Robots don’t challenge surgeons such as me – they challenge dogmatic practice | Ara Darzi

On Friday 10 March, I will perform an operation in public for the first time. In a live demonstration, I will aim to show how robots can assist surgeons to cut more safely, with greater precision, and achieve better results for patients.

I should say at the outset that no patient’s life will be put at risk during this event. I will be operating on a surgical mannequin – a specially adapted version of the shop mannequin designed to respond like a human body – and the event will take place at the Science Museum in London.

I will be using the same surgical robot that I used in 2001 when I performed the first such operation on a patient in the UK. It has three arms controlled from a console a few feet away, where I sit, allowing me to cut and stitch with great precision. Almost 16 years on, this will be a nostalgic moment for me. From cutting-edge technology to museum piece in less than two decades.

I am taking part in this demonstration, together with Professor Roger Kneebone, head of the Centre for Engagement at Imperial College, because I know that technological innovation of the kind represented by the robot has transformed surgery. But it will only continue to do so in the future if we have the vision and the courage to support it.

Critics will say that past technological advances have not delivered on their early promise. Certainly there have been challenges. Last year a research paper published in the Lancet comparing robotic with non-robotic surgery for prostate cancer found both achieved similar outcomes after three months.

The Times reported the story under the headline “Robots no better than human surgeons”. The Daily Mail, however, went with “Robots are better than humans at cancer ops”, on the grounds that the patients who had the robot surgery suffered less pain immediately after the operation. Is the glass half-full? Or half-empty?

I am firmly in the former camp. As I wrote in the Lancet at the time, the fact that the robot-assisted surgery achieved an equivalent outcome should be seen as a positive result. It shows that the innovation has preserved the intended purpose of the surgery. Advances in technology such as this provide the platform on which additional innovations can be developed, to further improve the quality and safety of surgery.

The device, called the iknife, can detect almost instantly whether tissue is cancerous or not

Consider where we have come from: in little more than 100 years since the two-part silver scalpel, with handle and replaceable blade, was invented by Morgan Parker in 1915, it has increasingly been replaced by the electrosurgical knife – a probe carrying an electric current that burns through tissue, sealing the tiny capillaries as it cuts, reducing blood loss, improving the surgeon’s field of view and the speed of the surgery.

Now a third advance is imminent, with the invention of an electronic “nose” attached to the electrosurgical knife. This absorbs the smoke given off as the blade burns through tissue and analyses it in a mass spectrometer. The device, called the intelligent knife or iknife, can detect almost instantly what kind of tissue the surgeon is cutting through – whether, for instance, it is cancerous or not. Instead of sending tissue samples to the laboratory and waiting days or weeks for them to be tested, the surgeon will in future be able to tell whether all the cancer has been removed before the operation is complete.

Membership Event: Robot Surgery Live

Advances such as this are ushering in a new era of precision surgery, in which established clinical and pathological signs are linked with state-of-the-art molecular profiling, enabling us for the first time to tailor specific interventions to the individual biology of the patient.

I was delighted with the interest and enthusiasm shown by the Science Museum in displaying the first surgical robot ever used in Britain as part of their robotics exhibition. It will remain with the museum as a donation from the department of surgery at Imperial College London.

But if we are to continue moving forward, we need disruptive innovators who are ready to challenge dogmatic practice and an environment in which they are free to experiment. What today looks revolutionary is tomorrow’s museum exhibit.

Robots don’t challenge surgeons such as me – they challenge dogmatic practice | Ara Darzi

Royal College of Surgeons slam plans to cut back on hip and knee replacements

The Royal College of Surgeons has hit out at cost-cutting plans to ration who can receive hip and knee replacements.

Three clinical commissioning groups (CCGs) in the West Midlands have proposed slashing the number of people who qualify for hip replacements by 12% and introducing a 19% cut over who is eligible for knee replacements.

Under the new rules patients would now need to have such severe levels of pain that they cannot sleep or carry out daily tasks to qualify for an operation. Board papers reported by the Health Service Journal suggest an “opportunity to reduce expenditure on hip and knee replacement surgery” by £2m a year.

This would include only treating “severe to the upper end of moderate” cases, and people who are obese with a body mass index of 35 or over who need to lose 10% of their weight unless their problems were very severe.

Documents said a “patient’s pain and disability should be sufficiently severe that it interferes with the patient’s daily life and/or ability to sleep”.

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest are the CCGs that intend to change their scoring system for eligibility, hoping to prevent about 350 operations needing to be carried out each year. But the Royal College of Surgeons has said there is “no clinical justification” for their plans.

The move is the latest in a round of cost-cutting by CCGs – with some slashing access to treatments, expensive drugs and IIVF despite guidelines from the National Institute for Health and Care Excellence (Nice).

Stephen Cannon, vice president of the Royal College of Surgeons, said: “We appreciate that the CCGs face significant financial challenges, which now mean they are looking at which groups of patients they can target to save money.

“While the CCGs have stated they hope this policy will save them £2m a year, it is unclear whether they have considered the costs of not treating a patient. This could include the cost of pain relief medication and a later operation when the patient does meet the required pain and weight thresholds.

“Delaying access to surgery also adversely affects a patient’s quality of life and surgical outcomes, meaning the operation may not be as beneficial as if it had been carried out earlier.”

He said the scoring system used by the CCGs – known as the Oxford scoring system – were designed to measure outcomes of care and “should not be used to create barriers to care”.

He added: “Such criteria are in explicit contravention of Nice and surgical commissioning guidance, and have no clinical justification in being applied to a general population to determine who gets NHS treatment. This policy is the latest demonstration of how NHS financial pressures are directly affecting patients.”

Paul Green, from Saga Group – which focuses on needs for over-50s, said: “To suggest that it is acceptable for people to have to wait until they are unable to sleep before they are eligible for an operation is an outrage, how would these people feel if that was their mother or father or grandparent?

“Remaining mobile is fundamental for people’s mental as well as their physical wellbeing, it appears an unkind cut and the bean counters should examine their conscience.”

A spokesman for NHS Redditch and Bromsgrove CCG said: “The Oxford scoring system is a guidance for clinicians and they recognise that many patients will benefit from physiotherapy and weight loss before considering surgery.

“If a patient feels that they require this surgery but do not meet these criteria, there is a clear appeals system via individual funding requests whereby the effects can be considered upon the patient and the decision made regarding eligibility for funding.”

Royal College of Surgeons slam plans to cut back on hip and knee replacements

NHS hospitals suffer from chronic bed shortage, surgeons say

The Royal College of Surgeons said there was a chronic shortage of NHS hospital beds in England, after occupancy rates for overnight stays topped 89% for a fourth successive quarter.

The maximum occupancy rate for ensuring patients are well looked after and not exposed to health risks, is considered to be 85%, a figure that has not been achieved since NHS England began publishing statistics in 2010.

From July to September this year the percentage of beds occupied in wards open overnight was 89.1%, compared with 87.0% in the same period last year. That was the last time it was below 89%.

The Royal College of Surgeons (RCS) said the figures, published on Thursday, made for alarming reading and indicated a failure to cope with the increasing number of older patients in hospital.

Ian Eardley, a consultant urological surgeon and RCS vice president, said: “The NHS has been able to reduce bed numbers as medical advances mean more modern surgery can take place without an overnight stay. However, these figures suggest bed reductions have now gone too far in the absence of sufficient social care or community care alternatives. We are now seeing increasing numbers of frail older patients in hospital because they have nowhere else to go. The lack of additional money in the autumn statement for social care and the NHS is only going to make this even harder.”

The chancellor, Philip Hammond, had been urged to increase funding for social care, amid warnings that it was in a critical condition, and to help plug current and future shortfalls at NHS trusts, but health providers were left disappointed.

The situation is set to deteriorate further with more beds expected to disappear under local sustainability and transformation plans designed to improve NHS services and ensure their viability.

Among the acute service beds at general hospitals set to be cut are 535 in Derbyshire, 400 each in Devon and West Yorkshire, and 30% of all beds in hospitals in Bristol, North Somerset and South Gloucestershire.

Eardley said: “NHS leaders need to think carefully about whether this is a good idea without first putting in place better care in the community.”

Last month the Nuffield trust warned that the statistics underestimated the problem because they took a snapshot of occupancy at midnight, so did not capture squeezes in availability of beds during the day.

Eardley said: “I and too many of my colleagues all around the country are regularly having to cancel patients’ operations due to a lack of beds and delays in transferring patients back into the community.”

NHS hospitals suffer from chronic bed shortage, surgeons say

Patients must understand options, says Royal College of Surgeons

Surgeons should stop being “paternalistic” and simply lay out all the options to “let patients choose” whether to undergo surgery, according to radical new guidance for medics.

The Royal College of Surgeons (RCS) has warned its 20,000 members that unless changes are made to the processes currently used to gain consent ahead of surgery, they could face a dramatic increase in the number of expensive litigation cases and compensation payouts. NHS trusts in England paid out more than £1.4bn in claims during 2015-16.

The new guidance follows a judgment last year from the supreme court in the case of Nadine Montgomery from Lanarkshire, whose son Sam has cerebral palsy. Montgomery was awarded £5.25m compensation because doctors did not explain the very small risk associated with a normal birth in her case – she is small and a type 1 diabetic.

