A study showed that some doctors, particularly surgeons, are not explaining the risk of specific outcomes that matter most to patients. Overlooked risks that led to a legal claim or complaint included chronic pain, sexual dysfunction, visual or hearing loss, and the need for re-operation.

Lead author Dr Marie Bismark from the University of Melbourne School of Population Health said the study revealed that doctors may routinely underestimate the importance patients place on understanding certain risks in advance of treatment.

‘Increasingly, doctors are expected to advise and empower patients to make rational choices by sharing information that may affect treatment decisions, including risks of adverse outcomes,’ she said.

‘However, doctors, especially surgeons, are often unsure which clinical risks they should disclose and discuss with patients before treatment and this is reflected in this study.’

The authors found that the most common justifications doctors gave for not telling patients about particular risks before treatment were that they considered such risks too rare to warrant discussion, or that the specific risk was covered by a more general risk that was discussed.

‘It is not necessary, or helpful, for doctors to provide a laundry list of all possible risks. Instead, doctors should focus on discussing those risks which are likely to matter most to the patient before them,’ she said.

From a sample of nearly 10,000 patient complaints and malpractice claims from Australia between 2001 and 2008, researchers identified 481 disputes involving alleged deficiencies in obtaining informed consent.

The authors found that 45 (9%) of the cases studied were disputed duty cases

Leading clinicians and health researchers from across Europe say much greater emphasis must be placed on the scientific evidence for the effectiveness of treatments and other healthcare interventions to ensure patients receive the best care available. The call is contained in a Science Policy Briefing published by the European Medical Research Councils, which also made ten key recommendations on how to improve the quality of research and healthcare in Europe. The briefing,

University of Michigan heart researchers are shedding light on a new method for steadying an abnormal heart rhythm.
Irregular heart rhythms, or arrhythmias, set the stage for a common, debilitating disorder called atrial fibrillation that puts adults as young as age 40 at risk for fatigue, fainting, cardiac arrest, and even death.
Medications can help, but doctors also use catheter ablation in which electrical impulses are delivered to a region of the heart to disrupt the arrhythmia.
However, half of patients require more than one ablation to see results. In a laboratory study, the U-M used photodynamic therapy, a technique long used in cancer research, to disrupt the specific cells causing the arrhythmia.
The study suggests cell-specific cardiac ablation could help patients avoid complications, and get closer to an arrhythmia-free life without having to undergo repeat hospital visits.
Chemists in the U-M Department of Chemistry and electrophysiologists at the U-M Center for Arrhythmia Research collaborated on the study that will require further examination before it is available in the hospital setting.
‘This cell-selective therapy may represent an innovative concept to overcome some of the current limitations of cardiac ablation,’ says lead study author Uma Mahesh Avula, M.D., research fellow at the U-M Center for Arrhythmia Research.
The heart consists of different types of cells such as myocytes, fibroblast, adiopocytes and purkinje fibres, which are all needed for normal cardiac activity.
The new study is the first of its kind to use photodynamic therapy and nanotechnology to ablate only the cardiac myocytes responsible for arrhythmias. In current ablative techniques, all cardiac cells receive ablative energy, which can lead to complications such as puncturing the heart muscle, bleeding or stroke.
‘Current ablation techniques are severely limited by its non-specific nature of cellular damage. Besides this lack of cellular discrimination markedly increases the required energy amounts and prolongs procedure times, all of which reduces overall ablation results,’ Avula says.
Catheter ablation has emerged as an important treatment option that requires careful assessment, planning and execution for optimal success rates. Advances over the past 20 years have made the treatment safer, but it remains highly complex.
‘Approaches that could simplify and shorten the procedure may contribute to more patients being treated,’ Avula says.
Rather than radiofrequency energy, the most common type used in cardiac ablation, the U-M team introduces the use of PDT in cardiac electrophysiology to target specific cell types. Targeted PDT, which was pioneered in the labs of study senior author U-M chemist and engineer Raoul Kopelman, Ph.D., is extensively used in cancer research for selectively killing cancerous cells.
The disruption induced by PDT is confined to cells that have been photosensitised, while adjacent non-photosensitised cells are unaffected. The U-M has applied for a patent for this technology.
‘We think this approach will decrease the extent of unwanted cell injury, inflammation, and ablation-related tissue damage, and pave a way for the development of more effective therapies for cardiac arrhythmias,’ says study senior author J

