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Archive for April 11, 2012

Sticky salmon with Chinese greens

A quick way to liven up salmon fillets, with stir-fried veg and the classic trio of garlic, chilli and ginger

  • Cook 15 mins
  • Prep 5 mins

Nutrition per serving

354 kcalories, protein 35.0g, carbohydrate 10.0g, fat 20.0g, saturated fat 4.0g, fibre 0.0g, salt 2.81g.

Ingredients

Serves 4

  • 4 skinless salmon fillets , 150g/4oz each
  • 3 tbsp oyster sauce
  • 2 tbsp teriyaki sauce
  • 1 tbsp honey
  • 1 tbsp oil (a mix of vegetable and sesame)
  • 1 tbsp finely grated fresh root ginger
  • 1 garlic clove , finely sliced
  • 1 red chilli , deseeded amd finely sliced
  • mixed green vegetables – we used bok choi, sugar snaps and broccoli

    Method

    1. Heat oven to 200C/fan 180C/gas 6. Place the salmon on a baking tray. Mix together the oyster sauce, teriyaki and honey, then brush a little over the fish. Roast for 8-10 mins until glazed and just cooked through. Set aside.
    2. Heat the oil in a wok, then fry the ginger, garlic and chilli for 1 min. Stir-fry the broccoli or any larger, harder veg for 3 mins, then add the leafy veg and cook for 1-2 mins more. Stir in the rest of the sticky sauce, heat through and serve with the fish.

Read More: Good Food

Spinach and Onion Tart

This is a classic combination for a quiche, but it’s lighter, with a whole-wheat and olive oil crust.

1 yeasted olive oil pastry (1/2 recipe)

1 1/2 pounds fresh spinach, stemmed and washed in 2 changes of water, or 3/4 pound baby spinach, rinsed

1 tablespoon extra virgin olive oil

1 medium onion, finely chopped

Salt and freshly ground pepper to taste

1 teaspoon fresh thyme leaves, coarsely chopped, or 1/2 teaspoon dried thyme

4 eggs

3/4 cup low-fat milk

2 ounces Gruyère cheese, grated (1/2 cup)

1 ounce freshly grated Parmesan (1/4 cup)

 

1. Preheat the oven to 350 degrees. Oil a 10-inch tart pan and line it with the pastry. Keep it in the refrigerator while you prepare the filling.

2. Steam the spinach above an inch of boiling water for 2 to 3 minutes, until wilted.  You will probably have to do this in batches. I like to use a pasta pot with an insert for steaming spinach, as I can get a lot of it into the insert. Rinse briefly with cold water, squeeze out excess water and chop medium-fine.

3. Heat the olive oil over medium heat in a large, heavy skillet and add the onion. Cook, stirring often, until it is tender and beginning to color, about 8 minutes. Add the spinach, thyme and salt and pepper to taste, and stir together. Remove from the heat.

4. Whisk the eggs in a large bowl. Add salt to taste (I use about 1/2 teaspoon) and whisk in the milk. Stir in the onion and spinach mixture and the cheeses. Scrape into the pastry-lined tart pan. Place in the oven and bake 40 to 45 minutes, until tart is set and beginning to color on the top. Remove from the heat and allow to cool for at least 15 minutes before cutting. Serve warm or room temperature.

Yield: 6 servings.

Advance preparation: You can make this a day ahead. You can make the filling through Step 3 a day ahead, and the crust can be made weeks ahead and frozen.

Variation: This also works without the crust as a gratin, baked in a 2-quart baking dish.

Nutritional information per serving (6 servings): 289 calories; 16 grams fat; 5 grams saturated fat; 2 grams polyunsaturated fat; 8 grams monounsaturated fat; 156 milligrams cholesterol; 23 grams carbohydrates; 4 grams dietary fiber; 395 milligrams sodium (does not include salt to taste); 16 grams protein

Read More: NYT

Artificial heart keeps boy alive for record 251 days

By James Gallagher Health and science reporter, BBC News

Joe Skerratt
Joe Skerratt, fit and well after 251 days with an artificial heart.

