Monday 19th December. The Health Committee report recommends that ‘the Government introduce a comprehensive ban on smoking in all public places and workplaces, which includes Crown property and which has very limited exemptions’. Please see the links above for further details.

The Patients Association survey – public perception of patient rights
Tue, 20 Dec 2005 00:00 - NeLM Headline News
According to the results of a survey carried out by the Patients Association, NHS patients in the UK are under the impression that they have more rights than they actually do. According to the report entitled ‘The Public Perception of Patients Rights within the UK National Health Service’, members of the public want to know far more about the quality of the healthcare providers, the treatments they are offered and the healthcare options that are available to them (please see the link above for the full report). Some examples of the statistics uncovered are as follows: • 90% believe that the NHS gives patients the right to be treated in a hospital that meets government standards; • 80% are under the impression that they are entitled to receive information about the quality of the performance of the hospital they are due to attend; • 75% think they have a right to a second opinion on the NHS; • 75% believe they have the right to be protected against medical error while attending hospital; • 67% say they have the right to be treated, or to have an operation, before their condition gets worse; and • 50% believe they have the right to receive information about the quality and performance of their GP.

Expanded license for Nicorette products
Tue, 20 Dec 2005 00:00 - NeLM Headline News
Nicorette gum, patches, tablets and inhalator are now indicated for the relief of nicotine withdrawal symptoms as an aid to smoking cessation in children over 12 years of age. As data are limited in this age group, the recommended treatment duration is 12 weeks. If longer treatment is required, advice from a healthcare professional should be sought. The Nicorette products listed above are also now indicated in pregnant and lactating women. The decision to use nicotine replacement therapy (NRT) in pregnant women should be made after a risk-benefit assessment and as early on in the pregnancy as possible, with the aim of discontinuing use as soon as possible. For lactating women, the SPCs recommend using intermittent dose NRT preparations to minimize the amount of nicotine in the breast milk, as the time between administrations of NRT and feeding can be more easily prolonged.

‘Hitting the headlines’ assessment of Cervarix (cervical cancer vaccine) study
Tue, 20 Dec 2005 00:00 - NeLM Headline News
As part of the "Hitting the Headlines" service on the National Electronic Library for Health (NELH) website, a quality assessment of a Cervarix (cervical cancer vaccine) trial involving adolescents and young women is now available. This was featured on NeLM news yesterday (see link), with data being reported by Reuters and various national newspapers. According to the data reported, the response was greater in those girls aged 10-14 years than in those aged 15 to 25 years. As the newspaper reports appear to be based on an abstract of a conference presentation, it is not possible to evaluate the research as full details of the study are not available.

Cervical cancer vaccine more effective in 10-14 year olds?
Mon, 19 Dec 2005 00:00 - NeLM Headline News
According to a report in the Daily Telegraph and Reuters, girls aged 10 to 14 who received a new cervical cancer vaccine, Cervarix (GlaxoSmithKline) had an immune response to the human papilloma virus that was twice as strong as women 15-25 years old given the vaccine. The findings come from a phase III trial which was not designed to confirm the effectiveness of the vaccine in the 10-14 year age group. The trial, conducted in Europe and Russia, involved 158 healthy girls aged 10-14 and 458 women aged 15-25 who received three doses of the vaccine over a six month period. However these findings may cause controversial debate as some may argue that allowing younger children to receive the cervical cancer vaccine may promote sexual activity at an earlier age. Cervarix, has not yet been submitted for regulatory approvals. It is expected to be the main competitor of Gardasil, the cervical cancer vaccine developed by Merck

NICE issues guide on how to implement its guidance
Mon, 19 Dec 2005 00:00 - NeLM Headline News
NICE has published a guide that aims to help organisations achieve the following : • implement NICE guidance and other national policy • comply with core and developmental standards set in ‘Standards for better health’ • meet the Healthcare Commission’s expectations This guide is split into three parts – the first two focus on organisations directly responsible for implementation, and the third focuses on commissioning organisations. The guide is based on NICE’s work with NHS organisations across the country, feedback received from workshops, and published literature.

MHRA ban African herbal products with toxic ingredients
Mon, 19 Dec 2005 00:00 - NeLM Headline News
The Medicines and Healthcare products Regulatory Agency (MHRA) has taken the African herbal products “M2” and “Energy 2000”, off the UK market with immediate effect. The total ban follows the MHRA warning given earlier this month when it became aware that these products contained toxic ingredients that could cause life threatening conditions including kidney failure, cancer and heart related problems.

Health Survey of England - 2004
Mon, 19 Dec 2005 00:00 - NeLM Headline News
The Health Survey for England is a series of annual surveys designed to measure health and health related behaviours in adults and children living in private households in England. Their 2004 survey show the following key findings: • Fewer people are smoking, although there are now slightly more female than male smokers. Between 1993 and 2004 the number of men who smoke dropped from 28% to 22%, while the percentage of women who smoke has moved from 26% to 23%. • There was some variation in alcohol consumption across the age ranges, with younger men and women being more likely to exceed the guidelines of four units for men and three units for women. Among women aged 16-24, the proportion consuming more than three units increased from 39% in 1998, to 49% in 2002, falling to 43% in 2004. • Fruit and vegetables are playing a greater part in the nation’s diet. The numbers eating a minimum of five portions of fruit and vegetables a day increased from 22% to 24% for men and 25% to 27% for women between 2001 and 2004. • More people are exercising. Between 1997 and 2004 the numbers of adults taking a minimum of 30 minutes of at least moderate exercise five times a week or more, increased. Men continue to exercise more than women, rising from 32% to 35% for men and 21% to 24% for women. • Since 1995, mean Body Mass Index has increased among boys (from 17.6 to 18.1) and girls (from18.0 to 18.4) aged 2-15. This rise, although small, is nevertheless an indicator that children in England are on average getting bigger.

Novartis fails to win EU support for Zelnorm™
Fri, 16 Dec 2005 00:00 - NeLM Headline News
A European Medicines Agency committee has decided not to back the use of Novartis' Zelnorm™ (tegaserod maleate) for the treatment of women with irritable bowel syndrome-induced constipation. According to Pharmatimes, Novartis said it will appeal the decision. The drug is currently used in 56 countries across the world, including the USA. However, the drug has been associated with safety concerns, leading the US Food and Drug Administration to add a stronger warning on its label regarding an increased risk of serious diarrhoea and a condition where blood flow to the intestines is affected.

