UTI test used by GPs gives wrong results in at least a fifth of cases, study claims

A test that is routinely used by doctors to diagnose urinary tract infections wrongly gives a negative result in a fifth of cases, scientists have found.

The findings imply that a large proportion of women who seek medical help for UTIs such as cystitis are being misdiagnosed, with some being told their problem is psychological. Many women with severe symptoms are also likely to have been refused antibiotics.

Stefan Heytens, a practicing GP and a researcher at the University of Ghent, said: “A substantial percentage of women visiting their GP with symptoms of a UTI, who test negative for a bacterial infection, are told they have no infection and sent home without treatment.”

Rather than using unreliable tests, he said, women should be diagnosed and treated on the basis of their symptoms.

Each year an estimated four million people, the vast majority women, will have a bout of cystitis. It typically involves bladder pain, an intense burning sensation when passing urine and the need to urinate urgently, sometimes several times an hour.

While unpleasant and inconvenient, cystitis normally clears without medicine within a couple of days. But if symptoms are severe or linger and antibiotics are required, GPs often carry out a “dipstick” test using a litmus-style indicator or send a urine sample to a microbiology lab, where it is cultured to see whether harmful bacteria is present.

In at least a fifth of cases, these tests come back negative, and doctors had been at a loss to explain what was wrong with this subset of patients. Some have been diagnosed with unexplained “urethral syndrome” while for others it has been suggested the root cause might be psychological.

The latest work proposes a third explanation: the tests are at fault.

The study, published in Clinical Microbiology and Infection, recruited 220 women who were visiting their GP for UTI symptoms and 86 healthy volunteers, all of whom gave urine samples.

The standard culture test detected bacteria in 81% of the samples. But a more advanced technique, designed to spot tiny quantities of bacterial DNA, found evidence of an infection in 98% of the women with symptoms.

Only about 10% of the healthy women tested positive for bacteria such as E. coli, suggesting that the results were not simply explained by trace levels of bacteria that are always present.

The authors are not sure why some infections failed to grow in culture. “The microbiologists in our institution do not have the slightest idea,” said Heygens. “They are just surprised that their test is not as infallible as they thought.”

However, he had this advice for doctors: “The woman that is visiting you with typical urinary complaints has an infection. There is nothing more to explore.”

The findings come after researchers concluded last year that cranberry juice, traditionally recommended by doctors as a natural cure, has no discernible effect on cystitis.

Prof James Malone Lee, who runs a specialist clinic for chronic UTIs at Whittington Hospital in London, highlighted the inadequacies of current testing in parliament last year. “The patients attending our centre describe frequent occurrences of them presenting with typical symptoms of urinary infection but being denied treatment because the tests are negative,” he said. “They are told emphatically that nothing is wrong.”

The consequences for the minority of women who suffer chronic infections could be devastating, he added. “It is appalling that patients coming to our centre have been told that their problems are psychological,” he said. “We have got to accept that our tests are discredited and we must start to consider what happens to those who go untreated because they tested negative.”

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said the vast majority of women who present at their GP surgery with a UTI are given a test aimed at identifying infection. “GPs rely on the results of these tests, so if [they are] ineffective in properly determining the type of infection – as this research suggests the urine test is – it is certainly concerning, and it needs to be addressed,” she said.

UTI test used by GPs gives wrong results in at least a fifth of cases, study claims

NHS risking people"s health by rationing test strips, Diabetes UK says

The NHS is putting diabetic patients at risk of serious illness by rationing test strips that monitor blood glucose levelsin an attempt to save money, a charity claims. A survey carried out by Diabetes UK found that one in four complained of restrictions placed on the number of test strips they were prescribed by GP practices.

People with diabetes need to test their blood glucose regularly to monitor the condition. If not managed properly, diabetes can lead to health complications such as heart disease, strokes, blindness and amputations.

More than half of those professing problems had type 1 diabetes. Government guidance says this group should test themselves at least four times a day. Older people and those on low incomes were also affected, the charity found. Many said they felt they needed to buy test stripsonline, where quality cannot always be guaranteed.

People with diabetes were given a variety of reasons for the reduced number of strips prescribed, according to the charity. Some respondents to the survey said they had been told they should test less often. Some were told there were “budget constraints”, while others were told it was because they were testing too frequently.

“They said I had my allowance for the month,” said one respondent. Another said: “I was told they were expensive and we should test less. Only need to test four times a day. We use a pump, so need to test every two hours.”

Some said they were having to ask for repeat prescriptions more often. “I now need to order and collect a prescription monthly, or sooner, depending on any issues that crop up,” wrote one. Often when people complained to the practice, their normal prescription was reinstated. But Diabetes UK said they were concerned that people had to challenge the GP practice to get an essential piece of equipment.

Many clinical commissioning groups (CCGs), which have come under fire for rationing other NHS services, have guidance on how often people should test their blood glucose levels and how many boxes of strips should be issued each month. They have also urged GPs to switch patients to cheaper blood glucose meters and strips, sometimes against the patient’s wishes.

Diabetes UK said the rationing was a false economy because the cost of dealing with complications caused by poorly managed diabetes is far higher.

The findings came just weeks after Simon Stevens, the chief executive of NHS England, announced that the health service would stop prescribing some drugs and gluten-free foods to cut spiralling costs.

Diabetes UK’s policy manager, Nikki Joule, said: “These shortsighted cost savings cause people real anguish and potential financial distress. It also means people are struggling to manage their diabetes, which can lead to serious consequences for their health.”

Norman Lamb, the Liberal Democrats’ health spokesman, agreed. “This is more evidence of an insidious creeping retreat of the NHS without any public debate,” he said. “It makes no sense to undermine good preventive care in this way. More people will end up unnecessarily with their health deteriorating.”

It makes no sense to undermine good preventive care in this way

Norman Lamb, Lib Dem health spokesman

Testing strips are part of a kit used to check the condition. Diabetics prick their finger and put drops of blood on a strip, which then goes into a meter that measures blood glucose levels.

Dr Stephen Lawrence, clinical lead for diabetes for the Royal College of GPs, said: “£24m of the scarce NHS budget is spent on diabetes care every day, and it would be irresponsible not to make the most appropriate use of limited resources.”

He added that the need for strips varied between individuals and that doctors should sit down and discuss appropriate treatments with patients. “We urge NHS England to deliver on the pledges made in its GP Forward View for greater investment in general practice – including more GPs – so that we can give more time to all our patients, including those with diabetes,” Lawrence said.

The charity agreed that decisions on testing and access to strips should be made jointly between a patient and their GP. But their research suggested this did not always happen.

Colin Frampton, an 86-year-old pensioner with type 2 diabetes from Winchester, Hampshire, told Diabetes UK he was paying for test strips out of his pension after being restricted to 50 for the year – enough to test his blood glucose just once a week. He said: “If I didn’t challenge my GP, I’d still have to take money out of my pension to help me manage my condition.”

One pregnant woman, who is type 1 diabetic, saw her strips reduced from 300 to 50 a month, although the National Institute of Health and Clinical Excellence (Nice) guidelines suggest testing for pregnant women of 10 times a day or more.

The report also found that family doctors were overburdened and that receptionists and other surgery staff were increasingly preparing prescriptions. Some of these lacked the necessary understanding of diabetes. When a prescription was restricted, it was usually reinstated once challenged.

The charity said it was concerned that some people with type 2 diabetes who would have benefited from testing had been advised they did not need it, and called for a review of government guidance on this.

Professor Jonathan Valabhji, NHS England’s national clinical director for diabetes and obesity, said: “Ultimately, these are decisions for CCGs, but should be informed by best evidence and national guidance where appropriate. We need to ensure adequate provision and that clinicians take into account widely recognised Nice guidelines, which are clear about the need for test strips to support people in particular with type 1 diabetes.”

NHS risking people"s health by rationing test strips, Diabetes UK says

Smartphone app could allow men to test their fertility at home

Men may soon be able to measure their own sperm count and quality at home, using a smartphone app developed by scientists.

