Friday, November 21, 2014

Cardiology November 5

Report to Orthopaedic Surgeryfrom Cardiovascular Services:

He developed angina towards the end of 2013 precipitating an angiogram which was performed in April 2014, This showed patent grafts [including a patent LIMA graft to the LAD, patent RIMA to the marginal system, patent vein grafts to the diagonal and right coronary arteries].

Overall, this was a reassuring angiogram and means that no myocardial revascularisation was indicated.

From the point of view of elective orthopaedic surgery, [there is] significant co-morbidity and his operatve risk will be influenced by that. From the coronary point of view however he is very stable and already takes low dose beta-blockers. His condition is therefore optimal and nothing further can be done to reduce what will be a moderate peri-operative risk.

The question is whether to press for a right knee replacement, or should I put up with it for the 20 months I probably have left. The vascular surgeons will probably recommend against it.

Tuesday, November 11, 2014

Product Development Partnerships

Developing Countries: Health Services


Asked by Lord Avebury
To ask Her Majesty’s Government what steps they plan to take to promote integrated healthcare structures and policy in the United Nations post-2015 development agenda.[HL2444]
The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD):The UK government supports the inclusion of integrated approaches to healthcare in a post 2015 agenda, as shown through the emphasis on Universal Health Coverage in the Report of the High-Level Panel, chaired by the Prime Minister, and its inclusion as a target in the proposal of the Open Working Group for Sustainable Development Goals.
Asked by Lord Avebury
To ask Her Majesty’s Government whether they plan to promote innovative medical technologies and product development partnerships as part of the post-2015 development agenda.[HL2445]
To ask Her Majesty’s Government what is their policy on the potential role of product development partnerships in the post-2015 development agenda. [HL2447]
Baroness Northover: The UK Government recognises the important role of new health technologies and product development partnerships (PDPs) in achieving the Millennium Development Goals and in the post-2015
10 Nov 2014 : Column WA3
agenda. The UK is the second largest government supporter of this research and will continue to promote it along with international partners.
Asked by Lord Avebury
To ask Her Majesty’s Government what discussions they have held with international counterparts on including product development partnerships in the post-2015 development agenda.[HL2446]
Baroness Northover: Officials from my Department regularly discuss the importance of product development partnerships (PDPs) and the continued important role for technology development in the post-2015 development agenda. The UK currently chairs the international Product Development Funders’ Group, including both bilateral and multilateral agencies as well as private foundations. Officials also participate in the annual Product Development Forum arranged by the Bill and Melinda Gates Foundation.
Asked by Lord Avebury
To ask Her Majesty’s Government what assessment they have made of the outcomes arising from the Department for International Developments-sponsored product development partnerships.[HL2448]
Baroness Northover: Public private product development partnerships (PDPs) have been shown to expedite the development of new drugs, vaccines and diagnostic tests, achieving results faster than either the public or private sectors alone.

Prior to the creation of PDPs, only 20 drugs were developed for neglected diseases between 1975 and 2000. Since 2000, UK Government funded PDPs have developed 19 new products including drugs for malaria, TB, neglected tropical diseases (such as sleeping sickness and visceral leishmaniasis), one vaccine for diarrhoea (rotavirus) and six new diagnostic tests (5 for TB and the first ever rapid diagnostic test for sleeping sickness).

Saturday, November 08, 2014


Consultation October 29. Blood results (last reading 4 weeks before in brackets) Hb 100 g/L(105); WBC 3.1x109/L (3.1)); neutrophils 1.43x 109/L (1.30); platelets 424x109/L (347), MCV 110 fL. Hydroxycarbamide to remain at 5 times/week but might be reduced further at next consultation November 26 if Hb continues to fall. Problem then would be that platelets would rise above desirable level.

Thursday, November 06, 2014

In Dylan Thomas's sitting room

Lindsay sitting at Dylan Thomas's desk at 5 Cwmdonkin Drive, Swansea with a photograph of her mother with Dylan in Caswell Bay behind her, November 5

Sunday, October 26, 2014

Labrador overnight guests

House guests last night - Fiki (white) and Khulu (black_

Thursday, October 16, 2014

Ophthalmology October 2

Diagnosis: Bilateral cataracts, bilateral macular degeneration
Visual acuity: 6/9 right eye, 6/9 left eye

OCT scan showed atrophy and mild subretinal fluid at the left macula, and retinal pigment epithelium disturbance with no fluid at the right macula. Both eyes are white and quiet and lens opacities were noted bilaterally. Geographic atrophy was noted at the left macula with some subretinal fluid. Retinal pigment epithelium disturbance was noted at the right macula with patchy hyperpigmentation. No treatment is indicated at present.

We have explained to him the risks and benefits of cataract surgery and the guarded prognosis due to macular degeneration. We have given him some information to read regarding cataract surgery and we will see him again in 2 to 3 months time with his decision......
The 'Guide to cataract surgery' says nothing about the 'guarded prognosis due to macular degeneration', but since 95 out of 100 notice an improvement in their vision and only 1 in 1,000 experience a total loss of vision after surgery it is a good bet. The Guide says there isn't a point when the condition is 'ripe' or 'ready' for surgery, but it should be when it affects daily life. Though I can still drive, 6/9 is getting close to the margin, so I think I'll ask to go ahead at the next appointment.

With Jason Brooke, founder of the Brooke Heritage Trust today