Irish study finds primary care prescribing of antidepressive drugs to children has fallen
Fri, 16 Dec 2005 00:00 - NeLM Headline News
A pharmacoepidemiological study using data from an Irish primary care claims database found that over the period January 2001 to August 2004, prescribing of antidepressive drugs to children decreased. Use of SSRIs in children, however, was unchanged. The authors used data from the claims database of Irish General Medical Services, which provides means-tested free health services to about 30% of the Irish population (n=1.24 million). They identified all people who had been prescribed an antidepressive drug between the indicated dates and categorised them as child (age 0-15) or adult (age 16+). Analysis showed that in 2003, antidepressives were prescribed to 0.43% of children and 16.9% of adults, with a disparity towards females (odds ratio for girls 1.60 and for women 1.40). Type of antidepressive used was similar in adults and children, SSRIs being most commonly used. A majority of the children (58%) received only one prescription, whereas a majority of the adults (66.5%) received three months worth or more. Between January 2001 and August 2004, the overall trend in prescribing of these drugs for children showed a significant reduction. For SSRIs, however, there was no significant downward trend. Prescribing for adults showed an upward trend over the period. The authors conclude that there was a decrease in prescribing of antidepressive treatment to children over time overall, but that prescribing of SSRI did not change despite warnings from regulatory authorities. They note that a majority of children only received one month's treatment, although this may be of limited efficacy. They suggest that prescribers may need to receive regular reminders about potential safety problems and efficacy with antidepressants in children especially in the first few weeks of treatment. They note some limitations of their study - diagnostic data were not available, and social disadvantage is over-represented in the database.

Minister challenged over DoH’s decision on Herceptin™
Fri, 16 Dec 2005 00:00 - NeLM Headline News
BMJ news reports that the minister for quality and patient safety has said that the NHS should not use the fact that the National Institute for Health and Clinical Excellence (NICE) has not yet provided guidance on a treatment to refuse that treatment. She was speaking to delegates at the annual NICE conference in Birmingham last week. However, Iain Chalmers, founder of the Cochrane Library, challenged the minister and asked why the secretary of state for health, Patricia Hewitt, had undermined the culture of “seeing beyond the individual patient” and the role of NICE “by announcing the extended use of Herceptin™ (trastuzumab) on the basis of no very good evidence at all”. The minister responded that, “This was an instance where we had an unlicensed drug that was being sought by women in the early stages of breast cancer and being strongly supported by their clinicians. We were getting reports that PCTs were refusing to authorise the treatment on the grounds that there was no NICE guidance available. The absence of NICE guidance ought not to be the only reason given. We appreciated caution had to be taken [because the drug was unlicensed], but at the same time we were facing a very clear demand from patients and their clinicians”. The minister also said that the development of the Centre for Public Health Excellence at NICE was an important step in providing evidence based public health practice.

Healthcare Commission reports two thirds of hospitals failing to meet cleanliness standards
Thu, 15 Dec 2005 00:00 - NeLM Headline News
According to NetDoctor, a new report from the Healthcare Commission following an inspection of the UK's hospitals has found that two thirds are still failing to meet the highest standards in cleanliness across the board. The Healthcare Commission is calling for an improvement in cleanliness in order to "regain the confidence of patients", after visits to 99 NHS and private hospitals between July and September this year, which uncovered variable standards of cleanliness. Mental health hospitals visited performed particularly poorly on standards of cleanliness. There was also evidence of systemic problems in 23 hospitals, suggesting that cleanliness was unsatisfactory. Items examined by the Healthcare Commission inspectors included medical equipment, beds, sinks, bedpans and toilets and, where appropriate A&E department areas, for spillages, dust, dirt and stains. Each hospital visited has been given a detailed account of the inspectors' findings to help them make improvements. The commission plans to build on its initial findings, carrying out inspections of further hospitals and re-inspecting those that performed poorly. The evidence will be used to improve best practice guidelines and feed into a longer-term study of healthcare associated infection that will begin early next year.

Switching from tamoxifen to anastrozole after 2 years - a meta-analysis
Thu, 15 Dec 2005 00:00 - NeLM Headline News
AstraZeneca has presented data from a meta-analysis of three anastrozole studies at the San Antonio Breast Cancer Symposium, which indicated that women who switched from tamoxifen to Arimidex™ (anastrozole) after two years of a five-year treatment course were 29% less likely to die than those who remained on tamoxifen for the entire period. The three similarly designed trials were the Arimidex-Nolvadex (ARNO) 95 trial, the Italian Tamoxifen Arimidex (ITA) trial and the Austrian Breast & Colorectal Cancer Study Group (ABCSG) 8 trial. They involved over 4000 women who had undergone surgery and received tamoxifen for two years, followed by either continuation of tamoxifen or changing to anastrozole for the remaining 5 years. The women were monitored for an average of 2.5 years. The analysis found that in the anastrozole group: • The risk of dying was reduced by 29% (HR 0.71; 95% CI 0.52 - 0.98; p=0.0377) • The risk of the disease returning was reduced by 45% (HR 0.55; 95% CI 0.42 - 0.71; p<0.0001) • The risk of the disease spreading from the breast to other parts of the body was reduced by 39% (HR 0.61; 95% CI 0.45 - 0.83; p=0.0015) In addition, the meta-analysis showed that the safety profiles for anastrozole and tamoxifen were consistent with those previously observed. The authors concluded that “postmenopausal women currently receiving adjuvant tamoxifen should be switched to anastrozole upon completion of 2-3 years treatment”. However, NICE is due to deliver a verdict on the use of all three of these drugs in the post-surgery setting next November. Ref: Jonat W et al. Switching from adjuvant tamoxifen to anastrozole in postmenopausal women with hormone-responsive early breast cancer: a meta-analysis of the ARNO 95 trial, ABCSG Trial 8, and the ITA trial. Abstract No. 18. San Antonio Breast Cancer Symposium 2005.

Clinical review - hirsutism
Thu, 15 Dec 2005 00:00 - NeLM Headline News
A clinical review of hirsutism in a format that presents a characteristic case and then discusses management issues of the condition. The case presented is of a 19-year old woman with excess hair growth characteristic of hirsutism - that is, limited to androgen-sensitive areas. The authors discuss the potential diagnoses: about half of women with mild forms have idiopathic hirsutism in which there is increased sensitivity to normal levels of circulating androgen; the remainder, and most of those with severe forms will have excess androgen levels. This is most frequently due to polycystic ovary syndrome, but there may be other causes. Diagnostic strategies are discussed, including specialist referral if necessary, followed by an outline of management. Treatment can be by physical or pharmacological methods. Physical and cosmetic measures are the cornerstone of management, however drug treatments that affect production of or response to androgens are also of value. Guidelines noted discuss hirsutism as a part of hyperandrogenism.

