Progress on stroke prevention

@HealthMed 
Stroke is an increasingly common cause of death and disability worldwide. See the summary below and comments related to our new research report just published online in the major American Heart Association journal Stroke, based on results from the Warwick Carotid Artery Disease Registry. 

See media interest in the research, both in the 'tests for spotting 'minuscule “breakaway” blood clots which usually go undetected' and in this potential new treatment approach. 

Finding and reducing high risk of stroke

Narrowing of carotid arteries in the neck is a very important cause of stroke. A major reason for the increase stroke risk is that the roughened carotid artery surface can trigger formation of small clots that can then dislodge into the brain circulation. These microemboli can block brain arteries to lead to weakness, disturbed speach, loss of vision and other serious stroke syndromes.

Doppler trace: red line shows micro-embolus signal.

A team of scientists at the University Hospital Coventry and University of Warwick led by Vascular Surgeon Professor Chris Imray and Professor of Therapeutics Donald Singer have developed a Carotid Research Group to find new ways to predict and prevent high stroke risk in patients with carotid artery disease. Using ultrasound scanning they are able to detect microemboli to find out which patients are at very high risk of stroke.

The major US journal Stroke has now published a report from Imray and Singer's team with two main findings. Despite single or dual anti-platelet treatment with aspirin and clopidogrel before carotid artery surgery, patients can develop high rates of microemboli. And the team looked at different rescue treatments aimed at stopping these microemboli. The anti-platelet drug tirofiban had previously been shown to be helpful in treating patients with acute coronary artery syndromes. In Stroke, Imray and Singer's team report that with rescue tirofiban there was a large decrease in the half-life of micro-emboli (23 vs. 60 minutes) and in time for these microemboli to be resolved (68 vs. 113 minutes), compared to an alternative treatment using infusion of the clot-preventing polysaccharide dextran-40.

Professor Imray said: 'These findings show the importance of ultrasound testing for micro-emboli in carotid disease patients. These biomarkers of high stroke risk cannot be predicted just from assessing the severity of risk factors such as smoking history, cholesterol, and blood pressure.'

Professor Singer  added 'These findings show that the choice of rescue medicine is very important when carotid patients develop microemboli despite previous treatment with powerful anti-platelet drugs such as aspirin and clopidogrel. We now need to go on to further studies of anti-microemboli rescue treatments, to aim for the right balance between protection and risk for our patients.' 

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Meet Senior Policy makers in Health Policy and Technology

@HealthMed @FPGMed
The UK Fellowship of Postgraduate Medicine, in partnership with international publisher Elsevier, has launched a major new international journal - Health Policy and Technology, now coming to the end of its first year of publication

Initial issues have included papers on UK Biobank and on the pioneering new Centre for Health Technology Assessment of Devices and Diagnostics within the UK’s National Institute for Health and Clinical Excellence (NICE), and papers on health policy, and technology from drug discovery to personalised medicine and e-health from the USA, Europe, the Middle East and India. 

There is also a series of interviews in print, online and as podcasts, with international leaders in the field of health policy and technology.

Listen to the first 4 podcasts
Sir Michael Rawlins, Chairman of NICE

Since Sir Michael Rawlins was appointed its founding Chairman in 1999, NICE has released 800 individual pieces of guidance covering not just guidelines and technological appraisals but also public health matters. NICE has also recently started looking at medical devices started to assess diagnostics, and the quality, safety and effectiveness of new interventional procedures.

Gonzalo Calvo, Chairman of EACPT
The European Association of Clinical Pharmacology and Therapeutics represents the National Clinical Pharmacology Societies from the 29 established and accession countries in Europe and their ~4000 clinical pharmacologist members.

Alexander von Gabain, Chairman of EIT
The European Institute of Innovation & Technology is an Agency of the European Union established in 2008 to address Europe's innovation gap. The EIT budget from 2008-2013 is €308.7million.

Andrew Kicman on Drugs in Sport
Dr Andrew Kicman is Head of Research and Development in the Drug Control Centre, Kings College, London, which is a World Anti-Doping Agency accredited laboratory, dedicated to drug control in sport. 

Background to the new journal and to the FPM

Home page for Health Policy and Technology

The Hippocrates Prize for Young Poets

@HealthMed The Hippocrates Initiative has launched the international Hippocrates Prize for Young Poets for an unpublished poem of up to 50 lines in English on a medical theme. 

To date there have been entries from young poets from the UK, USA, Hungary and Australia.

Entrants may be young poets from anywhere in the world aged 14 to 18 years. 

New deadline: midnight GMT 31st March, 2013. 

The Hippocrates Prize for Young Poets will be judged by poet Clare Pollard who published her first collection of poetry at the age of 19.

This new award offers a prize of £500 for the best poem (in English) on a medical subject, no longer than 50 lines, by a schoolchild (anywhere in the world). There will also be ten commendations. 

A medical subject may be anything from experience of illness, birth or death, to hospitals, ambulances and doctors’ surgeries, to the nature and history of medical instruments, processes, drugs, and much more. The field is vast. Poems may be entered individually or in batches by schools, and submission costs £2 per poem or £15 for a group of ten. 

The deadline is midnight GMT 31st March 2013 and the winner will receive his/her prize at an award ceremony at the annual international poetry and medicine symposium at the Wellcome Collection in London on 18 May 2013. 

The first prize is GBP 500 for the winning young poet, with a further 10 awards of commendation for the most highly rated entries.

Judge Clare Pollard said:  “The great thing about poetry is that age doesn't matter. It's hard as a teenager to find the time and stamina to write a perfect novel, but you can write three perfect verses.  If you put down the things you really want to say about our world, in your own voice, you will have written a powerful poem.”

