Network of general practices aims to improve standards

Greater consistency and providing a choice of services are essential traits of future NHS general practice, says Simon Bradley. Photograph: Rex Features

Most people will have noticed that there is something up with the NHS and that Jeremy Hunt is no white knight, no matter how much he tells us he is. To expect GPs, facing a funding freeze despite burgeoning demand driven by demographic change and heightened consumer expectation, to come riding over the horizon may seem unlikely. However, that is what our new network of high-quality general practices, Quality Practice, is setting out to do.

Quality Practice is a national network of general practices that is designed to enhance standards of patient care and lift medical morale, as well as to strengthen practices by extending their core activities, share back-office services and increase efficiency, so that general practice will be able to deliver more for less, for everyone.

So, why form the Quality Practice network? Simply, because there seems to be no prospect of external investment in general practice. Quality Practice intends to bring new NHS and private income streams into practices. This may sound more like business than the caring profession but investment in primary care has been identified as a prerequisite for an effective healthcare system, and the NHS is not going to achieve the necessary shift of provision of more complex care into the community without it.

Sixty-five years on, Nye Bevan would readily recognise the general practice of today, and in that lies both its success and its weakness: personal, local and responsive on one side, but disparate and poor at working more corporately as a health community on the other. This builds in inefficiency and slows the adoption of new ways of working between practices, and, at least in part, explains the considerable variation in performance.

How can we achieve more consistently high standards? Albert, our social network platform, developed by Interact Intranet is our solution. Albert allows our member practices to work as one large virtual practice, pooling their talent, enhancing their practice and that of every member practice, with every good idea they share.

We also have a growing number of small federations, drawn together by geography, and in inner cities, the formation of "super practices" such as the Vitality partnership, which employs dozens of GPs. These might be seen as competition for the Quality Practice model but also clearly demonstrate that the need for change is not just being felt on the ground, but acted upon.

So how will Quality Practice differ? The Quality Practice model differentiates itself by scale: our ambition is to get to a total of around 500 member practices over the next four years, to both maximise economies in shared services and to provide local outlets for regional and national contracts. Ownership will also differ, with our member practices owning shares in the organisation.

They will have to have an outstanding commitment to continuous quality improvement that is essential for sustaining our relationship with NHS and other commissioners.

Setting up this sort of organisation at this time in the NHS's evolutionary stage means we have to contend with practices barely coping with everyday demands. But, working with our foundation practices in London, Manchester, Bristol and beyond, we are convinced that we have the model right. Funding is tight in practices, and so our financial model has to be solid. This was successfully tested in a public fundraising session through Crowd Cube recently, bringing in two more early investor practices and more than 40 private investors.

Greater consistency between general practices while simultaneously providing an extended choice of services for patients, as varied as chemotherapy and eyelid surgery, are essential traits of future NHS general practice. Achieving this is how Quality Practice will re-set general practice as the cornerstone of the NHS.

Dr Simon Bradley is founder and medical director of Quality Practice

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Dementia-friendly communities can improve care and save money

Central to creating a dementia-friendly Crawley is training. There are short courses for hairdressers, shop assistants and taxi drivers. Photograph: Darrin Jenkins /Alamy

The idea of dementia-friendly communities brilliantly encapsulates what a progressive care system could deliver, both for those who need support and for the taxpayer.

The concept is simple: to improve the quality of life for people with dementia and help them to become active members of the community. Making it happen involves bringing together every part of a community – health services, social care, transport, local businesses, charities and voluntary groups, the police, the fire brigade and local people.

Clinical commissioning groups (CCGs) are at the heart of the dementia-friendly drive, and their approach demonstrates how healthcare can and should extend well beyond the borders of the NHS. For some CCGs, the work around dementia builds on existing relationships formed to tackle different issues; shared efforts to reduce harm from town centre drinking, for example, involves many of the same professionals. The relationship between health and local government is key, as councils can provide much of the infrastructure needed to make a dementia-friendly community successful.

