Questions to ask your doctor before an operation

Each year thousands of people in the UK undergo private surgery, paid for by their health insurance or paid for by themselves (self-pay surgery). Before selecting your surgeon, or agreeing to go ahead with a private operation, it’s important that you are fully informed. There are benefits to every operation; but there are also associated risks.

Our checklist of questions to ask your doctor will ensure that you get the feedback you need to make an informed decision about going private for your operation. Take this checklist to your consultation or write out your own list of questions. Ask the doctor if you can record the consultation so that you can play it back afterwards. (It’s a stressful situation; people often forget much of what they have been told or fail to take it in.)

We have a separate checklist of questions for cosmetic surgery.

• Questions to help you decide on whether to have surgery
  
• Questions about the surgeon
  
• Questions about the hospital or clinic
  
• Questions about the payment terms
  
• Questions about the operation
  
• Questions about after the operation and recovery
  

Making the decision

• Do you have any advice leaflets or video material about this operation that I can use?
  
• Are there any published papers about this operation that you would recommend?
  
• Are there any web sites that you recommend that would be informative?
  
• What are the risks involved in this operation? How likely are these risks?
  
• How much improvement can I expect from this kind of operation?
  
• What can I expect if I decide not to have the operation?
  
• What are the alternative treatments/options to having the operation?
  
• If I decide to delay the operation, what are the implications of this?
  

The surgeon

• What is your experience of doing this type of surgery?
  
• How many operations of this type do you carry out each year in the NHS and in the private sector?
  
• What are your success rates for this operation?
  
• Do you have any additional certification/qualifications that make you more experienced in performing this operation? (See our list of medical qualifications)
  
• What is the rate of complications that you experience with this kind of operation?
  
• Can I speak to any of your past patients?
  

The hospital or clinic

• Where will the surgery be carried out?
• What are the back up medical facilities there, if something goes wrong during the operation?
  
• How often do you operate there?
  
• Where else do you operate?
  
• Do I have a choice of private hospital or clinic where the operation is carried out?
  
• What is the post-operative infection rate at the clinic/hospital where the operation will take place?
  

Payment terms

These questions depend on how you are paying for surgery. Are you covered by health insurance, or are you paying for yourself? It may be more appropriate for you to direct these questions to the private hospital or clinic.

• What is included in the price?
  
• What is not included in the price?
  
• What happens if something goes wrong and I need further treatment or another operation? Who pays for your additional fees? Who pays for the additional hospital costs?
  

The operation

• How long will I have to stay in the hospital?
• How long does the operation last?
  
• What type of anaesthesia will be used? What are the risks of this type of anaesthesia?
  
• What can I expect after the operation?
  

For joint replacements

• What type of joint replacement/prosthesis will be used?
  
• What is the success rate for this type of joint replacement/prosthesis?
  
• Where can I find more information about this type of joint replacement/prosthesis?
  
• How long will the joint replacement/prosthesis last?
  

After the operation

• How much pain is it normal to expect after the operation? How long will the pain last?
  
• What complications can occur with this kind of operation?
  
• How soon can I have visitors?
  
• Will I need physiotherapy after the operation? For how long? Where will this take place?
  
• What help will I need at home after the operation? For how long will I need help?
  
• How long will it be before I can go back to work?
  
• What restrictions will there be on my normal activities after the operation? For example, will I be able to drive/climb stairs/run/play sport/have sex/take a bath?
  
• When will I need to come back for a follow up appointment?
  

Medical training of UK doctors and specialists

Becoming a doctor in the United Kingdom involves study at university for a Degree in Medicine known as a Bachelor of Medicine or BM; the undergraduate course usually takes five years.  It has a core curriculum which is overseen by the General Medical Council (GMC).  To get into medical school, entrants must achieve high grades at ‘A’ level (or equivalent) and show evidence of their commitment to medicine, for example by doing work experience or voluntary work. 

The GMC revised the undergraduate curriculum in 1993 and the programme is now an integration of the former ‘preclinical’ and ‘clinical’ courses (which involved two years preclinical and a three year clinical course where students worked in hospital wards under supervision) and includes dedicated time for other crucial competencies such as communication skills, problem-based learning and practical clinical tasks. 
Upon successful completion of their degree doctors receive their primary medical qualification and are given one of the following abbreviations to denote this:  MB, MBBS, MBChB, BM and BCh.