Diabetic mothers can give birth to larger babies. One of the risks is shoulder dystocia, when the baby gets stuck during labour, which happened in Sam’s case. He was deprived of oxygen and suffered brain damage in 1999. Her obstetrician did not discuss that risk because it was small and did not offer a caesarean section.

Seven judges – an unusually large number because of the significance of the case – agreed that doctors must tell patients not only what they think they need to know but also the risks that might matter to the patient. “Up to now it has been the Bolam standard [from a 1957 case of that name] – what a responsible body of other doctors would do,” said Leslie Hamilton, a council member of the RCS. “This is a new standard. It is really about focusing on the ­individual patient. We now need to sit down and tell the patient all the other options and let the patient choose and not tell them.”

The implications for doctors are huge, said Hamilton, who said the supreme court ruling was a “real wake-up call”.

Lady Hale, one of the judges, also said that doctors must not discuss one particular treatment over other possible options. “It makes a lot of sense but we have never really done that,” said Hamilton. “We tell patients about a particular option and get them to sign the form.”

NHS practice has traditionally been to leave it to doctors to decide what risks to communicate to patients – in what the RCS called a more “paternalistic approach”.

The Montgomery case means that doctors will have to explain all the options to their patients, including the ones they themselves would not recommend, and let them choose for themselves.

It will also probably have to be the consultant rather than one of the junior doctors who talks through the options and finally gets the patient’s agreement. ­Hamilton says the consent form – often signed on the morning of surgery – will have to be replaced by “a decision-making record” for which the details of the discussion are written down.

Consent forms have never been strong evidence in court anyway, said Hamilton, because a signature does not prove that the patient had all the details of the risks and benefits of the operation explained fully to them in advance of surgery. “The RCS is very concerned that doctors and hospitals haven’t fully appreciated how much the judgment given in 2015 changed our understanding of patient consent,” he said.

“The watershed judgment in the Montgomery case shifted the focus of consent towards the ­specific needs of the patient. Hospitals and medical staff are leaving themselves very vulnerable to expensive litigation and increased payouts by being slow to change the way the consent process happens. We cannot underestimate the psychological impact facing litigation can also have on doctors. It can do serious damage to their confidence in practice and their reputation. Doctors must protect themselves and their patients by ensuring the consent process is carried out properly.”

The RCS is also concerned that many NHS trusts are not allowing enough time for the consent process to be carried out properly during consultations. “The NHS is under huge pressure and seeing more patients than ever. It’s not hard to see how in many hospitals gaining a patient’s consent has become a paper tick-box exercise, hurriedly done in the minutes before a patient is wheeled into theatre for their procedure. Operating lists and consultation clinics are packed leaving little time for these important consent discussions,” said Hamilton.

Patients must understand options, says Royal College of Surgeons

The secret life of an anaesthetist: if surgeons are the blood, we are the brains

You have to get used to being invisible as an anaesthetist. A large percentage of the public has no idea that we’re medically qualified. I’ve been asked how many GCSEs you need to be an anaesthetist. In fact our training is as long as that of a surgeon. It takes seven years of specialist studies after you’ve already completed two years of basic general training; and that’s after five or six years at medical school.

Patients always remember the name of their surgeon, never that of their anaesthetist. But it’s still a hugely rewarding job. We’re everywhere in the hospital. In theatre obviously, but also in intensive care, on the wards, in the emergency department, and in the pain clinic, with those who are really suffering. We assess people’s fitness for surgery, how likely they are to suffer complications, and support them through the operation itself and into the postoperative period.

If there’s an emergency during an operation the team looks to the anaesthetist for leadership. If you panic, it spreads

When you first start anaesthetising patients early on in your career it’s terrifying. You know that if you get it wrong you might kill someone. Our drugs stop people breathing and it’s our job to take over that function. Even after nine years I still get a frisson of nerves in some situations. I hide it though; it’s an important part of the job to stay calm at all times. If there’s an emergency during an operation the team looks to the anaesthetist for leadership, as the surgeon is often too focused on fixing the immediate problem. If you panic, it spreads and the team loses the ability to function efficiently.

Anaesthesia is a very safety-oriented speciality; we’ve led the way in reducing patient harm by looking at human factors, using simulation training and reporting “near misses”. By sharing episodes where a patient has nearly come to harm, we hope to address the causes and prevent actual harm from occurring in the future. We’ve embraced ideas from aviation and other high-reliability industries about how a team functions effectively. We try to flatten the hierarchy in theatre so that the least qualified individual can raise concerns without feeling intimidated. This makes it especially frustrating when patients come to harm after they leave your care because the rest of the system is struggling to cope.

There are so many gaps in rotas of doctors, nurses and the wider healthcare team, and the proposed junior doctor contract changes will only make this worse. The outlook for patients who suffer complications after surgery is determined not by the presence of the complication, but by how quickly it is picked up and dealt with. This simply can’t happen when workloads are too high.

I look after one patient at a time. This ability to offer a premium level of care is one of the reasons I became an anaesthetist in the first place. On the wards each doctor will be responsible for up to 30 people a day, and even more at night. I can see with each heartbeat what the patient’s blood pressure is in the operating theatre; on the wards, it might only be checked once every four hours.

The speciality is a broad church, so there is room for all personality types. But given the precision involved there is perhaps a tendency to obsessive traits. I’ve worked with colleagues who have a 10-minute ritual for putting in an intravenous cannula that had to be completed in the correct sequence. Our postgraduate exams are renowned for being tricky but they are really a test of commitment. We’re experts in physiology, pharmacology, and physics; we have to know about everything from cellular respiration to how our drugs work, to the internal workings of a defibrillator.

Patients are usually nervous when they arrive in my anaesthetic room. It’s an exercise in trust to place your whole life in the hands of others. Every anaesthetist will have their spiel, some small talk to distract the patient from their imminent surgery. I ask them about family, talk about their favourite place to visit, what they do for a living. I modify my “going to sleep” talk depending on the small talk that’s gone before. If they love travelling, I’ll talk about a white sandy beach, with crystal clear waters, a gentle breeze. The more nervous they are, the longer they take to go to sleep. Many young, usually male, patients have commented as the drugs take effect that it feels just like a Saturday night. I’ve also been asked if I liked to have sex in a vest – I decided not to pursue what he meant by that when he woke up.

Every anaesthetist has a secret weapon when working in the operating theatre. We always work with an assistant, who might be a nurse or an operating department practitioner (ODP). The very best of them could do my job without thinking twice, but they choose even greater anonymity than the anaesthetist enjoys. Many a time I’ve had my bacon saved by an astute ODP. Some appear to have powers of extrasensory perception; I turn to ask for something and there it is in my hand.

I’ve also worked with many theatre colleagues with a wicked sense of humour. Before my first unsupervised operating shift, I confessed to the ODP that I’d never worked alone before. He paused and stuttered that neither had he, it was his first day at work, being newly qualified. I spent the entire day terrified that some disaster would befall us, and we wouldn’t be up to the challenge. At the end of the day he came clean – he’d been doing the job for 20 years.

Frustrations creep in to the job when the system fails. I often arrive at 7.30am (30 minutes before my shift begins), so I can find space on the pre-op ward to see my patients in private, find out their history and take the time to address any concerns. It’s then immensely distressing when operations are cancelled due to lack of beds, or lack of notes, or the surgeon’s been double booked, or you are moved to another job at short notice. Anaesthesia can also become routine; it’s a far cry from the early days of the speciality when unpredictable drugs were used without monitoring. If the patient is fit, it’s rare for them to come to harm from a general anaesthetic.

It is important to have other interests to distract from the stresses, strains and occasional boredom of the job. In my spare time I’m a volunteer doctor for the ambulance service. Being under a car in a ditch in the rain at 2am is very different from the bright lights of the operating theatre. Some of my colleagues are real polymaths. There are painters, musicians, novelists, as well as some quite serious sports people. The coffee room in the morning is the preserve of the middle-aged man in lycra. We see every day the damaging effects of too little aerobic fitness, so we’re staving off our own mortality.

The best bits? Reassuring nervous patients, rendering labouring women pain-free with the magic of epidural analgesia and, of course, merciless surgeon baiting. I’ll ask if they need me to Google instructions for the operation, or if they’ll be finished before new year. We say there’s a blood-brain barrier between the surgeon and the anaesthetist: they’re the blood, and we’re the brains.

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The secret life of an anaesthetist: if surgeons are the blood, we are the brains

Surgeons use robot to operate inside eye in world first

British surgeons have successfully performed the world’s first robotic operation inside the eye, potentially revolutionising the way such conditions are treated.

The procedure was carried out at John Radcliffe hospital in Oxford, where surgeons welcomed its success.

On completing the operation, Professor Robert MacLaren said: “There is no doubt in my mind that we have just witnessed a vision of eye surgery in the future.

“Current technology with laser scanners and microscopes allows us to monitor retinal diseases at the microscopic level, but the things we see are beyond the physiological limit of what the human hand can operate on.

“With a robotic system, we open up a whole new chapter of eye operations that currently cannot be performed.”