Contraception in systemic lupus erythematosus - safe with care
Thu, 15 Dec 2005 00:00 - NeLM Headline News
Two clinical trials published today investigate the safety of various contraceptive measures in women with systemic lupus erythematosus (SLE) and find that none of the methods studied had an adverse impact on the disease. Past practice has been to avoid the used of hormonal contraception in women with SLE because of fears that it might exacerbate the disease process. These trials aimed to determine whether the fears were justified. A randomised double-blind controlled non-inferiority trial enrolled 183 women with inactive (76%) or stable active (24%) SLE to receive either a triphasic combined oral contraceptive (COC) or placebo; all were asked to used another form of contraception during the study. Duration was twelve months and the primary outcome was a severe lupus flare. Over the course of the study, a severe flare occurred in 7.7% (7/91) of women receiving the COC compared to 7.6% (7/92) of those receiving placebo. Twelve-month rates of flare were similar in the two groups (0.084 for the group receiving oral contraceptives and 0.087 for the placebo group [P=0.95; upper limit of the one-sided 95 percent confidence interval for this difference, 0.069], which is within the prespecified 9 percent margin for noninferiority). From their results, the authors conclude that COC do not increase the risk of flare in women with stable SLE. Another trial, of single-blind design, compared the rate of flare in 162 women assigned to COC, progestogen-only pill, or a copper-containing IUD (n=54 in each). Duration was for twelve months, and the primary outcome was of global disease activity measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), a standard tool for assessment of SLE. Results showed no significant difference between the groups in global disease activity or in any of the secondary outcomes used (mean SLEDAI score was 6.1±5.6 in the group assigned to combined oral contraceptives, 6.4±4.6 in the group assigned to the progestin-only pill, and 5.0 +/- 5.3 in the group assigned to the IUD (P=0.36)). Disease activity remained mild and stable in all three groups throughout the trial. The authors conclude that in women without severe SLE, disease activity was not affected by type of contraceptive used. An accompanying editorial discusses the trials and concludes that they support the use of oral contraceptives in women with inactive or moderately active stable SLE.

Configuration of NHS ambulance trusts in England: A DoH consultation
Thu, 15 Dec 2005 00:00 - NeLM Headline News
The Department of Health has issued a consultation on proposals for changes to help ambulance trusts to deliver a better, more responsive, more efficient service. The proposed changes are administrative and managerial, and do not involve changes to service provision. The deadline for all responses to this consultation is 22 March 2006.

Department of Health publishes national framework to support local workforce development: A guide for HR directors in the NHS and social care
Thu, 15 Dec 2005 00:00 - NeLM Headline News
The Department of Health has issued a document intended to provide a national framework for use by human resources (HR) directors in the development of local workforce strategies. The document has been developed in collaboration with stakeholders across health and social care and suggests a framework within which governing bodies and boards supported by HR directors and managers across health and social care can develop their local strategies. For NHS organisations, it aims to complement 'A workforce response to local delivery plans' published in August 2005. For social care organisations, this framework aims to provide a useful, stand-alone guide which can help develop thinking at a local level by highlighting some of the important issues which might feature in localised strategies. Within this, it recognises the wide diversity of employers in the social care sector.

Department of health publication: What a patient-led NHS feels like
Thu, 15 Dec 2005 00:00 - NeLM Headline News
The Department of Health has published guidance which provides examples of good practice showing how the NHS is improving the patient’s emotional experience. It also outlines the policy context and explains why improving the emotional experience of patients matters. This document is for chief executives, directors and all staff who work in the National Health Service.

Cash crisis leads to freeze on NHS investment
Wed, 14 Dec 2005 00:01 - Telegraph Health
The escalating cash crisis in the NHS has led to the Department of Health imposing a freeze on new investment, which could hit public health programmes, it has emerged.

Woman in cannabis trial died
Wed, 14 Dec 2005 00:01 - Telegraph Health
A diabetic woman developed severe mental health problems and died five months after taking part in trials of a cannabis-based treatment.

Dark danger hanging over communities
Wed, 14 Dec 2005 00:01 - Telegraph Health
As a pall of smoke hangs over southern England, David Derbyshire and Celia Hall examine the threats to health and the environment.

A web-based decision aid can improve parents' attitudes to MMR vaccination?
Wed, 14 Dec 2005 00:00 - NeLM Headline News
A pilot study aimed at determining the effect of a web-based decision aid on MMR vaccination found that it was successful in changing attitudes to the vaccine in those who answered the questionnaire associated with it. The aid was based on verifiable facts about the vaccine, presented in a clear and visually appealing manner. It was advertised on Australian and New Zealand parenting and health-related websites and data collection took place between April 2004 and January 2005. Outcome measured was change in attitude to the vaccine after completing the decision aid. A total of 1277 people accessed the website and of these 158 completed the aid by answering the set questions. Of these, 39% reported 'leaning towards' the vaccine before completing the aid compared to 55% after (p<0.001). Those who reported leaning towards the vaccine tended to be concerned about protecting their children from the adverse effects of the diseases, and also protecting other children who could not be vaccinated; those with an unfavourable attitude to vaccination were more likely to be very concerned about the rare side effects of vaccination (78% v 57%), have residual concerns about autism and bowel disease (78% v 27%), and anticipate guilt should their child have an adverse reaction (77% v 50%). Those with a positive attitude to vaccination after using the decision aid were also more likely to feel well informed (83% v 48%). The authors conclude that the web-based decision aid significantly improved parents' attitudes to the MMR vaccine. Factors that remained as barriers in those patients who were still unfavourable to it were residual concerns about autism and bowel disease, and concern about rare serious vaccine complications.

Health Protection Agency estimates burden of chronic hepatitis C infections
Wed, 14 Dec 2005 00:00 - NeLM Headline News
The Health Protection Agency have published ‘Hepatitis C in England’, a report on the burden of chronic Hepatitis C infection in England. It is estimated that there are currently around 4,500 people living with severe liver disease as a result of having a chronic hepatitis C infection; this figure could rise to around 7,000 by 2010. Professor Pat Troop, Chief Executive of the Agency, said, “Our report shows that the burden hepatitis C places on the individual and on healthcare services is high and will rise in the future. Within the report there is invaluable information for healthcare professionals, voluntary organisations and those planning healthcare services. Public and professional awareness campaigns, such as “FaCe It”, being run by the Department of Health are vital, as they will help reduce the level of undiagnosed infections, and consequently the level of disease.”