Postgraduate study

In 2005, a new two year Foundation Programme was introduced by the Modernising Medical Careers (MMC) initiative within the NHS for trainee doctors - United Kingdom.  Involving a series of placements within a variety of specialties and healthcare settings it provides a thorough grounding in practical medicine and the opportunity to develop core clinical skills.  Placing more emphasis on communication, team working and IT skills within an NHS hospital, the first year, known as Foundation Year 1 (F1) is equivalent to the old pre-registration house officer (PRHO) year and the second year, or Foundation Year 2 (F2) is equivalent to the first year as a senior house officer (SHO).

Consultant and specialist training

After doctors have undertaken Foundation Years 1 and 2 (the old PRHO and SHO) they can undertake further specialist training in Senior House Officer (SHO) and then Specialist Registrar (SpR) posts.  SpR training usually takes around four to six years, depending on the specialty.  New training programmes for specialists are planned from August 2007.

The Postgraduate Medical Education and Training Board (PMETB) is responsible for all postgraduate medical training in the UK, including general practice.  PMETB awards Certificates of Completion of Training (CCTs) to doctors who reach the necessary level of competence to be included on the Specialist Register which is maintained by the GMC. 
 

General Practitioners (GPs)

Postgraduate training to become a General Practitioner (GP) involves the two-year Foundation Programme and at least three years' further training in posts approved by PMETB including a minimum of 12 months' vocational training (with this amount due to increase) as a GP Registrar.  The PMETB awards CCTs to general practitioners.
In April 2006 the GMC introduced a new Register of GPs for doctors who have completed the appropriate training and all doctors working in general practice in the NHS (with the exception of doctors in training such as GP Registrars), must register.

Continuing Professional Development (CPD)

The education and training doesn’t stop once the text books have been closed and the final exam taken.  After years of formal study doctors are expected to keep their knowledge and skills up to date through Continuing Professional Development (CPD) programmes.  CPD helps doctors keep abreast of the constantly evolving world of medicine, changes to the profession or their environment and helps them to maintain good medical practice.

Links

• Modernising Medical Careers (MMC) – Information on the NHS programmes.
• The Postgraduate Medical Education and Training Board (PMETB).
• The Royal College of General Practitioners (RCGP), the academic organisation for general practitioners in the UK.

Skin disorders (dermatology): Private clinics in the UK

Dermatology is the branch of medicine dealing with skin disorders such as lumps, ulcers, eczema, acne and skin cancer.

A skin specialist or dematologist will deal with many different types of skin disorder. In the UK, the professional dermatology association is the British Association of Dermatologists.

New pathway 'could prevent brain cancer surgery'

Brain tumour patients could soon be treated without the need for surgery.

Research from the German Cancer Research Center and Heidelberg University Hospital has indentified a metabolic pathway that causes glicomas – an aggressive brain tumour – to grow while inhibiting the body's immune system.

Doctors explained the newly-discovered metabolic pathway begins with the breakdown of an amino acid and results in the stimulation of tumour-growing receptors.

"We will start searching for substances that specifically inhibit this metabolic pathway and may be used as potential anti-tumour drugs," said Professor Wolfgang Wick, co-leader of the study.

Scientists believe this development is important as many glicomas reoccur after they are removed by surgery.

Malignant brain and spinal cord tumours were responsible for 3,674 deaths in the UK in 2008, according to Cancer Research UK.

© Adfero Ltd
  
Cancer treatment news : 8 October 2011

New screening could improve brain cancer treatment

12 October 2011

Cancer diagnosis for brain tumours could see a change as research has found a new way to screen for killer cells.

Researchers at the UCLA Jonsson Comprehensive Cancer Center have developed a molecular screening approach that identifies chemical compounds that can target the stem cells responsible for creating deadly brain tumours.

The study found that an advanced screening method could detect two types of cells - a larger, heterogeneous population of tumour cells and a smaller sub-population of stem cells, which are often treatment-resistant.

Led by Dr Harley Kornblum, a Jonsson Cancer Center scientist and a professor of psychiatry and biobehavioral sciences, the study is to be published in the October edition of Molecular Cancer Therapeutics.

Dr Kornblum said: "When brain cancer stem cells were first discovered, we all realised rapidly that we would need to find drugs that attack these cells specifically, because they're resistant to our conventional therapies. We needed a way to kill these stem cells."

He added that the new screening method, which tested 31,000 compounds, will allow for further drug development and cancer detection.

A combination of radiotherapy, chemotherapy and surgery are the most common methods currently used to treat brain tumours.

