Mammography screening may cut breast cancer death rates by 26 per cent amongst women affected in their 40s.

The study, published online in the journal Cancer, co-authored by Dr Stephen Duffy, an Epidemiologist at the University of London, and Dr Laszlo Tabar, Professor of Radiology at the University of Uppsala School of Medicine in Sweden, both have been strong advocates of mammography screening. The study detailed the Swedish standard where since 1986 mammograms were offered to women in their 40s to diagnose breast cancer early.

Last week (September 29), The New York Times reported that these study results were greeted with scepticism by some experts because they said the study overestimated the benefit of the mammogram.

These findings contradict a report in 2009 by the United States Preventive Services Task Force, an independent group, that published guidelines on cancer screening and questioned the benefit of screening women younger than 50.

Dr Jennifer C. Obel from the Oncology Society said the study “captured the real-world experience of mammograms in this age group”. She suggested that all women, starting at age 40, should “speak to their doctors about mammograms”.

The HSE has implemented the international reference measurement system HbA1c for diabetes, to identify those at greater risk of developing complications and to assess the effectiveness of care.

The International Federation of Clinical Chemistry (IFCC) and Laboratory Medicine developed the HbA1c system, which came into use here on 1 July. It measures blood-glucose concentrations over the previous six-to-eight weeks. Dual reporting in both DCCT and HbA1c values will continue until December 31, 2011. The HbA1c system will ultimately lead to comparisons with clinical trials internationally.
Thirty-two HbA1c analysers have been installed in hospitals and 42 have been installed in point-of-care settings. Some 32 of these needed to be replaced with entirely new systems. Valued at €413,300, these were supplied at no additional cost to the HSE. Upgrades and new hardware for HbA1c lab equipment were supplied by Medicon and Unitech. Upgrades and replacement of HbA1c equipment in point-of-care settings were supplied by Cruinn.
Dr Ned Barrett, Chair of the HbA1c Project Team, Mid-Western Regional Hospital, Limerick, told IMT: “There was an acknowledgement that the transfer needed to be done by all involved in diabetes care, so Ireland became a pilot country for the international suppliers. Other countries have gone half way and decided to complete the approach later on. We’ve done it all in one step.”

With innovative technology, it may be possible to screen for stomach and colon cancer and identify patients who need more invasive tests such as colonoscopy, noted Prof Colm Ó Moráin when he delivered the 50th Graves Lecture hosted by the Royal Academy of Medicine in Ireland last week.
The Trinity College Professor of Gastroenterology believes screening for colon cancer is probably more cost-effective than breast cancer screening. Prof Ó Moráin pointed out that stomach cancer was associated with Helicobacter infection and that diagnosing and eradicating the infection would reduce the death rate from this cancer.

He also presented the results of a trial conducted in the Adelaide and Meath Hospital, Tallaght, which showed when patients in the community were properly informed, compliance with screening was very encouraging.
Patients with a positive sample were offered colonoscopy, and the majority of tumours detected were early and curable.
Speaking on the problem of patients not taking action until symptoms had been present for some time, Prof Ó Moráin said: “Not alone is cure rare in these circumstances, but treatment is far more costly. With the increasing expense of modern drug treatments, the argument for screening becomes more difficult to resist.”

The Chairman of the IMO NCHD Committee has described recent predictions of an impending crisis in NCHD numbers as a ‘phoney war’.
Dr Matt Sadlier told IMT that it would probably only be in the week before the July changeover that a definite idea of the numbers would emerge, and thus the possible implications for the health service and the current NCHD workforce.

“At the moment, the HSE is still looking to recruit and fill the posts, so it has not looked to reassign doctors or change rosters. If that were to happen, then we would have to respond,” he stated.
Dr Sadlier believed recent media reports of an impeding crisis were part of a ‘phoney war’, as there had been no change as yet in either HSE policy or actual NCHD numbers.

It is because of expected reductions in applications for NCHD posts – and not because of budgetary challenges – that the HSE is seeking “reductions in tiered on-call and improved cross-cover arrangements”, Health Minister Harney has claimed.
Speaking in the Dáil, she said: “Instead of cases being referred through successive tiers of doctors, we need to increase the extent to which consultants and other senior clinical decision-makers respond to urgent or emergency cases.”

