US cancer death rates continue to fall as 5-year survival rates rise – study

Cancer death rates in the United States are continuing to fall and the five-year survival rates of those diagnosed with the disease have risen, research shows.

The Annual Report to the Nation on the Status of Cancer, published on Friday, also shows a decline in incidence of cancer among men in recent years, although it remained stable among women.

Death rates from 2010 to 2014 decreased for 11 of the 16 most common types of cancer in men and for 13 of the 18 most common types of cancer in women, including lung, colorectal, female breast, and prostate cancers.

The authors, from the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute and the North American Association of Central Cancer Registries (NAACCR) suggest a decline in smoking – down more than 50% over the last 50 years – as well as improved early detection and more effective treatment helped bring about the fall.

But they warn that smoking continues to pose a threat along with obesity, rates of which are at 20% or or more in every state.

NAACCR executive director Betsy Kohler said. “The continued drops in overall cancer death rates in the United States are welcome news, reflecting improvements in prevention, early detection, and treatment.

“But this report also shows us that progress has been limited for several cancers, which should compel us to renew our commitment to efforts to discover new strategies for prevention, early detection, and treatment, and to apply proven interventions broadly and equitably.”

The report, published in the Journal of the National Cancer Institute, showed that death rates increased for cancers of the liver, pancreas, and brain in men and for liver and uterine cancer in women.

Overall, cancer death rates decreased by 1.8% per year in men and 1.4% a year in women.

During the period 1999 to 2013, cancer incidence rates in men fell by 2.3%, according to the study.

Compared with cases diagnosed between 1975 and 1977, five-year survival for cancers diagnosed in 2006 to 2012 increased significantly for all manifestations of the disease bar cervical and uterine cancer.

The greatest absolute increases in survival (25% or greater) were seen in prostate and kidney cancers, non-Hodgkin lymphoma, myeloma (bone marrow cancer) and leukaemia.

Further improvements in survival prospects are expected in the wake of recent advances in precision medicine and immunotherapy for late stage cancers. But the authors warn that the high cost of new cancer drugs – up to $ 10,000 (£8,000) per month – may put them out of reach even to Medicare-insured patients, who would still be left with a bill for around 20% of the drug’s cost.

US cancer death rates continue to fall as 5-year survival rates rise – study

Noise-cancelling headphones: the secret survival tool for modern life

There’s one thing other than my wallet and my travel card I wouldn’t be without in a big city, and it’s my headphones. But I don’t actually listen to music that much: I just activate the noise-cancelling feature, and leave it at that.

No sound plays into my ears – instead a quiet fills my head, as if the sounds of the world have been turned down. Until I got noise-cancelling headphones, I had no idea how loud the city always was, and just how hungry I’d been for silence.

On public transport, using the noise-cancelling feature will soften the roar of engine and traffic. In the open-plan office, it eliminates the constant chatter and limits interruptions. On an airplane, it’s a revelation. I’m not alone in using state-of-the-art headphones not for music, but to tune out the constant drone of urban living – it’s becoming a modern life survival tool.

‘It was like that moment in a film where the sound cuts out’

Matt Thomas, an animator and motion graphics designer in London, is a convert. He discovered he could use the silencing feature on its own one day by accident, when his music cut out on the tube: “I thought, wait a minute, there’s this really nice peace and quiet. It was like that moment in a film where the sound cuts out and everything goes into slow motion.”

Heavy traffic generates noise levels of up to 85 decibels (dB), which the Health and Safety Executive deems sufficient to cause permanent hearing damage if we’re exposed to it for several hours every day. Underground trains can pass the 100dB mark when roaring around a loud corner.

Thomas often puts his headphones on silent when on public transport (he no longer does this in the street after nearly getting run over), but prefers music for work. For Johanna Vogel, an economist in Vienna, Austria, it’s the opposite: she plays music on the bus but works in silence. Vogel bought her noise-cancelling headphones hoping they would help her concentrate in an open-plan office. “It’s so relaxing,” she says. “At first I was doubtful it would make a big difference, but now couldn’t live without them. In noisy environments I really need some way to create quiet for myself.”

Noise damages more just our ears. Research studies have found links between long-term noise exposure and increased risk of heart attack and stroke, as well as low mood and difficulties with sleeping and concentrating. Adverse effects on mental and physical health can start at just 65dB, a level that seems moderate: a refrigerator hums steadily at 40dB, and an open plan office buzzes at around 60dB.

Underground trains can pass the 100dB mark when in transit. Photograph: Dinendra Haria/REX/Shutterstock

Josi Livingston, a developer at a technology startup in London, often uses the silencing feature to block out office chatter while she’s coding, but likes how she can still hear if someone talks to her. “I’m trying to minimise distraction. I need to focus, and any kind of extra stimuli will detract from that,” she says. “I think of it as engineering my environment to be the most comfortable.”

Unwanted noise can cause irritation and anger if it feels like an invasion of privacy, says Stephen Stansfeld, a Professor of Psychiatry at Queen Mary University of London who focuses on noise and health. “Having a lot of background noise when you’re doing something is tiring. Without noticing, you’re putting in a lot more effort in order to block out the noise. So when you shut it out, there’s a sense of relief.”