Patient Father William Beaver, 70, an associate priest at St Mary the Virgin church in Oxford, said his eyesight was returning following the procedure, having previously experienced distorted vision similar to “looking in a hall of mirrors at a fairground”.

The procedure was necessary because the patient had a membrane growing on the surface of his retina, which had contracted and pulled it into an uneven shape. The membrane is about 100th of a millimetre thick and needed to be dissected off the retina without damaging it.

Surgeons normally attempt this by slowing their pulse and timing movements between heart beats, but the robot could make it much easier. Experts said the robot could enable new, high-precision procedures that are beyond the abilities of the human hand.

The surgeons used a joystick and touchscreen outside the eye to control the robot while monitoring its progress through the operating microscope. This gave medics a notable advantage as significant movements of the joystick resulted in tiny movements of the robot.

This is the first time a device has been available that achieves the three-dimensional precision required to operate inside the human eye.

Speaking at his follow-up visit at the Oxford eye hospital, Father Beaver said: “My sight is coming back.

“I am delighted that my surgery went so well and I feel honoured to be part of this pioneering research project.”

MacLaren said: “This will help to develop novel surgical treatments for blindness, such as gene therapy and stem cells, which need to be inserted under the retina with a high degree of precision.”

The robotic eye surgery trial involves 12 patients undergoing operations with increasing complexity. In the first part of the trial, the robot is used to peel membranes off the delicate retina without damaging it.

If this part is successful, as has been the case so far, the second phase of the trial will assess how the robot can place a fine needle under the retina and inject fluid through it.

Experts said this could lead to use of the robot in retinal gene therapy, a new treatment for blindness which is currently being trialled in a number of centres around the world.

Surgeons use robot to operate inside eye in world first

Sufferers denied vital operations by NHS bodies, surgeons report

Shadow well being secretary Andy Burnham. Photograph: Stefan Rousseau/PA

Sufferers are getting denied accessibility to crucial surgery by NHS bodies, which are ignoring suggestions and choosing to ration some operations, according to an investigation by the Royal College of Surgeons.

The surgeon’s report mentioned that 73% of Clinical Commissioning Groups (CCGs) –the GP-led organisations concerned in the delivery of a variety of NHS solutions – do not adhere to guidelines set down by the National Institute for Wellness and Care Excellence and clinical advice on referral for hip replacements, or have no policy in place for this procedure.

It also located that much more than a third of CCGs (44%) need individuals to be in a variety of degrees of pain and immobility – with no consistency applied across the nation – or to get rid of bodyweight before surgery.

Clare Marx, president of the Royal College of Surgeons, said: “This report looks to demonstrate that local commissioners are imposing arbitrary rules governing access to some routine surgical procedure.

“The inspiration might not be monetary but it is clear that some CCGs do not commission providers making use of clinically accepted evidence-primarily based guidance.”

The report, Is Access to Surgical treatment A Postcode Lottery?, analysed details obtained under the Freedom of Data Act and looked at tonsillectomy, hip substitute, inguinal hernia restore and surgical remedy for glue ear (Otitis media with effusion). Only 27% of CCGs reviewed have been discovered to have had policies that complied with Nice or surgical guidance on inguinal hernia fix, whilst 58% have no policy at all. As a lot of as 15% essential evidence of a hernia escalating in size or a history of reoccurring problems, even if a patient is in debilitating pain.

Responding to the report, the physique representing CCGs explained that they were clinically led organisations that make clinically led selections centred on the needs of their individuals and local populations.

“To insinuate that their determination is purely economic is wrong,” mentioned Dr Steve Kell, co-chair of NHS Clinical Commissioners (NHSCC). “There have to be a stability between neighborhood determination generating and nationwide recommendations and NHSCC will be functioning with Great and other people to make sure that occurs. In my CCG, for example, we have developed greatest practice guides with the neighborhood consultants to improve primary and secondary care management which replaced the old method in which individuals essential prior authorisation. This type of locally designed perform is going on correct across the country.”

Dr Amanda Doyle, co-chair of NHSCC, extra “Making sure sufferers get the ideal possible care against a backdrop of increasingly squeezed finances is one particular of the biggest problems CCGs face, but we know that clinical commissioners are currently operating challenging to improve neighborhood providers by producing responsible, clinically led selections in partnership with GPs, individuals and companies.”

“Asking sufferers to shed weight just before having hip operations is about decreasing the clinical threat to the patient and bettering the possibility of a effective operations, it is not about money. Tonsillectomy, despite the fact that 1 of the most common procedures still carries risks to the patient – the observe and wait strategy indicates clinicians can assess the severity and frequency of attacks to guarantee the benefit of having an operation outweighs the risks to the patient.”

The report was seized on by the Labour get together, which sought to link its findings to the government’s NHS reorganisation.

Andy Burnham MP, Labour’s Shadow Wellness Secretary, mentioned: “Labour often warned that David Cameron’s re-organisation would be an assault on the ‘N’ in ‘NHS’ and lead to a postcode lottery operating riot. This is precisely what has occurred.”

“Sufferers should not be waiting in soreness and discomfort for operations that are freely offered elsewhere. Ministers promised to rule out arbitrary rationing and they can’t run from this guarantee any longer.”

The Royal College of Surgeons suggested that the Government and NHS England need to have to evaluation what even more action is essential to ensure the NHS is delivering equitable entry to substantial top quality surgical care.

Sufferers denied vital operations by NHS bodies, surgeons report

NHS "defies the law" to deny pensioners important operations, warns Royal School of Surgeons

It exposes a main postcode lottery in practice across the country – with a 37-fold variation in costs of surgery for breast cancer for ladies aged 65 and more than, based on in which they live. Hip replacements had been 10 times as common in some elements of the nation as other individuals, with a sixfold variation in prices of surgical treatment for bowel cancer in 2011-12, the figures display.

The RCS president, Prof Norman Williams, mentioned the scale of the distinctions was “extremely worrying,” raising suspicions that some elements of the NHS had been working covert blanket bans against procedures on age grounds.

Final October, the Government launched age discrimination laws which indicate sufferers ought to not be denied procedures on grounds of age. Physicians are supposed to assess sufferers based mostly on their fitness for an operation, and likely benefit from it.

But charities explained they have been concerned that the figures could imply that GPs were “writing off” pensioners, and not referring them to experts, although in other circumstances cost-cutting by NHS authorities was hitting older individuals hardest.

Specialists calculated the fee of surgical treatment per 10,000 folks in England’s 211 overall health authorities, known as clinical commissioning groups (CCGs) during 2011-12. They found that in some regions, amongst individuals aged 65 and above, there were 37 breast excision procedures to eliminate cancerous tumours. In other parts of the nation, complete numbers had been so minimal that they had been calculated as a fee of zero, that means that in total, fewer than five patients obtained the procedure in excess of the 12 months.

Seventeen CCGs had no individuals above the age of 75 receiving the surgery, even though some places had been providing operations for 27 females per 10,000 population.

Equivalent trends have been found in other common procedures.

Fourteen regions supplied no surgical procedure to get rid of gall bladders for these in excess of the age of 75. Twenty-9 places offered “zero surgery” for those aged 75 and over for a single of the six operations analysed.

Some CCGs supplied no surgical procedure to older patients for a range of procedures.

Bradford City supplied no breast excision surgery, gall bladder operations or knee replacement surgical treatment to these 75 and more than in the course of the period.

West Lancashire offered neither breast excision surgery or knee replacements for individuals 75 and more than, even though Corby did not offer any breast excision or gall bladder replacements for individuals of that age. Prof Williams suggested some components of the NHS could be working unofficial “age bans” on certain remedies.

He explained: “These are huge discrepancies – actually large. It is unattainable to demonstrate the motives behind all the variation but we have our suspicions and I fret about age discrimination.

“It is truly worrying when you look at something like colorectal cancer and there is a sixfold difference amongst various components of the nation after the age of 65 — when we know surgical treatment is the greatest type of treatment.”.

The Overall health Secretary mentioned: “We expect the NHS to make confident that all sufferers can access the treatment method they want – discrimination of any type is unacceptable.”

Tom Gentry, Age UK’s policy adviser and one of the report’s authors, mentioned there was no defence for charges of zero surgical treatment for frequent situations amongst the over 75s and that attempts to enhance the scenario needed to tackle a number of barriers, like making certain sufferers came forward with symptoms, and creating positive their medical doctors took them seriously.

He mentioned: “GPs have been recognized to write off symptoms in older age groups, dismissing troubles as aches and pains when in reality they are serious troubles.”

Mr Gentry said sometimes outdated understanding amid medical employees meant they assumed a patient had “had a excellent innings”, when with the right treatment, they could live at least a decade more.

Martin McShane, NHS England’s national clinical director for prolonged term problems, mentioned: “NHS England is committed to making certain older individuals have equal entry to remedy which need to often be primarily based on what is proper for each and every individual patient, on their informed preferences, not their age.”

A spokesman for Bradford City CCG stated all its decisions had been based mostly on clinical need to have and patient choice.

Meanwile, a main report has referred to as for towns and cities to be redesigned to make them match for an ageing population.