Harney conceded there are likely to be difficulties in filling some NCHD posts when doctors begin their next rotation in July. “The indications are that there will be a reduction in the number of applications for certain NCHD posts, especially in posts that aren’t part of a formal training rotation scheme and in emergency medicine, anaesthesia and general medicine. However, the extent of any shortfall will only become evident over the coming weeks,” the Minister said.
“I’ve made it clear to the HSE that it needs to increase the number of consultants and reduce the number of NCHDs to achieve a more appropriate balance between both groups,” Minister Harney said.
“I’m also determined to support the changes in the NCHD training status and associated medical registration status…under the Medical Practitioners Act 2007.”

Day-patient discharges increased by 7.3 per cent and inpatient discharges decreased by 0.2 per cent between 2007-’08, according to the latest ESRI hospital activity figures.
The report — which presents information on discharges from acute public hospitals participating in the Hospital In-Patient Enquiry scheme (HIPE) in 2008 — reveals that close to 1.37 million discharges were reported in 2008 compared to 1.32 million discharges in 2007. Some 56.3 per cent of total discharges were day patients.

Total discharges used over 4.47 million bed days in 2008 — an increase of 0.5 per cent on the 2007 figure. Acute in-patients with a length of stay of 30 days accounted for 42.5 per cent of total discharges and 60 per cent of total bed days.
Extended-stay inpatients (length of stay greater than 30 days) accounted for just 1.2 per cent of total discharges, but 22.8 per cent of total bed days, while day patients accounted for 17.2 per cent of total bed days.
The average length of stay for acute inpatient discharges was 4.6 days. This varied by hospital type: voluntary hospitals recorded an average length of stay of 6.1 days for acute in-patient discharges, compared to 4.5 days for regional hospitals and 4.3 days reported for county hospitals.

The Government is presiding over the closure of almost a quarter of the hospital beds in the country, the Fine Gael Health Spokesperson, Dr James Reilly, has claimed. HSE figures show that there are over 1,500 beds closed or unavailable around the country for a variety of reasons including delayed discharges.
Three hundred and thirty-three more beds are closed due to cost savings, infection control or refurbishment than were closed this time last year.

“Together with the 1,100 closures the HSE is planning, this means that almost a quarter of our hospital beds will be closed,” said Dr Reilly.
He said the inevitable result would be more patients on trolleys, more cancelled operations and longer waiting lists.
“Long-term facilities that are publicly funded are also facing the Government’s axe. This makes no sense when these long-stay beds are going to be needed to care for people who are stranded in acute beds. How can the HSE confidently predict a positive impact from the Fair Deal if long-stay beds are being closed down?”

Greater efforts could be made to cut waiting times of over 12 months at five hospitals across the country, according to the Chief Executive of the National Treatment Purchase Fund (NTPF).
CEO Pat O’Byrne said the Fund was still experiencing difficulties with regard to Tallaght, Tullamore, Crumlin, Temple Street and Limerick Regional hospitals. “If a hospital can treat patients waiting fewer than 12 months, why can they not treat a handful of patients waiting more than 12 months? If patients are deemed to only be treatable in-house, why cannot these hospitals do this? The solution is a two-way process,” O’Byrne said at the recent launch of the NTPF’s 2009 Annual Report.

Approximately 6 per cent of the NTPF’s work was performed in public hospitals last year — a figure on which the CEO would like to see ‘more progress made’. Some progress had been achieved at Crumlin and Temple Street hospitals, where many more ‘slots’ for children have been provided.
“I would like to see the slots used. But the issues are wider than quotas,” he added.
The measures put in place by the three children’s hospitals, together with Cappagh, were ‘more than capable of dealing with the scoliosis issue, for instance’, O’Byrne added.
On average, waiting times across the country have been reduced to 2.5 months, he claimed. “Two years ago, there were over 4,000 patients waiting over 12 months. Three years ago the figure was 6,000 patients. Today the figure is 611,” he added.

The training body for psychiatrists in this country has said that there is ‘no evidence’ of a link existing between antidepressant use and homicide, and that research has failed to establish a causal link between the use of these medications and suicide.
In a detailed three-page document released recently, the College of Psychiatry of Ireland said recent discussions surround-ing these risks had been ‘speculative’ and failed to recognise that untreated depression can have a fatal outcome.

