NEWS


Cutting ‘unnecessary’ antibiotic prescriptions


A major University study which led to long-term reductions in the number of antibiotic prescriptions byWelsh GPs could see ‘unnecessary’ prescriptions cut by 1.6 million per year, if replicated across the UK. The Stemming the Tide of Antimicrobial


Resistance, or ‘STAR’, programme was designed by and implemented by experts from the University’s School ofMedicine’s Institute of Primary Care and Public Health and South East Wales Trials Unit (SEWTU) to cut the number of unnecessary antibiotic prescriptions for common conditions such as acute cough and sinusitis. Led by Professor Chris Butler, the two-year


trial involved 68 practices acrossWales covering some 480,000 patients offered GPs access to antibiotic prescribing and resistance data derived from their own practices and advanced ‘consulting skills’ tools. The learning tools, the result of over 15 years of work in infections and communication sciences by members of the Institute of Primary Care and Public Health team, are designed to enable GPs to discuss treatment options more effectively with their patients to better achieve evidence-based, shared and acceptable treatment decisions. The study gave GPs access to on-line


learning materials including videos, and allowed them the flexibility to learn and try out the new skills with their patients at times that were convenient to themselves. “Antibiotic resistance remains one of the most


important public health issues of our time, with antibiotic prescribing driving up resistance,” said Prof. Butler, who led the study. “As most antibiotics are prescribed in General


Practice, safely reducing the number of unnecessary prescriptions is essential. The STAR programme helpedWelsh GPs gain new skills derived from motivational interviewing so they could achieve evidence-based treatment while taking patient perspectives into account. “Although the percentage reduction in


antibiotic prescribing was fairly small, based on national population estimates, if the findings of this study were replicated across the whole of Wales this would imply a reduction of well over 78,000 dispensed oral antibiotic items per year, and if replicated across the UK, a reduction of over 1.6 million dispensed oral antibiotic items per year,” he added. The results of the study were published in the British Medical Journal (BMJ).


Potential new treatment for atrial fibrillation


A potential new blood thinning treatment to prevent strokes in patients with atrial fibrillation (a common form of irregular heartbeat) could have fewer dangerous side- effects than the traditional treatment, warfarin. Research has found that the drug Rivaroxaban is less likely to cause bleeding in the brain. The study found that the risk of a bleed


in the brain is 2.2 per 100 people on warfarin but only 1.7 per 100 people for those on Rivaroxaban. Dr Sharlin Ahmed, research liaison officer


at The Stroke Association said: “Warfarin is often prescribed as a highly effective treatment to prevent strokes in patients with atrial fibrillation. However, as with all medications, it carries side-effects and, in some patients, it can increase the likelihood of bleeding in the brain, which can cause a different type of stroke. The results of this study provide a positive backing for Rivaroxaban and show that it is less likely to cause bleeding in the brain which is encouraging.We are interested to see how this potential treatment progresses.”


Breakthrough discovery on hypoxic response


A new family of proteins which regulate the human body’s hypoxic response to low levels of oxygen has been discovered by scientists at Barts Cancer Institute at Queen Mary, University of London and The University of Nottingham. The discovery has been published in the international journal Nature Cell Biology. It marks a significant step towards understanding the complex processes involved in the hypoxic response which, when it malfunctions, can cause and affect the progress of many types of serious disease, including cancer. The researchers have uncovered a previously


unknown level of hypoxic regulation at a molecular level in human cells which could provide a novel pathway for the development of new drug therapeutics to fight disease. The cutting-edge work was funded by the Biotechnology and Biological Sciences Research Council (BBSRC). Proteins are biochemical compounds which


carry out specific duties within the living cell. Every cell in our body has the ability to recognise and respond to changes in the availability of oxygen. The best example of this is when we climb to high altitudes where the air contains less oxygen. The cells recognise the decrease in oxygen via the bloodstream and are able to react, using the ‘hypoxic response’, to produce a protein called EPO. This protein in turn stimulates the body to produce more red blood


MARCH 2012


cells to absorb as much of the reduced levels of oxygen as possible. This response is essential for a normal


healthy physiology but when the hypoxic response in cells malfunctions, diseases like cancer can develop and spread. Cancer cells have a faulty hypoxic response which means that as the cells multiply they highjack the response to create their own rogue blood supply. In this way the cells can form large tumours. The new blood supply also helps the cancer cells spread to other parts of the body, called ‘metastasis’, which is how ultimately cancer kills patients.


The scientists have identified a new family of


hypoxic regulator proteins called ‘LIM domain containing proteins’ which function as molecular scaffolds or ‘adapters’ bringing together or bridging two key enzymes in the hypoxic response pathway, namely PHD2 and VHL. Both of these are involved in down-regulating the master regulator protein called Hypoxia-inducible factors (HIF1). The research has shown that loss of LIMD1 breaks down the bridge it creates between PHD2 and VHL and this then enables the master regulator to function out of control and thus contribute to cancer formation.


Plans to improve care for children


A new focus on improving care for children and young people will be unveiled later this year, Health Secretary, Andrew Lansley, has announced. The Children’sand Young People’s outcomes strategy will focus the health service on improving health results for children, including those needing primary, hospital and urgent care, and children with long-termconditions. It will identify health issues that matter most to children and young people, and how a modernNHS will meet their needs. The Children’s and Young People’s Forum will be jointly chaired by Professor Ian Lewis,


medical director at the Alder Hey Children’s NHS Foundation Trust, and Christine Lenehan, director at the council for Disabled Children. Prof. Ian Lewis said: “This is a welcome opportunity to focus on children and young people in order to ensure that the modernisation of health services work well for them. It is a genuine chance to make a difference to improve the availability and quality of healthcare provided to them by the NHS.We look forward to working alongside other experts as part of the Children’s and Young People’s Forum.”


THE CLINICAL SERVICES JOURNAL 15


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