By Jeanette Royston

Kornblum, Harley, et al., "A Molecular Screening Approach to Identify and Characterize Inhibitors of Glioblastoma Stem Cells", Molecular Cancer Therapies, October 2011.

Health News is provided by Adfero in collaboration with Spire Healthcare. Please note that all copy above is ©Adfero Ltd. and does not reflect views or opinions of Spire Healthcare unless explicitly stated. Additional comments on the page from individual Spire consultants do not necessarily reflect the views or opinions of other consultants or Spire Healthcare.
 

Preclinical Testing Shows Improved Effectiveness Of New Oncolytic Virus

News Date: 10/28/2011 Outlet: mediLexicon

Main Category: Cancer / Oncology

Also Included In: Breast Cancer | Neurology / Neuroscience | Prostate / Prostate Cancer

Article Date: 28 Oct 2011

A new fourth-generation oncolytic virus designed to both kill cancer cells and inhibit blood-vessel growth has shown greater effectiveness than earlier versions when tested in animal models of human brain cancer.

Researchers at the Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James) are developing the oncolytic virus as a treatment for glioblastoma, the most common and deadly form of brain cancer (average survival: 15 months after diagnosis).

The new oncolytic virus, called 34.5ENVE, improved survival of mice with transplanted human glioblastoma tumors by 50 percent in a majority of cases compared with the previous-generation oncolytic virus.

The study was published online in the journal Molecular Therapy.

"These findings show the amazing therapeutic efficacy of this new oncolytic virus against four different glioblastoma models in animals," says cancer researcher Dr. Balveen Kaur, associate professor of neurological surgery, and a member of the OSUCCC - James viral oncology research program.

The new oncolytic virus is engineered to replicate in cells that express the protein nestin. First identified as a marker for neuronal stem cells, nestin is also expressed in glioblastoma and other malignancies including gastrointestinal, pancreatic, prostate and breast cancer.

"We believe that nestin-driven oncolytic viruses will prove valuable for the treatment of many types of cancer," Kaur says.

The new oncolytic virus also carries a gene to inhibit tumor blood-vessel growth. That gene, called Vstat120, was added to increase its anti-tumor effectiveness and prolong the virus's presence within tumors.

In this study of eight animals with intracranial tumors, six lived longer than 80 days, and these were later found to be tumor free. By comparison, control mice survived a median of 20 days, and mice treated with a first-, a second-, and a third-generation oncolytic virus survived 33, 34 and 53 days, respectively.

"Magnetic resonance imaging and histological analyses revealed extensive tumor destruction in animals treated with 34.5 ENVE," says Kaur, who is also chief of Ohio State's Dardinger Laboratory of Neurosciences. "We hope that we can soon evaluate the safety of this virus in patients with cancer."

Theralase Successfully Expands Cancer Destruction Applications Brain and Colon Cancer Cells Killed by Light Activated Photo Dynamic Compounds (PDCs) - Suggesting a Promising Approach for Cancer Therapy

TORONTO, ONTARIO, Oct 27, 2011 (MARKETWIRE via COMTEX) -- Theralase Technologies Inc. CA:TLT -12.00% announced today results of investigational studies demonstrating destruction of specific brain and colon cancer cell lines, when successfully treated with Theralase's patented light activated Photo Dynamic Compounds (PDCs).

Roger Dumoulin-White, President and CEO of Theralase stated, "This new research expands the application of Theralase's patented PDC technology in the cancer field and introduces the potential for a successful impact on two devastating forms of cancer; specifically, brain and colon cancer. Our research has demonstrated a significant kill rate of greater than 90% in specific human brain and colon cancer cells lines. These results now lay the groundwork for further pre-clinical trials, which if proved successful may lead to human clinical trials. Theralase plans to aggressively pursue commercialization of its ground-breaking PDT technology through the accelerated FDA regulatory approval process. This FDA process "fast-tracks" approval when a treatment is shown, through proven success rate, to have a positive impact on serious, life-threatening medical conditions for which no other drug or treatment exists or is as effective. Theralase also plans to continue its research and development to optimize its PDCs, from the same platform, to destroy a variety of life threatening cancers."

