Tuesday, 19 January 2016

Tuberculosis (TB) is still a danger!

A recent paper in the New England Journal of Medicine once again highlights the fact that we tend to ignore certain older disease states that we have archived before their demise. TB is one of these. In developed countries it rarely gets a mention, except in immune-compromised patients. In Third World countries TB is still an issue.

The World Health Organisation (WHO) in 2014 places mortality at 1.5 million, with a total of 9.6 million infected individuals(http://www.who.int/mediacentre/factsheets/fs104/en/).

The study carried out in the article emphasises that intensified therapy does not improve intervention outcomes and that mortality is still significant. In a global context, more emphasis must be placed on eradicating basic and long-standing communicable disease, prior to simply discovering new ways in which to market and monetise pharmaceutical care!

The paper, "Intensified Antituberculosis Therapy in Adults with Tuberculous Meningitis",
can be found @http://www.nejm.org/doi/full/10.1056/NEJMoa1507062.

Sunday, 28 June 2015

Exercise and fasting are good for the brain!

Watch this TED talk. Stimulating concept and topical for various reasons.

The official Youtube attribution is below:

"Mark Mattson is the current Chief of the Laboratory of Neurosciences at the National Institute on Aging. He is also a professor of Neuroscience at The Johns Hopkins University. Mattson is one of the foremost researchers in the area of cellular and molecular mechanisms underlying neurodegenerative disorders such as Alzheimer's Disease, Parkinson's Disease, and amyotrophic lateral sclerosis."

I'm back!!

After a two year hiatus, I have finally decided to continue updating this blog. Watch this space!

Sunday, 10 March 2013

The only way forward!

Now that all is said and done, a new administration is in place.

It is up to all of us involved in the provision and administration of healthcare in the Maltese Islands to form a united front and co-operate in an effort to ameliorate  a system that albiet of a very high standard, can be made to perform even better.

We are one nation and one people and our moral responsibility is to all Maltese, regardless of political belief, colour or creed.

Monday, 11 February 2013

Multiple chronic conditions increase the cost of care

At the risk of stating the obvious this what a recent post on the Healthcare Economist blog discusses. It draws from data forming part of a report by Robert Wood Johnson which tackles the problem of caring for patients suffering from chronic conditions. 

Highlighted in this report are the facts that the percentage of individuals in the United States diagnosed with multiple chronic disease is increasing rapidly, 28% of the population suffer from two or more chronic conditions and that two-thirds of Medicare expenditure are for individuals with five or more chronic states.

The chart above evidences the fact that multiple diagnoses of chronic disease account for the lion's share of expenditure. This view is reinforced by the second chart below where one can note that the per capita spend rises exponentially as the number of comorbidities increases.


It would be interesting and also valuable to the administration of our healthcare system if we could get hold of data for the local population and derive a detailed analysis. If the data had to mirror that in the United States it would be both worrying and enlightening and it would allow us to develop strategies to minimise or avoid an impending healthcare crisis.

The original post by Jason Shafrin can be found here: http://healthcare-economist.com/2013/02/07/multiple-chronic-conditions/

Sunday, 20 January 2013

Back to basics to move forward!

Back to basics to move forward!

The world is changing at a speed none of us could have imagined in our undergraduate years. I typed out my undergrad project on a so-called computer with an 8086 processor chip; these days a scientific calculator packs more punch and occupies much less space. This example is just one of countless ways in which the educational and professional aspects of the pharmacy profession have evolved, in the most part for the better.

There is one area where we have ostensibly taken a step backwards and this is in the manner in which we approach our face to face meetings with our patients. One of the reasons for this is the lack of personal communication skills which are fundamental to productive human interaction.

The main drivers in this lack of drive for human connection can be summarized as such:

I) Social media such as Facebook, Twitter and others have reduced a large percentage of our person to person interventions to electronic means, e-mail included. This decrease in direct communication has engendered a confidence gap and also a lcl of warmth and understanding in professional exchanges.

II) The majority of undergraduates, and also to a certain extent of pharmacy graduates, have no clear idea of why they have chosen their appointed profession. In some instances it is a case of following in the footsteps of a parent or close relative and taking over a long-held family business. In others it is a case of taking the easiest route to a good quality degree as a health professional. However, how many of these individuals can actually profess that they always wanted to become a pharmacist?

Thus what is missing in the majority of cases is the vocation to work as a health professional, to listen, emphasize and sympathize with patients and provide moral comfort as well as physical relief to the condition at hand. The mind and body are inextricably linked and no one medical professional can hope to heal the latter without paying great attention to the needs of the former.

III) Educational institutions are failing to recognize this gap between better informed students or graduates and better world-ready and personable ones. Focused and specific training in personal communication is missing in the curricula of most health professions. At least, with respect to our local pharmacy course, a six month work placement in the fifth year Master stage goes someway to addressing this point since Bachelor of Science graduates can observe licensed pharmacists in their daily patient interactions. The only drawback to this is that the educational and professional gain to be made depends on the randomness of a students placement, and thus uniformity of education is not guaranteed.

The take-home message of this short piece is that educational priority within the health professions, with the inclusion of the local pharmacy profession, should not only be on academic prowess but also on the development of graduates with a capacity for the basic human skills of communication and empathy.


Sunday, 6 January 2013

The National Audit Office Report 2011 - The healthcare perspective

The latest version of the NAO report out last week highlights deficiencies across the board with the government sector, as is the remit of the individuals trusted with its collation and publication. What is of concern to those of us with a vested interest in the health sector and the formulation of health policy and its actuation, are certain grave and fundamental shortcomings within this same sector. The aim of this short note is not to dwell in depth on each point but to emphasize the importance and relevance of the basic facts elucidated by this report.

The NAO report 2011 review of the Ministry for Health and the Elderly can be easily subdivided into the following criticisms:

I) The lack of control on employee attendance and the brazen refusal of doctors' and dentists' unions to accept such a basic tenet of employment. 

II) The fact that tendering procedures for medicines and surgical materials and also non-surgical equipment are routinely circumvented by direct orders, and the limits and approvals required for the latter are disregarded at will.

III) The storage of medicines and surgical materials is not centralized and one of the depots does not provide satisfactory storage conditions under the regulations laid out by the MA. This suggests that sub-standard medicinal and supplies are being passed onto the local treatment chain.

IV) The discrepancy in stocks held was said to be less than Eur 2,000 on a total figure of over Eur 18 million. This range of accuracy is not credible to the trained observer, as it implies no human error in stock transfers and no inventory pilferage. For some reason this did not seem odd to the auditors.

The implications of the NAO report are many and will be discussed in detail in a future note. What these brief points do immediately emphasize is that the Maltese healthcare system is not suffering from a lack of funding, but rather from a very inefficient utilization of the funds available to it. With points of failure at every main cost sector: wages, stocks and purchasing and stock control are all major weaknesses. This implies that major gains are to be had by simply getting the basics done right. Deeper analysis is required to quantify the magnitude of the savings to be had, but the report leaves no doubt that the material impact on the level of local health outcomes would be dramatic, given the gross wastage of resources identified.