Outdoor health club tools for all ages, futuristic “urban pods” to transport individuals close to and even swings at bus stops could also aid folks get out and about more simply and combat loneliness.

The suggestions are contained in a report published jointly by the Global Longevity Centre and Age Uk.

NHS "defies the law" to deny pensioners important operations, warns Royal School of Surgeons

Central African Republic a surgeon"s diary from a nation on the brink

They come in ones and twos, sometimes a lot more. Some of the individuals have fresh bullet holes or machete wounds other people have wounds that have been neglected for days due to the fact of an inability to attain the hospital. Some are innocents caught in the crossfire, some the very ones who shoot.

And as is most typically the situation in civil conflicts, the majority of patients are not the ones immediately wounded but individuals who suffer the consequences of the disruptions of an previously-feeble health technique: intestinal perforations from typhoid fever pregnancies challenging by arrested labour significant skin and muscle infections that have spilled more than into the bloodstream, foremost to septic shock.

The Bangui General Hospital is a single of three primary hospitals working in the Central African Republic’s capital, with its population of some 1 million folks. Built in the 1960s by the Moroccan government, the big complex sits a few miles in one route from the relative peace of the Oubangui river, and in the other course from the chaos of Bangui’s violence-torn PK5 and PK12 neighbourhoods.

It is from the latter two locations that practically all of Bangui’s Muslim citizens have fled or been evacuated in the past few months as sectarian violence amongst Muslims and Christians threatens to tear the nation apart. Most have continued on to the north-west of the nation, or to neighbouring Chad or Cameroon.

I am part of a skeleton staff of expatriate physicians, nurses and support staff from Médecins Sans Frontières that functions with Central African physicians and nurses to give emergency space and surgical care at the hospital, although other teams focus on outreach in refugee camps and mobile clinics across the nation. From the hospital’s rooftop we peer across the city.

A flock of birds floats languidly across the sky, the crimson glow of the sun setting behind the unlit spotlight towers of the main soccer stadium. The peaceful scene belies the spasmodic chaos below. At evening we hear scattered gunfire and grenade explosions in the distance and wonder how a lot of patients will come, and when.

Muslim in the P12 district of Bangui put together to flee the violence. Photograph: Eric Feferberg/AFP/Getty Pictures

A 23 yr-previous lady arrives one particular early morning, her body riddled with bullet holes. Numerous slugs have blasted via her limbs, shattering bones. Despite our ideal efforts, her gaping chest wounds portend a death that can’t be averted by restricted surgical capacity. I wonder – no more here than back house in the US – what prospects people to violence. The human physique is not meant to be torn apart by bullets.

Spasms of violence grip this country, whilst in the background regular societal structures unravel. Thirteen percent of the population is internally displaced, schoolrooms are usually empty and crops go unplanted.

A yr in the past, the overt violence in the capital was possibly worse aid workers who have been here described dead bodies lining the streets on the way to the hospital and extrajudicial killings happening everyday across the city, some even outdoors the paediatric ward down the street.

And what now? Regardless of the presence of some two,000 French troops and 6,000 members of an African Union-led peacekeeping force, the Central African Republic appears to teeter on the brink.

The UN just lately approved the deployment of 12,000 extra troops and police to support maintain buy, but they are not due to arrive right up until September. Meanwhile, the disorder in this former French colony continues.

While the war-wounded might be the most visible victims, the true and lasting tragedy could lay in the consequences of worsening malnutrition, estimated to impact in excess of two million citizens, many of them young children. A society broken at the centre is fraying ever much more at the edges.

A rebel fighter in the Central African Republic smokes during a patrol, near to the border with the DRC. Photograph: Goran Tomasevic/Reuters

From the northern village of Boguila, near to the Chadian border, information of the slaying of 16 civilians, like three Médecins Sans Frontières nationwide staff, chills our hearts and rattles nerves.

Unprovoked, and taking place throughout an armed robbery at a well being outpost clearly marked as a Médecins Sans Frontières facility, the killings have sparked a debate within the organisation, utilized as it is to working in challenging situations. Médecins Sans Frontières made a decision to decrease its pursuits during Central African Republic in protest for a quick time, though the function at the hospital continues unabated.

Final week, a 35-12 months-previous female in her 10th pregnancy arrives in the emergency room in shock, barely coherent. The shape of her swollen abdomen suggests a ruptured uterus and she is rushed to the operating space. The eight-month-old foetus has perished and the mother’s life hangs by a thread as we perform an emergency hysterectomy.

Uterine rupture occurs up to ten occasions more frequently in least-produced nations than it does in the most-developed nations. It can be a last blow right after the domino result of having several pregnancies, limited pre-natal care and obstructed labour with impaired entry to well being care services. Up to 90% of girls with uterine rupture die, as will this patient in a couple of hours.

There is too little that we can do, also late. The patient’s mom waits outside and receives the news, translated from French to Sango and back, with an unmoving face. A short while later on, as daylight breaks and the sounds of roosters and the waking hospital fills the grounds, I observe as she carries away the wrapped physique of her unborn grandson. She disappears behind a cement column painted a rusty red, bare feet padding along the floor. It ought not finish like this…and nevertheless it does.

David Rothstein is a paediatric surgeon at the Lady and Children’s Hospital of Buffalo. He started operating with Médecins Sans Frontières in 2007 in northern Sri Lanka and has made month-extended journeys for MSF each 12 months because, working in Chad, Nigeria, Democratic Republic of Congo and the Central African Republic

This report initial appeared on Warscapes

Central African Republic a surgeon"s diary from a nation on the brink

Why do so several eye surgeons dress in glasses?

My eyesight hit the buffers for the duration of puberty. I couldn’t even see the blackboard, allow alone study anything on it, but I survived by copying from William “Thicky” Hickey (who can not have been that thick or else I’d have never ever made it to health care school). But I was located out when my suspicious Mum attempted an impromptu sight test. “Could you read the best line of that chart?” “What chart?” Boom, boom, and off we go to the opticians.

The sight check was the simple bit, but picking the NHS frames was genuinely tough. Back in 1973, they have been all a bit, well, clear. I walked out of the opticians with what looked like a sea slug asleep on my forehead. Not that that was my major concern. The lenses were so robust that the pavement came up to meet me. Nevertheless, it was more affordable than cider.

Monday morning at Marlborough Grammar College, tentative entrance from ginger boy in new glasses. “Hey, appear! It’s Joe Ninety!” “No it’s not. It’s the Milky Bar Kid.” How we all laughed.

Thankfully, it was a total yr prior to we went complete so I had a bit of time to work on my self-image just before the heckling got truly private. Even then, I only wore my glasses in class. I want I’d been brave enough to put on them round the back of the French hut for impromptu intercourse education. All my adolescent fumbling was misplaced in a purple haze. And I refused to dress in glasses for the walk home from college, which encompassed Britain’s widest high street. Miraculously, I was only hit twice.

At 16, my eyesight stabilised and I switched to contact lenses. I after crashed out right after a party, place them in a glass of water by the bed, woke with a raging thirst and swallowed them. The optician informed me that my insurance did not cover gross acts of stupidity but I received both of them back with a bit of determination and a sieve.

But the outdated challenging get in touch with lenses were hopeless for a junior medical professional on get in touch with. I could not rest in them and I could not invest five minutes putting them in when I was named out to a cardiac arrest. So I switched back to glasses and have stuck with them ever considering that. They’re fantastic for a doctor. You can choose good curvy frames that make you appear more caring and studies have proven that relatives are significantly less very likely to punch you if you are sporting glasses. And if you ever want to escape from actuality, just get off your glasses and the total world gets a scrumptious blur*.

Dr Phil’s glasses attribute proudly on all his books, Medicine Balls (funny), Trust Me, I’m Nevertheless a Medical doctor (scandalous) and Sex, Sleep or Scrabble? (How to pleasure your self in a secure and sustainable way).

* Not advised although sword-fighting or working heavy machinery.

Why do so several eye surgeons dress in glasses?

Surgeons Know Bad Surgeons When They See Them

The surgeon advised the Weindel loved ones that the operation had gone properly. He had taken Dale Weindel’s stomach and cut it into two, and rerouted his modest intestines so that all the meals Weindel ate would now pass by means of the smaller portion of his stomach. He had offered Weindel a “gastric bypass” operation, the best and, some would say, only successful treatment method for morbid obesity. Inside of a number of days, however, Weindel took a flip for the worse. He developed a pocket of infection – an abscess – in his abdomen. The infection spread despite his doctor’s ideal efforts to deal with it, and bacteria quickly infiltrated his lungs triggering pneumonia. Three weeks following the operation, Weindel was dead at the age of 38.

Was it undesirable luck that killed Dave Weindel or surgical incompetence?

There is an outdated saying in medication: “The operation was a achievement, but the patient died.” It mocks surgeons who get so caught up in the technical difficulties of a offered process that they shed sight of regardless of whether their sufferers are healthier sufficient to advantage from the procedure. But the phrase is not constantly used satirically. All surgical procedures carry risks, following all. Even in the ideal of hands, the process Dave Weindel acquired – gastric bypass – carries a higher risk of problems. Some surgeons have higher complication rates than other people, but it is typically tough to tell regardless of whether this is since some are much more experienced or simply because some surgeons operate on “riskier” individuals – these with other healthcare troubles that increase the chances that something will go incorrect.