Getting worked up about noise can raise stress levels and leads to ill health. “But there’s no doubt that even if you’re not focused on the noise, it can still have an effect. If you’re asleep you may not wake up, but your body is still responding if you hear a loud sound,” says Stansfeld. “The body responds to noise as a stressor.”

Bethany Temple, an attorney in Raleigh, North Carolina, sometimes uses her headphones to avoid having to hear the TV when she’s at home with her husband. Temple says the silencing feature helps her feel more centred in herself: “When you realise just how much ambient noise there is everywhere: the refrigerator is running, the dishwasher, the washing machine and air conditioner, cars are going by outside. When that goes away, and you have the ability to be silent with your thoughts – once you realise that exists in the world, you start craving more.”

From airline pilots to urban dwellers

Noise-cancelling headphones were originally created for airplane pilots to improve their comfort on long flights, and the first consumer versions were also intended for travellers.

The technology, known as active noise-cancellation (ANC), works by using microphones to pick up low-frequency noise and neutralise it before it reaches the ear. The headset generates a sound that’s phase-inverted by 180 degrees to the unwanted noise, resulting in the two sounds cancelling each other out.

ANC headphones turn down the volume of the world by about 30dB, says Brian Brorsbøl, Director of Product Management at Sennheiser Communications – the reduction ranges between 20dB and 45dB, as the technology is more efficient against low-frequency sounds. “Using noise-cancelling technology on its own is something we’ve heard some people are doing,” he says.

When my partner, who even uses the silencing function when walking down the street, first told me these headphones would change my life, I was skeptical. How could it possibly be so revolutionary? But I get it now.

These headphones let me create breathing room in a busy city. They let me hear myself think. Every time I put them on and switch on the quiet, the feeling is one of relief.

Noise-cancelling headphones: the secret survival tool for modern life

Trial finds combination of pancreatic cancer drugs extends survival

Cancer campaigners are hailing a “monumental leap forward” in pancreatic cancer treatment after a new drug trial significantly extended survival from what is the most lethal form of the disease.

The clinical trial found that 29% of patients given a combination of two chemotherapy drugs lived for at least five years compared with 16% who received the one chemotherapy drug that is still the NHS’s standard treatment.

The results are important because they could lead to an improvement in the prospects for people who develop pancreatic cancer, which has the lowest survival rates among the 21 most common forms of the disease and kills 8,800 Britons a year. Only one in 100 people survive for 10 or more years after their diagnosis.

“These results are a monumental leap forward in pancreatic cancer treatment. We believe this could herald a true step change in the treatment of this tough cancer, offering substantially more patients who have had surgery the chance to live for longer and, crucially, without significant added side-effects,” said Leanne Reynolds, head of research at the charity Pancreatic Cancer UK.

About 10,000 people are diagnosed with pancreatic cancer each year in the UK. However, the apparent breakthrough may only benefit the 800 who have surgery. The cancer is too advanced in most of the other 9,200 cases for surgery to be worthwhile.

Four in five patients are only diagnosed when the cancer has reached an advanced stage, and in 46% of cases only after they have presented as an emergency at an A&E unit. Survival rates have barely improved for 40 years, in contrast to some other forms of the disease. It is the fifth most common cause of cancer death in the UK.

The ESPAC-4 (European study group for pancreatic cancer) trial involved 732 patients from 92 hospitals in England, Scotland, Wales, Germany, France and Sweden. Of those given both gemcitabine and capecitabine, 28.8% survived for at least five years, compared with just 16.3% who received only gemcitabine.

Pancreatic Cancer UK and the researchers behind the findings are now urging the NHS to replace gemcitabine with the combination as the standard treatment for the one in 12 sufferers of the disease who undergo a resection of their pancreas.

“This is one of the biggest ever breakthroughs prolonging survival for pancreatic cancer patients,” said Prof John Neoptolemos of Liverpool University, who lead the team of researchers.

“When this combination becomes the new standard of care it will give many patients living with the disease valuable months and even years.” The two drugs taken together extend median overall survival from 25 and a half months for those on gemcitabine alone to 28 months, according to the study, which has been published in the Lancet.

Cancer survival rates in England and Wales

“The difference in short-term survival may seem modest, but improvement in long-term survival is substantial for this type of cancer,” added Neoptolemos.

Meanwhile, separate research has also brought good news about lung cancer, which has the second worst survival rates among the commonest forms of cancer.

The number of people surviving for at least a year after diagnosis rose from 31% to 38% between 2010-2015, according to the NHS’s latest audit of the quality of care patients receive. Experts in the disease welcomed the increase, which is mainly the result of earlier diagnosis.

Ian Woolhouse, the audit’s senior clinical lead, said it was “very encouraging” that one-year survival had improved in what is the UK’s second most common form of cancer after breast cancer.