In West Sussex, the Crawley Dementia Alliance brings together GPs, mental health teams, community nurses, hospices, the borough and county councils, fire service, police, the Alzheimer's Society, Age UK and other local voluntary groups. The first step in making Crawley a dementia-friendly town has been to listen to residents living with the condition, and to their carers to understand how they can best be supported. This in itself is therapeutic, demonstrating to people with dementia that they have a voice.

Movingly, Crawley is planning a campaign of planting forget-me-not flowers, involving everyone from shops to places of worship. Intergenerational work is important; people with dementia will be going into schools to tell them how to plant and care for the flowers and explain what it feels like to have dementia.

Central to creating a dementia-friendly Crawley is training. There are short courses for shop assistants, taxi drivers and hairdressers, in-depth support for care workers and a major clinical awareness programme for GPs. Crawley is now setting up a joint research programme on dementia friendly communities with New Brunswick in Canada.

Scores of clinical commissioning groups are developing their own dementia-friendly communities, many with support from government funds following prime minister David Cameron's announcement last year of his Dementia Challenge, aimed at tackling all aspects of the disease.

Much of the power in the idea of dementia-friendly communities is the profound difference that simple changes can make. For example, an unsteady or confused passenger on a bus is typically drunk, so it is hardly surprising that, without training, a bus driver is likely to assume the same of someone with dementia. So thousands of bus drivers are now attending sessions to help them identify someone who might have dementia, to understand what it feels like for them to use public transport, and how small acts such as eye contact and personal warmth can make getting on a bus a less threatening experience.

All these changes take time and investment, but in the long term they will save the NHS and social care system a great deal of money, while improving the quality of life for many of the people living with the disease.

The most inspiring aspect of dementia-friendly communities is that it involves changing our attitudes and behaviour towards a condition that is frightening and difficult to comprehend. It encourages tolerance and thoughtfulness, as we try to see the world through someone else's eyes.

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Omega-3 rich oils improve membrane fluidity in retina cells and can help fight age-related eye diseases

Main Category: Eye Health / Blindness
Also Included In: Nutrition / Diet;  Seniors / Aging
Article Date: 19 Aug 2013 - 1:00 PDT Current ratings for:
Omega-3 rich oils improve membrane fluidity in retina cells and can help fight age-related eye diseases

Scientists working at the Research Center on Aging at the Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke (CSSS-IUGS) have been studying strategies for protecting retinal pigment epithelium (RPE) cells. Dysfunction of the RPE is found in retinopathy and age-related macular degeneration, which is the leading cause of blindness of elderly people in developed countries.

Findings published in the Canadian Journal of Physiology and Pharmacology suggest that incubating retinal cells with vegetable oils induces biochemical and biophysical changes in the cell membrane, which may have a beneficial effect in preventing or slowing the development of retinopathy.

"Membrane fluidity, which refers to the viscosity of the lipid bi-layer of a cell membrane, is a marker of the cell function," explained Prof. A. Khalil, professor at the Université de Sherbrooke and principal investigator of the study. "A decrease of membrane fluidity can affect the rotation and diffusion of proteins and other bio-molecules within the membrane, thereby affecting the functions of these molecules. Whereas, an increase in membrane fluidity makes for a more flexible membrane and facilitates the transmission of light through the eye."

The researchers discovered that vegetable oil fatty acids incorporate in retina cells and increase the plasma membrane fluidity. They concluded that a diet low in trans-unsaturated fats and rich in omega-3 fatty acids and olive oil may reduce the risk of retinopathy. In addition, the research suggests that replacing the neutral oil used in eye drops with oil that possesses valuable biological properties for the eye could also contribute to the prevention of retina diseases.

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Purdue innovation could improve personalized cancer-care outcomes

Main Category: Cancer / Oncology
Also Included In: Medical Devices / Diagnostics
Article Date: 16 Aug 2013 - 2:00 PDT Current ratings for:
Purdue innovation could improve personalized cancer-care outcomes

An innovation created by Purdue University researchers could improve therapy selection for personalized cancer care by helping specialists better identify the most effective drug treatment combinations for patients.