That may possibly adjust quickly. A study published earlier this 12 months in the New England Journal of Medication factors towards a way of making use of surgical video that will not only enhance how we measure the top quality of surgical care, but could even aid surgeons increase their operative strategy. The examine was conducted by Dr. John Birkmeyer, a gastric bypass surgeon at the University of Michigan as well as a researcher who studies the quality of surgical care. Birkmeyer and colleagues had twenty surgeons submit videotapes of themselves carrying out gastric bypass procedures.  He then had other gastric bypass surgeons view the videos and judge the quality of every of surgeons’ method.

Birkmeyer wondered no matter whether professionals surveilling others doing the process would be in a position to tell which surgeons had greatest mastered its complexities and, a lot more importantly, whether this kind of judgments would determine surgeons whose patients had been most likely to encounter problems. The results have been striking: Soon after watching a surgeon complete a single operation, the judges could predict how typically all of the doctor’s individuals suffered from issues.   Patients operated on by significantly less skilled surgeons experienced complication rates of ten to fifteen per cent people operated upon by a lot more skilled surgeons knowledgeable complication prices closer to five or 7 per cent of the time.

Birkmeyer chose to review gastric bypass the two because it is a risky procedure—with one in thirteen sufferers going through a significant postoperative complication —and because  it is technically demanding, requiring surgeons to cut through and reconnect delicate bowel tissue. (Imagine the thin tissue that encases sausages if the surgeon punctures a small hole in intestinal tissue, which is equivalent, bacteria will spill out into the patient’s abdomen, causing a possibly lethal infection.) One more complicating factor is that gastric bypass is used to treat morbid weight problems, and “obese patients are more difficult to operate on,” Birkmeyer says. “It is hard to get a clear see of the surgical discipline.” Making matters worse, the dimension of this kind of patients increases the distance between the surgeon’s hands and the body parts they are operating on, forcing them to use longer instruments, which helps make delicate movements far more hard to perform. Birkmeyer puts it colorfully: “Picture skiing a slalom course with downhill skis.”

Birkmeyer himself was stunned at how revealing the movies had been: “Practicing surgeons aren’t employed to watching each and every other operate, so the Michigan surgeons did not know what to assume.  As I watched all the video clips, I was amazed—and a tiny disheartened—at how experienced some of my peers were.  At the same time, some of the surgeons at the other finish of the skill spectrum created me extremely unpleasant.”

What need to health care authorities do in light of these findings?  Birkmeyer and colleagues propose that if their findings can be replicated, video assessment of surgical approach could become a central component of surgical good quality measurement and improve the way that specialist organizations check doctor overall performance. At the moment, the American Board of Surgical procedure recertifies surgeons annually by administering a two-hundred question a number of-decision examination. This kind of an exam is useful in identifying whether or not surgeons are trying to keep up with health care knowledge, but does nothing to check whether or not their surgical method is up to snuff.

We might also be in a position to leverage video technologies to boost medical care. The quality of  surgical approach, following all, is not set in stone when surgeons finish their residency training. Atul Gawande wrote about the position that coaching could play in strengthening surgical performance for skilled surgeons.  Gawande pointed out that the world’s best tennis gamers nevertheless use coaches to increase their overall performance, in contrast to surgeons, who stop getting suggestions on their operative technique as soon as they comprehensive their clinical training. Keen to see what a good coach could accomplish, Gawande recruited a former mentor to observe his operate in the working space. Right after obtaining suggestions from this mentor, Gawande noticed considerable improvement in his surgical efficiency.

Birkmeyer and his Michigan colleagues will quickly know regardless of whether Gawande’s perceptions of coaching hold up to scientific scrutiny.  With new funding from the Nationwide Institutes of Well being, Michigan surgeons are embarking on a statewide experiment in which each and every bariatric surgeon is professionally coached.  “I do not feel coaching will ever level the enjoying field fully, but our objective is to make every surgeon a small better,” says Birkmeyer. Maybe in the not too distant future, surgeons will prove their mettle by submitting surgical video to licensing boards, while bettering their surgical abilities viewing the identical video clips with the assist of surgical coaches.

Surgeons Know Bad Surgeons When They See Them

Trainee surgeons more probably to be bullied: survey

The poll by the Royal School of Surgeons of Edinburgh, the oldest royal college in Britain, identified 60 per cent of surgical trainees had been on the receiving end of this type of aggression and practically all had observed it.

Nevertheless just more than a third felt in a position to report it by means of the appropriate channels.

Surgeon-in-training Mr Richard McGregor, chairman of the Trainees’ Committee, said: “According to a latest publication in the British Health-related Journal, 1 in 5 NHS personnel have been the victim of bullying and just over two in five have witnessed it.

“These figures are dwarfed by the expertise of surgical trainees, three in 5 having been targets and nine in ten observing this damaging behaviour up near in the workplace. These figures proceed to back a latest GMC survey highlighted surgical procedure as 1 of the worst specialties for bullying and undermining.

“There requirements to be tougher lines for these guilty of this variety of unacceptable harassment and trainees have to be created to come to feel that they can raise concerns securely, rather than just placing up with the abuse simply because of concern of repercussion. Robert Francis QC stated in his report that trainees are the ‘eyes and ears’ of the well being support and a toxic culture of institutional undermining can ultimately influence patient safety.”

Craig McIlhenny, consultant urological surgeon and the surgical director of the RCSEd’s Faculty of Surgical Trainers mentioned he was frequently rapped across the knuckles with a pair of metal forceps when he created a blunder tying stitches throughout operations.

“Surgical treatment has always been observed as a macho, hierarchical culture and the trainers are emulating the behaviour of their seniors from the 1950s. It impacts overall performance and is a really negative for safety.

“Anyone in the NHS will recognise the scenario of a surgeon throwing a tantrum in theatre, shouting, swearing and often even throwing instruments. Some trainers equate their undesirable behaviour as a sign of their energy and authority and that has to change.”

The college is launching a set of standards for trainers to illustrate clearly what is anticipated of them and peer help groups will give a risk-free forum for trainees to air their worries.

Consultant transplant surgeon Lorna Marsdon, convener of the RCSEd’s ‘Professional Excellence’ peer mentoring groups, due to launch in September, stated: “Undermining and, to a lesser extent, bullying, has been a component of surgical culture for a long time, and it is very likely that this could in portion be due to the hierarchy of the setting. There is tiny doubt that we learn our behavioural patterns from senior colleagues, and if the senior surgeons are exhibiting destructive behaviours, the cycle will carry on.

“For a although, I’ve been exploring a way of mentoring as a implies of supporting surgeons in instruction, and consultants.

“One particular of the issues concerning senior surgeons mentoring trainees is that this may possibly perpetuate the hierarchical culture. I came across a group of folks, outside of the surgical arena, who run peer to peer mentoring and support schemes, and was so struck by how strong it was that it grew to become a model for the Expert Excellence Groups.

“These signify a protected network in which folks can share tips and problems, and assistance to assist men and women deal with conditions.”

Vice president, Mike Lavelle-Jones, who was voted surgical trainer of the yr, said: “It is critical to hold in mind that not everyone is a born trainer – occasionally, inexcusable situations of aggression or harassment can emerge if men and women are tasked with a responsibility they simply do not have the equipment to cope with.

“Matters surrounding bullying and harassment in the workplace might be complex, but this kind of routines have no place in the NHS setting, and I’m pleased to help in undertaking a detailed analysis of these troubles and produce strategies to tackle them head on.”

Advisor trauma and orthopaedic surgeon Ian Ritchie, president of the Royal College of Surgeons of Edinburgh, said: “Bullying and harassment is obviously nonetheless a important concern for trainees and one particular which the University is determined to address. For individuals who are subject to this kind of behaviour it can have a considerable and lasting impact, but individuals who witness it inside of their staff can also be impacted deeply.

“As a consequence trust, the cornerstone of any staff, are not able to be established, and a climate of concern and mistrust can produce which obviously has an result on patient safety.

“Clinicians historically tend to have a mother or father/youngster technique with trainees, when, in truth, it would possibly be more healthy if they were regarded as equal grownups, albeit with less clinical experience. Maybe that would advertise the notion of rational discussion among adults rather than scenarios that could be viewed as bullying.

“Most importantly, trainees must not truly feel that they will be fingered by speaking out they must respond honestly to any surveys because it’ll get back by means of the method for remediation to get spot.”

A spokesman for NHS Employers said: “NHS organisations all have their own personal HR policies, but we would count on all employers in the health support to have zero tolerance of any form of bullying, whether verbal or bodily, when it is brought to their attention.

“It is imperative that employees speak up immediately if they are currently being bullied, in order to guarantee it is brought to an instantaneous halt as soon as possible, and it is just as important that staff are supported to increase concerns about bullying wherever they need to.”

Trainee surgeons more probably to be bullied: survey

Plastic surgeon"s profession in tatters following transsexual patient falsely claims he botched ear operation

“I’m going to see you dog, f****** c***. You’ve deformed me for lifestyle.”