His team noted other progress too in how the NHS treats patients, including the fact that 60% of patients now receive some for of anti-cancer treatment. They analysed the records of 43,000 people diagnosed with lung cancer in 2015.

However, they voiced concern about the persistent “wide and unacceptable variation in standards of care” provided by NHS trusts and boards across England, Wales, Scotland and Guernsey. Only 57% of patients are seen by a specialist lung cancer nurse, for example, even though the target for that is 90%.

Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, said: “We are pleased to see this encouraging increase in patient survival. However, there is much still to do to ensure that lung cancer patients are diagnosed as early as possible and are able to access best practice treatment and care.”

Trial finds combination of pancreatic cancer drugs extends survival

2016 was the worst year in NHS history – we must fight for its survival

The last 12 months have been the worst in the history of the NHS. Our health system is under pressure like never before. The moment of crisis many warned of has arrived, and it is not clear that the NHS can be retrieved from this state of affairs.

We used to say that flailing A&Es represented an early warning sign that the health service was under pressure. And so that has proven to be. England’s major A&Es are under record strain with black alerts being regularly sounded, and in some instances wards turning patients away. Last year the A&E crisis spread to other sectors.

Ambulance response times have reached critically low levels, with one third of ambulances failing to meet their targets for life threatening callouts. The acute care sector is bulging with unnecessary admissions particularly from over-75s who are presenting themselves at A&Es when they should be cared for by the social care sector that has suffered £5bn of cuts.

In the community, general practice is on life support; as more is demanded of it, the proportion of the NHS budget that goes to primary care has effectively shrunk. Primary care provides 90% of the consultations in the NHS yet only gets 8% of the budget. GPs are leaving, and new entrants are declining to enter general practice.

We once bickered with the Treasury for clawing back millions in Department of Health underspend under Labour. Under the Tories, that is a distant memory as NHS trusts recorded a deficit in excess of £2bn last year.

A government elected to fix near-bankrupted banks has replaced that by bankrupting our hospitals. Idiotic spending decisions in the NHS have been rife.

The most worrying aspect of the government delivering the lowest additional funding increase to the NHS in its history has been the knock-on effect on patients, in terms of treatment and facilities available. More than 13,000 beds have been closed, cutting the capacity of the NHS by 5 million a year.

So bad was 2016, that nine former health secretaries condemned the government for failing to live up to its promises on mental health.

Commissioners and providers alike have had to resort to rationing care to try to balance their books. Unfortunately, this is not always to the benefit of customers or patients.

As the health service’s budget faces greater pressure than before, it is difficult to ignore the toll the intrusion of the free market has taken. Last year, £13bn of healthcare was purchased from non NHS providers (pdf), a 76% increase since 2010. Given that the private sector has a stated goal to make 8%-14% profits from the NHS, can taxpayers really afford this choice?

While the NHS has increased the cash it takes from the private sector by 30% to £558m last year (pdf), waiting lists have soared to an eight-year high. Now, 4 million patients are on waiting lists. This in effect means NHS patients are being delayed in their treatment to make way for wealthy private patients who can afford to skip the queue.

The pressure on our staff has also reached unprecedented levels. Nurses have seen real-term pay cuts since 2010 of over £2,000. Moreover, aspiring nurses will also be denied a bursary to train and this at a time when unfilled nursing vacancies have climbed 600% since 2010. It will not surprise you to learn that applicants for trainee nursing courses have fallen 20% this year.

Likewise, the pressure on junior doctors remains intense. They too have seen real-term pay cuts, as well as an enforced contract.

It remains impossible to meet the demands of the ill-described seven-day NHS until serious funding issues have been resolved, otherwise we are asking our doctors to shoulder the blame for unsafe care.

The continuing media war Jeremy Hunt has waged against doctors has so depleted workforce morale that there are more doctors wanting to leave the NHS than are in training.

It will take a political will only witnessed twice in the last 70 years, 1948 and 1997, to alter the current trajectory on which the NHS is set. The £22bn of efficiencies (a euphemism for cuts), dressed up as sustainability and transformation plans smacks of what was tried with the Nicholson challenge. The National Audit Office has warned that these efficiencies are not possible without causing lasting damage to the NHS’s ability to provide safe care.

We are at a cliff edge. Do we carry on into the unknown with broken funding promises and more cuts or do we cry foul now, and demand a rethink before it is too late?

Let’s pledge in 2017 to fight for its survival. The NHS belongs to us, not the politicians and not the privateers. We cannot trust the government to be its safe custodian. It’s up to each and every one of us to fight for the NHS, otherwise it won’t be there to look after us, never mind the next generation.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

2016 was the worst year in NHS history – we must fight for its survival

How to Stay Healthy While Travelling the World: A Vegetarian Survival Guide

For backpackers, long-term travelers, or anyone who travels widely for work, sampling new local cuisines is one of the things to look forward to most. Who wouldn’t be enthusiastic about to trying traditional tacos in Mexico, sampling steaming-hot street food in Southeast Asia, or digging into a bowl of fresh spaghetti in Italy?