A three-year-old boy has been kept alive with an artificial heart for more than eight months, which doctors say is a record for a child in the UK.

Joe Skerratt from Gillingham, Kent, was diagnosed with dilated cardiomyopathy, which meant his heart struggled to pump blood around his body.

He was temporarily fitted with a “Berlin heart”, to give his own a helping hand.

After 251 days, he finally had a heart transplant last year.

Joe’s mother, Rachel, said “we started to see his character coming back” after he was fitted with the Berlin heart. But this was the start of a long wait for a heart donor.

“When Joe passed the 200-day mark on the Berlin heart we started to really question what else could be done if a heart wasn’t found, but we knew deep down there wouldn’t be much,” she said.

“On day 251 the call we had been waiting for came. We were offered a heart for Joe. The call came early in the morning and time seemed to stand still before he was taken down to theatre.”

After the operation, Joe’s chest would not be closed for four days. Rachel said: “Seeing his new heart – a normal size and thumping away in his chest – was incredible.”

Their first night back home was celebrated with Joe’s favourite meal – pizza.

Joe Skerratt
Joe attached to the Berlin heart

 

Joe was first diagnosed with dilated cardiomyopathy when he was taken to hospital looking grey at just three weeks old. An X-ray showed his heart was severely enlarged. He was later diagnosed with a genetic disorder – Barth syndrome, which leads to muscle weakness, short stature and feeding problems.

In December 2010, Joe’s heart was failing and doctors found his valves were leaking. His heart had now become even more enlarged and was taking up too much space in his chest.

A few days later his heart stopped twice while he was in hospital. He was then transferred to Great Ormond Street Hospital in London, where his heart stopped for a third time.

Berlin heart
The Berlin heart is used as a bridge to a heart transplant

 

Doctors stabilised Joe and he was fitted to a Berlin heart.

The Berlin heart is about the size of a small fridge. Some children need to be on the device for only a couple of weeks, while for others, the wait for a new heart can take many months.

Dr Alessandro Giardini, consultant paediatric cardiologist at Great Ormond Street, said: “We are really delighted to see Joe doing so well and thriving at home. He spent a long time with us in hospital.

“Joe was very lucky to be able to have a heart transplant. There is a chronic shortage of donor organs for children in the UK and at any one time we have several children in the hospital awaiting a transplant. Lots of children wait years for an organ to become available and can very sadly die while they are doing so.”

Joe’s parents have both called for people to join the NHS organ donor register. Rachel said: “We are eternally grateful to the donor family.

“We cannot imagine what they went through, their generosity of thought at such a horrendous time is completely selfless and amazing.”

Read More : BBC

Nursing regulator ‘poorly organised and weak’

The body that regulates nurses and midwives in the UK is failing to carry out its duties due to institutional weakness, an interim review says.

The Council for Healthcare Regulatory Excellence was asked to look at the conduct of the Nursing and Midwifery Council (NMC) after concerns were raised about how it ensures NHS staff are fit to practise.

It says poor management has, in part, led to a backlog of misconduct cases.

A final report is due in the summer.

The NMC, which regulates some 670,000 nurses and midwives, said it was aware of the problems and was addressing them.

Prof Judith Ellis, interim chair of the NMC, said: “We accept the report’s findings in its entirety and we are already working hard to address the recommendations.”

Safeguarding patients

Undue delays in hearing complaints against nurses potentially put patient safety at risk, the report says.

Currently, there are 4,000 open cases.

Some cases take more than a year to be heard.

The NMC says it will take them a couple of years to ensure that all cases are heard within the desired 15-month limit.

Harry Cayton, chief executive of the Council for Healthcare Regulatory Excellence (CHRE), said: “The Nursing and Midwifery Council needs to have a clear and consistent focus on its regulatory purpose. There are serious problems but we acknowledge the effort the Council, executive team and staff are putting into managing this transition.”

The CHRE says the NMC must act rapidly to recruit a new Chair and Chief Executive in order to give staff and registrants “the settled leadership they need and deserve'”.