David D. Nolte, a professor in Purdue's Department of Physics, and his collaborators Ran An, a graduate student in physics, and John J. Turek in the Department of Basic Medical Sciences have created a technique called BioDynamic Imaging that measures the activity inside cancer biopsies, or samples of cells. It allows technicians to assess the efficacy of drug combinations, called regimens, on personal cancers.

"Technicians can use BioDynamic Imaging to measure tumor response to cancer therapy, such as metabolism and cell division. This can tell how well the drug is working and if there are side effects," Nolte said. "Our approach is called phenotypic testing, which is more pertinent than genetic testing because it captures the holistic response of cancer to chemotherapy."

BioDynamic Imaging tailors therapies to fit each cancer patient.

"No two cancers are alike," Nolte said. "Therefore, every patient needs his or her own selected therapy to get the best results."

Nolte said BioDynamic Imaging has other applications, including drug discovery and improving success rates for in vitro fertilization.

"BioDynamic Imaging is a new type of imaging that has broad uses and many applications," he said. "In IVF clinics, it can select the most viable embryos for implantation, improving pregnancy rates and decreasing the risk of having twins or triplets. It also can be used on a large scale to help search for new types of drugs."

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Animated Dynamics LLC, based in the Purdue Research Park, is commercializing the BioDynamic Imaging technology. The company will manufacture the first commercial units for laboratories and clinics for testing and appraisal. The company won first place and $30,000 in the 2013 Burton D. Morgan Business Plan Competition.

Purdue University

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Revealing the gene network for producing the toxin in green potatoes may help improve crops

Main Category: Water - Air Quality / Agriculture
Article Date: 04 Aug 2013 - 0:00 PDT Current ratings for:
Revealing the gene network for producing the toxin in green potatoes may help improve crops

In 1924, Science magazine reported on a fatal case of potato poisoning: James B. Matheney of Vandalia, Illinois, had gathered about one and a half bushels of tubers, which had turned green due to sunlight exposure. Two days after eating the potatoes, most of his family - wife, two daughters and four sons - showed symptoms of poisoning; the only exceptions were James himself, who didn't eat the potatoes, and a breast-fed baby boy. His wife, aged 45, died a week later, followed by their 16-year-old daughter. The other five members of the family recovered.

Although such fatalities are rare among human beings, farm animals often get sick or die after eating green potatoes. Symptoms include damage to the digestive system as well as loss of sensation, hallucinations and other neurological disturbances. Death can be caused by a disruption of the heart beat. The culprits are the toxic substances solanine and chaconine; their concentration rises sharply with exposure to light or during sprouting, and they protect the tubers from insects and disease.

Solanine and chaconine belong to the large family of glycoalkaloids, which includes thousands of toxins found in small amounts in other edible plants, including tomatoes and eggplant. These substances have been known for over 200 years, but only recently has Prof. Asaph Aharoni of the Plant Sciences Department begun to unravel how they are produced in plants. He and his team have mapped out the biochemical pathway responsible for manufacturing glycoalkaloids from cholesterol. Their findings will facilitate the breeding of toxin-free crops and the development of new crop varieties from wild strains that contain such large amounts of glycoalkaloids, they are currently considered inedible. On the other hand, causing plants to produce glycoalkaloids if they don't do so naturally or increasing their glycoalkaloid content can help protect them against disease.

Two years ago, in research reported in The Plant Cell, the scientists identified the first gene in the chain of reactions that leads to the production of glycoalkaloids. In a new study published recently in Science, they have now managed to identify nine other genes in the chain by using the original gene as a marker and comparing gene expression patterns in different parts of tomatoes and potatoes. Disrupting the activity of one of these genes, they found, prevented the accumulation of glycoalkaloids in potato tubers and tomatoes. The team then revealed the function of each of the genes and outlined the entire pathway, consisting of ten stages, in which cholesterol molecules turn into glycoalkaloids.

