Pediatric Grand Rounds

Following on from posting the Grand Rounds, there are also the Pediatric Grand Rounds started by Clark Bartrams in April 2006.

Paediatric Approaches to ALL

We posted earlier about the advantages of paediatric protocols in the treatment of Acute Lymphoblastic Leukaemia in young adults.

There now seems to be evidence that paediatric protocols may be advantageous up to the age of 40 or beyond!

In the French GRAALL-2003 trial a paediatric-type protocol was applied to adults and showed significantly increased rates of 2-year Event Free Survival and Overall Survival in comparison with the earlier LALA-94 trial adult protocol. The results were even more impressive for T-cell lineage ALL.

Link to abstract of presentation at the 2006 American Society of Hematology conference here.

At the same conference the Canadian Princess Margaret Hospital presented evidence that a modified Dana Farber Cancer Institute pediatric ALL protocol (DFCI 91-01) was beneficial for adults.

U.K. - Final Post

To finish up, an assortment of photos from my trip to the U.K.

Bollywood Karaoke

Taking my photo on her BarbieCam.

You know who that is!

Doctors and Patients.

M.'s daughter C.

Jaime looking macho.

Tackling an Easter Egg.

Grand Rounds

From Wikipedia "A ritual of medical education, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents, and medical students. The patient is usually present for the presentation and may answer questions."

I once attended a Grand Round as a patient when I got malaria for the very first time.

Nicholas Genes at blogborygmi started the Grand Rounds of the medical blogosphere back in 2004. Rather like NHS Blog Doctor's weekly BritMeds but with a small difference in that each week a different medical blogger composes and hosts the Grand Rounds. The schedule and archives are available here.

UKALL 2003 - Delayed Intensification II (again!)

Kezia's counts were good enough today to start the reconsolidation phase of DI2. Four more weeks and counting!

Bury Market - Something for Everyone

Bury market is debatedly the most famous market in the U.K. and in 2006 won the Market of the Year award (links here and here). And as it's down the road from us, a trip definitely had the potential of a good day out.

Although not the most direct route to Bury, we caught a bus to Rawtenstall to catch the East Lancashire Railway to Bury. The ELR is a private railway running steam engines on the old Bury-Heywood branchline. Although started as a trainspotters' hobby (and I was one once, anorak and all!), it is now a valuable community service.

Up the valleys by bus to Rawtenstall (one end of the line) - beautiful sunshine, small towns, old cotton mills, stone terraces ... A short stop in Bacup where the driver advised me I could get off for a smoke. A one-legged pensioner in a wheelchair couldn't negotiate the narrow pavement and alighting so we manhandled him on. Jaime fascinated by a one-legged person!

We just made it onto the train. Kezia and Jaime were enthralled. All the Tommy the Tank Engine comic book images became real, a couple of tunnels - whooh! - the engine hoots and whistles, smoke and chugger, chugger, chugger ... We pull up in Bury and have time for photo opportunities. Jaime is invited onto the footplate (not sure he can be made out through the smoke in the photo!).





And then to Bury market.

Now I have to admit an ulterior motive here! Bury is the home of the Black Pudding! Nowhere else in the U.K. can you have a Black Pudding Sandwich - a hot, boiled black pudding sliced in two with a filling of picallili, tomato ketchup, HP sauce or mustard. A culinary delight!


The culinary delights continued - a meat-and-potato pie with mushy peas (dried peas boiled and mashed) covered in gravy (another traditional northern dish) - and then I took home some real (as opposed to shrink-wrapped) farm-made Lancashire cheese - strong, tangy, crumbly. Angus is a happy boy!

And Nanda went shopping!

Something for everyone!

Blog, MD - New Link

Sam Blackman is a paediatric haematologist-oncologist, whose blog, Blog, MD, I referred to in our last post, clearly merits a permanent link. He does not limit himself to cancers at all and is both thought-provoking and entertaining. See our links on the right.

The Sacramento Bee

Via NHSBlogDoctor and BlogMD

"the power and beauty of the photographs that earned Renee Byer of The Sacramento Bee the 2007 Pulitzer Prize for Feature reporting ... twenty photographs documenting Derek Maden, and his mother Cyndie French, during his 11-month battle against neuroblastoma."

Socialist Healthcare Horror Story

Via Jonathan at Past Peak I come across this story by Jerome a Paris about his son's treatment under the French healthcare system.

Easter Monday

Instead of going on her usual Easter (High) Church of England retreat, our dear friend M. was entertaining her daughter C. for the weekend and they offered to cook Easter Monday dinner for us.

No, not going round their place - they brought the whole kit-and-kaboodle to ours! A leg of lamb, potatoes, parsnips, carrots, greens, mint jelly and dessert!

Me and Nanda had nothing to do! Kezia and Jaime joined in!


I've known M. since I was a young teenager and she has been in and out of my life (along with her sister T.) ever since. However, this is the first time I've met her now very adult daughter. Thanks M. and C. - that was just wonderful!

P.S. ... and M. went on retreat last week and was last seen in the bar! C. of E.!

Landmines and Shavebowls II

I had to transit via an intermediate airport on the way to the U.K., hoping my change of shaving soap would resolve previous problems.

My plan backfired! Bodyshop shaving soap is so soft it might be or is considered a "gel" by airport security - and as the tub was 200 ml, more than the regulation maximum of 100 ml, it was confiscated.

Does Bodyshop sell their shaving soap in airport security-friendly 100 ml tubs? Should this be a new cosmetic industry standard?

Back to Work

I arrived back on Saturday, a 24 hour trip, and have spent the weekend recovering. A bit depressed. Back to work today and busy getting back up to speed. I will try and post more later in the week.