But if you don’t eat meat or fish, things can be trickier. Though the vegetarian movement is growing across the world, in many places meals still center on meat, and even the concept of vegetarianism can be met with a blank look. It isn’t easy for vegetarians to stay healthy on the road, particularly if you’re on a backpacker’s budget. Often, veggie-friendly restaurants hike their prices up, because they know vegetarian tourists will pay for a good meal.

But it doesn’t have to be so difficult. If you’re a committed vegetarian and avid traveler, here’s how to stay healthy while traveling the world.

CHOOSE YOUR DESTINATIONS WISELY

Admittedly, this isn’t always something you can control – if you travel for work you often don’t get a say where you’re sent. But if you’re traveling independently, you have the luxury of choosing destinations where Vegetarians are spoilt for choice – and sometimes these aren’t the countries you expect.

Take Belgium, for example. While it’s not exactly known for being a veggie-friendly country, it’s also home to the city with the largest number of vegetarians per capita: Ghent. This trailblazing town is also home to ‘Donderdag Veggiedag’ – Meat Free Thursdays, an initiative created to tackle growing obesity and greenhouse gas emissions. This soon spread throughout the city, and vegetarian street maps are handed out to visitors to Ghent.

Away from Europe, there are vegetarian hotspots across the globe. India is quite simply a vegetarian’s dream: around a third of people here are vegetarian, and most restaurants have clearly marked meat-free meals. In Southeast Asia, the Buddhist culture that pervades Thailand means vegetarian meals are plentiful, and because dairy is rarely used vegans will also be in their element. In the Middle East, Israel offers a mouth-watering array of vegetarian treats, from pita bread and hummus to falafel to baba ganoush.

Do your research before you go and consider what meat-free food options will be easily available. Bear in mind that some South American countries are notoriously bad for vegetarians.

DON’T BE SCARED TO SAMPLE STREET FOOD

Many vegetarians I’ve spoken to shun street food, believing that it’s usually meat-orientated and unhealthy. While this is often the case (particularly in the U.S.), in many countries the majority of street-food is in fact vegetarian by default. Meat is universally expensive, and the point of street food is usually that it’s quick and cheap.

Take Guatemala, for example. This country is the darling of backpackers across the globe and offers a wide-array of healthy and delicious vegetarian street food. This is starkly contrasted against its meat-loving neighbors – Mexican street food is infrequently vegetarian and in other Central American countries, meat makes an appearance at most street food stalls. In Guatemala, you can enjoy a whole array of vegetarian street food, from empanadas to rellenitos to salads and soups.

IF IN DOUBT, ASK

Though even the idea of vegetarian food is still alien in some cultures, most people will be happy to help you out if you ask.

The local diet in much of Central America is known to revolve around simple meals of meat or fish with rice, beans, and vegetables. Take Costa Rica, for example, where the traditional meal of ‘casado’ consists of rice, beans, plantains, salad and some meat. One vegetarian traveler described how, on explaining she was vegetarian (“soy vegetarian” in Spanish), the restaurant staff happily replaced the customary meat with grilled cheese. This is a great way to stay healthy in Central and South America, as due to their reliance on beans these meals provide vegetarians with enough protein.

Bear in mind that ‘vegetarian’ can mean something else in other countries: it can refer to someone who doesn’t eat red meat but does eat chicken and fish. In Thailand, the term “vegetarian food” often isn’t understood unless you’re in touristy hubs, and asking for just vegetables – “pak” – is sometimes inferred as asking for pork. If you’re unsure, refer to yourself as a Buddhist, and it’ll be instantly understood that you don’t eat any meat.

WHEN ALL ELSE FAILS, COOK

Cooking for yourself rather than eating out in a foreign country can seem like an admission of failure for vegetarians, especially if you’re someone who excitedly looks forward to trying new food. But it doesn’t have to be that way. Head to a local market and pick up some of the oft-used ingredients there, and make a vegetarian version of one of the national dishes.

For example, you don’t have to buy fish to make a delicious ceviche; vegetarian ceviche is becoming a thing, and the blend of fresh vegetables with citrus makes an exceptionally healthy as well as a delicious meal. If you’re in Asia, replace the meat or fish in dishes with extra veg or tofu; a few tweaks to the traditional Tom Yum recipe will result in a wonderful vegetarian alternative that’s packed with vitamins.

In addition to helping you find healthy, delicious and varied vegetarian meals, traversing vibrant and bustling local markets is one of the best ways to understand a new culture. Buying fresh fruit and vegetables will always be cheap and healthy, and whether you’re on a budget or not, is a great way of ensuring you’re getting your five-a-day.

Be brave and imaginative, and you may find yourself with a new understanding of a country’s culture – as well as a lasting appreciation of their cuisine.