An analysis of the findings produced an intriguing insight: Most of the genes involved are grouped on chromosome 7 of the potato and tomato genome. Such grouping apparently prevents the plants from passing on to their offspring an incomplete glycoalkaloid pathway, which can result in the manufacture of chemicals harmful to the plants.

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The research was conducted by postdoctoral fellow Dr. Maxim Itkin, who worked with Dr. Uwe Heinig, Dr. Oren Tzfadia, Pablo D. Cardenas, Dr. Samuel Bocobza, Dr. Sergey Malitsky and Dr. Ilana Rogachev of Prof. Aharoni’s lab; as well as Dr. Tamar Unger of the Israel Structural Proteomics Center at the Weizmann Institute, and scientists from the National Chemical Laboratory in Pune, India, the Hebrew University of Jerusalem and the Wageningen University, the Netherlands.

Prof. Asaph Aharoni's research is supported by the Clore Center for Biological Physics; the Kahn Family Research Center for Systems Biology of the Human Cell; the Tom and Sondra Rykoff Family Foundation; Roberto and Renata Ruhman, Brazil; the Adelis Foundation; the Leona M. and Harry B. Helmsley Charitable Trust; the Minna James Heineman Stiftung; and the Raymond Burton Plant Genome Research Fund. Prof. Aharoni is the incumbent of the Peter J. Cohn Professorial Chair.

Weizmann Institute of Science

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Improve your health, improve your sex life

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Staying tobacco-free, eating healthy foods and exercising regularly can improve your overall health and your sex life. And be sure to see your doctor regularly, especially if you have any chronic health conditions or take prescription medications.

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Treatments for tuberculosis, cancer will likely improve following breakthrough in detecting DNA mutations

Main Category: Tuberculosis
Also Included In: Cancer / Oncology;  Genetics
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Treatments for tuberculosis, cancer will likely improve following breakthrough in detecting DNA mutations

The slightest variation in a sequence of DNA can have profound effects. Modern genomics has shown that just one mutation can be the difference between successfully treating a disease and having it spread rampantly throughout the body.

Now, researchers have developed a new method that can look at a specific segment of DNA and pinpoint a single mutation, which could help diagnose and treat diseases such as cancer and tuberculosis. These small changes can be the root of a disease or the reason some infectious diseases resist certain antibiotics. The findings were published online in the journal Nature Chemistry.

"We've really improved on previous approaches because our solution doesn't require any complicated reactions or added enzymes, it just uses DNA," said lead author Georg Seelig, a University of Washington assistant professor of electrical engineering and of computer science and engineering. "This means that the method is robust to changes in temperature and other environmental variables, making it well-suited for diagnostic applications in low-resource settings."

DNA is a type of nucleic acid, the biological molecule that gives all living things their unique genetic signatures. In a double strand of DNA, known as a double helix, a series of base pairs bond and encode our genetic information. As genomics research has progressed, it's clear that a change of just one base pair - a sequence mutation, an insertion or a deletion - is enough to trigger major biological consequences. This could explain the onset of disease, or the reason some diseases don't respond to usual antibiotic treatment.

Take, for example, tuberculosis ?" a disease that's known to have drug-resistant strains. Its resistance to antibiotics often is due to a small number of mutations in a specific gene. If a person with tuberculosis isn't responding to treatment, it's likely because there is a mutation, Seelig said.

Now, researchers have the ability to check for that mutation preventatively.

Seelig, along with David Zhang of Rice University and Sherry Chen, a UW doctoral student in electrical engineering, designed probes that can pick out mutations in a single base pair in a target stretch of DNA. The probes allow researchers to look in much more detail for variations in long sequences - up to 200 base pairs ?" while current methods can detect mutations in stretches of up to only 20.

"In terms of specificity, our research suggests that we can do quadratically better, meaning that whatever the best level of specificity, our best will be that number squared," said Zhang, an assistant professor of bioengineering at Rice University.