Dr. Arkady Mandel, Chief Scientific Officer at Theralase Inc. stated, "We are extremely pleased with our results. Remarkably, with only 10 minutes of light exposure by Theralase's proprietary light source is sufficient to effectively energize Theralase's patented Photo Dynamic Compounds to destroy human brain and colon cancer cells in-vitro. Moreover, initial drug stability testing suggests that the efficacy of the PDC was not compromised even after one year of storage at appropriate conditions. This suggests a highly stable compound, which is an important consideration in product clinical development and commercialization. Further studies are planned to correlate these findings with improvement in brain and colon cancer survival."

About Theralase Technologies Inc.

Theralase Technologies Inc. founded in 1995, designs, develops, manufactures and markets patented, superpulsed laser technology utilized in biostimulation and biodestruction applications. The technology is safe and effective in the treatment of chronic pain, neural muscular-skeletal conditions and wound healing. When combined with its patented, light-sensitive Photo Dynamic Compounds, Theralase laser technology is able to specifically target and destroy cancers, bacteria, viruses as well as microbial pathogens associated with food contamination. For further information please visit www.theralase.com , regulatory filings may be viewed by visiting www.sedar.com .

This press release contains forward-looking statements which reflect the Company's current expectations regarding future events. The forward-looking statements involve risks and uncertainties. Actual results could differ materially from those projected herein. The Company disclaims any obligation to update these forward-looking statements.

Neither TSX Venture Exchange nor its Regulation Services Provider (as that term is defined in the policies of the TSX Venture Exchanges) accepts responsibility for the adequacy or accuracy of this release.

ABTA Lends Its Voice to National Patient Advocacy Initiatives

The American Brain Tumor Association is proud to join with other national patient advocacy organizations in supporting numerous worthwhile initiatives aimed at helping individuals with brain tumors and other diseases.

• Recently, we applauded the House Appropriations Committees’ inclusion of a much-needed increase in funding granted to the National Institutes of Health (NIH) in its draft FY12 Labor, Health and Human Services, Education, and Related Agencies funding bill. NIH funding vital to the millions of Americans hoping for breakthroughs in medical research.

• We also encouraged the Congressional Joint Select Committee on Deficit Reduction to protect funding for Medicare Part D—which is beneficial to millions of Americans who rely on its provisions for essential medications—as they look for ways in which to trim federal spending.

• Finally, we encouraged the Committee on Health, Education, Labor and Pensions to re-examine conflict of interest provisions on Special Government Employees serving on Food and Drug Administration (FDA) Advisory Committees, in order to ensure that such rules do not unnecessarily deprive the FDA of the expertise of the most well-informed researchers, clinicians and patients, especially in the area of rare diseases, where the potential pool of qualified individuals is already limited.

Victoria Reggie Kennedy Shares Her Thoughts with ABTA

Victoria Reggie Kennedy on "Our Brain Tumor"

Victoria Reggie Kennedy on Bringing Attention to the Cause

Victoria Reggie Kennedy on Leading by Example

Victoria Reggie Kennedy on Living in the Present, Planning for the Future

Victoria Reggie Kennedy on Inner Strength

Victoria Reggie Kennedy on The Need for Research Funding

Victoria Reggie Kennedy on Her Advice to Others

Victoria Reggie Kennedy on Being an Advocate

Victoria Reggie Kennedy on The Importance of Asking Questions

Victoria Reggie Kennedy on "The Greatest Gift"

Victoria Reggie Kennedy on The American Brain Tumor Association

ABTA Presented with 2011 Ellyn Bushkin Friend of the Foundation Award from Oncology Nursing Society

The Oncology Nursing Society Foundation honored the American Brain Tumor Association this month with the 2011 Ellyn Bushkin Friend of the Foundation Award.  Craig J. Byrum, ONSF Director of Development and Margaret Hansen Frogge, RN, MS, a member of the ONS Board of Trustees and Immediate Past President, were on hand to present the Award to the ABTA President and Chief Executive Officer Elizabeth Wilson, as well as two members of the ABTA Board of Directors – Chair Claudette Yasell and Vice-Chair Ronald Petrocelli, MD.

“The Ellyn Bushkin Friend of the Foundation Award is given to an individual or group who clearly exemplifies charity, leadership and service, and the American Brain Tumor Association, in support of small research grants over the years, certainly exemplified these attributes,” said Ms. Frogge. 

“The American Brain Tumor Association has given over $80,000 that supported ten small research grants for quality of life research, symptom management, survivor issues, all of which are very critical to neuro-oncology nursing,” said Margaret Hansen Frogge.  “The Oncology Nursing Society is extremely grateful for the past and ongoing support of the ABTA.”

.abta.org