How to Stay Healthy While Travelling the World: A Vegetarian Survival Guide

Survival in a Pill Bottle

Survival in a Pill Bottle

Believe it or not basic survival tools can be arranged and stored within the small confines of an average pill bottle.  As long as you do not intend on surviving multiple days out in the wilderness with just a survival kit stored in a pill bottle.  The survival kit in a pill bottle is intended to get you either through the day or through the night with some basic tools that will keep you warm, fed and hopefully dry until safety can be reached or until you can be found.  The greatest factor of keeping a survival kit in a pill bottle is that you can keep the pill bottle just about anywhere.  From your vehicle glove box to your backpack or even pants pockets, the survival in a pill bottle is designed to keep you alive.

Matches

Matches can come in handy especially if you are forced to spend overnight in the wilderness.  Matches can provide basic fire starting abilities so that a campfire can be made to keep you warm and keep predators away as well as to even cook your food.  Be sure to carry, if possible, waterproof matches, windproof matches or matches that can ultimately maintain resistance to extreme weather conditions.

 

Fishing Line and Hooks

Fishing line and hooks will come in handy when food is needed to be found.  More often than not small streams, lakes and even rivers are found all throughout the wilderness and with a little bit of time a fish can be eventually caught.  Many fishing hooks come with fishing line already tied for your convenience.  Take advantage of these fishing hooks and lines by storing them in your survival in a pill bottle.

 

Band Aids

It’s better to be safe than sorry by storing additional band aids.  As well as they really do not take up much space. The average pill bottle can store almost any amount of band aids.  Having roughly three or four band aids however will be plenty if only an overnight in the wilderness is anticipated.  Band aids will go a long way as to prevent any further infections from open wounds or sores if stumbling around in the wilderness especially if in the dark.

 

Wooden Clothespin

A wooden clothespin can surprisingly come in handy for all sorts of activities.  Whether it is for ensuring the fishing line and hooks are secured for catching small fish or for simply holding back pieces of clothing in order to make a tourniquet for extreme cuts or wounds.  It is better to have a wooden clothespin and not need it than to need it and not have one.

 

Sanitary Wipe

Ensure the prevention of infection from cuts, scrapes and small wounds by packing a sanitary wipe in your survival in a pill bottle.  This will help to clean out wounds that might occur from an emergency situation that forces you to stay overnight in the wilderness.  Sanitary wipes will also come in handy for small rashes if various plants are accidentally on your path to safety.

 

Twisty Ties

Believe it or not twisty ties can go a long way in the game of survival.  They are durable and usually will hold small amounts of weight.  For example, using twisty ties as a part of your fishing line and hooks to catch small fish will ensure that your line and hook doesn’t get away from you.  Also, twisty ties can be used as small markers around trees and bushes if you need to find your way back to a specific location.  Twisty ties are great and large quantities can be stored in small areas making them an excellent choice for a survival tool in a survival in a pill bottle.

 Watch a short video here: Survival Kit in a Pill Bottle

Survival in a Pill Bottle

"Don"t be a smart arse" – a junior doctor"s survival guide

Ask questions

Patients look to you for reassurance, but your job isn’t to always know the right answer – it’s to find the person in the building who does. The only stupid question is the one you didn’t ask. Ask for help, share problems and try and find solutions for others who come to you for help.

Oliver Long, consultant anaesthetist, London

Don’t be a smart arse

Always seek advice from everyone and anyone including nurses, domestics, porters and your medical peers. Develop a bedside manner for your ward/hospital colleagues as well as with your patients – no-one likes a smart arse, medical degree or no medical degree.

Jude, community hospital nurse, Gloucestershire

Enjoy it – make friends and maybe even find love

It’s the hardest and best two years of your life. The job, and more importantly, your reaction to it, will define the person you will be, the speciality you will choose and the life you will lead. It is also where you will meet many friends that you will keep for life. As a final note, I find anecdotally that many foundation doctors also meet the love of their life in the first two years of training.

Tony, GP, Manchester

Related: What really happens the day junior doctors start work in the NHS

Don’t view patients as a set of signs and symptoms

Take a step back from observations and test results and look at the whole patient. Try not to view them as just a set of signs and symptoms that need to be sorted out but as a complex individual who lives beyond this admission to hospital.

Listen to relatives. Respect your patient’s autonomy even if they are making unwise or unsafe decisions. Listen to your patients more than you talk to them.

Catherine Bowdler, specialist physiotherapist, Cheshire

Eat and drink

Always make time to eat. Keep a water bottle with you. Hungry doctors don’t function as well as fed and watered ones.

Tom Palmer, doctor – emergency medicine, London

Don’t hide

On the senior team, we have seen people come and go and we expect problems, there’s very little that can surprise an NHS consultant. If you share it, it is likely we can solve it.

Find time to wallow in misery

You will be miserable and that’s fine, don’t apologise for it and make sure you schedule time to groan in the mess. On the shop floor, remember who you are and stay cheerful, you will be amazed at how a team of colleagues can carry each other through anything.

Anthony Hopkins, paediatric registrar, south west

Don’t fall out with the nurses

Never ever fall out with the nurses – they are your lifeline, and have an abundance of knowledge (about their patients, the hospital, how to make stuff happen, the location of teabags/mugs/secret chocolate supply etc)

Sarah, specialty doctor, south west

Tidy up after yourself

My advice is clear up after yourself eg blood-taking equipment, notes etc. Leaving stuff around makes you appear that you have little regard for other staff and you will get people’s backs up.