In early tests the gadget, designed to clip onto a smartphone, detected abnormal sperm samples with an accuracy of 98%.

In more than 40% of cases where couples struggle to conceive, the underlying fertility issue is linked to sperm abnormalities, but the researchers said that social stigma and lack of access to testing meant than many men never seek evaluation.

Hadi Shafiee, who led the work at Brigham and Women’s Hospital in Boston, US, said: “We wanted to come up with a solution to make male infertility testing as simple and affordable as home pregnancy tests.”

The team put the device together using spare parts from DVD and CD drives at a total cost of $ 4.45. Using the device simply involves drawing semen into a disposable holder that is plugged into one side of the phone attachment, in a similar way to a USB. In seconds, results of the analysis are displayed on the phone’s screen.

In the study, published in the journal Science Translational Medicine, the research team recruited 10 volunteers with no formal training, including administrative assistants employed at a Boston fertility clinic. They correctly classified more than 100 semen samples using the app.

The test is an inexpensive smartphone attachment that quickly and accurately evaluates semen samples for fertility testing. Photograph: [Credit: M.K. Kanakasabapathy et al., Science Translational Medicine (2017)]

Overall, the scientists examined 350 clinic samples and were able to identify those with low sperm counts and inactive or poorly motile sperm with 98% accuracy.

John Petrozza, director of the Massachusetts General Hospital Fertility Center and a co-author, described the device as a “true game-changer”. “Men have to provide semen samples in these rooms at a hospital, a situation in which they often experience stress, embarrassment, pessimism and disappointment,” he said.

“Current clinical tests are lab-based, time-consuming and subjective. This test is low-cost, quantitative, highly accurate and can analyse a video of an undiluted, unwashed semen sample in less than five seconds.”

Allan Pacey, professor of andrology at the University of Sheffield, who was not involved in the research, said that the techniques used for sperm quality assessment have not changed significantly since the 1950s, and that even when carried out at specialist centres can be prone to errors if the laboratory worker has not had sufficient training.

“As such, the development of an easy, cheap and accurate method to evaluate the sperm present in a sample of semen would be very welcome, particularly if it could be carried out by someone without specific training and in any location,” he said.

However, he added that the smartphone device could not replicate all the tests carried out in a specialist lab and did not analyse morphology – sperm size and shape.

“For a small number of men whose sperm are badly made, and have poor morphology, it would be important to get this diagnosed correctly,” he said. “So any man who struggles with infertility for a significant length of time, say more than 12 months, should consider getting their test repeated in a specialist laboratory, regardless of what the phone app might have concluded.”

The team behind the device are planning to perform additional testing and will file for approval from the FDA, the US regulator.

Smartphone app could allow men to test their fertility at home

New Alzheimer"s test can predict age when disease will appear

Scientists have developed a new genetic test for Alzheimer’s risk that can be used to predict the age at which a person will develop the disease.

A high score on the test, which is based on 31 genetic markers, can translate to being diagnosed many years earlier than those with a low-risk genetic profile, the study found. Those ranked in the top 10% in terms of risk were more than three times as likely to develop Alzheimer’s during the course of the study, and did so more than a decade before those who ranked in the lowest 10%.

Rahul Desikan, of the University of California – who led the international effort, said the test could be used to calculate any individual’s risk of developing Alzheimer’s that year.

“That is, if you don’t already have dementia, what is your yearly risk for AD onset, based on your age and genetic information,” he said.

The so-called polygenic hazard score test was developed using genetic data from more than 70,000 individuals, including patients with Alzheimer’s disease and healthy elderly people.

It is already known that genetics plays a powerful role in Alzheimer’s. Around a quarter of patients have a strong family history of the disease, and scientists have shown this is partly explained by a gene called ApoE, which comes in three versions, and is known to have a powerful influence on the risk of getting the most common late-onset type of Alzheimer’s. One version of ApoE appears to reduce risk by up to 40%, while those with two copies (one from each parent) of the high-risk version can increase risk by 12 times.

The latest study takes a new approach, showing that, aside from ApoE, there are thousands of background genetic variations that each have a tiny influence on Alzheimer’s risk, but whose cumulative influence is substantial.

The researchers first identified nearly 2,000 single letter differences in the genetic code (known as SNPs) and, after ranking them for influence, developed a test based on 31 of the markers. The test was then used to accurately predict an individual’s risk of getting the disease in an independent patient cohort.

In people with the high-risk version of ApoE, those ranked in the top 10% of risk on the new test got Alzheimer’s at an average age of 84 years, compared with 95 years for those ranked in the lowest 10%.

James Pickett, head of research at Alzheimer’s Society, said: “Preventing the development of dementia symptoms is the holy grail of Alzheimer’s research but to succeed we first need accurate methods to predict who is most likely to develop the condition. This study’s approach was fairly successful at predicting the likelihood of someone developing dementia over the coming year, but needs to be tested further in mixed, non-US populations.”

Pickett added that, while the score could help to identify people for trials, it was too early to apply it as a genetic testing tool for use in the clinic.

Rosa Sancho, head of research at Alzheimer’s Research UK, said that while genetic makeup can influence the chances of developing dementia, a healthy diet, regular physical activity and remaining mentally active can also drive down the risk. “Genetics is only part of the story and we know that lifestyle factors also influence our risk of developing Alzheimer’s,” she said. “The best current evidence points to habits we can all adopt to help lower our risk and indicates that what’s good for your heart is also good for the brain.”

The findings are published in the journal PLOS Medicine.

New Alzheimer"s test can predict age when disease will appear

Test all pregnant women for smoking, say NHS chiefs

England’s public health chief is urging hospitals to give every pregnant woman a carbon monoxide test to see if they smoke, as part of an NHS-wide drive to persuade patients to kick the habit.

Duncan Selbie wants midwives and nurses to routinely screen mothers-to-be when their pregnancy is first “booked”, monitor them at all their antenatal appointments and support those who want to quit.

Hospitals would also ban smoking shelters used by staff and patients, hand out nicotine gum and patches and include helping smokers to quit in patients’ treatment plans under Public Health England (PHE)’s plans. It also wants doctors and nurses to use their conversations with patients to advise them how to give up tobacco or encourage them to switch to e-cigarettes instead.

“One in four hospital inpatients smokes, but too many hospitals do too little to try to help them to give up. I want people who are in a hospital bed or in a consulting room to have a conversation about their smoking with a member of staff and, if they want to quit, refer them on to stop smoking services”, Selbie, PHE’s chief executive, told the Observer.

“This isn’t about scaring or hectoring people. It’s about making people aware that if they want to give up, NHS staff can help them. The evidence shows that if someone is helped to quit, they are four times more likely to succeed than if they do it on their own.

“We talk a lot about sugar and diet as health risks, but smoking remains the UK’s biggest killer and is responsible for near half a million admissions to hospital each year. One in four beds is occupied by a smoker and seven in 10 of them want to quit. It is time to consign tobacco to history and for the NHS to help people to give up.

“There’s something anachronistic about the NHS being associated with smoking,” he added.

The Royal College of Midwives (RCM) backed carbon monoxide testing for expectant mothers as long as they had the right to refuse to undergo it if they chose not to.

“The RCM is supportive of pregnant women being offered carbon monoxide testing at a time when it is appropriate to do so. Depending on the circumstances, it could be at the initial antenatal booking or during subsequent antenatal visits. Women should have the ability to decline testing as with any other area of antenatal screening,” said Janet Fyle, the RCM’s professional policy adviser.

But the NHS needed to understand that some women, especially those from poorer backgrounds, smoke as a way of helping relieve the stress of preparing to have a baby, Fyle added. “Having a baby and caring for a newborn along with other family members is one of the most stressful life events for some women, as some new mothers struggle to adapt to their new roles with little or no social support,” she said.

“We know that the incidence of smoking is higher in lower socioeconomic groups. We cannot ignore the psychological, social or economic circumstances of new mothers when developing strategies for how we communicate the risks of smoking and health care.”

