Patches giving oestrogen through the skin could be an easy and safe alternative to hormone therapies used to treat prostate cancer.

The Cancer Research UK funded study found that oestrogen patches, usually used to treat menopause symptoms in women, reduced levels of testosterone in men to a similar extent as the current hormone treatment, LHRHa injections.

Many prostate cancers need the male hormone testosterone to grow. Using drugs to reduce testosterone in advanced stages of the disease can shrink the tumour or slow growth.

In the 1960s this was done by using oestrogen tablets, but this caused heart and blood clotting side effects for some men. Now, LHRHa injections are the main treatment for reducing testosterone but these may also cause serious side effects including hot flushes, osteoporosis, bone fractures and diabetes.

The trial was run by researchers from Imperial College London and the Medical Research Council Clinical Trials Unit with clinicians at Imperial College Healthcare NHS Trust.

They compared LHRHa injections to oestrogen patches in 254 men with locally advanced prostate cancer or prostate cancer that had spread, in order to test the benefits and side effects from the patches.

The results showed that patches appeared to suppress testosterone levels to a similar extent as LHRHa injections. After 12 months, the researchers also found that those having the LHRHa treatment had higher blood glucose and cholesterol levels, which can increase the risk of heart disease, compared to men treated with patches. The patches did not cause the same degree of heart and blood clotting problems caused by oestrogen tablets.

The initial trial has now been extended to study the long-term effectiveness and side effects of oestrogen patches in a larger group of 660 men.

Dr Ruth Langley, a study author from the Medical Research Council Clinical Trials Unit, said: ‘These promising new findings suggest that we might be able to use oestrogen patches or an oestrogen gel to treat prostate cancer without significantly increasing the risk of heart disease and stroke. We think the reason oral oestrogen causes these side effects is because the oestrogen reaches the liver in high concentrations straight from the stomach, whereas if the oestrogen can be absorbed through the skin, the effect on the liver is avoided.’

Professor Paul Abel, from the Department of Surgery and Cancer at Imperial College London and an honorary consultant in urology at Imperial College Healthcare, said: ‘The next step is to test if the oestrogen patches are as effective at stopping the growth of prostate cancer as the current hormone treatments. We

Cardiologists at Imperial College Healthcare NHS Trust test a high-tech vest which helps them accurately pinpoint the cause of rapid and abnormal heartbeats (arrhythmias).

The team, led by consultant cardiologist Dr Prapa Kanagaratnam, have tested the ECVUE system in 40 patients at St Mary

It appears that sugar really may help the medicine go down – studies suggest a few drops can comfort babies who are having their jabs. The Cochrane team reviewed 14 studies involving more than 1,500 infants going for routine childhood immunisations or a heel-prick blood test.
Babies given a sugary solution to suck as they were about to be injected cried far less than those given water. While sugar may pacify, it is unclear if it also relieves pain.
Experts say more research is needed to explore this.
A small study published a couple of years ago in The Lancet medical journal looked at the responses of 44 infants given either sugar or water as they had a heel-prick blood test. The sugar did not appear to make a difference to pain – all babies similarly grimaced and had comparable electrical activity measured with EEG readings in areas of the brain that process pain.
The lead researcher in the Cochrane review, Dr Manal Kassab of the Jordan University of Science and Technology in Irib, Jordan, said: ‘Giving babies something sweet to taste before injections may stop them from crying for as long.
‘Although we can’t confidently say that sugary solutions reduce needle pain, these results do look promising.’
Dr David Elliman of the Royal College of Paediatrics and Child Health said sugar solution was not used routinely in practice.
‘Generally, doctors recommend that the mother holds the baby and comforts it while they have their immunisation. If she is breastfeeding still, she might want to breastfeed her baby at the same time.
‘With older children we try to distract them. If you do the usual holding and comforting, I’m not sure how much sucrose would add.
‘What we do know is that using a shorter needle tends to be more painful, even though this might seem counterintuitive. That’s because the injections need to go into the muscle.’
By the time a child has reached its second birthday it should have had around 10 different injections to protect against various infectious diseases, including measles, mumps and rubella. BBC

Very low birth weight infants, those weighing less than 3.25 pounds, account for half of infant deaths in the United States each year, yet a new study released documents that these critically ill infants do not receive optimal nursing care, which can lead to hospital-acquired infections that double their death rate and may result in long-term developmental issues affecting the quality of their lives as adults.
These vulnerable infants are the highest risk pediatric patients in hospitals and account for half of all infant deaths in the country each year. These hospital-acquired infections afflicted 13.9 percent of these frail infants in 2009, the last year reported in the study.

The lead authors, based at the University of Medicine and Dentistry of New Jersey- School of Public Health and the University of Pennsylvania School of Nursing, studied very low birth weight infants cared for in 67 Neonatal Intensive Care Units (NICU).

‘One-third of NICU infants were understaffed, according to current guidelines. Understaffing varies further across acuity levels with the greatest fraction of understaffed infants (92 percent) requiring the most complex critical care, translating into a needed 25% increase in the numbers of nurses,’ wrote co-principal investigators Jeannette A. Rogowski, PhD, the University Professor in Health Economics at the UMDNJ-School of Public Health and Eileen T. Lake, PHD, RN, FAAN, associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

The researchers noted that infection caused four to seven days of longer hospitalisation with associated increased costs, notably to Medicaid. ‘Under recent changes in Medicaid policy, hospitals will no longer be reimbursed for the costs associated with these infections,’ said Lake. ‘Sadly, because Medicaid is the largest payer for premature newborns, the additional costs may lead hospitals to further cut the nursing staff, leading to a cycle of infection and mortality that could impact even more of these fragile infants.’

‘These are the first data that demonstrate the extent of adherence to national staffing guidelines and the shortfall is dramatic,’ said Rogowski. ‘Fewer nursing hours could lead to less time devoted to cleaning and maintaining intravenous catheters used to deliver medications thus leading to the higher rates of infection.’ University of Pennsylvania School of Nursing

Immobile patients are in constant danger of developing pressure ulcers on the skin. Empa, Schoeller Medical and the Swiss Paraplegic Centre have worked together to develop a special sheet that is gentle on the skin and helps to make patients more comfortable.
The skin is the most versatile of our organs: It protects the body from environmental effects, contributes to the body