Health Reform in England: update and next steps
Wed, 14 Dec 2005 00:00 - NeLM Headline News
This document describes a framework for reform of the NHS in England and: • explains how the reforms are intended to be mutually reinforcing; • re-states the rationale for reform; • summarises the initiatives already announced; • lays out a programme of further policy development for 2006. This is the first in a series of publications building on the commitment in ‘Creating a patient-led NHS’ to explain how the whole reform programme fits together.

Reform report – ‘the NHS in 2010: reform or bust’
Wed, 14 Dec 2005 00:00 - NeLM Headline News
This report by the think-tank Reform warns that cost pressures on the health service will demand an extra £18.2 billion of funding yet only an extra £11.4 billion is likely to be available. Reform researchers looked at the cost pressures on the NHS over the next five years, including the consequences of extra staff, improved contracts, more expensive drugs and large building projects. The report said the NHS had two options - radical reform or cutting more jobs or delaying treatment - if the debts were not to get worse. Report co-author Henry de Zoete said: "What we are saying is that if the financial situation is not going to get worse, change is needed - "We are already seeing the signs with deficits being built up and recruitment freezes being introduced. There is a real risk it will get worse." The study welcomes the Government’s aim to create a reformed “patient-led” NHS based on patient choice and a variety of providers. It shows that the NHS will have more than enough resources to achieve that aim by the end of the decade. But it suggests that extra resources may be used to prop up existing providers rather than to develop new modern community-based services.

Responses to National Health Research Strategy consultation
Wed, 14 Dec 2005 00:00 - NeLM Headline News
The proposed new National Health Research Strategy aims to create a health research system in which the NHS supports those engaged in leading-edge research to focus on the needs of the patient and the public. A summary of responses to the proposals set out in the consultation document has now been published (see link). The final R&D strategy will be published in early 2006.

National children's database gets go-ahead
Wed, 14 Dec 2005 00:00 - NeLM Headline News
According to a report by E-Health Insider, the government has given the go-ahead for the creation of an electronic information sharing index (IS Index) containing information on all children aged 0 to 18 in England, which is to be rolled out by the end of 2008. The IS Index will contain basic information on each child and basic identifying information about the child’s parent/carer and contact details for services involved with the child (school and GP practice as a minimum). The aim of the index is to allow practitioners working with children to identify and contact one another easily and quickly to enable better sharing of information. Those expected to use the index include GPs, health visitors, school nurses and accident and emergency staff as well as social services teams. Access to the index will be according to the role of the practitioners, all of whom will need to have undergone relevant training and checks. The government says it will invest £243 million in the creation of the index plus a further £41 million a year to maintain it. They estimate the index could save £88million a year in time spent by practitioners trying to identify and contact each other.

New trial data for letrozole in breast cancer
Wed, 14 Dec 2005 00:00 - NeLM Headline News
According to BioSpace, results of a new analysis of the Phase III MA-17 trial have been presented at the 28th annual San Antonio Breast Cancer Symposium. They show that those women with hormone-sensitive early breast cancer who switched from placebo to Femara(R) (letrozole) experienced significant improvements in overall survival, disease-free survival and distant metastases. In the original trial, women were randomly assigned to receive letrozole or placebo after completing approximately five years of tamoxifen post-surgery for early breast cancer (see previous news item). This new data comes from an analysis of those women who had originally been assigned to placebo, but then switched over to letrozole following unblinding of the trial. This therefore represents a population of women who went through a period of no treatment between finishing tamoxifen therapy and starting letrozole. According to the report, postmenopausal women who switched from placebo to letrozole experienced a 69% reduction in the risk of breast cancer recurrence, a 72% reduction in the risk of metastatic disease, and a 47% reduction in breast cancer mortality (the BioSpace abstract did not provide any further detailed statistical results). These observations need to be confirmed by additional analysis and longer-term follow-up.

NHS £300m over budget due to new GP contracts
Tue, 13 Dec 2005 00:00 - NeLM Headline News
According to a report in the Health Service Journal, the Department of Health (DoH) finance director Richard Douglas has admitted that the new GP contract has cost the NHS £300m more than it had planned, and the consultant contract had gone £90m over budget. He told MPs on the Commons health select committee that the £300 million overspend on the general medical services contract was mainly due to over-achievement on the quality and outcomes framework, and along with the cost of the consultant contract, the total overspend would be £340m. However, he said reports of a £900 million overspend on new contracts for healthcare staff under Agenda for Change was ‘nowhere near’ that figure, and the DoH had not yet put a figure on the cost.

Almirall licenses European rights to Sativex
Tue, 13 Dec 2005 00:00 - NeLM Headline News
In a £46 million deal, Spain's biggest pharmaceutical company, Almirall Prodesfarma, has licensed European rights to Sativex™, GW Pharmaceuticals’ cannabis-based treatment for treating pain in MS patients. Sativex is available in Canada, where it is sold by Bayer HealthCare, who also has rights to the drug in the UK, where regulators have asked for more evidence of efficacy to support the application for marketing approval. GW had originally hoped for UK approval in 2003. Sativex is currently in phase III trials for the treatment of MS symptoms (neuropathic pain and spasticity), neuropathic pain (peripheral and general) and cancer pain. Under the agreement, GW is responsible for completing the development of Sativex in these three indications. In a separate news item, the BBC has reported the death of a 69 year old diabetic woman, who had been taking part in a trial to investigate whether Sativex could relieve neuropathic pain. The patient suffered a series of physical problems after she was admitted to hospital in October 2003, 23 days after starting to take Sativex. These included pneumonia which resulted in her death five months later. An inquest will examine what links there were, if any, between Sativex and the physical deterioration which led to the fatality.

HPA launches new online training course to help doctors spot pandemic influenza
Tue, 13 Dec 2005 00:00 - NeLM Headline News
The HPA has launched a new online training course to help doctors learn more about the signs, symptoms and treatment of patients with pandemic flu. The course consists of mock cases of patients who might turn up at a surgery, including a holidaymaker returning from Thailand with flu-like symptoms and a patient worried by the recent media coverage on bird flu asking to be vaccinated. GPs must correctly diagnose each patient and decide on a course of action including appropriate treatment, whether they should be referred to hospital or told to stay at home, and whether to alert the local health protection unit. The Agency is aiming to train around 10,000 to 15,000 primary care doctors. The training programme can be downloaded from www.Doctors.net.uk.