PHE officials are frustrated that hospitals are doing too little to tackle smoking. In a strongly worded blog for the British Medical Journal, Dr Mary Black, its head of digital strategy, accused them of displaying “a kind of misguided sympathy [that] keeps the last vestiges of tobacco acceptability alive in the NHS.

“We falter before ill patients in pyjamas dragging their IV fluid stands out into the winter street in front of a hospital to have a fag, we pass with no comment past colleagues clustered around the emergency department exit having a communal smoke – some staff even smoke with patients at the exits of mental health units or in the last few remaining smoking shelters. Tolerating smoking on NHS premises is a form of collusion,” she said.

Black was especially critical of NHS personnel who light up outside their hospital. “Staff who smoke in NHS uniforms are sending a very clear pro-tobacco signal. Health staff who smoke with patients are empathising in a harmful way,” she said.

The National Institute of Health and Care Excellence (Nice) already advises hospitals to screen pregnant women to see if they smoke. However, many do not do so, even though recent evidence shows that it helps double the number of women who quit smoking during pregnancy and that those who do go on to have heavier and healthier babies. Smoking in pregnancy increases the risk of stillbirth, babies being small for gestational age, having trouble breathing and other problems.

Selbie praised Taunton and Somerset NHS Trust for playing messages recorded by children over the loudspeaker system in its grounds to ask those who are smoking to stop. The South London and Maudsley NHS Foundation Trust tells patients in all the letters it sends them that they should not bring tobacco, cigarettes, lighters or matches on to its premises or smoke anywhere in its grounds.

Selbie also highlighted Medway NHS Foundation Trust in Kent’s raft of anti-smoking measures, including its use of wardens to patrol the grounds telling people to stop smoking and a policy of frontline staff checking a patient’s smoking status and referring them for specialist help to quit if wanted.

Test all pregnant women for smoking, say NHS chiefs

New screening test cuts bowel cancer risk by a third, study finds

A one-off screening test being introduced across the NHS cuts the risk of developing bowel cancer by a third, a long-term study has found.

The test, which is being rolled out across England, will invite men and women to have bowel scope screening around the time of their 55th birthday.

This is in addition to the current test from the age of 60, the faecal occult blood test (FOB), which is posted to people’s homes.

FOB detects blood hidden in small samples of faeces, with further tests recommended if blood is detected.

Research published in the medical journal the Lancet has found that the bowel scope test reduces the risk of all cases of the cancer by a third. Experts predict it will save thousands of lives every year.

It works by threading a tiny camera attached to a thin flexible tube into the lower part of the bowel. As well as detecting tumours, it helps spot small growths, called polyps, on the bowel wall. If left untreated polyps can become cancerous, and any found during a bowel scope can usually be removed immediately.

Bowel scope screening will not detect cancers higher up in the bowel and patients may need a colonoscopy if they have persistent symptoms.

But the research found the new test was able to prevent 35% of bowel cancers overall and 40% of deaths.

In the lower bowel, the test prevented more than half of potential cancers from developing in that area.

Researchers from Imperial College London followed more than 170,000 people for 17 years on average, of whom more than 40,000 had the bowel scope test.

There are more than 41,000 new cases of bowel cancer every year in the UK, and about 16,000 deaths.

Prof Wendy Atkin, Cancer Research UK’s bowel screening expert and lead author at Imperial, said: “Although no screening test is perfect, this study shows that bowel scope is effective in reducing cancer deaths for at least 17 years.

“Bowel cancer can be prevented. And the bowel scope screening test is a great way to reduce the number of people diagnosed with the disease so it’s vital that no one misses out on the opportunity to get the test.”

Julie Sharp, Cancer Research UK’s head of health information, said: “Like other types of screening, bowel scope is meant for people without symptoms. It’s a great way to help reduce the number of people developing or dying from bowel cancer, but it can’t pick up everything.

“So it’s still important to take part in the rest of the bowel screening programme and not ignore the home testing kits when they arrive.”

The government estimates the bowel scope test will take at least another three years before it will be offered to everyone eligible across England. This is in order to train specialist staff to carry out the tests. Governments in Scotland, Wales and Northern Ireland have not yet committed to introducing the test.

The research was funded by the Medical Research Council and National Institute for Health Research. About half of bowel cancers occur in the lower part of the bowel and the rectum – the area covered by the bowel scope test.

The health secretary, Jeremy Hunt, said: “This report is really encouraging – prevention and early diagnosis are key to improving outcomes, and this new screening test could help us save thousands more lives.

“Cancer survival is at its highest rate ever, but more must be done: we are investing £300 million a year by 2020 to increase diagnostic capacity for all cancers, so we can save more from this devastating disease.”

New screening test cuts bowel cancer risk by a third, study finds

New screening test cuts bowel cancer risk by a third, study finds

A one-off screening test being introduced across the NHS cuts the risk of developing bowel cancer by a third, a long-term study has found.

The test, which is being rolled out across England, will invite men and women to have bowel scope screening around the time of their 55th birthday.

This is in addition to the current test from the age of 60, the faecal occult blood test (FOB), which is posted to people’s homes.

FOB detects blood hidden in small samples of faeces, with further tests recommended if blood is detected.

Research published in the medical journal the Lancet has found that the bowel scope test reduces the risk of all cases of the cancer by a third. Experts predict it will save thousands of lives every year.

It works by threading a tiny camera attached to a thin flexible tube into the lower part of the bowel. As well as detecting tumours, it helps spot small growths, called polyps, on the bowel wall. If left untreated polyps can become cancerous, and any found during a bowel scope can usually be removed immediately.

Bowel scope screening will not detect cancers higher up in the bowel and patients may need a colonoscopy if they have persistent symptoms.

But the research found the new test was able to prevent 35% of bowel cancers overall and 40% of deaths.

In the lower bowel, the test prevented more than half of potential cancers from developing in that area.

Researchers from Imperial College London followed more than 170,000 people for 17 years on average, of whom more than 40,000 had the bowel scope test.

There are more than 41,000 new cases of bowel cancer every year in the UK, and about 16,000 deaths.

Prof Wendy Atkin, Cancer Research UK’s bowel screening expert and lead author at Imperial, said: “Although no screening test is perfect, this study shows that bowel scope is effective in reducing cancer deaths for at least 17 years.

“Bowel cancer can be prevented. And the bowel scope screening test is a great way to reduce the number of people diagnosed with the disease so it’s vital that no one misses out on the opportunity to get the test.”

Julie Sharp, Cancer Research UK’s head of health information, said: “Like other types of screening, bowel scope is meant for people without symptoms. It’s a great way to help reduce the number of people developing or dying from bowel cancer, but it can’t pick up everything.

“So it’s still important to take part in the rest of the bowel screening programme and not ignore the home testing kits when they arrive.”

The government estimates the bowel scope test will take at least another three years before it will be offered to everyone eligible across England. This is in order to train specialist staff to carry out the tests. Governments in Scotland, Wales and Northern Ireland have not yet committed to introducing the test.

The research was funded by the Medical Research Council and National Institute for Health Research. About half of bowel cancers occur in the lower part of the bowel and the rectum – the area covered by the bowel scope test.

The health secretary, Jeremy Hunt, said: “This report is really encouraging – prevention and early diagnosis are key to improving outcomes, and this new screening test could help us save thousands more lives.

“Cancer survival is at its highest rate ever, but more must be done: we are investing £300 million a year by 2020 to increase diagnostic capacity for all cancers, so we can save more from this devastating disease.”

New screening test cuts bowel cancer risk by a third, study finds

Alkaline Eating: How To Test and Improve Your pH Levels

Alkaline Eating: How To Test and Improve Your pH Levels

Ohio "heartbeat" abortion bill could be test case for overturning Roe v Wade

The Ohio state legislature threw down the gauntlet this week to the supreme court, passing a new anti-abortion “heartbeat” bill that would ban terminations from as early as six weeks, the most severe restrictions in the country.