^{Dr. Brian Mayou founded the Cadogan Clinic in Belgravia}

Charles also talked about Dr Mayou’s wife and daughters, calling 1 of his ladies a “pig” and a “slut” and branding the surgeon a “kiddie fiddler.”

The medical doctor was also forced to apply for fifty on the web posts to be eliminated from three different sites, which contained material this kind of as: “He is a paedophile and demands to be locked up.”

The former advisor and honorary lecturer at Guys and St. Thomas’ Hospital, who was the plastic surgeon who initial launched liposuction to the United kingdom, now has the complaint completely on his Common Health-related Council record.

“There have been a number of forms of threats over a long period of time,” magistrate Mrs Nicola Leach advised Charles. “The threats have impacted Dr Mayou’s family, occupation, track record and earnings. The impact is unimaginable.”

Charles made the unfounded allegations during a two-and-a-half 12 months campaign, resulting in the surgeon’s appropriate to perform at South Kensington’s private Cromwell Hospital currently being withdrawn.

Charles, Cowbridge Road East, Cardiff, of pleaded guilty to harassing Dr Mayou between December sixteen, 2010 and May possibly 16, last 12 months by sending many unwanted insulting messages and was sentenced to 6 months imprisonment, suspended for two many years.

“This surgeon, who has pressed these charges, has induced me so a lot pain and distress,” Charles informed the court. “If you knew the full story and what this man has completed to me you would be shocked.”

Charles was also ordered to pay out £2,500 compensation to the surgeon, £150 fees an £80 victim surcharge and was made topic to a 9-month drug rehabilitation necessity.

Charles was arrested when arriving in the Uk at Bristol Airport on July 22, final 12 months, after a journey to the continent.

In his victim impact statement Dr Mayou explained the abuse gave him sleepless nights and patients had cancelled surgical procedure as a end result of Charles’ on the internet rants.

“He has carried out a social media campaign towards me and the clinic,” stated the surgeon. “Sufferers have cancelled as a direct outcome of the posts.”

Charles’ lawyer Miss Julie Stanhope advised the court: “My client suffers a large-degree of self-hatred and in his early thirties decided to handle his gender issues.

“The very first stage was surgery on his ears by Dr Mayou and he accepts the behaviour the physician endured was extreme and unacceptable.”

Charles has because had facial reconstruction surgical treatment and breast augmentation.

He previously jumped bail right after telling the court: “I am halfway through a intercourse-change and sending me to a male penitentiary would be sexual abuse.”

Plastic surgeon"s profession in tatters following transsexual patient falsely claims he botched ear operation

French Surgeons Execute 1st Aortic Valve Surgery Without Opening The Chest

Surgeons in France report that they have performed the very first complete endoscopic aortic valve replacement (TEAVR) in 2 human patients. Their paper has been published in the the Journal of Thoracic and Cardiovascular Surgery [subscription required].

In latest many years the development of TAVR (transcatheter aortic valve replacement) has attracted enormous focus. But TAVR, which is carried out by an interventional cardiologist, is generally restricted to patients who are either not appropriate for surgical procedure or at extremely higher risk for surgery.  The new paper is the most recent indication that surgeons also are now doing work to restrict as much as feasible the trauma of  aortic valve surgical procedure.

The new process could allow surgeons to change the aortic valve without having opening the chest, even though it will nonetheless require cardiopulmonary bypass and excision of the old valve. The essential to the new procedure is the latest availability of sutureless aortic valve bioprostheses, in this situation  the Medtronic 3f Allow bioprosthesis. In current many years these gadgets have allowed surgeons to build “minimally invasive” surgical techniques. The new report is about the very first surgical method in which the chest is not opened and the method is carried out totally by way of endoscopes. The authors pointed out that 1 advantage of TEAVR is that it is really straightforward to convert to a much more traditional open surgical procedure if it gets needed.

The two patients have been 82 and 93 years of age and had aortic valve stenosis. The patients spent about 2 and 1/two hours under cardiopulmonary bypass, but the real implantation of the device took only 45 minutes. Both individuals have been discharged from the hospital in a week and have had no severe complications.

The authors said that the procedure occasions were “acceptable” and that they think the studying curve for TEAVR could be shorter than for completely endoscopic bypass surgical procedure. They further anticipate that advances in engineering will lead to a lot more productive procedures.

The lead author of the paper, Marco Vola, a cardiovascular surgeon in Saint-Etienne, France, mentioned the improvement of the procedure in a press release issued by the journal: “In our institution, we started by adopting the mini-sternotomy strategy, involving a tiny incision via the sternum, as regimen. We then transitioned to the correct mini-thoracotomy technique, involving a small incision by way of the thorax, very first beneath direct see, then with an endoscopic camera. Finally we adopted a entirely endoscopic method.”

“These 1st procedures show that totally endoscopic sutureless aortic valve replacement is technically feasible,” he stated. “Further clinical expertise and technical development are essential to shorten operation occasions and to assess further the prospective postoperative benefits of TEAVR.”

French Surgeons Execute 1st Aortic Valve Surgery Without Opening The Chest

Surgeons attach leg to arm in cancer operation

The large tumour which was removed in the procedure had spread from Mr McGregor’s pelvis into his thigh, and attempts to treat it over the last decade had failed.

Surgeons at Newcastle’s Freeman Hospital designed a procedure to remove the tumour and use his calf to repair the hole that it left.

They detached part of his leg, except for the bones, and attached it to one of his forearms, allowing blood to continue flowing through it. Following the removal of the tumour, the calf was disconnected from his arm and attached to the site.

The operation, which took place last August, lasted from around 9am one day until after 3am the following day.

It was carried out by three consultants, whose work Mr McGregor described as “amazing”.

“You can’t describe the feeling, you think you’re at death’s door and then you wake up and think wow, I’m here. It’s a wonderful feeling,” he said.

The team of consultants believe this was the first procedure of its kind, although it is thought that it may have been attempted before over the course of two operations.

One of the consultants, Mani Ragbir, a plastic and reconstructive surgeon, said: “It’s not easy for a surgeon to tell a patient that they haven’t done this particular procedure before.”

Surgeons attach leg to arm in cancer operation

Surgeons attach leg to arm in cancer operation

The large tumour which was removed in the procedure had spread from Mr McGregor’s pelvis into his thigh, and attempts to treat it over the last decade had failed.

Surgeons at Newcastle’s Freeman Hospital designed a procedure to remove the tumour and use his calf to repair the hole that it left.

They detached part of his leg, except for the bones, and attached it to one of his forearms, allowing blood to continue flowing through it. Following the removal of the tumour, the calf was disconnected from his arm and attached to the site.

The operation, which took place last August, lasted from around 9am one day until after 3am the following day.

It was carried out by three consultants, whose work Mr McGregor described as “amazing”.

“You can’t describe the feeling, you think you’re at death’s door and then you wake up and think wow, I’m here. It’s a wonderful feeling,” he said.

The team of consultants believe this was the first procedure of its kind, although it is thought that it may have been attempted before over the course of two operations.

One of the consultants, Mani Ragbir, a plastic and reconstructive surgeon, said: “It’s not easy for a surgeon to tell a patient that they haven’t done this particular procedure before.”

Surgeons attach leg to arm in cancer operation

Surgeons condemn "appalling" lack of action on cosmetic surgery regulation

The Keogh report was commissioned in response to the PIP implant scandal, but plastic surgeons say the government has failed to comply with via on its suggestions. Photograph: Anne-Christine Poujoulat/AFP/Getty Images

Cosmetic surgical procedure will proceed to be the wild west of medicine, say expert bodies, simply because of the government’s failure to deliver in the controls advisable by its own NHS healthcare director.

Plastic surgeons say they are appalled by the government’s response, which stops short of the regulation recommended by Sir Bruce Keogh’s report into cosmetic surgery. It does not clamp down heavily on the use of dermal fillers – substances injected underneath the skin, typically to plump out the encounter. Nor does it need that anybody concerned in cosmetic procedures is appropriately trained, certified and registered.

“Frankly, we are no significantly less than appalled at the lack of action taken – this review, not the initial one particular conducted into the sector, represents but an additional totally wasted possibility to make sure patient security,” explained Rajiv Grover, president of the British Association of Aesthetic Plastic Surgeons.

“With all the proof supplied by the clinical neighborhood, picking not to reclassify fillers as medicines with immediate impact or setting up any variety of compulsory register beggars belief. Legislators have obviously been paying out only lip services to the sector’s dire warnings that dermal fillers are a crisis waiting to take place.

“Most shockingly of all, the truth that there is no necessity for the real surgeon concerned to acquire consent for the procedure helps make a mockery of the total method. It truly is business as normal in the wild west and the message from the government is clear: roll up and come to feel totally free to have a stab.”

The Royal School of Surgeons will play a central role in determining what level of training and qualification cosmetic surgeons must have, but its remit does not lengthen to other healthcare professionals, this kind of as GPs, dentists and nurses who might be concerned in cosmetic procedures.