HPA issues health advice for Hertfordshire residents following Buncefield oil fire
Tue, 13 Dec 2005 00:00 - NeLM Headline News
The HPA has issued health advice for Hertfordshire residents in response to the oil fire near Hemel Hempstead. The agency states that the general health advice for people in the Hemel Hempstead area continues to be ‘stay in doors, keep windows closed and tune into local media for further updates’. It adds that air quality testing has not shown significant pollution from the fire and therefore the risk to health is low but as a precaution residents are advised to follow the existing advice. Those most at risk from inhalation of smoke particles are people with existing respiratory problem such as asthma or chronic bronchitis or cardiac problems, and should contact NHS Direct on 0845 4647 if they have concerns

PSNC claim lack of N3 connections in community pharmacy jeopardising EPS
Mon, 12 Dec 2005 00:00 - NeLM Headline News
According to the Pharmaceutical Services Negotiating Committee (PSNC), only a handful of England’s 10,500 community pharmacists have been issued with smart cards or received N3 connections, which allow them to securely communicate electronically with GP surgeries. This has been said to jeopardise the roll out of the electronic prescribing service (EPS) and important elements of the new pharmacy contract including Medicine Use Reviews (MURs). The PSNC have accused PCTs of holding back smartcards from pharmacists in order to save money. Under the new pharmacy contract, although community pharmacists pay for their own pharmacy computer systems, they will be able to reclaim a £200 monthly charge for their N3 from PCTs providing they have an approved smartcard, N3 connection and software in place. In its defence, NHS Connecting for Health has rejected the claim, saying that the EPS is rolling out in a controlled way and is not due to the lack of smartcards. Their sources suggest that pharmacy software compliance is the rate-limiting factor in community pharmacy as only one pharmacy system supplier’s software (AAH Link Evolution version 7) has been approved as compliant with EPS.

Chief Executive's report to the NHS: December 2005
Mon, 12 Dec 2005 00:00 - NeLM Headline News
The Chief Executives report describes the activity in the NHS over the past year and since publication of the NHS Plan. The report highlights that : • hospital waiting lists are lower than ever, over half a million down from their peak • early deaths from cancer, coronary heart disease and suicide continue to fall as services improve • patients have more choice and involvement in their own care and will have more choice about which hospital they are referred to in the new year. In addition it shows how changes to the way the NHS works has helped to drive improvements. The Autumn performance report is the annex to the Chief Executive's report to the NHS, December 2005. It discusses the Department of Health's aims and objectives that were agreed in Spending Review SR2004 along with an analysis of progress against these targets.

DH report on healthcare output and productivity measurement
Mon, 12 Dec 2005 00:00 - NeLM Headline News
A DH paper, entitled ‘Healthcare output and productivity: Accounting for quality change’ discusses the way the output of the NHS is measured, with ways of including measurement of quality change.

Kings Fund report - Regulating Health Care
Mon, 12 Dec 2005 00:00 - NeLM Headline News
The King's Fund has published a paper entitled, ‘Regulating health care’ which explores the impact of market incentives in the NHS on the regulatory regime and emphasises the importance of clarifying the respective roles of government and independent regulators. It suggests that economic regulation needs to be developed and aligned more closely with that in the private sector, and urges change to quality regulation, particularly in relation to improvement of performance.

Glucotide Reagent Strips blacklisted
Mon, 12 Dec 2005 00:00 - NeLM Headline News
Bayer Healthcare has announced that Glucotide reagent strips are to be blacklisted from the England and Wales Drug Tariff, the Scotland Drug Tariff and the Northern Ireland Drug Tariff from 1st January 2006.

Medicines Partnership publishes new MUR booklet
Mon, 12 Dec 2005 00:00 - NeLM Headline News
The Medicines Partnership, commissioned by the Department of Health, has developed a new booklet for patients about the Medicines Use Review (MUR) service (‘Understand your medicines’). It can be downloaded in pdf format or ordered from the Department of Health publications orderline (tel. 08701 555 455) from 21st December.

MHRA issue advice on paroxetine (Seroxat™) - safety in pregnancy
Fri, 09 Dec 2005 00:00 - NeLM Headline News
The MHRA reports that new data from Denmark, Sweden and the US warn of a potential increased risk of congenital malformations following maternal use of paroxetine in the first trimester. However, they note that other epidemiological studies have not supported such an increased risk. All available data are being actively investigated by the Commission on Human Medicines (CHM) and the MHRA and, following their further investigations and discussions within Europe, if necessary new guidance will be issued. The current advice given to prescribers and patients in the alert is as follows: Advice to prescribers: • Paroxetine should only be used in pregnancy when strictly indicated and only if the benefits for the mother are thought to outweigh the potential risk to the foetus. • Until this issue is further investigated, consideration should be given as to whether paroxetine is the most suitable SSRI to be used in pregnant women or those planning to become pregnant. • If a decision is made to stop paroxetine treatment, this should be done gradually over a period of several weeks. Abrupt cessation can cause withdrawal symptoms (most commonly dizziness, numbness and tingling, gastrointestinal disturbances, headache, sweating, anxiety and sleep disturbances), which can be severe in some patients. Advice to patients: • Women taking paroxetine who want to become pregnant are advised to discuss the balance of risks and benefits of continued treatment with their doctor. • Pregnant women who are currently taking paroxetine should not stop their treatment but should discuss their treatment with their doctor or midwife at their next routine appointment The full alert and accompanying documents can be accessed via the links above. In a separate news story, Pharmatimes has reported that for the second time in three months, the US Food and Drug Administration has also warned that paroxetine should not be used in pregnant women because it increases the risk of birth defects. The agency said a second study has now shown that the drug is associated with heart defects and other problems when women take it during the first three months of pregnancy. The two studies have shown that women who took paroxetine during the first three months of pregnancy are about one and a half to two times as likely to have a baby with a heart defect as women who received other antidepressants or women in the general population. The FDA said it is currently gathering additional data and waiting for the final results of the recent studies to evaluate the risks further. According to Pharmatimes, GSK has been asked to change the pregnancy category from C to D, and it is the only antidepressant in this category. The company updated the drug's labelling in September to add the data from one study, and will now include the results of the second.

MUR limit increased
Fri, 09 Dec 2005 00:00 - NeLM Headline News
The PSNC reports that the Department of Health has announced that the maximum number of MURs (Medication Use Reviews)/Prescription Interventions that can be carried out during the first year of the new contract (April 2005 to March 2006) has been raised from 200 to 250. This increase will be stated in the Drug Tariff Part VIC. The PSNC add that the increase applies only to pharmacies that have commenced provision of the service before 1st January 2006.