Ohio politicians say they were motivated to push through the bill by Trump’s win, believing they might find a more friendly US supreme court that would uphold the law.

If passed by Governor John Kasich, the bill could serve as a test case for the limits of constitutional protections of abortion, and even for overturning the landmark decision Roe v Wade, which enshrines a woman’s right to choose abortion until the fetus is “viable” (between 24 and 28 weeks gestation). But activists on both sides of the issue doubt that strategy is likely to succeed, and say it could do more to harm the legal movement than help it.

The bill passed by the Ohio state legislature Tuesday night stops just short of banning abortion from the time a fetus’s heartbeat is detectable, which is usually around six weeks. The new law states that if a doctor terminates a pregnancy without listening for a heartbeat or when a heartbeat is audible, then the physician would be committing a fifth-degree felony and facing up to a year in jail, disciplinary action and civil lawsuits.

Many women do not even realize they are pregnant at this early stage.

“If this law would take effect, it really is a flat out abortion ban,” said Amanda Allen, senior state legislative counsel at the Center for Reproductive Rights.

Many other states have also tried to get “heartbeat bills” through in the past. North Dakota and Arkansas state legislature passed similar laws in March 2013, however the eighth circuit appellate court ruled them unconstitutional in 2015 and the laws were never enacted.

Ohio lawmakers have considered their own bill in the past. But lawmakers said that Trump’s election and a free seat on the supreme court gave them new impetus for the bill and make it more likely that the bill would be upheld in the courts.

“A new president, new supreme court appointees change the dynamic, and there was consensus in our caucus to move forward,” Senate president Keith Faber.

But despite lawmakers’ views, many anti-abortion activists in the state are not celebrating the move.

Mike Gonidakis from Ohio Right to Life, an anti-abortion lobby group, says his group is officially “neutral” on the bill because he fears the law would be struck down, after an expensive and lengthy court battle. He believes the six-week ban would be so dramatic that even the supreme court would vote 5-4 to strike it down, even if another conservative justice were confirmed to replace the vacancy on the court.

“You have to be patient and strategic with the courts,” said Gonidakis.

“That doesn’t even take into account millions of dollars Ohio would be forced to pay the lawyers for Planned Parenthood and the ACLU,” he added.

Gonidakis thinks it may even strengthen Roe v Wade.

“We will be inviting nothing more than damage and danger to all we’ve accomplished for the past 40 years,” said Gonidakis.

And while some are worried that the law sets up a test case that might become a referendum on the supreme court’s Roe v Wade president, Ohio’s arm of the American Civil Liberties Union says it’s ready to declare a legal challenge if the bill becomes law. Allen says she’s not too worried the legal challenge would have an adverse effect at the high court, since another court has already judged the North Dakota and Arkansas laws unconstitutional.

“These types of bans are completely unconstitutional and have very little chance of standing up in court,” said Allen, noting that Roe v Wade has been settled law for over 40 years.

Ohio has tightened abortion restrictions in recent years, and this legislation was tacked on to an unrelated bill last minute in Ohio this week.

This was the third time Ohio attempted to pass it, after it failed in 2012 and 2014.

On Thursday, the Ohio state legislature passed another anti-abortion bill, which would ban abortion from 20 weeks. Currently 18 states have enacted some form of 20-week abortion ban, and Allen noted that lawmakers may be pushing the “heartbeat” bill as a red herring while the other, also controversial measure flies under the radar.

“That could certainly be part of the strategy,” noted Allen. “Both bans are prohibitions on abortion prior to viability and the US Supreme Court has been very clear that states may not do that.”

Kasich, who ran as a moderate during the Republican primaries but has signed several restrictions on abortion into law in the last few years, will have to decide whether to sign one or both bills into law, veto them, or ignore them, in which case they would automatically be enacted into law within a few weeks.

Ohio "heartbeat" abortion bill could be test case for overturning Roe v Wade

HIV vaccine test hopes for breakthrough in combat against the virus

The first new trial of a potential vaccine against HIV in seven years has begun in South Africa, raising hopes that it will help bring about the end of the epidemic.

Although fewer people are now dying from Aids because 18.2 million are on drug treatment for life to suppress the virus, efforts to prevent people from becoming infected have not been very successful. The infection rate has continued to rise and experts do not believe the epidemic will be ended without a vaccine.

The vaccine being tested is a modified version of the only one to have shown a positive effect, out of many that have gone into trials. Seven years ago, the vaccine known as RV144 showed a modest benefit of about 31% in a trial in Thailand.

That trial was controversial because the vaccine was a combination of two, called AidsVax and ALVAC, which were already 15 years old when it began. One of them, AidsVax, had failed in a trial on its own. The RV144 trial was very large – more than 16,400 Thai men and women without HIV took part, randomly assigned to receive either the combined vaccine or a placebo injection. At the end of the three-year trial, 125 people had become infected – 51 who had received the vaccine and 74 who had not.

But researchers chasing the holy grail of a vaccine think they could have better success in South Africa, because of a number of modifications. The new trial, called HVTN 702, has just begun to enrol the first of 5,400 men and women aged 18-35.

“HIV has taken a devastating toll in South Africa, but now we begin a scientific exploration that could hold great promise for our country. If an HIV vaccine were found to work in South Africa, it could dramatically alter the course of the pandemic,” said Dr Glenda Gray, chief executive of the South African Medical Research Council, which is involved in the study.

“It’s an important trial to do. I’m very pleased that we were able to get it off the ground,” said Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US that is co-funding the trial.

The Thai trial’s modest success was in people at low risk of HIV infection. “We have always said that if a vaccine is going to be ultimately effective, it is going to have to prove itself in a relatively high-risk group. So we always had the intention of extending and extrapolating the principle of the RV144 study to a setting such as southern Africa,” said Fauci.

The aspiration is to push the effectiveness up from 31% to between 50% and 60%, he said. “Obviously we’d like it to be 90% but that is probably asking too much given the complexity of HIV and the body’s immune response to it,” he said. If they could get a vaccine of at least 50% efficacy for use in combination with other prevention tools, such as condoms, antiretroviral drugs and circumcision, “that will be a major, major advance”, he said.

The modified vaccine uses an isolate of the virus that circulates in southern Africa, called the C clade. There will be more booster shots of the vaccine and the use of an adjuvant to enhance the response of the immune system. Volunteers will get five shots of the vaccine and three boosters – a schedule that the researchers will look to slim down for use in the real world if it is successful.

Prof Linda-Gail Bekker, of the University of Cape Town and president of the International AIDS Society, who is also involved in the study, said the result from the Thai trial, although only 31% “made those of us in the HIV vaccine world quite excited”. For the first time, it looked as though a vaccine was possible.

“Pretty soon after the trial, the world started to galvanise to decide what we needed to do,” she said. The epidemic in Thailand was abating, so with a low rate of new infections, it was not the best place to study the vaccine further. “We recognised we had to come to southern Africa to do the trial, so we had to modify the vaccine product.”

The aim of the new trial is to produce evidence for the regulators and obtain a licence for a vaccine. “Probably the magic number is 50% at three years,” she said. “I think nobody will be very interested in a vaccine that is less than 50%.” A vaccine with lower efficacy could be a problem if people assume they are protected and take no further precautions against HIV. But a vaccine with 50% efficacy could make a big impact, she said.

At least two-thirds of the participants will be women, who are more likely to get infected at that age than men. “The toolbox is in desperate need of something like this. We remain very optimistic,” said Bekker. “We are constantly aware of the desperate need and very excited that we are finally getting on and trying something again now.

“We’ve never treated our way out of an epidemic. There’s no doubt we have to have primary prevention alongside treatment in order to get HIV control, but we are not going to get HIV eradication without a vaccine. That is very clear.”

HIV vaccine test hopes for breakthrough in combat against the virus

"186m needless emails": NHS-wide test message and replies-to-all crash system

Sending an email to everyone in the company is usually a guaranteed way of making yourself unpopular, but the potential for annoyance is even greater if you work in the NHS, employer of 1.2 million people.