Edward Daniels, staff nurse, drugs and alcohol, Nottingham

Don’t view older patients as old and boring

Some of them are the most amazing people with incredible life stories that deserve to be listened to.

Anonymous, cardiac physiologist, East Midlands

Relax

The first day on your new job is going to be jam-packed. New hospital, new colleagues, new patients, and of course new hospital systems to figure out. These are the first days of the rest of your life in medicine so start off by taking a deep breath.

Christopher Meally, physician associate in cardiology, Warwickshire

Don’t overshare

Don’t talk loudly about how drunk you were on a night out while standing at the nurses’ station (everyone will hear you) – you deserve to let your hair down as much as the next person but your patient needs to see you as a professional, not imagine you staggering along the street.

Emily Graves, consultant haematologist, Sunderland

Make an effort to understand and value all members of the team

Everybody is essential, from the admin staff to the occupational therapists and other lesser known allied health professionals, and sometimes it can be easy to under-appreciate a team member’s contribution.

Hannah Wightman, occupational therapist, East Midlands

Don’t neglect your social life

If you have any time left over from working 48 hours a week, do not neglect your social and personal life. You will need this time to recharge your batteries.

Deborah Tomlinson, retired nurse of 40 years, London

Pass the granny test

Make sure everything you do passes the granny test. If it wouldn’t have been good enough for your granny, it’s not good enough for your patient.

Claire, mental health service manager, north west

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

"Don"t be a smart arse" – a junior doctor"s survival guide

Improved Survival For Males With Localized Prostate Cancer: 6 Months Hormonal Therapy Combined With Radiation

Based mostly on new research, guys with localized prostate cancer but at substantial risk for metastasis, have far better outcomes if they are taken care of with radiation combined with androgen deprivation treatment which decreases testosterone, thus decreasing opportunity for tumor spread and growth.

The investigation was presented at the 33^rd conference of the European Society for Radiotherapy and Oncology (ESTRO-33) in Vienna on April seven. Findings from the research could represent a new strategy to remedy of localized prostate cancer that is at higher danger for spread.

“Although we need to have longer comply with-up to assess the influence on these men’s overall survival”, said Dr. Michel Bolla, a professor of radiation oncology at Grenoble University Hospital, “these findings require to be taken into account in everyday clinical practice.”

“They display that three-dimensional conformal radiotherapy,” Bolla explained, “whether intensity modulated or not, and regardless of the dose degree, has to be combined with short-term androgen deprivation therapy in purchase to receive a significant lessen in the danger of relapse”. “Therefore, for the duration of multidisciplinary crew meetings to examine a patient’s treatment method, this combined remedy technique ought to be one particular of the alternatives proposed for males with localized prostate cancer that has an intermediate or higher risk of increasing and spreading,” additional Bolla.

Intensity modulated radiotherapy (IMRT) is a model of three-D radiation therapy that employs computer-generated photos to demonstrate the dimension and shape of the tumor. This allows the size, form, and intensity of the radiation beam to be altered to conform to the dimension, form, and spot of the patient’s tumor, decreasing injury to close by healthful tissue.

Bolla and colleagues evaluated 819 men at 37 web sites in 14 countries. The patients had early stage prostate tumors (as confirmed by amounts of prostate specific antigen (PSA) and biopsy) that had been at moderate or high danger of metastasis.

The sufferers had been randomized to obtain both radiation alone or radiation and two injections of luteinizing hormone-releasing hormone analogues (LH-RH analogues), which minimize ranges of testosterone to result in reversible chemical castration. Every single drug injection lasted three months the very first drug was provided on the first day of radiation and the 2nd three months later.

When LH-RH analogues are at first administered, testosterone increases for a brief period prior to dropping to reduced ranges. This leads to ranges to sharply enhance, (referred to as flare”. To decrease this response, individuals took an oral anti-androgen (bicalutamide, 50 mg per day) for 15 days before the first injection.

In the research, treating doctors picked amongst 1 of three irradiation doses, 70, 74 or 78 Grays (Gy).  Follow-up was for an typical of seven.2 many years. Findings indicate that the 403 males who had been taken care of with radiation combined with anti-androgen treatment had been significantly less probably to have suffered a relapse and progression of their cancer than the 407 men who had been handled with radiation alone, irrespective of the radiotherapy dose and no matter whether it was intensity modulated or not.

Compared to guys treated with radiation only, sufferers who acquired the combined method had nearly half the danger (47%) of biochemical progression of their condition. In contrast with 201 males in the radiation only group, only 118 males in the combined remedy group had a biochemical progression of their disease. (Biochemical progression is defined by PSA values being elevated above the lowest level plus two nanograms per ml).

Soon after five years, males in the combined treatment group were faring considerably greater. “They had far better survival without biochemical progression,” stated Bolla. “Among these obtaining the combined treatment method, 17.five% had progressed compared to thirty.seven% receiving radiotherapy alone.”