BMJ Review: Treating obesity in individuals and populations
Fri, 09 Dec 2005 00:00 - NeLM Headline News
In this review, the author discusses the evidence behind interventions to treat or prevent obesity in adults, children, and communities; the strengths and weaknesses of current research; and recommends a direction for future treatment and research. The review is carried out under the following headings: • What has been studied? • Do any treatments work? • How good is the evidence? • Where do we go from here? • Conclusion The main summary points (taken directly from the article) are as follows: • A thorough search of the evidence for obesity treatment and prevention reveals that the research to date shows clearly what does not work but fails to establish what does • Research studies have largely concentrated on individually based treatments, which result in small amounts of weight loss and have little impact on the obesity epidemic in the population • Despite most experts agreeing that the obesity epidemic is due to environmental factors, the research has largely ignored this • It is time to be realistic with individuals about the effectiveness of lifestyle interventions and obesity drugs, and to focus on public health interventions rather than individual treatments, to halt the obesity epidemic

Practice based commissioning: applying the research evidence
Fri, 09 Dec 2005 00:00 - NeLM Headline News
This “Education and Debate” article is part of a series examining the government's planned market reforms to healthcare provision. In this article, the authors assess current policy on purchasing in the light of evidence from research concerning purchasing by primary care organisations in the 1990s and more recent evaluations of primary care groups and trusts. They draw out some key messages that may be helpful in its further development. The article is carried out under the following headings: • Commissioning by primary care • Importance of context • Effect of practice based commissioning • Process of practice based commissioning • Challenges for the future The main summary points (taken directly form the article) are as follows: • Practice based commissioning is to be rolled out across all general practices in the English NHS by the end of 2006 • Research evidence from previous experiments with practice based commissioning in the UK provides valuable insight • The evidence points to the importance of ensuring clear incentives for general practitioners if practice based commissioning is to succeed • The main incentives for practice based commissioning lie in the potential for practices to extend their role as providers of care in an increasingly contestable NHS market

Drug and Therapeutics Bulletin reviews the place for action plans in asthma
Fri, 09 Dec 2005 00:00 - NeLM Headline News
A review of the evidence for action plans in asthma with discussion of their potential content. The Bulletin notes that personal action plans for patients with asthma are included as recommendations in national guidelines, but that at present only a minority have them. Because the symptoms of asthma are variable, a fixed treatment regimen may not be appropriate and personal action plans aim to give patients more control over the management of their condition. In theory, they should improve patient satisfaction, and lead to fewer exacerbations and consultations with more efficient use of medication. The evidence available suggests that for patients with moderate to severe asthma, action plans do indeed improve outcomes, however for those with milder asthma the evidence is less convincing. Action plans need to be tailored to the individual and agreed between both patient and healthcare professional.

BMJ Editorial: Is methadone too dangerous for opiate addiction?
Fri, 09 Dec 2005 00:00 - NeLM Headline News
The authors of this editorial discuss the use of methadone vs. buprenorphine for heroin addiction. Although they note that methadone is an effective treatment for heroin addiction, and it remains the mainstay of drug treatment for opiate dependence in the United Kingdom, they add that there are risks and concerns associated with using methadone for this purpose. As examples, they cite respiratory depression or risks to users from black market methadone. They add “It is time it (buprenorphione) replaced methadone as the mainstay of drug treatment for opiate dependence”. Comment: 1. Current guidelines from the Department of Health on the clinical management of drug misuse and dependence can be accessed via the link above. 2. NICE are currently preparing a technology appraisal on the clinical and cost effectiveness of oral methadone and sublingual buprenorphine as substitute opiates for the management of opioid dependent individuals. The scope for this appraisal can be accessed via the link above.

Older people are wrongly excluded from drug trials
Fri, 09 Dec 2005 00:00 - NeLM Headline News
BMJ News reports on a conference on medication for older people at which speakers reported that age discrimination exists in many aspects of elderly people’s health care. One speaker (the President elect of the British Geriatrics Society) said, “The common imposition of upper age limits for clinical trials was an important form of discrimination. Frail older people show differences in their response to drugs. It is important that trials on drugs often used in older people are also performed in the [relevant] age group”. He added that when trials were performed in people older than 80 they mostly looked at the risks and not the benefits.

Monitor releases short discussion paper on effective commissioning in the NHS
Fri, 09 Dec 2005 00:00 - NeLM Headline News
Monitor, the Independent Regulator of NHS Foundation Trusts, has published a discussion paper on “Developing effective commissioning in the NHS”. This paper is the second in a series of publications focusing on areas of policy critical to the delivery of system reform. The first paper in this series is “Developing an effective market regulatory framework in healthcare”. The discussion papers can be accessed via the links above.

Malaria deaths prompt health warning to ‘Winter Sun’ travellers
Fri, 09 Dec 2005 00:00 - NeLM Headline News
The Health Protection Agency (HPA) has issued a warning about the importance of taking anti-malarial medication when travelling to known malarious destinations. This follows two deaths and four other cases of malaria in travellers returning from The Gambia who did not take the appropriate anti-malarial medication. Nearly two thousand cases of malaria are reported in returning UK travellers each year, of which around 1 in 100 die. Anti-malarial medication must be taken prior to travelling, while abroad, and for a period after returning. In addition, simple measures to avoid mosquito bites, such as wearing insect repellent and cover-up clothing and sleeping under an insecticide-treated net are also highly effective and add enormously to the benefits of drug protection.

Payment to healthcare professionals for patient recruitment to trials: a systematic review
Fri, 09 Dec 2005 00:00 - NeLM Headline News
The authors of this paper carried out a systematic review to synthesise the evidence on the effectiveness of payment to healthcare professionals for patient recruitment to trials. The authors found that the evidence is very limited in quantity and quality and is inconclusive. No controlled trials comparing recruitment rates achieved with and without financial incentives were identified by them. They conclude, “Evidence on the effectiveness of payment to healthcare professionals for recruiting patients to trials is lacking; funding bodies must consider whether to extrapolate from the evidence of effectiveness of financial incentives in other areas or to undertake new work”.