The problem that appeared to workout the Keogh overview most was the use of dermal fillers. “A man or woman possessing a non-surgical cosmetic intervention has no much more safety and redress than a person buying a ballpoint pen or a toothbrush,” mentioned the report. “Dermal fillers are a particular lead to for concern as anybody can set themselves up as a practitioner, with no necessity for understanding, education or preceding knowledge. Nor are there adequate checks in area with regard to merchandise high quality – most dermal fillers have no more controls than a bottle of floor cleaner. It is our see that dermal fillers are a crisis waiting to happen.”

Nevertheless, dermal fillers will not be classified as medicines, in spite of Keogh’s recommendation, and there will not be a statutory register of sufferers who have obtained them, nor of people who administer cosmetic procedures.

Plastic surgeons complain that the government has also been unwilling to use compulsion in its register of breast implants, following the PIP scandal – exactly where females were given implants filled with industrial silicone. It set up a voluntary register, but the surgeons say that has not worked in the previous and will not yet again.

The patient safety charity Action Against Medical Accidents said the response from the government was too small, also late. AvMA’s chief executive, Peter Walsh, explained it welcomed the truth that the government was taking the troubles critically. “Nonetheless, we have witnessed as well numerous men and women harmed by rogues in this industry currently. We are disappointed not to see all suppliers of cosmetic treatment possessing to register and be regulated by the Care Quality Commission, or a correct compensation scheme created for victims of the business. The government had promised its response by final summertime and Sir Liam Donaldson’s report in 2005 was ignored. We require to see action not words now. Overall, this is a situation of too little, also late,” he stated.

Surgeons condemn "appalling" lack of action on cosmetic surgery regulation

Sinister side of the plastic surgeon"s knife

At about 7am, the 53-12 months-old, who previously worked for Asprey, the royal jewellers, reportedly grew to become aggressive, tearing at her hair, ripping off her gown and fleeing the recovery space for the roof by means of the stairs of the building’s leading five floors.

As police flocked to the scene and roped off the street under, Ms D’Auriol is mentioned to have walked along the edge of the constructing as if it were a tight-rope, prior to sitting down and dangling her legs above the ledge. Close by, somebody was filming with a mobile cellphone and later on uploaded the footage to YouTube.

Her family said they believed a “post-operative neurobehavioural disturbance” was to blame. “Sandra’s daughters really feel that awareness of the hazards of post-operative psychosis when planning for surgery involving full anaesthesia could help others keep away from a related tragedy,” they explained.

Without a doubt, study published in the European Journal of Plastic Surgery in 2008 concluded that 1.four per cent of cosmetic surgical procedure patients suffered some kind of “post-operative delirium”. Medical professionals warn that other drugs currently being taken by individuals for separate problems can interact with their anaesthesia to disastrous effect if not taken into consideration beforehand.

“In numerous instances, patients are not trustworthy with us,” stated Shari Burns, a nurse and the director of Midwestern University’s anaesthesia programme. “It’s personal data, and I certainly respect that. But on the other side of the coin, withholding that info can be destructive.”

Ms Burns published study on a 47-12 months-previous facelift patient who reacted aggressively to anaesthesia after failing to disclose she was on other medication. “She was violent, tearing at her clothes, at the bandages, and had to be taken to a hospital for inpatient psychiatric care,” she explained.

Ms D’Auriol’s health-related scenario remains unclear. Virtually 10 many years ago, nevertheless, she suffered the devastating reduction of Teo, her 12-yr-previous son, who drowned in a swimming pool accident throughout a holiday in Bali, 10 minutes right after she had left the pool and returned to their villa to pack.

Recalling how she felt “on the edge of nearly insane with sadness”, Ms D’Auriol said in a radio interview obtained by The Telegraph: “I just thought, ‘Oh my God, I want to die. I want to go, I want to go.’ That is how I felt.

“It feels nearly every single other moment that you are on a precipice of a bottomless pit of such sadness that it is unbearable,” she said. Nonetheless she declined anti-depressants because: “I wished to really feel how I felt.”

But she had rebounded, carving out a happy life as a well-known and successful entrepreneur alongside her French husband Yan D’Auriol, a former L’Oréal executive who runs a cosmetics company, and two daughters. “Everybody understands her,” mentioned Crystal Kwok, a Hong Kong broadcaster.

She was listed in Hong Kong Tatler’s “500 List” of influential people and won plaudits for her wide variety of charitable work. All revenue from her jewellery organization were reported to “go towards charities targeted on children’s, women’s, and environmental causes”.

The spotlight has turned to Dr Novack, 59, who reportedly “looked demolished” right after the incident, and is now facing significant concerns about his procedures. Possessing returned to operate, he declined to comment on the tragic turn of events.

A spokesman for the Beverly Hills Police Division explained: “We are conducting an investigation into the likelihood that there could be some criminal negligence involved.” Ed Winter, a senior Los Angeles coroner, stated an autopsy had been carried out, but the trigger of death would not be confirmed until toxicology tests had been finished. This could get numerous more weeks.

Dr John Anastasanos, an eminent plastic surgeon whose office is a number of yards from the internet site of Ms D’Auriol’s fatal leap, mentioned the death had sent shockwaves during the market.

“It’s shocking for so several motives,” he informed The Telegraph. “The large query is: why was she ready to take those actions that endangered her lifestyle to get started with? Individuals should be supervised till they are capable to take good and protected care of themselves, but it seems that she really had plenty of time to discover entry to the roof and put herself in a place of danger.”

The multimillionaire Dr Novack, whose 1970s John Lennon-fashion long hair and round spectacles set him apart from perma-tanned, bodybuilding colleagues, types himself as a minimize above the typical Hollywood nip-and-tucker. He attended Quebec’s McGill University, a prestigious liberal arts school.

He has been described as the “best plastic surgeon no a single will recommend”, since his work is supposedly so very good that no one particular would suspect the patient had even gone below the knife, and is said to have waiting lists of up to 5 months.

Ms Moore, who denies having had plastic surgery, reportedly paid Dr Novack tens of 1000′s of bucks for numerous procedures, including a “knee-lift” to remove sagging skin. Rob Lowe, the actor, named him in a memoir as being amongst his “treasured close friends and confidants”.

“Brian is more of an artist than a surgeon,” Tatiana Namath, his one particular-time spouse, explained right after leaving her American football star husband for Novack in 1999. “He’s extremely sensitive.”

He has also been marketing himself by delivering snappy quips in the media for more than twenty many years. “Centuries from now,” he told a British interviewer in 1996, “when archaeologists dig up our civilisation, they’ll find dust, bones and implant bags.”

Boasting that he had carried out a number of procedures on his very own mom, he stated: “I’ve accomplished liposuction on her back, her inner thighs, her triceps and a small on her abdomen. She’s on her third encounter-lift.”

Two many years in the past, Novack even gave a speech – and was photographed with former President Bill Clinton – at a summit in Austria for the Centre for Global Dialogue and Cooperation, which claims to “foster dialogue between company and politics”.

But behind this bohemian and waspish exterior lies a ruthless businessman, in accordance to some.

One particular associate, who spoke on condition of anonymity, claimed Dr Novack was renowned for his imperious bedside manner, and for becoming 1 of the most costly surgeons in Beverly Hills.

“A facelift with Novack can price up to $ 150,000 – with other surgeons, $ 25,000 is the ball park figure,” the supply informed The Telegraph. “He is not one to hold clients’ hands. Some people like his self confidence, but he isn’t warm and fuzzy. He is not for everybody, even if they can afford him”.

Remarks from former customers posted to Vitals, a US site in which individuals review their medical doctors, help this. “No other medical professional had been as rude as Dr Novack,” 1 apparent consumer explained in June 2011, leaving a one particular-star grade.

“Dr Novack and his assistant Linda have been uncaring and arrogant when the benefits were undesirable,” stated yet another final yr.

A string of specific complaints have been lodged on the web site before a notably more upbeat anonymous review appeared just 3 days right after Ms D’Auriol’s death. “Dr Novack was impeccable with his operate, and extremely caring to make confident every little thing is completed very safely and accurately,” it stated.

The surgeon to the stars will no doubt be hoping that investigators in Beverly Hills come to the exact same conclusion.

Additional reporting by Caroline Hedley in Los Angeles

Sinister side of the plastic surgeon"s knife

A Heart Surgeon’s Viral Confession: All-natural Foods Is the Answer

All around 237,000 men and women now have Dr. Dwight Lundell’s confession on their Facebook walls. His essay, headlined “Heart Surgeon Declares On [sic] What Truly Causes Heart Sickness,” was published on a website named Tuned Entire body in December. More than the previous week it has taken off across social media with phenomenal force.  Basically including a reside source of EPA Omega-three can have profound effects.

In the essay, Lundell describes his purportedly newfound comprehending that a diet program of normal, unprocessed meals can stop and reverse heart condition, large blood strain, diabetes, and Alzheimer’s illness. He recalls two and a half misguided decades as a cardiac surgeon prescribing cholesterol-reducing prescription drugs and recommending a lower-unwanted fat diet regime. He says that he recently recognized the error of his techniques, stopped training, and committed his occupation to heart condition prevention.