On Monday, NHS employees complained on Twitter about a “test email” sent by an IT contractor at Croydon NHS to everyone in the organisation, as well as replies-to-all, leading to claims the entire email system has crashed.

One NHS statistician estimated that at least 186m emails, including replies-to-all asking to be taken off the distribution list, had been sent, clogging up people’s inboxes.

Gavin (@68_gavin)

Another waste of a working day due to some pillick in #nhsmail sending email to entire directory, unable to connect and do my job #epicfail

November 14, 2016

James Andrews (@aptaim)

Hmmmm… wonder if this is why I can’t log in to #NHSmail at the moment ?! https://t.co/wBvuREsB6X

November 14, 2016

Project iHypE (@PIhype)

If you’re trying to get in touch with us today, please be patient, it seems #NHSmail has gone down for the time being. We’ll reply ASAP. A

November 14, 2016

Colin McDonnell (@Malignanthero)

Slow handclap for the individual that sent a test email to the entire NHSMail user base, and bravo to those that “replied to all”… pic.twitter.com/zkg5uG7t2M

November 14, 2016

Graham Hyde (@GrahamHyde)

#nhsmail 1.2 million people have received approx 151 emails in error this morning. That’s 186 million needless emails so far today.

November 14, 2016

A message to NHS mail users described the global email as a “high severity service incident”. It said: “An issue with a distribution list has meant that several test emails have been widely received by users. This has been exacerbated by recipients replying in response and increasing the volume of emails associated with the list.

“The impact of this issue has meant that some users are unable to access OWA [Outlook web access] due to the volume of emails being circulated. The distribution list has been removed and associated emails are being traced and cleared. In the meantime, users will experience slow performance with OWA and email delivery delays from internal and external sources to nhs.net addresses.”

Spare a thought for the NHSmail helpdesk, to which complaints have trebled since the email system was introduced in May.

NHSmail, a secure email service, is approved by the Department of Health for sharing patient identifiable/sensitive information.

"186m needless emails": NHS-wide test message and replies-to-all crash system

New prenatal test for Down"s syndrome "will not lead to more terminations"

A safer prenatal test for Down’s syndrome due to be introduced on the NHS is not predicted to lead to more pregnancies being terminated, according to one of Britain’s most eminent statisticians.

Sir David Spiegelhalter, professor for the public understanding of risk at the University of Cambridge, said that the best evidence available suggests that the blood test, which will be made available in 2018, would lead to an increase of around 20 in the number of positive diagnoses made each year through screening.

He added the test would result in far fewer women opting for invasive testing, reducing miscarriage numbers.

Spiegelhalter cautioned that this evidence sometimes appeared to have fallen out of view in debates in which some campaigners have warned that a generation with Down’s syndrome could be “screened out”.

“People feel very strongly about it, of course they do. It’s all the more reason to stand back and look at the figures,” he said. “There’s a mismatch at the moment between the official basis on which this is being rolled out and the discussion around it.”

According to the Department of Health’s own projections, Spiegelhalter said, more than 40 miscarriages would be avoided every year because far fewer women would be given amniocentesis, an invasive test in which a tiny amount of fluid is removed from the womb. He added, however, that it was impossible to predict exactly how families would respond to the new screening regime.

“There’s been a lot of concerns expressed about the increased number of terminations,” said Spiegelhalter. “In the assumptions under the current model that’s not the case. The estimate is that there wouldn’t be a change.”

The new test, which works by detecting tiny quantities of foetal DNA circulating in the mother’s blood, will be offered to about 10,000 women a year who are considered to have a higher chance of giving birth to a baby with Down’s syndrome, or two rarer genetic conditions: Edwards’ and Patau’s syndromes.

The test is offered after the standard screening that all pregnant women receive at 12 weeks, which involves an ultrasound and a blood test.

According to recent Department of Health figures, 7,900 women agreed to an invasive test and 46 miscarried. More than 3,000 chose not to have the test for fear of losing their baby or because they would wish to continue with their pregnancy regardless of the result. The figures showed 1,031 Down’s cases detected in a year.

The blood test, which predicts Down’s syndrome with more than 90% accuracy, means most high-risk women will be able to avoid amniocentesis. The government predicts that around 10,000 women would opt to have the non-invasive prenatal test (NIPT). Of these, the Department of Health predicts that most would be screened out and fewer than 1,500 would proceed to the invasive test, where 1,055 Down’s cases would be positively identified.

The motivation for introducing the new blood test is safety, but controversy has been building based on concerns that far more parents would be inclined to find out if their baby was affected by a genetic disorder, potentially leading to more pregnancies being terminated.

In a BBC documentary last month, A World Without Down’s Syndrome?, actor Sally Phillips, whose son Olly has Down’s syndrome, raised concerns about the new test and highlighted the joy that her son had brought to her family.

Spiegelhalter said he “in no way seeks to criticise the campaign groups”, but wants to give people access to the best evidence available. His analysis is due to be published on the website of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, which launched last week and will aim to provide unbiased statistics on public health and policy issues.

Philip Dunne, the health minister, said: “We want women to be able to access the safest screening tests available, so based on the clinical evidence, we have approved the use of a new non-invasive prenatal test for Down’s, Edwards’ and Patau’s syndromes. By offering non-invasive prenatal testing, fewer pregnant women will go on to be offered diagnostic testing which carries a risk of miscarriage.”

Lynn Murray, spokesperson for the campaign group Don’t Screen Us Out, said that the concerns of those opposed to the policy went beyond the projected screening statistics. “We are very disappointed that the Department of Health have approved the NIPT roll-out without consultation with the very group that this is going to have the biggest impact on, people with Down’s syndrome and their families,” she said. “The government has admitted itself that it has made no assessment of the impact this will have on the community of people with Down’s syndrome.”

New prenatal test for Down"s syndrome "will not lead to more terminations"

Test cholesterol of one-year-olds to prevent early heart attacks, study suggests

Screening one-year-olds for high cholesterol during routine vaccination visits could prevent hundreds of heart attacks in young adults each year, researchers in England said on Wednesday.

Their study in the New England Journal of Medicine aimed to uncover a silent killer in young adults known as familial hypercholesterolemia (FH), a genetic disorder that often leads to early heart disease.

FH runs in families, and if left untreated can raise the risk of heart disease at a young age as much as 100 times, the report stated.

In the largest screening study to date, more than 10,000 children around a year old were tested for high cholesterol and genetic mutations known to be associated with FH at 92 facilities across England.

Forty children tested positive for FH, at a rate of about one in 270 children.

Their parents were then contacted for screening, revealing an additional FH-positive parent, the report said.

“Overall, one person at high risk of early heart attack was identified for every 125 people tested,” it said.

Such screening throughout Britain could prevent about 600 heart attacks in people under 40, according to the researchers from Queen Mary University of London’s Wolfson institute of preventive medicine.

“This is the first demonstration that child-parent screening works on a large scale,” lead researcher David Wald said.

“It’s the only screening method that stands a reasonable chance of covering the whole population and identifying those at highest risk of an early heart attack.”

Once high-risk children are identified, they can take steps to lower cholesterol, including exercise, avoiding smoking, maintaining a heathy diet, and – when older – taking statin medication.

“Now that we’ve demonstrated this as being effective across England, the next step is for public health agencies to consider offering this routinely at the time of childhood vaccination to test all children aged one to two years,” Wald said.

“No extra clinic visits are needed and uptake is high because parents are already focused on the future health of their children and the family as a whole.”

Test cholesterol of one-year-olds to prevent early heart attacks, study suggests

Do I really need "the test"? Too many tests could do patients more harm than good | Ranjana Srivastava

“How are you doing? It’s nice to see you again.”

“OK,” she replies, unusually tersely.

“How was your daughter’s wedding? I thought of you when the sun came out.”

“Yeah, it was good.”

And then, she burst into tears.