She added 'I'm very pleased to be judging the first Hippocrates Prize for Young Poets - in bringing science and art together, I hope it will deepen students' understanding of both, and uncover poets of the future.'

Awards will be announced on Saturday 18th May, 2013 at the end of the 4th International Symposium on Poetry and Medicine, at the Wellcome Collection Rooms, Euston Road, London. 

Clare Pollard has published four collections of poetry, the most recent of which, Changeling (Bloodaxe, 2011) is a Poetry Book Society Recommendation. She published her first collection, The Heavy-Petting Zoo, with Bloodaxe in 1998 aged 19. Her play The Weather premiered at the Royal Court Theatre and her documentary for radio, ‘My Male Muse’, was a Radio 4 Pick of the year.  She co-edited the anthology Voice Recognition: 21 Poets for the 21^st Century and her new version of Ovid’s Heroines will be published by Bloodaxe in 2013.

The inaugural Hippocrates Prize for Young Poets is supported by the UK medical charity the Fellowship of Postgraduate Medicine and the UK National Association of Writers in Education.

NAWE said it is delighted that it is becoming a partner in the Hippocrates initiative and will be sponsoring the first Hippocrates Prize for Young Poets.

Full details and rules, and the name of the young poets competition judge, are posted on the Hippocrates initiative website (www.hippocrates-poetry.org).

'The Hippocrates initiative was established in 2009 and already offers two successful annual poetry prizes, one open to submissions from anyone anywhere in the world, the other restricted to NHS employees (present and past) and UK health students. In each category a first prize of £5,000 is awarded. The Hippocrates Prize has attracted thousands of entries from 44 countries, from the Americas to Fiji, from Finland to Australasia, and prizewinners have come from New Zealand and the US as well as the UK. Judges have included poets Gwyneth Lewis, Marilyn Hacker and Dannie Abse, journalists James Naughtie, Mark Lawson and Martha Kearney, and NHS medical director Professor Sir Bruce Keogh, Professor Steve Field CBE, and Professor Rod Flower representing the medical profession. In 2011 the Hippocrates initiative received a Times Higher Education Award for Excellence and Innovation in the Arts.

Professor Donald Singer and poet Michael Hulse, of Warwick University, said: “We are delighted to welcome NAWE as the sponsor of the £500 Hippocrates Prize for Young Poets, and look forward to reading exciting work by a new generation of poets.”

Further information on the Hippocrates Prize for Young Poets

Enter online for the Hippocrates Prize for Young Poets

Website for the Hippocrates Prize

Listen to interview with John Humphrys on BBC Radio 4 Today about the Hippocrates Prize.

Listen to BBC World Service interview with Clare Bolderson about the Hippocrates Awards.

See Guardian article about the Hippocrates Prize by 2011 judge Mark Lawson.

Listen to Mark Lawson discussing previous Hippocrates awards.

Hear Anne Hudson Jones from Texas and Hugues Marchal from Basel, Switzerland  discussing poetry and medicine.

Listen to Michael Hulse, Femi Oyebode and Donald Singer discussing poetry and medicine

More on senior health policy leaders - Alex von Gabain

The December 2012 issue of Health Policy and Technology features a discussion with Professor Alex von Gabain, founding chairman of The European Institute for Innovation and Technology. The EIT is an agency of the European Union established in 2008 to ‘address Europe's innovation gap’. He obtained his Ph.D. in Genetics at the University of Heidelberg before research posts at Stanford University, USA and the University of Umeå and the Karolinska Institutet in Sweden, and later from 1992-1998 Chair of Microbiology at the University of Vienna.

In 1997, he co-founded Intercell AG and led the company as CEO until 2005. Chairman of the HPT Advisory Board Professor Donald Singer interviewed Professor Alex von Gabain at the Transatlantic Policy Network meeting in Washington in May 2012 where they were both panel discussants.

To hear the podcast and read the full transcript of the interview, see the Winter issue on HPT journal website.

@HealthMed

Dissociation syndromes - scope for misinterpretations

@HealthMed The complex phrases 'dissociation syndrome', 'extinction syndrome' and 'neglect syndrome' embraces a wide range of categories of altered perception from 'out of body' experience to failure to recognize parts of the body as one's own. Causes may include generalised altered perception in response for example to effects of inflammatory cytokines/toxins/prescribed and recreational drugs. And localised altered perception, typically due to a stroke affecting the pre-motor cortex altering proprioception of the affected contra-lateral part of the body or the visual cortex.

Visual perception may compensate for tactile extinction or neglect however patients with these problems find it more difficult to convalesce, for example in returning to normal physical aspects of daily life from dressing to other complex motor tasks. Physicians need to take care to assess for occult visual or other forms of sensory dissociation (or extinction) syndromes in at risk patients.

Psychotic disorders are a further category, either due to endogenous syndromes or to neuroleptic effects of prescribed or recreational drugs. As a caution for patients and health professionals wishing to know more about the syndromes and their consequences, writers have been attracted to this theme and texts may be misunderstood as literal description, from generalised dissociation, to local abnormal perception e.g. Le bras cassé (The broken arm) by Belgian-born French poet, writer and artist Henri Michaux.

With evolving digital repositories meshed with expert multi-focus editing, it will become possible to provide appropriate 'health warnings' for the patient, health professional or casual reader, explaining the complex nature of the work. However, it would not be surprising to discover works largely of the imagination misfiled in factual medical sections in conventional libraries and bookshops.

It is unclear what inspired Michaux to write on this theme, beyond his personal experience of breaking his arm. Or whether his descriptions and text were influenced by the coincidence of his self-declared experimentation with mescalin and other drugs: through long-term effects on his personal perception of his body or perhaps through use of these drugs during convalescence from his fracture.