(Press-News.org) The UK is poorly prepared for the forthcoming epidemic of degenerative valvular heart disease, prompted by a rapidly ageing population, say leading experts in the journal Heart.
The prevalence of valvular heart disease, or VHD for short, rises with age. European and US data indicate that more than 13% of those aged 75 and above have the progressive condition. And by 2018, there will be an estimated 4 million people in the UK aged between 75 and 84.
The exact causes of VHD have been poorly researched, but the condition is associated with a great deal of ill health, poor quality of life, and is expensive to treat, say the authors from Oxford's John Radcliffe Hospital, St Thomas' Hospital, London, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, and the National Institute for Clinical Outcomes Research.
This is largely because a defective valve is often not picked up until it is too late to treat successfully.
Data from the latest National Adult Cardiac Surgery Database for Great Britain and Northern Ireland show that there has been a sharp increase in all types of valve surgery. But it also shows wide variation in treatment provision.
More than a third of those undergoing surgery to repair their defective mitral or aortic valves had advanced disease, significantly increasing their likelihood of complications, death, and ineffective symptom relief, say the authors.
"These observations suggest that both initial diagnoses and subsequent follow up are currently inadequate and that patients are routinely referred late in the natural history of the condition, beyond the window where surgery is of maximum benefit," they comment.
Ageism and sexism also seem to be factors, with twice as many men undergoing aortic valve replacement as women, and patients over the age of 75 with moderate to severe disease half as likely to be treated surgically as their younger counterparts.
"Advancing age is often used to justify the decision to withhold surgery, but suitably selected patients may derive considerable improvement in symptomatic burden and overall quality of life, following successful intervention," say the authors.
But the risk scoring system used to predict who might not survive surgery is not up to the job, say the authors, while the wide variations in access to aortic valve replacement cannot be explained by demographic factors alone.
The volume of surgery required to ensure appropriate levels of expertise and good outcomes also leaves much to be desired, they add. Most of the UK centres performing mitral valve replacement/repair undertake fewer than 20 procedures a year: the guidance recommends at least 50 procedures and 25 for each individual surgeon a year.
International guidelines recommend that early mitral valve surgery in patients with few or no symptoms should only be contemplated in specialist units where there's a 90% chance that a repair will be performed, but this is far from the case, the figures suggest.
The authors call for specialist VHD centres to be set up, staffed by specialists with access to the right screening tests and equipment.
"VHD has been relatively neglected by politicians, health economists and even by cardiologists," say the authors. "National programmes already exist for heart failure and coronary disease. A similar coordinated approach to research, education, and clinical management is now needed to ensure improved outcomes for all patients with VHD," they conclude.
INFORMATION: END
UK medical schools are failing to comply with the recommended curriculum for ophthalmology, set out by the International Council of Ophthalmologists (ICO), suggests a survey published online in the British Journal of Ophthalmology.
Amid concerns that the specialty was being squeezed out of undergraduate education, the council urged medical schools to make it a core subject and produced guidance to help them do this.
But a questionnaire sent to 32 UK medical schools, which prompted 18 to complete returns, shows that while all include ophthalmology in the curriculum, ...
Although rare, the true incidence of neonaticides - the unlawful killing of a baby within the first 24 hours of its life - is more than five times as common as official estimates suggest, suggests research published online in the Fetal and Neonatal edition of the Archives of Disease in Childhood.
Low maternal self esteem and emotional immaturity, rather than obvious mental illness or social disadvantage, are key drivers, the research indicates.
The researchers reviewed the case records of 26 courts in three regions of France, involving the death of a child within the ...
What makes cancer cells so dangerous is that they grow in an unregulated way and proliferate much faster than other cells. The proteasome, a large protein complex, plays a key role in this process: By breaking down used proteins for recycling, it clears the way for the next cycle. New hope was spawned several years ago with the discovery that inhibiting proteasomes can be used as a means to put the brakes on cell growth. In the mean time, the first drug using this approach, Bortezomib, generates revenues in excess of one billion U.S. dollars per year. However, it also inhibits ...
The researchers decided to embark on this study in order to find out which mechanisms are used by plants when they extract water from very dry or somewhat inhospitable land. "In the case of mangrove swamps, for example, the plants are able to extract freshwater from a saltwater environment, despite the fact that the osmotic pressure should make quite the opposite happen", explains Professor José Luis Pérez Díaz, who studies this type of relatively unknown phenomenon as part of a new line of research that the Department of Mechanical Engineering at UC3M has begun.
The ...
Tel Aviv ― Will Rona and Sol kiss and seal their fate as a couple forever, or will Sol answer the ringing phone and change the course of history? A new movie format developed by Tel Aviv University lets the viewer decide.
Utilizing complicated video coding procedures, the new format provides smooth interaction and transition between scenes as audience members watch ― and determine the plot of ― Turbulence, created by Prof. Nitzan Ben Shaul of Tel Aviv University's Department of Film and Television. Made with his unique scene-sequencing technique, Turbulence ...
Storing massive amounts of carbon dioxide underground in an effort to combat global warming may not be easy to do because of the potential for triggering small- to moderate-sized earthquakes, according to Stanford geophysicist Mark Zoback.
While those earthquakes are unlikely to be big enough to hurt people or property, they could still cause serious problems for the reservoirs containing the gas.
"It is not the shaking an earthquake causes at the surface that creates the hazard in this instance, it is what it does at depth," Zoback said. "It may not take a very big ...
The National Centre for Social Research today released its latest British Social Attitudes report, its landmark study of the public's attitudes and values, published annually for almost thirty years.
This year's report delivers the public's verdict after thirteen years of Labour rule. It shows a nation at a political crossroads. On the one hand attitudes on welfare have hardened to the right. On the other, many think there were marked improvements in health and education under Labour, creating potential resistance to reform or cuts in these areas.
A shift to the right ...
INDIANAPOLIS – Along with integrity and compassion, respect for patients, colleagues and other team members is an essential attribute of medical professionalism. A new study examines how medical students learn respectful or disrespectful professional behavior.
"Exploring the Meaning of Respect in Medical Student Education: An Analysis of Student Narratives" appears in the December 2010 issue of the Journal of General Internal Medicine. From the observations and conclusions of third-year medical students, the article provides insight into how future physicians acquire ...
Researchers from the Peninsula Technology Assessment Group (PenTAG) at the Peninsula College of Medicine and Dentistry have contributed to new National Institute for Health and Clinical Excellence (NICE) guidance on preventing unintentional injury to the under-15s.
The public health guidance is based on reviews of research evidence produced by the team at PenTAG. There are three linked pieces of guidance on: home safety assessments and safety equipment; road design and modification; and broader strategies to prevent unintentional injuries to among children and young people ...
You can touch a functioning light bulb and know right away that it's hot. Ouch! But you can't touch a single molecule and get the same feedback.
Rice University researchers say they have the next best thing -- a way to determine the temperature of a molecule or flowing electrons by using Raman spectroscopy combined with an optical antenna.
A new paper from the lab of Douglas Natelson, a Rice professor of physics and astronomy, details a technique that measures the temperature of molecules set between two gold nanowires and heated either by current applied to the wires ...