“Is everything OK?”

“Look love, I don’t mean to be rude but can you just tell me what my test showed? I haven’t slept all week and am nauseous with worry. I can’t take this anymore.”

“You had a test? But I didn’t order one. Your breast cancer has been stable for some years.”

“My GP did, and said you’d have the results. You mean you don’t know?”

Conventional medical training teaches doctors to start with perfunctory questions and build rapport before delivering significant news. After all, patients, especially in the public health system, don’t always see the same doctor and it’s important to cover or recap important details.

I used to greet patients at the door, ensure they were comfortably seated with phone turned off, hearing aid tuned in and notebook ready. I’d exchange a few pleasantries to humanise the interaction. But frankly, I am surprised it has taken me so long to appreciate that no oncology consultation goes far without first relaying the news of “the test”. “The test” is an umbrella term encompassing all manner of bloods and x-rays – haemoglobin, biochemistry, liver function, tumour markers, CT scans, PET scans and the rest. From the moment of their cancer diagnosis, patients are wedded to “the test”.

It’s different for brand new patients who are resigned to repeating their story multiple times to multiple doctors but when long-term patients return for their regular check-up they have one thing on their mind. So I have learnt to get to the point fast.

If the news is good, I tell the patient as soon as we’re out of earshot: “Your tests were fine, come and sit down.” Grips loosen, shoulders relax and some days you can feel the hiss of dissipating tension. When the news is bad, I escort the patient to a chair, make eye contact, and say, “I’m afraid the scans found a problem – we’ll have plenty of time to discuss this.”

Everyone does it differently but over time, I have decided this is kinder than, “How are you? Let’s go over any symptoms before we get to your results.”

Every patient has a story about spending sleepless nights and nail-biting days, fearing the worst but praying for a reprieve. When someone cries with relief at a scan that I’d always expected to be normal, I can’t help reflecting on how automatically scribbled test slips have the power to govern people’s lives.

“Your bone scan was normal again. There was no sign of cancer in your spine, only arthritis,” I recently reassured an elderly man with prostate cancer. He suffered from chronic back pain but the moment he mentioned it to a new provider, he scored himself another test. This time, a chiropractor had encouraged him to ask his GP for a scan.

Tests crowded his life – he rued that there wasn’t an event in recent times that hadn’t been disrupted by an appointment or a test, from his nephew’s wedding to his sister’s funeral. Knowing that I’d played a part in his misery, I suggested, giving him a break from tests. “They don’t really help nearly as much as talking to you and seeing how you are doing,” I said. But his wife was quick to squash his glee, “Oh no, I’d go mad not knowing! You must do a blood test at least.”

As cancer patients are living longer, they are seeing their oncologists more and many visits are accompanied by some sort of test. In the case of breast cancer, but also others such as prostate and colon cancer, blood tumour markers are used to track tumour activity, with changing markers often triggering costly scans. Patients regard painful and inconvenient tests as the cross to bear if they are to stay alive. After all, without tests how will their oncologist know what’s going on inside their body? For oncologists, writing test slips is as routine as breathing.

But the evidence suggests that cancer patients who are not receiving chemotherapy and are not enrolled in clinical trials do not need frequent testing. Depending on the disease, professional guidelines have long recommended against so-called “routine” testing in cancer surveillance but patients continue to receive them. Not all tests are ordered by oncologists – in a fragmented environment, patients see multiple providers. They order a test hoping it will reveal something that a good history won’t but this is seldom the case.

Tumour marker measurements in a range of advanced cancers altered management in a mere 2% of patients.

Pathology and radiology tests have grown by around 10% each year. The Grattan Institute estimates the overall cost of wasteful healthcare spending to be as much as a billion dollars.

It might seem intuitive that early detection of disease progression through tests might be helpful in instituting or switching therapies, avoiding unnecessary toxicity and guiding therapeutic choices but there is no evidence that a particular test done at a particular interval alone determines a change in course.

On the other hand, there is evidence that more tests cause more anxiety. Up to 65% of patients with advanced cancer are said to suffer some form of psychological distress. Undergoing frequent tests, not clearly understanding why and waiting weeks, even months, for results traps them in an unenviable situation. Patients who are preoccupied by test results have been shown to have a worse quality of life.

A recent study of more than 2,000 American women with metastatic breast cancer published in the Journal of Clinical Oncology found that more than a third of their providers were “extreme users” of blood tests and scans. (Here, extreme use was defined as more than 12 tumour marker tests and more than four scans per year.) Patients who were cared for by these providers had a 60% higher cost of care, more hospital-based care and later use of palliative care. A previous study found that tumour marker measurements in a range of advanced cancers altered management in a mere 2% of patients.

The overuse of pathology and radiology tests is by no means a problem specific to oncology but cancer patients are among the most heavily investigated, with the direct cost of cancer care in Australia reaching over $ 4.5bn.

Entrenched physician practice is hard to change through guidelines alone. In one study, over 90% of oncologists reported that repeat tests were ordered by someone simply copying the previous order. Without being constrained by rigid rules, doctors must be accountable for the tests they order. Making doctors aware, individually where possible, of the cost of tests, has been shown to influence practice, at least in the short-term. Awareness of the myriad costs of over-investigation must begin early in a doctor’s career. Good clinical practice means asking with every test ordered, “How will the results change my management?”

Patient expectations play a role in the prescribing habits of doctors. Comparisons in cancer are rife. “My neighbour with the same cancer gets a test every time, why don’t I?” is a common question posed to oncologists. The answer is not to order the test, rather to educate the patient. Patient surveys show a willingness to understand and avoid the harmful effects of indiscriminate testing. A key motivation for enduring tests is a feeling of security but patients need to understand that a good doctor-patient relationship, where concerns are promptly heeded, is no match for a battery of tests.

When I tell patients I’d rather not order tests that don’t provide meaningful results in their clinical context, they often ask what else they can do to look after themselves, as if submitting to tests were a proxy for self-care. I tell them that there is growing evidence that they should maintain a healthy weight, eat everything but in moderation, get some form of regular exercise, stop smoking and nurture good relationships.

Frequent testing improves neither quality nor quantity of life but these other recommendations nod to the foremost tenet of medicine, first do no harm.

Do I really need "the test"? Too many tests could do patients more harm than good | Ranjana Srivastava

Theresa May"s first test was obesity strategy and she has failed, health experts say

Leading health experts have accused Theresa May of failing the first test of her premiership over the government’s response to the obesity crisis.

The delayed obesity strategy had already attracted strong criticism over its failure to restrict junk-food marketing and advertising and its reliance on voluntary action by the food and drink industry.

And now one campaigner has labelled it a “national scandal” that augurs ill for the future given that, on entering No 10, May pledged to reduce inequalities and that obesity disproportionately affects those in socially deprived areas.

Related: May’s obesity ‘plan’ betrays children who face a rising tide of preventable cancer | Harpal Kumar

Prof Graham MacGregor, an NHS cardiovascular expert and chair of Action on Sugar, said he had seen a previous version of the plan under David Cameron and while it was still not satisfactory, Thursday’s final version was even worse.

“She [May] came in saying ‘We are going to look after the poor and the socially deprived’ and immediately shown she’s absolutely not interested. This is a huge crisis facing the UK: we are the most obese nation in Europe; it’s going to bankrupt the NHS. Farcically, she’s gone backwards even on Cameron. It’s a national scandal.

“It’s been watered down in the last three weeks. To release it [while May is] on holiday when neither Jeremy Hunt nor her are there, it augurs very badly for her as prime minister. If she continues like that it’s [going to be] a disaster.”

The strategy was delayed for more than a year amid much speculation about its contents and grave warnings by campaigners about the consequences if it did not take a tough line on practices they say are fuelling obesity.

They include: supermarket price-cutting promotions on junk food; promotion of unhealthy food to children in restaurants, cafes and takeaways; and advertising of unhealthy food through family TV programmes, social media and websites.