ABC of health informatics: eHealth and the future: promise or peril?
Fri, 09 Dec 2005 00:00 - NeLM Headline News
A review under the following headings: • Factors encouraging eHealth • How will eHealth develop? • Personal agents • Will clinicians become telecarers? • Concerns about eHealth • Summary

NICE website redesign - views of users
Fri, 09 Dec 2005 00:00 - NeLM Headline News
NICE is launching a new website in April 2006. Key findings of a consultation with internal and external users were as follows: • The new website should integrate clinical and public health content and be designed for the site's primary audiences: the public (patients, carers) and health professionals • The website's main objective should be to communicate NICE guidance in the clearest, most accessible way to anyone wishing to view it, using language appropriate to all its audiences. There was strong support for on-screen guidance summaries. • The website should also support guidance development and implementation and provide a separate media section • The website design would benefit from more use of images and less text • The website search should provide more searching options and produce more tailored search results NICE are now inviting feedback on two potential concept designs for the new site. Further information on the concept designs and how to feedback is available via the link above.

Statistical Press Notice: Location of Dental Surgeries, Opticians and Pharmacies
Fri, 09 Dec 2005 00:00 - NeLM Headline News
The Health and Social Care Information Centre have released statistics on the point location of dental surgeries, pharmacies, and opticians in England, April 2004. The information can be accessed via the link above.

Letrozole (Femara) approved in UK for early adjuvant use in breast cancer
Thu, 08 Dec 2005 00:00 - NeLM Headline News
Letrozole (Femara™) has been approved in the UK for use immediately after surgery in women with early-stage breast cancer. Approval was based on data from the BIG1-98 trial, which had shown that letrozole reduced the recurrence of disease when given after surgery to post-menopausal women with invasive breast cancer. Compared to those on tamoxifen, letrozole improved disease free survival by 19% in all women taking it and by 29% in high risk women whose cancer had spread to the lymph nodes. This approval makes letrozole the only aromatase inhibitor approved for use before surgery, directly post-surgery, after 5 years of standard tamoxifen treatment and in advanced cancer.

PSNC response to DoH proposals to simplify Drug Tariff
Thu, 08 Dec 2005 00:00 - NeLM Headline News
The PSNC has raised concerns about a number of the Department of Health's proposals to simplify the reimbursement arrangements for NHS dispensing contractors, suggesting that this could lead to substantial inequity of funding for pharmacy contractors. The Committee has also advocated a comprehensive review of the system by which discount is deducted from the majority of dispensed items. Further information can be found at the above links.

Three strategic health authorities partially suspend use of “payment by results scheme”
Wed, 07 Dec 2005 00:00 - NeLM Headline News
According to BMJ UK news, the Financial Times, Daily Telegraph and The Independent have featured articles suggesting that 3 strategic health authorities (Surrey and Sussex, Thames Valley and Hampshire) have partially suspended the use of "payments by results", because they believe that their current finances cannot sustain the policy. The FT also reports how the prospect of a £650million NHS deficit this year has added weight to a warning from the King's Fund that NHS finances and services will suffer unless the government provides an effective regime to deal with hospital failure.

The Department of Health issues efficiency technical note following Gershon Report
Wed, 07 Dec 2005 00:00 - NeLM Headline News
The Department of Health has issued the “Efficiency Technical Note” which sets out the programmes and projects that will deliver efficiency savings included as part of the SR2004 settlement with Treasury following publication of the Gershon Report “Releasing resources to the Front Line”. The programme explains how efficiency benefits are likely to be realised through projects, the specific measurement processes and formulae that will be used to calculate and validate gains, and the processes and measures to ensure that efficiency related business change does not result in reduction in quality or service standards for NHS patients and other customers. The published technical note is an update that which was published in October 2004 and outlines the following as key areas for consideration: • Public Funding & Regulation – staffing reduction at the DoH • Productive Time – modernising the provision of frontline services • Procurement – making better use of NHS buying power • Corporate services - ensuring NHS organisations, particularly in primary care, can rationalise and where possible share back office services, such as finance, ICT and human resources • Social care – improving commissioning of social care • Central Budgets - reducing or eliminating centrally managed budgets where they do not provide value for money, and releasing to front-line NHS organisations

Department of Health announces NHS ahead of schedule to achieve efficiency savings
Wed, 07 Dec 2005 00:00 - NeLM Headline News
The Health Secretary has announced that efficiency savings across the NHS are being achieved ahead of schedule, with a saving of £1.7 billion having been achieved since March 2004 (£200million ahead of target). Following the Gershon Report “Releasing Resource to the Frontline”, the Department of Health had committed to annual efficiency gains of £6.5 billion by March 2008. According to the announcement, the savings of £1.7bn that have been achieved to date have been as a result of the following: • better management of patient admissions has reduced average hospital length • an increasing number of treatments are being done as day cases • improved proactive care of patients, particularly those with chronic conditions • reduced levels of staff sickness and reduced use of agency staff in 2004/05 • price reductions for branded and generic drugs effective in 2004 and early 2005 resulted in savings of £697 million, rising to an annual £975 million by March 2006 • recently renegotiated national procurement contracts for NHS supplies and services are already providing annualised savings of £90 million.

Monitor publishes discussion paper on effective commissioning in the NHS
Wed, 07 Dec 2005 00:00 - NeLM Headline News
Monitor has published a discussion paper on developing effective commissioning in the NHS. They state that commissioning encompasses the following 4 key functions: • strategic planning • contract management • demand management and • claims management. The paper discusses the key challenges and potential solutions. It is the second paper in a series of publications focusing on areas of policy critical to the delivery of system reform. The first paper in this series is “Developing an Effective Market Regulatory Framework in Healthcare”.

DoH issues paper regarding Healthcare Resource Groups and Payment by Results in the palliative care sector
Wed, 07 Dec 2005 00:00 - NeLM Headline News
The Department of Health has issued an information paper which has been produced on behalf of the National Partnership Group for Palliative Care and sets out the situation regarding Healthcare Resource Groups and Payment by Results and the understanding of how these will operate in the specialist palliative care field.

London Flu Pandemic Contingency Plan
Wed, 07 Dec 2005 00:00 - NeLM Headline News
As part of the Government's UK-wide Influenza Pandemic Contingency Plan programme of preparation, Regional Resilience Forums (RRF) had been tasked with ensuring that key agencies and organisations in their regions have the effective contingency plans in place to respond to a flu pandemic. The London Regional Resilience Forums (RRF) had commissioned the London Resilience Team (LRT) and Regional Public Health Group (RPHG) for this purpose and the teams have developed a London Flu Pandemic Contingency Plan Prompt Document.