The testing probes are designed to bind with a sequence of DNA that is suspected of having a mutation. The researchers do this by creating a complimentary sequence of DNA to the double-helix strand in question. Then, they allow molecules containing both sequences to mix in a test tube in salt water, where they naturally will match up to one another if the base pairs are intact. Unlike previous technologies, the probe molecule checks both strands of the target double helix for mutations rather than just one, which explains the increased specificity.

The probe is engineered to emit a fluorescent glow if there's a perfect match between it and the target. If it doesn't illuminate, that means the strands didn't match and there was in fact a mutation in the target strand of DNA.

The researchers have filed a patent on the technology and are working with the UW Center for Commercialization. They hope to integrate it into a paper-based diagnostic test for diseases that could be used in parts of the world with few medical resources.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The research was funded by the National Institutes of Health, the National Science Foundation and the Department of Defense's Advanced Research Projects Agency.

University of Washington

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How telehealth can improve patient care

Telecare should involve interaction as well as technology, says Simon Fradd. Photograph: Murdo Macleod

The NHS is facing a £30bn hole in its budget by 2020 and Clare Gerada, chair of the Council of the Royal College of GPs has said that we are currently short of 8,000 GPs, and by 2021 we shall need an additional 16,000.

It's obvious that the current way of delivering healthcare within the NHS is not sustainable.

There is already wide recognition of this and the development of integrated care pathways is evidence of progress. However, the savings generated are limited and the shift of location of care simply puts an even greater burden on general practice and primary care. Real savings come through removing the need for NHS care.

Britain is not alone in facing this problem. In the US, the Obamacare changes will give an additional 70 million people access to healthcare. The issue there is not financial – they have allocated a budget of $400bn – but the lack of a trained and skilled workforce.

In China the problem is even greater, as more than one billion people move from traditional forms of healthcare to western-style services. So it's no surprise that the annual international self-care day started in China last year on 24 July 2012.

What is interesting is the different focus that is emerging. In Europe the prime target for self-care has been around the management of minor self-limiting conditions, which account for 20% of GP consultations. However, the focus of the international self-care day movement is non-communicable diseases, which account for over 60% of NHS spending. It is this element of expenditure which is ballooning.

The initial focus is on illness prevention: living healthy lifestyles to improve quality and quantity of life. This only defers the need for healthcare, however. All our bodies start to fail at some point. The big issue in terms of self-care is full involvement in the management of one's own illness, especially long term conditions.

I have never understood why clinicians believe themselves to be the experts. Diabetics spend on average 3.5 hours a year with a clinician. For the remaining 8,756 hours they are on their own with minimal support. I have just been involved in an audit of readmissions to a major London teaching hospital within 28 days of discharge. The results were fascinating: a common theme was the lack of a clear ongoing care plan agreed with the patient and communicated before discharge to the GP and the patient's carers. I even came across a chronic bronchitis discharged without rescue medication.

Even where best practice is initiated, it is not always followed. I have been a patient in the past three years and am aware just how disempowering it is. Even as a GP who has been practising for 40 years, I waited to be told what to do rather than acting on my own initiative. What every patient needs is their own healthcare professional who can give reassurance and advice as soon as it's needed.

That scenario is now available, with telecare and telehealth. It astounds me that it is taking so long to become the norm. Placing this technology in a patient's home as part of a complete package of care can revolutionise their wellbeing as well as reduce hospital admissions. It does this at the same time as reducing GPs' workload, by interactively monitoring individuals in their home.

The vital thing here is interaction. As well as the technology, there must be a skilled, trained individual monitoring the data and interacting with the patient. If a chronic obstructive pulmonary disorder sufferer's breathing deteriorates, early advice to use rescue medication can avoid hospital admission. The same can apply to heart failure patients who gain weight as a result of fluid retention.

We are not going to get another 16,000 GPs or an additional £30bn. It's time to support patients in their role as experts in their own health. A prime plank of this should be telehealth.

Dr Simon Fradd is a GP in Southwark

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