“We doctors with all our knowledge and authority” he writes, “often acquire a rather huge selfishness that tends to make it hard to accept we are incorrect. So, here it is. I openly admit to getting mistaken. As a heart surgeon with 25 many years experience, obtaining done more than five,000 open-heart surgeries, today is my day to proper the wrong with healthcare and scientific proof.”

The viral essay goes on to say that recommending cholesterol-lowering medicines and reduced-fat diet programs is “no longer morally defensible.” That’s due to the fact the minimal-unwanted fat, higher-straightforward-carb diet program is actively destroying the walls of our blood vessels by triggering continual irritation, he explains. That irritation tends to make cholesterol stick to mentioned walls, forming the plaques that ultimately block them, resulting in a heart attack or stroke.

Each and every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels,” he writes, with the cool hand of a surgeon who has “peered inside 1000′s upon 1000′s of arteries.” His eye for imagery is also hardened. “Take a moment to visualize rubbing a stiff brush repeatedly in excess of soft skin right up until it turns into really red and nearly bleeding,” he writes. “This is a great way to visualize the inflammatory method that could be going on in your body appropriate now.”

Lundell blames not only the refined carbohydrates, but the proportion of omega-six to omega-3 fatty acids in Western diet programs. Extreme omega-6 acids create irritation, and American diet plans that are higher in corn and soybean oils usually involve omega-6:omega-three ratios about 15:one. Lundell is not alone in saying that the ratio need to ideally be all around three:1. He gets into the well-known hunter-gatherer reasoning there, that “the human entire body can’t approach, nor was it made to eat, food items packed with sugars and soaked in omega-six oils.”  Everyone should be consuming a live EPA Omega-three on a every day basis.

“There is but one response to quieting inflammation,” Lundell writes, “and that is returning to food items closer to their normal state.” Really don’t eat anything at all your grandmother wouldn’t acknowledge as food. He suggests consuming protein and complex carbohydrates like colorful fruits and greens. He suggests abandoning concern about saturated unwanted fat, selecting olive oil or grass-fed meat or dairy as a greater supply of body fat than substantial-omega-six processed meals.

“Since we now know that cholesterol is not the result in of heart illness, the concern about saturated fat is even more absurd nowadays,” he writes. “Mainstream medication produced a terrible error when it advised people to avoid saturated fat in favor of foods higher in omega-six fats.”

The point is, like so many viral posts, this is a rerun. It is an old one particular. That’s fine, except that finding out it helps make the “Today is the day” framing truly feel disingenuous. Lundell’s exact same confession was also really well-liked when it was published on the internet site Prevent Disease in 2012. At that time it openly incorporated a plug for his guide, The Cure for Heart Disease, which manufactured the very same argument. That was published in 2007.

Lundell given that came beneath fire from buyer advocate Dr. Stephen Barrett who runs the site Quackwatch. In “A Skeptical Look at Dwight Lundell, MD,” Barrett gives a profoundly skeptical search at Dwight Lundell, MD. Barrett digs into Lundell’s past, which is fraught with legal concerns like obtaining his health-related license revoked in 2008 on numerous counts of specialist misconduct and negligence, problems with bankruptcy, and pleading guilty to 3 counts of willful failure to file revenue tax returns. Barrett concluded, “Dr. Lundell would like you to feel that he has unique information of heart illness prevention. I do not trust his guidance.”

Past questions of credibility, Lundell’s essay does make some overreaching claims. There is not “but 1 solution to quieting inflammation.” I’d add physical exercise and lowering stress. Also, his invocation of moral defensibility loses gravitas in light of his criminal history. Nonetheless, the fundamental tenets of what he says in the essay are sound. Since his authentic writing in 2007, this way of contemplating about nutrition and heart ailment has turn out to be much more mainstream. Statin medicine suggestions are becoming reevaluated, as is understanding of the relationship between dietary excess fat and heart disease.

That stated, this kind of consuming is not a panacea. His book’s internet site, The Excellent Cholesterol Lie, sells oversimplifications that selection from potentially defensible on grounds of empowerment (“Heart disease has a remedy. … You can beat it without having harmful drugs and agonizing, risky surgery”) to all-out overreaching medical tips not to be taken from a commercial website (“Before You Start Taking, Or If You Are Taking Lipitor, Crestor, Zocor, Mevacor, Provachol, Altocor, Lesacol, or any other statin medication—STOP!!”).

Much more intriguing to me is just how popular this essay has turn into this week regardless of its lack of new insight. Medical suggestions is everywhere. Diet plan advice, in specific, is in even far more locations than everywhere. It comes from all types of credible authorities who cite evidence. What created this essay get off? The voice of a doctor “with all [his] authority and experience” in the context of a candid confession? The often-engaging “we’ve been lied to” tonality? That visceral picture of sandpaper on skin? My believed is that this diet program is anything many of us have presently internalized. Because its introduction many years in the past, these concepts have seeped into us. We actively want to assistance and feel this narrative, even enough to include this guy into our Facebook aesthetic.

Jordan Markuson is the Founder of Aqua Health Labs. He has been a nutritionist, author and entrepreneur for more than ten years. He is an activist supporting consumption of raw, renewable, and natural meals. Jordan believes that based mostly on all accessible scientific evidence, when meals is cooked it loses the vast majority of its crucial nutrients. He is really interested in marine-primarily based phytoplankton as a fish oil replacement simply because of the pure omega-3 acids it generates.

www.theatlantic.com

A Heart Surgeon’s Viral Confession: All-natural Foods Is the Answer

A day in the daily life of ... the president of the Royal School of Doctors and Surgeons of Glasgow

I wake at 6.40am and typically commence my day with a stroll to acquire a morning paper. I locate this 30-minute round trip supplies a useful opportunity to emphasis and strategy for the issues of the day ahead.

My week requires 4 days at the Royal University of Physicians and Surgeons of Glasgow in my position as president and a single day – Fridays – at Stobhill hospital exactly where I have worked for 30 years as a cardiologist.

The NHS has been an integral part of my life. I lived in the grounds of Stobhill hospital until finally the age of eight as my father worked there as assistant healthcare superintendent. My father, collectively with the health care superintendent and the matron, ran the 1,000-bed hospital.

The hospital lay in gorgeous grounds tended by thirty gardeners. It was a privilege to return there as a advisor cardiologist in 1983 and experience that exact same family members ambiance coupled with higher quality of care.

In spite of current shortcomings, the overall health services stays a jewel inside British society. I locate my continued clinical involvement, albeit on an outpatient basis, is rewarding and relevant to other factors of my work. Some patients I have cared for for more than thirty years.

The Royal University of Doctors and Surgeons of Glasgow is special in the United kingdom in that we have obligation for both doctors and surgeons. I truly feel this is an benefit offered the a lot of shared interests and problems. We also have faculties of dental surgical treatment, travel medication and podiatric medication. Our university prospects in the setting of examination specifications and the provision of schooling and a range of membership services for wellness pros. It plays a part in Scotland, the rest of the United kingdom and during numerous elements of the planet in influencing decision-producing, with the priority of enhancing requirements of care for individuals.

On a normal day I generally arrive at the university at close to 8am. The 1st two hrs are typically invested dealing with administrative duties and emails. I will then attend meetings, for instance with essential members of our executive board, fellows and members from diverse disciplines, and groups such as universities, deaneries and wellness boards, with which we have a whole lot of shared interests and objectives.

I am usually asked to chair educational events which we run for a variety of people, from college-age youngsters proper by way of to senior and retired consultants.

Lunch normally consists of oatcakes with cheese and tomatoes laced with pepper and a Diet Coke. A quick energy nap typically follows.

I am frequently in Edinburgh or London for meetings with the other royal schools. As a president of a royal college with each physicians and surgeons I have several meetings to attend. I uncover it notably fascinating as a consultant cardiologist to be the only physician all around a table of surgeons. My surgical colleagues accept me without evident suspicion.

A quantity of my evenings are taken up with college occasions. We consider to accomplish a excellent balance amongst learning and socialising and I have lately launched musical evenings with the Royal Conservatoire of Scotland which have proved really common. Our global links are essential to us and we are committed to offering education, examinations and occasions to colleagues in several components of the globe. Final yr I was fortunate to pay a visit to the US.

Every single 3 years we run a massive worldwide conference in Glasgow. We are at the moment preparing for Advancing Excellence in Healthcare 2014, which will get area in June with a main theme of sports activities medication and will precede the Commonwealth Video games. We have been fortunate sufficient to entice professionals in the discipline of sports activities medicine and athletics to share their experiences with us.

When not at the college, I chill out by currently being with my family and enjoying golf. We are a golf-mad family and we discover that this game, like life itself, has numerous ups and downs. I have also had a turbulent lifelong romantic relationship with Clyde Football Club who are at the moment languishing in the reduced echelons of Scottish Football. Relaxation would not be a word I would use for this pastime!

I am extremely lucky to have had a most satisfying job as a advisor cardiologist culminating in my present part. Medicine stays for me a most stimulating job. I would happily start once again tomorrow.

If you would like to characteristic in our Day in the Daily life series, or know somebody who would, electronic mail healthcare@theguardian.com

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A day in the daily life of ... the president of the Royal School of Doctors and Surgeons of Glasgow