Healthcare Commission issues plans on regulation of independent healthcare sector
Wed, 07 Dec 2005 00:00 - NeLM Headline News
The Healthcare Commission has issued a press release setting out plans that will improve and modernise the regulation of the independent healthcare sector. The proposals are part of the Commission's approach to ensure that its assessments of safety and quality of care offer patients the same standards in both the NHS and the independent sector. Four key aims have been identified: • “to ensure its assessments offer patients and users of services, the same assurance on the same core aspects of healthcare wherever provided • in partnership with the Government, to modernise the regulatory framework of standards and guidance so that the requirements for the quality of care in the independent sector are aligned with those for the NHS • to develop an approach driven by better information and a stronger focus on the outcomes of care • to establish a new system of regulatory fees that creates incentives for improvement by being proportionate to the actual costs of regulation”.

Fly-fishing gets an all-new cast
Tue, 06 Dec 2005 00:01 - Telegraph Health
Caroline Bankes discovers why more and more women are taking up angling.

NHS Caesareans at top private hospital
Tue, 06 Dec 2005 00:01 - Telegraph Health
The National Health Service has spent thousands of pounds for women to have Caesarean sections at an exclusive private London hospital favoured by celebrity mothers because of a crisis in maternity care.

Pre-menopause HRT 'may halt heart disease'
Tue, 06 Dec 2005 00:01 - Telegraph Health
Taking the Pill before the menopause or starting hormone replacement therapy before menopausal symptoms arrive could help prevent heart disease in women, an American researcher has said.

Tegaserod for irritable bowel syndrome with constipation
Tue, 06 Dec 2005 00:00 - NeLM Headline News
According to the results of a double-blind, placebo-controlled trial published in the journal ‘Gut’, tegaserod provides rapid relief during both initial and repeated treatment in women with irritable bowel syndrome with constipation (IBS-C). Researchers randomised women with IBS-C to tegaserod 6 mg twice daily (n=2132) or placebo (n=525) for one month. Those who experienced at least a partial response then entered a treatment free interval and were re-randomised to tegaserod (n=488) or placebo (n=495) for an additional month upon symptom recurrence. The four primary efficacy variables were response for relief of overall IBS symptoms and relief of abdominal discomfort/pain for both first and repeated treatment. Response was defined as at least three weeks with satisfactory relief during four weeks of treatment. Secondary efficacy variables included at least 2 weeks of satisfactory relief, and response for weekly relief of constipation. Comparisons between groups for repeated treatment were limited to those patients initially treated with tegaserod (i.e. responders in placebo group not included). The main results are as follows: • First treatment - 33.7% of tegaserod group gained relief of IBS symptoms versus 24.2% of the placebo group; 31.3% versus 22.1% respectively for relief of abdominal discomfort/pain (p<0.0001 for both) • Repeated treatment - 44.9% of tegaserod group experienced relief of IBS symptoms versus 28.7% of the placebo group; 42.4% versus 27.1% respectively for relief of abdominal discomfort/pain (p<0.0001 for both) • For both overall IBS symptoms and abdominal discomfort/pain, the weekly proportion of patients with satisfactory relief was greater with tegaserod than placebo for all weeks during first and repeated treatment (p<0.05) Tegaserod also produced greater satisfaction, work productivity, and improved quality of life than placebo (p < 0.05). [Please note that there was a high placebo response rate in this study]. Diarrhoea occurred significantly more frequently in tegaserod-treated patients (81/2132 [3.8%] versus 3/525 [0.6%] with placebo; p<0.0001). According to the authors, "Long-term follow-up with an intermittent treatment schedule is planned".

Chief Medical Officer reminds Hajj pilgrims to get meningitis jab
Tue, 06 Dec 2005 00:00 - NeLM Headline News
The Chief Medical Officer today urges all travellers to the annual Hajj Muslim Pilgrimage to Mecca to ensure they have received their quadrivalent meningitis vaccination before travelling. An estimated 50,000 pilgrims travel from England to Saudi Arabia as part of the annual Hajj pilgrimage, which this year takes place between 8th and 12th January 2006. Unvaccinated travellers are at risk of contracting the W135 strain of meningococcal disease. Since the Department of Health launched its awareness raising programme in November 2001, cases of meningococcal infection have been reduced and there have been no deaths due to the W135 strain.

PSNC responds to Department of Health’s proposals to simplify arrangements for NHS dispensing contractors
Tue, 06 Dec 2005 00:00 - NeLM Headline News
The PSNC has responded to the Department of Health's proposals to simplify the reimbursement arrangements for NHS dispensing contractors. In the response, PSNC has raised concerns about a number of the proposals which could lead to substantial inequity of funding for pharmacy contractors. The Committee has also advocated a comprehensive review of the system by which discount is deducted from the majority of dispensed items. Please see the links above for further information.

NHS organisations forecast surplus and deficits
Tue, 06 Dec 2005 00:00 - NeLM Headline News
Information on all NHS trusts, primary care trusts and strategic health authorities that forecast a surplus or deficit in 2005/06 month 6 is now available on the Department of Health website, along with the size of the forecast surplus or deficit. This information is included in the evidence provided to the Health Committee as part of the Public Expenditure Inquiry.

Cannabis: the final word
Mon, 05 Dec 2005 10:16 - Telegraph Health
A risk to mental health, or a boon for people with MS? Both, says Barbara Lantin.

Guidance on the Essential Small Pharmacy Scheme
Mon, 05 Dec 2005 00:00 - NeLM Headline News
The Department of Health has published detailed guidance on the Essential Small Pharmacy Local Pharmaceutical Service, which replaces the current ESPS arrangements from 1st April 2006. This guidance is intended for PCTs in processing of applications, but also provides useful information about the scheme and the time scales for implementation. Please see the link for further information and access to the document.

Passive smoking increases risk of pre-menopausal breast cancer?
Mon, 05 Dec 2005 00:00 - NeLM Headline News
According to a meta-analysis published in the International Journal of Cancer, passive smoking may raise the risk of breast cancer to a similar degree as active smoking, especially in pre-menopausal women. A total of 19 studies of passive smoking and breast cancer risk among women met the basic quality criteria. From these, five studies (all case-control) contained a more thorough assessment of exposure to tobacco smoke (quantitative long-term information on the 3 major sources of passive smoke exposure: childhood, adult residential and occupational). The researchers calculated pooled relative risk estimates for breast cancer for life-long non-smokers with regular passive exposure to smoke and for women who smoked compared to women who were never regularly exposed to tobacco smoke. The main results are as follows: • The pooled risk estimate for breast cancer in women who were life-long non-smokers