In contrast with 80.eight% of men obtaining radiotherapy alone, results  from the review demonstrated that 5 many years after treatment method, 88.7% of the men in the combined therapy group had not progressed.

Urinary troubles had been observed in 5.9% of patients acquiring the combined treatment versus three.six% of individuals on radiation alone. Erectile dysfunction was greater in the mixed treatment method group, versus radiation alone. (27% versus 19.4%.

“These final results demonstrate that, in men with localized prostate cancer that is at chance of recurring and spreading, the addition of 6 months of hormonal remedy to radiotherapy improves the time these males survive without having their disease progressing,” stated Bolla. “It is essential to guarantee that the radiation treatment is of the very best quality further clinical study is required to optimize radiation strategies and to find new hormonal treatment options.”

Improved Survival For Males With Localized Prostate Cancer: 6 Months Hormonal Therapy Combined With Radiation

Survival Benefit Found Following Extended-Phrase Resynchronization Therapy

MADIT-CRT was an influential trial that showed a reduction in heart failure complications — but not mortality — when cardiac resynchronization treatment (CRT) was extra to an implantable defibrillator in individuals with mild heart failure who also had left bundle-branch block (LBBB). Individuals in the trial were followed for two.four years, raising queries about the long-term effects of CRT. Now, a 2nd seem at 854 sufferers who participated in a stick to-up examine, presented at the American College of Cardiology and published in the New England Journal of Medication, suggests that over the lengthy phrase, CRT may save lives in this population. MADIT-CRT was sponsored by Boston Scientific.

All round, there was a highly significant 41% reduction in death (P=.001) connected with CRT therapy in the massive subgroup of sufferers with LBBB. The mortality fee was distinct right after 1 yr and remained important all through follow-up. At 7 many years, the mortality charge was 29% in the management group versus 18% in the CRT group. There was an even larger variation in nonfatal heart failure events (P&lt0.001). The positive aspects have been remarkably constant across a broad assortment of subgroups.

However, the group of MADIT-CRT individuals who did not have LBBB showed no reduction in either mortality or heart failure events related with CRT. The authors wrote that this “lack of benefit of CRT in individuals with no left bundle-branch block was steady, regardless of the QRS duration or ECG morphologic findings with respect to proper bundle-branch block and an intraventricular conduction delay. As a result, at present, our information do not help early intervention with CRT in any subset of this population.”

In an accompanying editorial, Jeffrey Goldberger writes that the outcomes should serve “as a strong impetus to pursue CRT in patients with mild heart failure with decreased ejection fraction and left bundle-branch block.”

Arthur Moss, responding in CardioExchange to a query from John Ryan, mentioned the 2013 heart failure tips, which advocate CRT for non-LBBB individuals with a QRS duration of &gt150 msec, demands to be revised.

Survival Benefit Found Following Extended-Phrase Resynchronization Therapy

Survival Benefit for TAVR More than Surgical treatment in Large-Chance Individuals

Transcatheter aortic valve substitute (TAVR), which has been slowly and cautiously coming into the clinical arena, will probably get a massive boost from a new trial displaying a substantial mortality advtange for TAVR more than classic surgical procedure.

Final results from the U.S. CoreValve Substantial-Risk Review had been presented at the American College of Cardiology in Washington, DC, and published concurrently in the New England Journal of Medicine. In the trial, 795 sufferers with significant aortic stenosis who who had been at higher risk for surgical treatment had been randomized to surgical aortic valve substitute (SAVR) or TAVR with the Medtronic Medtronic CoreValve device.

The headline information is the improved mortality with TAVR. In the as-handled analysis, at one year the fee of death was 14.two% in the TAVR group versus 19.one% in the SAVR group, a variation that was hugely important for noninferiority (P&lt0.001) and that reached significance for superiority (P=.04). A equivalent pattern occurred in the intention-to-treat evaluation: At one year, the rates of death were 13.9% for TAVR and 18.7% for SAVR (P&lt0.001 for non inferiority P=.04 for superiority).

Nevertheless, for the critical secondary endpoint of main adverse cardiovascular and cerebrovascular events at thirty days or discharge, TAVR did not meet the prespecified criteria for superiority (8.2% for TAVR vs. ten.9% for SAVR P=.ten). At thirty days, the stroke price was four.9% in the TAVR group and six.2% in the surgical group (P=.46). At 1 year, the strokes were 8.8% and twelve.6%, respectively (P=.10).

A lot more pacemakers were implanted in the TAVR group at 1 12 months (22.three% vs. eleven.three% for SAVR), and the TAVR group had a lot more key vascular issues. But bleeding complications occurred more regularly in the surgical procedure group.

In an interview with Rick Lange and David Hillis on CardioExchange, Columbia University interventional cardiologist Ajay Kirtane said that the trial “further tilts the stability toward TAVR in large-threat individuals.” He cautioned that it is unattainable at this stage to compare the CoreValve benefits with final results from the Sapien gadget in the Partner trials. “In the absence of a head-to-head comparison of the brief- and long-term functionality of these valves, it is truly challenging to speculate about valve-distinct distinctions, except theoretically,” he said. “I see this as a ‘win’ for TAVR as a complete.”