And it advises that the Council strengthen how it oversees its finances.

Secretary of State Andrew Lansley said he would ensure all recommendations from the report are taken forward.

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, welcomed the report but said he was concerned that the principle of professionally led regulation could be eroded by some of the recommendations.

Read More : BBC

Trust pushes for open access to research

By Matt McGrath Science reporter, BBC World Service

AIDS awareness poster
Critics of the “paid-for” model say it restricts research in important fields

One of the world’s largest research charities, the Wellcome Trust, is to support efforts by scientists to make their work freely available for all.

The Trust is to establish a free, online publication to compete with established academic journals.

They say their new title could be a “game changer” forcing other publishing houses to increase free access.

More than 9,000 scientists are boycotting a leading paid-for publisher for restricting access to their papers.

The Wellcome Trust’s move is the latest salvo in a battle about ownership of, and access to, the published work of scientists that has been simmering underneath the sedate surface of scientific research for years.

The majority of the world’s scientific journals are accessible only via subscription, including highly influential titles such as Nature, Science and the New England Journal of Medicine.

Others, such as the Public Library of Science stable, can be read by anybody. The cost of publication falls on the scientists or their institutions.

New model

Quality and open access, are completely separate, and it’s a bit of a red herring to conflate them”

Robert Kiley Wellcome Trust

Many researchers want their work to be freely available to all as they believe this will speed up discoveries.

They also argue it is unfair that publicly funded research should only be accessible behind the paywalls of private publishing houses.

According to Sir Mark Walport, the director of the Trust, it is hugely important that the fruits of research be available to all.

“One of the important things is that up until now if I submit a paper to a journal I’ve been signing away the copyright, and that’s actually ridiculous,” he said.

“What we need to do is make sure the research is available to anyone.”

Free currency

Later this year, the Wellcome Trust will launch an online open access journal called eLife that will compete with the paid-for heavyweights.

According to Robert Kiley, who is in charge of open access for the trust, it could tip the balance in favour of those who believe in an open approach.

First edition of Royal Society science journal
The majority of journals require subscriptions, often costing thousands of dollars per year

“The currency of researchers is really about making sure their work can be read and can be cited,” he said.

“And clearly having it freely available for everyone to read enhances that.

“So I think what will happen is that those publishers who do not have an open access model will move into this road; they’ll see which way the wind’s blowing, and they’ll provide options for researchers to publish under a fully open access model.”

The publishers of the leading paid-for titles say their income allows them to spend more on selecting papers, editing and production.

They point to journals like Nature that reject about 90% of the papers submitted.

However, Nature Publishing Group says it welcomes the introduction of eLife.

“It could positively impact, by demonstrating that open access on high impact titles can be sustainable,” it said in a statement.

But they have “concerns that the offer of free or subsidised publication might disrupt the growing open access market”.

Another to applaud the Wellcome initiative is Graham Taylor, director of educational, academic and professional publishing at the Publishers’ Association in Britain.

“We welcome this,” he said.

“It’s a competitive market, and publishers expect competition. I would say the high end journals are already doing or thinking about doing what the Wellcome Trust is going to do.”

Reviewing the position

One of the other concerns that some scientists have about open access publishing is that it would be damaging to the peer review system.

But according to Wellcome’s Robert Kiley, the peer review process operates the same way regardless of whether the journal is paid for or not.

“Those two elements, quality and open access, are completely separate, and it’s a bit of a red herring to conflate them,” he said.

“Of course there are low quality open access journals, but there are also low quality subscription journals. Quality and cost are not related.”

Frustrations about the costs of academic journals has already prompted a boycott of Elsevier, the world’s biggest publisher in this field.

On The Cost of Knowledge, a website set up as a focus for the protest, over 9,200 researchers say they will no longer submit or act as peer reviewers for Elsevier.

But while many scientists are in favour of open access, it may take some time for the idea to become the standard model for scientific publishing.

The Wellcome Trust has for years been urging the researchers that they fund to publish in open access journals. So far, little over half have agreed to do it.