Cancer Research UK’s chief executive, Sir Harpal Kumar, who headed up NHS England’s cancer taskforce, which reported last year, said the government had given in to industry lobbying despite May’s talk on entering office of not being in thrall to “the privileged few”.

Writing in the Guardian, he said: “The new prime minister entered Downing Street with a pledge to tackle health inequality and to champion the needs of the individual in preference to the ‘mighty’.

“Obesity has a disproportionate impact on the poorest in our society … The new government faced its first test of this pledge with a chance to address inequality and to protect the next generation from diseases like cancer. This plan fails that test.

“There can be little doubt that preventing cancer has fallen victim to economic scaremongering and industry lobbying, despite the fact that obesity costs UK society almost £1bn every week.”

Drinks cans labelled with their sugar content. Photograph: Frank Augstein/AP

While welcoming the reaffirmed commitment to the sugary drinks tax and the funding for school breakfast clubs and sport that it will facilitate, Kumar said there was an inexcusable failure to address the impact of marketing and in-store promotions.

“Some will say parents should be responsible for what their children eat,” he wrote. “Parents clearly have a key role, but as a father I know the pitfalls of pester power and how hard it can be for families to shun the tempting junk and ensure healthy food is always on the table.”

Kumar said restrictions on junk food adverts before the 9pm watershed could more than halve children’s exposure to them.

A Department of Health spokesman said: “Our obesity plan is world-leading, with more far-reaching and comprehensive measures than anything pursued by any other western government. Nevertheless, we will measure progress carefully and do not rule out further action if results are not seen.”

Theresa May"s first test was obesity strategy and she has failed, health experts say

A Easy Vision Test For Alzheimer"s? Scientists Unveil Eye Scans

A straightforward eye test could soon reveal regardless of whether you have Alzheimer’s Disease – or even if the condition looms in your future. In reality, according to trial final results launched this week, the vision test detected indications of Alzheimer’s 15 to twenty many years just before the look of clinical indicators.

This potentially game-modifying information comes out of the Alzheimer’s Association International Conference, presently ongoing in Copenhagen, Denmark, where two presentations highlighted the likely of new vision screening technologies that use retinal imaging to measure amyloid plaque formation in the back of the eye.

The technological innovation is primarily based on an astoundingly basic notion: The brain-clogging amyloid plaques regarded as an indicator of Alzheimer’s can also be noticed in the back of the eye, which is considered a mirror for brain well being. ”If this test operates, then a single day screening for Alzheimer’s condition could be as straightforward as acquiring your eyes checked,” said Yogi Kanagasingam, a single of the researchers conducting clinical trials.

English: PET scan of a human brain with Alzheimer’s illness (Photograph credit score: Wikipedia)

The 1st check, from Neurovision Imaging of Sacramento, California, utilizes retinal picture fluorescence photography to scan the supranucleus region of the retina for a fluorescent signature characteristic of beta amyloid plaques. In planning for the scan, participants consider curcumin, the ingredient in turmeric that provides the spice its fluorescent yellow shade, to “light up” the amyloid plaques with a specific fluorescent signature.

Preliminary data launched on 40 trial topics showed that amounts of amyloid in the retina correlated closely with amyloid levels in the brain as revealed by PET (positron emission tomography) scans, the current test strategy of selection. The retinal imaging was also in a position to inform topics with Alzheimer’s from those with out the illness with one hundred % sensitivity and 80.six % specificity. Neurovision is functioning with Australia’s Edith Cowan University McCusker Alzheimer’s Research Basis to check their retinal imaging scan.

NeuroVision isn’t alone in the retinal imaging discipline  a second information presentation, this time from Massachusetts-based Cognoptix, also showed promising final results from another pioneering technology. Cognoptix’s SAPPHIRE II technologies utilizes a fluorescent ligand eye scanning (FLES) method in which a topical ointment applied to the lens of the eye binds to beta-amyloid. The plaques are then detected with a laser scanner.

The Cognoptix clinical trial data, published in February in the Journal of Alzheimer’s Condition and Other Dementias, involved forty participants and predicted Alzheimer’s with 85 percent sensitivity. It differentiated participants with Alzheimer’s from people with out the illness with 95% accuracy.

A retinal imaging check for Alzheimer’s, if it proved accurate, could dramatically modify the way Alzheimer’s is diagnosed. “Presently the exams that are used in clinical trials are PET scan of the brain and CSF by way of lumbar puncture to measure amounts of amyloid and tau,” says CEO NeuroVision CEO Steven Verdooner. ”Our retinal imaging check is anticipated to be meaningfully less pricey than a PET scan, is noninvasive, and possibly much more sensitive.”

What’s far more, due to the fact a retinal imaging test is reasonably straightforward to get and without major longterm overall health effects, it could be re-administered often to keep track of the progress of the illness.  “We feel the potential to measure progression is really effective and are engaging in partnerships for therapeutic trials to demonstrate that out,” says Verdooner.

Proper now, simply because PET scans are radioactive, medical doctors don’t like to repeat them multiple instances and typically wait at least 18 months ahead of administering a 2nd PET scan. In accordance to Verdooner, Neurovision’s test can be repeated after an interval as brief as three months.

Whilst a vision test for Alzheimer’s is not going to be commercially accessible anytime soon, the wait isn’t going to be as prolonged as you may believe, either. The present trial winds up in the fall, at which stage Neurovision will get started doing work with academic institutions to carry on validating the retinal imaging procedure.

Commercialization is expected to be in the 2nd half of 2015, Verdooner says. “Once commercialized, we assume it to be accessible in doctors’ offices and can be administered by request from the patient or a referring medical professional.”

The retinal imaging check will be administered as element of a bundle, along with blood-primarily based biomarkers and cognitive screening, Verdooner says. “The paradigm we’re aiming at is a battery of tests that is price-effective, rapidly, and non-invasive.”

For a lot more wellness information, follow me here on Forbes.com, on Twitter and Instagram  @MelanieHaiken, and subscribe to my posts on Facebook.

A Easy Vision Test For Alzheimer"s? Scientists Unveil Eye Scans

Would you consider a test to predict the probability of Alzheimer"s?

Specialists at Kings University London have produced a blood check that can show which individuals with presently fading recollections will go on to produce Alzheimer’s disease. It can predict the onset of the illness inside the subsequent year with 87% accuracy. Regardless of this breakthrough, there are even now no successful prolonged-phrase therapies and no remedy for the disease. Would you get the test regardless of there getting no optimistic outcome if you do have the ailment?

Would you consider a test to predict the probability of Alzheimer"s?

Blood test could give early warning of breast cancer

In potential a easy blood check may indicate regardless of whether a woman is at larger threat of building breast cancer and help her choose if she would like tailored breast mammograms like the one over or other options. Photograph: Rui Vieira/PA

A simple blood test could offer numerous women an early warning of breast cancer even if they do not inherit genes linked to the disease. Scientists have identified a molecular “switch” in blood samples that increases a woman’s odds of possessing breast cancer.

The marker is connected with the BRCA1 breast cancer gene, but was also found in girls without the mutation who developed the illness.

About ten% of breast cancers are triggered by BRCA1 and BRCA2 gene variants inherited from dad and mom, leaving 90% of circumstances unexplained.

A lady with the BRCA1 gene has an 85% threat of creating breast cancer, top some carriers to get the drastic step of breast removal.

But until finally now there has been no reliable way of predicting the probability of non-inherited breast cancer.

The “switch” discovered by scientists is portion of the procedure by which particular molecules acting on DNA cause genes to be turned on or off.

Lead researcher Professor Martin Widschwendter, from University School London, explained: “We identified an epigenetic signature in females with a mutated BRCA1 gene that was linked to elevated cancer chance and reduced survival charges.

“Surprisingly, we found the exact same signature in big cohorts of ladies with out the BRCA1 mutation and it was able to predict breast cancer threat numerous years before diagnosis.

“The data is encouraging since it demonstrates the potential of a blood-based epigenetic check to recognize breast cancer chance in women with out known predisposing genetic mutations.”