A recent study in The Lancet found that the benefits of taking statins are greater than the increased risk of developing diabetes experienced by some patients In a randomised, double-blind JUPITER trial, 17 603 men and women without previous cardiovascular disease or diabetes were randomly assigned to rosuvastatin 20 mg or placebo and followed up for up to 5 years for the primary endpoint (myocardial infarction, stroke, admission to hospital for unstable angina, arterial revascularisation, or cardiovascular death) and the protocol-prespecified secondary endpoints of venous thromboembolism, all-cause mortality, and incident physician-reported diabetes. In this analysis, participants were stratified on the basis of having none or at least one of four major risk factors for developing diabetes: metabolic syndrome, impaired fasting glucose, body-mass index 30 kg/m2 or higher, or glycated haemoglobin A1c greater than 6%. Although statins increased the likelihood of developing diabetes in patients already at risk of the condition, these people were still 39% less likely to develop cardiovascular disease while taking the drug. Patients who were not already at risk of developing diabetes experienced a 52% reduction in cardiovascular disease when taking statins and had no increase in diabetes risk. The benefits of taking statins far outweigh the side effects for the majority of people who need to take them.

http://tinyurl.com/ce4t2ok

Researchers at Imperial College London have begun the first UK clinical trials of a gene therapy for heart failure.

Heart failure, when the heart is unable to pump blood adequately, affects more than 750,000 people in the UK, causing breathlessness and hindering day-to-day activities. The therapy is designed to increase the levels of SERCA2a protein in heart muscle cells by using a harmless virus to insert extra genes into the cells.

The two clinical trials announced mark the culmination of more than 20 years of research funded by the British Heart Foundation (BHF) at Imperial and the Royal Brompton Hospital, which have identified SERCA2a as an important factor affecting how well heart muscle cells can contract in people with heart failure.

The trials will be led in the UK by cardiologists and scientists at Brompton and Imperial, in collaboration with doctors at several UK hospitals including Harefield in London, Papworth in Cambridge and the Golden Jubilee National Hospital in Scotland. The announcement coincides with Fight For Every Heartbeat, a new hard-hitting campaign from the BHF that hails research as the weapon needed to win the battle against heart disease.

Dr Alexander Lyon, BHF Senior Lecturer at Imperial College London and Consultant Cardiologist at the Royal Brompton Hospital, who is the UK lead investigator for both studies, said: ‘Heart failure affects more than three quarters of a million people across the UK. Once heart failure starts, it progresses into a vicious cycle where the pumping becomes weaker and weaker, as each heart cell simply cannot respond to the increased demand.

‘Our goal is to fight back against heart failure by targeting and reversing some of the critical molecular changes arising in the heart when it fails.’

The trials are the next step in the research after laboratory studies found that the gene therapy can be used to effectively restore function to the failing heart, in collaboration with colleagues from the United States.

Doctors plan to study the gene therapy in two separate clinical trials. The first, called CUPID2, will begin treating people with heart failure in the next few weeks in the Cardiovascular Biomedical Research Unit at the Royal Brompton Hospital.

CUPID2 will assess whether cardiac gene therapy to increase SERCA2a is safe and can improve both quality and length of life, and reduce emergency hospital admissions, for heart failure patients. The trial will involve 200 patients with heart failure from the Royal Brompton Hospital and other centres across the world, and is funded by US biotech company Celladon.

The second trial, called SERCA-LVAD, is due to start recruitment in the summer of 2013. Co-funded by the BHF, this trial will test the SERCA2a gene therapy in 24 UK heart failure patients already fitted with mechanical heart pumps, known as left ventricular assist devices (LVADs). It will give vital information about the effectiveness of the therapy by measuring the amount of the SERCA2a gene and protein that has been introduced into heart muscle.

Professor Sian Harding, Professor of Cardiac Pharmacology and Head of the BHF Centre for Regenerative Medicine at Imperial College London, who developed the treatment, said: ‘It