Read More : BBC

Ambulance staff ‘can speed up stroke treatment’


Blood clots can block normal flow to the brain and cause stroke

By Michelle Roberts Health reporter, BBC News

Treating stroke in specialised ambulances en route to hospital is feasible and could boost the number of patients who receive life-saving therapy, experts believe.

Mobile stroke units can halve the time it takes a patient to get clot-busting drugs, a small German trial found.

The drugs only work if given within four and a half hours of stroke onset.

Since not all patients are suitable candidates, a rapid assessment is critical, The Lancet Neurology reports.

Clot-busting drugs (thrombolytics) can be effective if the stroke is caused by a blood clot (the cause in about 80% of cases), but not if it is due to a bleed.

The faster an eligible patient receives clot-busting treatment, the better their chances are of surviving and reducing long-term disability.

Brain scan

The latest trial, which involved 100 patients in Germany, found treatment decision times were reduced by equipping ambulance staff with the necessary tools, including CT scanners, to diagnose and manage stroke.

Treating suspected stroke patients at the site of the emergency is an interesting development ”

Nikki Hill The Stroke Association

In the study, thrombolysis was given within 35 minutes, on average, for those patients treated by mobile stroke units. In comparison, those sent to hospital for treatment in the usual way waited 76 minutes.

Patient outcomes did not differ significantly between the two groups but the researchers point out that the study was not designed to evaluate this and that the number of patients involved in their trial was small. The follow up was also short – a week.

Experts say larger studies are needed to explore what impact earlier treatment will have on prognosis, and to confirm whether mobile stroke units would also work in other geographical regions, not just in urban areas with short journey distances.

Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England will have a stroke, which costs the NHS over £2.8bn.

In 2007 the government set out a National Stroke Strategy to improve stroke services and recommended that patients with a suspected stroke should have a brain scan as soon as possible to determine if it was caused by a blocked artery or a burst blood vessel.

A stroke can be diagnosed using “FAST”:

  • Facial weakness – has the person’s face drooped, usually down one side
  • Arm weakness – is the person able to lift both arms above their head
  • Speech problems – does the person’s speech sound slurred
  • Time to call 999 – if one or more of these symptoms are present call 999 immediately

Only a minority of stroke patients reach hospital and undergo brain scanning within a few hours, which is necessary if these drugs are to be given.

But stroke care has been improving over recent years, audits show.

Nikki Hill of The Stroke Association said: “When a stroke strikes time lost is brain lost, meaning that getting urgent medical attention quickly is absolutely essential.

“Treating suspected stroke patients at the site of the emergency is an interesting development and it could help to speed up the whole treatment process for some patients.

“However, this research was conducted in an urban area of Germany, and so it’s difficult to say whether the same method would work in the more rural areas of the UK. A lot more research is needed.”

A Department of Health spokeswoman said: “The results of this study are interesting, but we would need more evidence on whether mobile stroke units would be a clinical and cost effective addition to NHS stroke services.

“In some instances, it could be just as quick or quicker to get the patient to hospital in an ambulance as it would to get a mobile stroke unit to the patient.”

Read More : BBC

乳房X光檢查加上超音波可幫助診斷有風險的婦女

根據包括2,662名緻密乳房且乳癌風險中度升高婦女進行的多中心研究,每年進行篩檢型乳房X光檢查加上超音波檢查,比單用乳房X光檢查多偵測34%的侵犯性乳癌。

「American College of Radiology Imaging Network(ACRIN) 6666」研究的3年結果顯示,篩檢型超音波的好處因為較多偽陽性與陰性乳房切片而略減。研究者也發現,進行篩檢型乳房X光檢查加超音波檢查後3年,乳房 磁振造影(MRI)診斷率較高(多發現56%的侵犯性乳癌),但是,限制包括偽陽性增加費用、成本較高、病患抗拒該手術。