Survival Benefit for TAVR More than Surgical treatment in Large-Chance Individuals

Soaring survival on breast cancer, new examine displays

The very best mortality charges are in Spain, Norway, Sweden and Portugal, which all had death prices below twenty per cent, the newest figures demonstrate.

In November a report by the Organisation for Economic Co-operation Advancement identified ptients with breast, bowel and cervical cancer fare worse in Britain than in the huge bulk of industrialised nations, with only Poland proven to be worse for all three of the cancers.

Charities explained that too typically illness is discovered as well late, with instances missed by GPs and delays for hospital scans and diagnostic exams.

Mike Hobday, Director of Policy and Analysis at Macmillan Cancer Help, explained: “Overall it is excellent information that more men and women than ever are surviving breast cancer in England and Wales, but plainly we even now have work to do in the Uk to catch up with our European counterparts.

“It’s crucial that cancer is caught in its early phases to ensure individuals have timely access to treatment and assistance. GPs perform a essential part here in early referral of suspected cancer and Macmillan is assisting them to drive via enhancements in diagnosis and to concentrate significantly much more on maintaining individuals nicely after their therapy.”

He stated the investigation also showed as well numerous older breast cancer individuals becoming failed.

Baroness Delyth Morgan, Chief Executive of Breast Cancer Campaign, mentioned: “Even however globally more breast cancer circumstances are being diagnosed, we do know that thanks to analysis and innovations in treatment method, mortality rates are falling in the United kingdom and it is reassuring to see this confirmed in these benefits.

“Despite this, there is nevertheless a lot far more perform to do to make certain that every person has the very best likelihood of surviving breast cancer, no matter where they live in the globe, the United kingdom, or even inside the same city. By functioning together and continuing to invest in crucial research into the ailment, we will be in a position to uncover the cures and conquer breast cancer by 2050.”

Dr Richard Francis, Study Manager at Breakthrough Breast Cancer, explained: “It is actually promising to see that breast cancer mortality prices have decreased across Europe, in particular that a single of the most notable decrease across the European countries concerned in this review was England.”

He explained that regardless of the improvements, main advances had been required.

Dr Francis said: “Now, a lot more than ever, folks require to understand that breast cancer is not yesterday’s difficulty – one particular lady is diagnosed with breast cancer every single 10 minutes. We’re continuing to urge drug firms and the Government to work collectively in order to build a better technique for acquiring patients accessibility to daily life-extending treatment options.”

Soaring survival on breast cancer, new examine displays

Discover Wilderness Survival Skills While Receiving Match - In Luxury Style

Canyon Ranch Tucson’s Outside Sports activities Manager Randy Kinkade teaches visitors how to start fires in the wild without having tools as portion of the resort’s new outside “primitive skills” classes.

Enjoy Television demonstrates like Survivorman, Man vs. Wild and Dual Survival? Or maybe you just worry about how you’d fare following surviving a plane crash, getting misplaced hiking or operating out of fuel in the middle of nowhere? Either way, this may well be the ideal trip for you.

Tucson’s Canyon Ranch is well-known as a luxury fitness retreat, a white glove boot camp of kinds the place people go to get into shape swiftly under the eye of specialist trainers supplying a enormous slate of workout courses although staying in posh accommodations, enjoying spa remedies and consuming healthily, but without having sacrifice.

Now it is tackling wilderness survival.

Hiking is a massive element of the fitness offerings at Tucson’s Canyon Ranch, in which hikers can also now learn better wilderness survival and security abilities.

The initial Primitive Outdoor Survival Capabilities session is currently being held at the Tucson Canyon Ranch place (there are also Canyon Ranch locations in the Berkshires, Miami Seashore, Las Vegas and at Sea) from January 22-25, 2014. If that’s too short recognize, just hang onto this info as the Primitive Outdoor Survival Skills will be repeated, whilst numerous elements of the plan are now permanent offerings guests can enjoy at any time. The resort not too long ago added a “Primitive Technology” part to its checklist of “Sports &amp Outdoors” classes, with Animal Tracking and Make Your Personal Arrowheads from stones portion of Canyon Ranch’s slate of paid extra-curricular classes, while other essential expertise, such as Primitive Fire Making and Normal Awareness (“Develop Your Outdoor Senses”) have been added to the roster of cost-free, integrated courses.

The real scheduled session is a bit much more immersive and consists of these over aspects plus partaking in a Spirit Lodge, a session on Naturopathic Medicine, and understanding the psychology of ecology. It concludes with the “The Ultimate Check,” exactly where the group operates collectively to attain a shock challenge using their newly acquired abilities. Participants also get access to all of Canyon Ranch’s several extra actions such as an outdoor rock climbing wall, hiking, biking and a lot more fitness courses than you can envision.

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Discover Wilderness Survival Skills While Receiving Match - In Luxury Style