Dr Matthew Lam, senior investigation officer at the charity Breakthrough Breast Cancer, described the findings as “undoubtedly promising”.

He extra: “This could suggest that in the potential a woman might be capable to have a simple blood test to appear for this DNA signature, and therefore know if she is at a increased risk of developing breast cancer.

“If she does have this signature, she could then perform with her medical professional to investigate the choices accessible to support her take handle of her very own danger.

“These could incorporate life style changes, tailored breast screening, threat-decreasing drugs or surgery.”

What proportion of ladies at increased risk of breast cancer have the epigenetic marker is unknown, but the reality that it is not confined to those carrying BRCA 1 is significant.

“DNA signatures this kind of as this have the possible to add an added layer of accuracy in the way we are able to assess a woman’s person risk of breast cancer and we are eager to find out much more in this location,” Dr Lam mentioned.

The scientists analysed blood sample DNA from 119 postmenopausal girls who went on to create breast cancer above a period of up to 12 years, and 122 who remained cancer-cost-free. Their benefits appear in the on the web journal Genome Medicine.

Blood test could give early warning of breast cancer

ACO Initiatives Test Pharma"s Standard Income Model

The US healthcare system’s shift from volume- to worth-based mostly reimbursement for treatment  in purchase to reduced charges and increase patient care is disrupting healthcare company versions.  The higher-profile government–led accountable care organizations (ACOs), which put economic strain on payers and providers to share obligation for meeting quality and expense goals, is no exception.

About ten% of the US population, or 34 million people, will be enrolled in either government-funded or commercial ACOs by 2015, according to consultants, up from twelve million in 2013. While the numbers are little some estimate that, for a range of causes, ACOs’ influence is considerably greater, with up to 170 million covered lives in the US impacted either indirectly or directly.

The Centers for Medicare and Medicaid Providers (CMS) established the ACO initiative, which primarily aim to improve coordination and management of sufferers whilst reducing the cost of care. Important to their effectiveness are monetary rewards for meeting or exceeding pre-determined good quality and expense metrics—or, in some versions, penalties for falling brief. The degree to which companies have a stake in the game and the varieties of targets they should meet vary depending on the model they stick to and regardless of whether the organization is aligned with the CMS or a private insurer.

No matter whether ACOs survive in their current type and broaden coverage to a vast bulk of the population is uncertain, but, regardless, they are shifting the way the US looks at well being care. CMS announced very first-12 months outcomes of the system, started out in 2012, earlier this 12 months.  The effect wasn’t major—the company estimated that the first crop of ACOs attained a total financial savings of about $ 275 million out of a $ 1 trillion budget–but several experts feel the model is on the proper path.

A lot of the focus has been on implications for suppliers and patients, but these pilots impact suppliers as nicely. Not as well several forums to date have focused on how ACOs can work with daily life sciences companies. That is partly simply because ACOs have been preoccupied obtaining off the ground. Managing pharmacy charges hasn’t been a best priority. And since the area is evolving so quickly and in such a fragmented trend, efforts to search at it systematically are complicated. Regulatory and other barriers avert ACOs and existence sciences businesses from working collectively and individuals are not easing. For more on this see The RPM Report May possibly 2014.

That said, industry’s engagement with these new entities will test traditional commercial designs and in the end could have broader results and accessibility to medication. Outcomes released earlier this yr of a Wellness Techniques Group review involving 110 ACOs supply some insights into their approach to pharmacy. The survey included on the web queries of leading executives, followed by thirty “deep-dive” interviews in order to greater recognize life sciences companies’ opportunities for partnering with ACOS and the probably pain factors concerned in carrying out so. Respondents had been senior executives at ACOs. Offered ACOs’ expanding influence, it is really worth a seem.

Between the survey’s findings, as presented at a latest ExL Pharma conference on the subject:

ACO are organized in several techniques based in portion on no matter whether they are operated by doctor groups, wellness plans or well being methods. Determination-producing authority varies as nicely, with overall health program-run ACOs viewing themselves as currently being the dominant arbiter inside their organizations  in determining chance arrangement and services, but they recognized physician groups have an essential role and health ideas much less so (forty%). Overall health prepare-led ACOs indicated a lot more sharing of selection producing authority between themselves, wellness techniques and doctor groups. These distinctions are crucial for pharma and other suppliers to recognize as they figure out who to talk to inside ACOs, said speaker Robert Shewbrooks, a principal at HSG and leader of its syndicated analysis practice.

For suppliers, the nuances are critical, as businesses tailor information about their medicines to certain varieties of consumers. Government-aligned ACOs technically do not consist of the pharmacy advantage (generally covering self-administered oral and injectable medicines) in their risk arrangements, though numerous executives surveyed consider it to be element of the combine indirectly since it affects the complete value of care. That means that ACOs conforming to CMS Medicare specifications are not on the hook financially for pharmacy benefits–at least however. CMS has submitted a request for public feedback to assess how and when drug utilization ought to be integrated in chance calculations, Shewbrooks mentioned, despite the fact that he additional that the timing isn’t clear. ACOs aligned with business payers and Medicaid are much a lot more aggressive about such as pharmacy advantages directly in their threat calculations.

Regardless of how they allocate economic chance, most ACOs do not have their own formulary teams or potential to drive formulary choices inside a greater health care system.  Much more particularly, only about 5% of ACOs are building their own formularies.  Many ACOs, nevertheless, are taking roles indirectly in formulary choice creating, for instance by participating on the formulary committees of payers with which they have relationships.

Only 27% say cost is the main explanation for their curiosity in managing pharmacy, but the very good news for pharma is that cost is not the only explanation. Some 23% are most interested in bettering good quality and outcomes and 15% in patient compliance and these other variables are more critical than expense reduction for the total good results of the ACO, Shewbrooks mentioned. Therapeutic locations on best of ACOs’ lists for value management are, in purchase:  Psoriasis (44% of respondents), very likely due to the influx of costly biologics into what had been a reasonably affordable category, followed by gastrointestinal conditions (39%) and rheumatoid arthritis (38%)

ACOs are focusing on quality since their monetary rewards depend on their ability to meet specific metrics. The best condition management priorities for ACOs, as determined by CMS and other good quality metrics established by nicely-regarded specialist organizations: diabetes, eye and heart disease. Diabetes and heart disease are predictable alternatives – diabetes is the emphasis of 6 CMS ACO measures and is emphasized in other extensively utilised good quality assessments. Eye care metrics are not component of the 33 Medicare ACO top quality measures, but they are a significant concern, the survey identified, partly driven by their inclusion in other quality measures that ACOs usually stick to. This is an opportunity for sector, Shewbrooks pointed out.

As for ache factors: The greatest challenge for executives is obtaining continuity of care across distinct entities within an ACO, followed by getting companies on board with goals, and logistics, this kind of as bettering infrastructure, notably clinical integration and bettering infrastructure, notably overall health IT platforms. Only 8% of respondents cited patient engagement as their biggest hurdle, although it should be best priority, argued Shewbrooks, noting that individuals who are not engaged are challenging to control.

Effective implementation of teams that make certain good quality across the care continuum will be more and more essential to ACOS. Survey respondents cite some improvements in care coordination, although not numerous have witnessed income rise. Only 47% decreased their charges per patient and 22% said no changes resulting to date.  That could be since the organizations are even now young and in the development and implementation phases of their applications, even though results are more likely to be available by Yr Three, stated Shewbrooks.

For pharma and other suppliers to these organizations, addressing ACO demands is fraught with uncertainty as these organizations proceed to evolve swiftly and in unpredictable ways. For now, organizations are working on outcomes data and developing worth propositions for their manufacturers that they hope payers and ACOs will accept. They are keen for partnerships, although they are not nevertheless clear on how people would be structured. At some point, they will have to think about different industrial versions, despite the fact that in the brief-term they are largely leveraging present assets, with innovations contained to pilot phases.

ACO Initiatives Test Pharma"s Standard Income Model