匹茲堡大學放射科Wendie A. Berg博士表示,這篇發表於4月4日JAMA期刊的研究,是第一篇具體探討乳癌篩檢超音波之臨床意義的重要研究。

美國癌症協會癌症篩檢資深主任Robert A. Smith博士表示,這是篇重要研究,因為它指出了進行乳房造影可以如何改善緻密乳房婦女或先天易患乳癌婦女的檢查;Smith博士未參與該研究。

Berg博士形容緻密乳房組織對癌症預防與發生率而言,可說是「禍不單行」。她表示,緻密乳房婦女發生乳癌的風險是脂肪性乳房婦女的5倍之多,而乳房X光攝影傾向會錯過緻密乳房中的癌症。

這篇試驗在21個機構進行,也確認了使用醫療影像為中度風險婦女進行篩檢的價值。研究中,8成婦女屬於這類,45%有乳癌病史,例如進行過乳房腫瘤切除術和放射線治療、或家族中曾有乳癌或卵巢癌患者;之前的非均質性緻密或極度緻密乳房組織的X光檢查證據是必要的。

研究對象納入時的平均年紀為55歲,不過,只要符合該研究的風險規範,即便年僅25歲者也會納入。

試驗開始時,這些婦女在單一影像機構進行乳房超音波檢查與篩檢型乳房X光攝影,之後在12個月和24個月後再度進行;在612名婦女完成全部3次乳房X光攝影和超音波檢查後,進行乳房MRI。

在這3年間,發現110例乳癌,有89例侵犯性癌症。

乳房X光攝影發現59例癌症(53%),診斷率相當於每1000人有7.9例癌症。

當進行篩檢型超音波時,侵犯性癌症偵測率增加34%,增加診斷率為每1000人有4.3例癌症。

乳房X光攝影和超音波檢查發現的癌症只有8%可以觸診發現,Berg博士指出,這是緻密乳房婦女預期偵測篩檢期間癌症率的一半,低於脂肪性乳房婦女之前報告指出的10%篩檢期間偵測率。

乳房MRI增加了56%癌症偵測率,相當於每1000人增加發現14.7例癌症(95% CI,3.5 – 25.9癌症/1000人;P = .004[與乳房X光攝影加超音波相比])。不過,篩檢型超音波和MRI需要額外的臨床費用,Smith博士稱之為「確實是相當大的差異」。

進行超音波篩檢的婦女有7%(95% CI,6.3% – 7.8%)需要額外檢查,包括5%轉介乳房切片,但只有7.4%的切片獲得陽性的癌症組織學結果。

進行MRI的612人中,乳房X光攝影和超音波檢查後的切片比率為6.2%(95% CI,4.4% – 8.4%),加入MRI後,切片率增加到81/612 (13.2%;95% CI,10.7%- 16.2%)(P < .001),這些手術只有19%獲得陽性癌症診斷。

諸多其他因素使Berg博士等人還不建議將MRI作為中度風險婦女之例行篩檢的一部分,包括MRI費用比超音波貴上許多,及所需的配套設備和受過訓練的專業人員等限制,此外,婦女對乳房MRI的耐受不佳。

在14個地點免費為選定的研究對象提供這些檢查。

她表示,令我們驚訝的是,只有58%的婦女實際上要進行MRI。

Berg博士表示,篩檢型超音波因為本身操作相關的問題受到批評,低給付率和高營運成本使它並不具經濟上的平衡優點,健康照護機構並不被鼓勵提供這項服務。

如果美國癌症協會建議併用乳房X光攝影和超音波篩檢於中度風險婦女,這類問題會被提出,就像2007年、它的指引修改指出篩檢型MRI用於先天乳癌高風險婦女的好處時。

Smith博士表示,ACS下次更新指引時,需要考量中度風險者乳癌篩檢的特定規範。我們一定要檢視這篇研究和其他試驗,以確認資料是否足以提供明確的指引給婦女和轉診的醫師,判斷是否需要不同的篩檢方法。

ACS的乳癌篩檢更新版指引登載於今年初的JAMA,更新的過程一般需要12個月,或許在2012年底會有新版問世。

原文出处: 24drs

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