Kezia's neutrophil count was too low to continue treatment Wednesday last, so hopefully this Wednesday.

Patientline III

Lucia tries to draw me into the Patientline debate - I refuse to be drawn!

However, I will make some observations on the Borchardt Ward at the Royal Manchester Children's Hospital. Each bed has a Patientline terminal and yes, televison for children is free. However, each bed also has a regular donated televison set (with headphones).

Concerning telephone sets there are two regular payphones, one at the entrance to the ward and one in the middle of the ward that accepts both incoming and outgoing calls. Given a relatively relaxed mobile phone policy as well and the fact that the younger children have little need for phone services, then it is little surprise that Patientline will not be making a profit on Borchardt Ward, and I suspect throughout the RMCH.

Chickenpox

Jaime has come down with chickenpox. Fortunately, Kezia tested positive for chickenpox antibodies at the beginning of her treatment so she shouldn't pick it up.

But as he is now off school I will be accompanying Kezia on her hospital visit tomorrow as I need to see our consultant J. and a child with chickenpox obviously cannot go the the hospital. And it is a biggie tomorrow - the start of the reconsolidation phase of Delayed Intensification II. This involves IT methotrexate followed by the lengthy administration of cyclophosphamide (our chemical warfare drug!).

Patientline II

I really didn't want to get into the Patientline bed-side telephone price-hike debate - my original post on Patientline was not about this, but rather about electronic medical records.

However, in the light of professional medical opinion that mobile phone use in hospitals should be relaxed (that we reported here), of continuing cuts in government spending on the National Health Service, and the trend towards the privatisation of NHS services, it is both interesting and ironic to note that in their Announcement of the results for the year ending 31st March 2006, two of the "challenges" facing the company are

• Ward closures and an increasing number of empty beds have reduced the number of terminals being used.
• The relaxation by some trusts of their policy regarding the use of mobile phones within hospitals, despite concerns relating to patient privacy (especially given the photographic capability of most modern mobile phones) and to the intrusion into what should be a quiet environment, has also affected performance.
  

Happy Birthday

3 years old! Many Happy Returns Kezia ... have lots more! Stefan organised a beautiful cake, Kezia didn't want to blow the candles out so Jaime did. P. and P. came round as did a couple of neighbours, laden with presents including Dora's Laptop, Kezia's first computer and a very endearing penguin (which given my penchant for Linux was very apt!).

Patientline

The local press has picked up on Patientline's bedside telephone price hikes. And the local Unison shop steward is not impressed! See our previous entry on Patientline here.

P.S. And read the comments to see what the consumers think.

P.P.S. And the Welch Family (via NHS Blog Doc - link right) comment here.

A Great

... seemingly. I had never heard of him but Jon Pritchard, a great in the development of child and family-focussed childhood cancer treatment, died in January this year. His obituary appears in the Guardian today. Ironically he died of the disease he devoted his career to.

Dexamethasone Trips

I have arrived in the middle of one.

When I arrived at Chritsmas, Kezia was at first a little shy and reticent of me - perhaps not surprising given my absence from her life. This time she has welcomed me with open arms- to the extent she walked to the shop and back with me, wanted me to accompany her in her siesta and sleep next to her in the night. She has wanted lots of cuddles and physical affection from me. Within all this she has been generally good with just a couple of sobbing, but not tantrum, episodes.

Such intellectual changes. Language coming on fast - a mixture of both languages. Jaime is teaching her alot of the English he is learning from school. But also the first signs of "thinking" - looking and considering me - I ask "Are you thinking?" she nods her head, "What are you thinking about?" she continues to consider me silently.

Growing up high on Dexamethasone.

What reality poor child are you going through? What trip is this?

P.S. Lauren reports that Fergus also gets "clingy and emotional" on Dexamethasone (see Fergus Times - link on right).

I've arrived !

I've arrived ! Thanks for comment Rob. After 26 hours no sleep forced to play football! The Joys of Parenthood!

On the Way

Just spoken to Nanda. Kezia crying - the Dexamethasone. This time tomorrow I should be on the way to see them, arriving early Sunday. Don't know how much I'll write here over the next two weeks but come and have a look. There may even be some photos.

Electronic Medical Records

Dr Crippen has written several times about the government's £6.8 billion pound initiative to put everybody's medical records on a centralised national computer system (for example, here and here). I feel he is right to be concerned.

Today I read that the private telecomms operator Patientline is raising the prices of its telephone services for patients in many UK hospitals by 160%! I won't criticise them for providing bedside television to the under-16s for free but ...

However, that is not what this post is about ... as a result of the above story I visited Patientline's website and found that they offer a range of other telecomms services to the NHS Trusts including keeping electronic patient records that can be consulted at the patient's bedside. No mention here of data protection and security. I wonder if any of the PCTs have taken up the service

John - we have every reason to be concerned at the Spine, but having my medical records held electronically by a private company that is £80 million in debt is perhaps even more scary!

UKALL 2003 - Delayed Intensification II contd

Treatment day again. Doxorubicin (her last ever - a milestone albeit a minor one!) and Vincristine. Kezia will be restarting Dexamethasone for a week. Jaime started his school holidays yesterday so went along as well. They are back from hospital as I write and Jaime got another present. At my suggestion that I will be able to look after Jaime during the next appointment, Nanda said he won't want to as he likes getting presents from the hospital!

Landmines and Shavebowls

This time next week I'll be with Kezia, Jaime and Nanda. Beginning to get excited.

Everytime my hand luggage goes through the X-ray machine at the airport the above metal shavebowl attracts the attention of security. I guess the handle on the lid could be pressed causing it to explode.

Anyway, my brother gave me a plastic cylindrical shavebowl for Christmas so I think I will take that one this time.