It was also concerned that a mooted link between antidepressants and violence, which it stressed did not have a basis in scientific evidence, risked perpetuating a ‘false and stigmatising stereotype’ that people living with mental illness were violent.
While not referring directly to the case, the College’s statement is a long-awaited direct response to issues raised by the tragic cases of 22-year-old Shane Clancy, who died in Bray in August 2009, after he had stabbed to death Sebastian Creane.
The College of Psychiatry of Ireland was not allowed to give evidence at the inquest into Clancy’s death.
The College indicated that evidence was given at the recent inquest at the Wicklow Coroner’s Court that the self-inflicted death of a person — and by inference, the killing of another person — was most likely the direct result of SSRI antidepressant use, specifically, citalopram.
“We address the inquest here simply to respond to the sworn expert evidence, which was, in our view, speculative,” the College stated, in reference to evidence given by Prof David Healy of the University of Cardiff, who said that while ‘extraordinarily rare’, SSRIs could spark suicidal or homicidal reactions.
Responding to this latest statement, Prof Healy was reported as stating that it was ‘astonishing’ that the College would say there was no scientific basis to claims there were risks.
The College recognised that suicide and homicide were events of the ‘utmost gravity’ and any possible role of any treatment in precipitating such tragedies warranted the most thorough investigation. “However, discussion of the risks involved must be based on evidence rather than conjecture or unfounded opinion,” it added.
It also recognised that, at an individual level, the period early in treatment may be a time of increased risk for suicidality, and that this was something of which all doctors should be aware.

The IHCA is to meet the HSE at the end of the month to discuss the implications of a planned 900 drop in NCHD posts across the health service this July, which the Association has described as a ‘new and unnecessary crisis in the Irish health system’.
The consultants believe the Executive is going to have to explore ‘every possibility’ to recruit doctors at the NCHD grade, who are competent, eligible for the Medical Register as it currently stands, and proficient in the English language, according to Irish Hospital Consultants Association Assistant Secretary General, Donal Duffy.

The HSE has designated just 3,600 NCHD posts as recognised training posts from 1 July, which will mean a reduction of approximately 900 posts from current figures. Duffy fears the greatest impact of these cuts in numbers will be seen in anaesthesia — with knock-on consequences for surgery and obstetrics — and in emergency medicine.
It has been suggested that the 900 doctors could be given a temporary training designation for the next two years to resolve the pending crisis. Another possibility would be to convert some of these NCHD posts to consultant posts, which would fulfil commitments given by successive Ministers that there should be a significant increase in the number of consultants.
Under the Medical Prac-titioners Act, the Medical Council oversees training and the HSE is obliged to designate training places. Whereas heretofore, every NCHD was regarded as a doctor-in-training, the Medical Council has now designated 3,600 such places – a drop of 900.
Meanwhile, the RCPI has described its new structured postgraduate medical training programme at registrar level as a ‘major advance’ for trainees, which will help resolve the glaring deficits of the unregulated ‘gap years’ between Basic and Higher Specialist Training. Launched last week (May 13, 2010), the Registrar Training Programme (RTP) will provide approximately 200 places to SHOs in general medicine (125 places), paediatrics (35), pathology (25) and obstetrics and gynaecology (25) looking to enter an SpR programme.
The programme has been approved by the Medical Council and HSE, and will be introduced as a one-year programme on a pilot basis on July 1.
Speaking to IMT, RCPI CEO Leo Kearns stressed that this new programme was primarily designed for those who had just completed BST, or who were one or two years finished, not for long-term registrars.
“There could be anything up to 1,100 to 1,200 NCHDs who don’t necessarily fall into these training programmes, either the existing programmes or this new programme. But they would be people who are much longer in their post,” he said, adding that the lack of accurate data made it difficult to come up with precise numbers.
Prof TJ McKenna, Chair of the Irish Committee on Higher Medical Training, added that the new programme was in no way an attempt to address the problem of these so-called ‘long-term registrars’. “We have made suggestions as to the best way of optimising the position of those individuals within the health service, but that is at a very early stage. But I think it is the next big thing to tackle,” Prof McKenna told IMT.