News Article | May 15, 2017
A "second spike" in cyber-attacks has not hit the NHS but some hospital trusts are suffering ongoing disruption due to Friday's ransomware attack. Routine surgery and GP appointments have been cancelled across the NHS as it recovers from the global outbreak. But the number of hospitals diverting patients from A&E has decreased from seven on Sunday to two. They are the Lister Hospital in Hertfordshire and the Broomfield Hospital in Essex. Health Secretary Jeremy Hunt, who attended a Cobra committee meeting on cyber-security on Monday, said it was "encouraging" that there has not been any fresh attacks, although the National Crime Agency said this did not mean there would not be one in the future. "We've not seen a second wave of attacks and the level of criminal activity is at the lower end of the range that we had anticipated," he said. At least 16 trusts out of 47 that were hit are still facing issues, leading to further cancellations and delays to services, BBC research suggests. Patients have been told to turn up for appointments, unless advised otherwise, although some GPs are asking people to consider whether they really need to attend the surgery imminently. But Dr Anne Rainsberry, national incident director at NHS England, said there were "encouraging signs" the situation was improving. "The message to patients is clear: the NHS is open for business. Staff are working hard to ensure that the small number of organisations still affected return to normal shortly." With the NHS slowly getting on top of the disruption caused by the cyber attack, attention, naturally, starts to turn to who is to blame for the fact it seems to have been so vulnerable. Some hospitals appear not to have installed patches sent out in April that were designed to deal with the vulnerability which this attack appears to have exploited. But there could be good reason for this - checking that they were compatible with the rest of the IT system is certainly one. And, as yet, it is not clear if the trusts affected are the ones which had not used the patch. So what about ministers? We know there have been warnings before about IT security in the NHS - last summer a review said it needed looking at. But the problem is that over the last three years the capital budget - which is a ring-fenced fund used to pay for buildings and equipment - has been raided by the government to bail out day-to-day services, such as A&E. Last year a fifth of the capital budget was diverted. That, of course, makes it more difficult for trusts to keep their systems up to date. The ransomware that hit the NHS in England and Scotland, known as Wanna Decryptor or WannaCry, has infected 200,000 machines in 150 countries since Friday. Europol, the EU's law enforcement agency, has called the cyber-attack the "largest ransomware attack observed in history". Home Secretary Amber Rudd, who chaired the Cobra meeting on cyber security, said the UK was working with international partners in the global manhunt to find the ransomware's creators. "The National Cyber Security Centre and the NCA are working with Europol and other international partners to make sure that we all collect the right evidence, which we need to do, to make sure we have the right material to find out who has done this and go after them, which we will," she said. Barts Health NHS Trust, which runs five hospitals in east London, says it continues to experience some "delays and disruption" to services. It says it has "reduced the volume" of planned services for Monday and Tuesday, which means some surgery and outpatient appointments will be cancelled. However, its hospitals remain open for emergency care and it is no longer diverting ambulances from its sites. The trust said its trauma and stroke care services are now fully operational, as are renal dialysis services. More on the latest NHS disruptions The ransomware, which locks users' files and demands a $300 (£230) payment to allow access, spread to organisations including FedEx, Renault and the Russian interior ministry. In England, 47 NHS trusts reported problems at hospitals and 13 NHS organisations in Scotland were affected. NHS Wales said none of its computer systems was affected and no patient data compromised, while police in Northern Ireland said no incidents had been reported. Responding to suggestions that the NHS had left itself open to an attack of this nature, Mr Hunt told the BBC it had "massively" upgraded its security before the incident. This included reducing the number of computers that were using an older Microsoft operating system and were therefore vulnerable to attack, and setting up a security centre. Pressed that the NHS was affected by the ransomware attack because its systems were vulnerable, Mr Hunt said the NHS was a "huge network" and more than 80% of it was unaffected. Prime Minister Theresa May has denied suggestions that the government ignored warnings that NHS systems were vulnerable to cyber-attacks. "It was clear warnings were given to hospital trusts, but this is not something that focused on attacking the NHS here in the UK," she said. In July last year, the Care Quality Commission and National Data Guardian, Dame Fiona Caldicott, wrote to Mr Hunt warning that an "external cyber threat is becoming a bigger consideration" within the NHS. It said a data security review of 60 hospitals, GP surgeries and dental practices found there was a "lack of understanding of security issues" and data breaches were caused by time-pressed staff often working "with ineffective processes and technology". Meanwhile, Security Minister Ben Wallace has insisted NHS trusts have enough money to protect themselves against cyber-attacks. The "real key" was whether trusts had regularly backed up data and whether they were installing security patches, he said. Chris Hopson, chief executive of NHS Providers, told Radio 4's Today programme many hospitals use sophisticated technology such as MRI and CT scanners which are "bound to be using old software" because they have a ten-year life expectancy, so are often linked to older operating systems. He said he was "disappointed" at the suggestion by some that the cyber-attack problem was down to "NHS manager incompetence". The government is insisting that the NHS had been repeatedly warned about the cyber-threat to its IT systems, with Defence Secretary Michael Fallon stating £50m was being spent on NHS systems to improve their security. But Labour criticised the Conservatives, saying they had cut funding to the NHS's IT budget and a contract to protect computer systems was not renewed after 2015. Shadow health secretary Jonathan Ashworth pointed to a report from the National Audit Office six months ago. It highlighted how, in February 2016, the Department of Health had "transferred £950m of its £4.6bn budget for capital projects, such as building works and IT, to revenue budgets to fund the day-to-day activities of NHS bodies". The WannaCry ransomware exploits a flaw in Microsoft Windows first identified by US intelligence. Microsoft, who released a security update in March to protect computers from it, described Friday's incident as a "wake-up call". Get news from the BBC in your inbox, each weekday morning
News Article | May 15, 2017
“It was chaos,” a receptionist working the night shift at Jakarta’s Dharmais Hospital, Indonesia’s biggest cancer center, tells Fast Company. “There were 150-200 people waiting for hours and getting more impatient, waiting for their appointments. Some of them were crying.” He was just one of hundreds of thousands of people around the world at hospitals, universities, and businesses large and small who were affected by the global ransomware attack that struck computers in at least 150 countries and at its peak even forced hospitals to turn away ambulances. “Our focus is getting our systems back up and making sure our patients don’t lose out,” says Peter Gibson, a spokesperson for the East and North Hertfordshire National Health Service Trust in the U.K., which on Monday told patients to only visit its Lister Hospital emergency unit “if it is absolutely essential or you are concerned.” The trust was one of at least 48 regional public medical groups in the U.K. affected by malware that has struck more than 200,000 victims around the globe since Friday, spreading rapidly through a security hole in Microsoft operating systems that was revealed in a set of NSA files. The cyber attack, known as “WannaCrypt” or “WannaCry,” encrypted files on affected computers and demanded a ransom of at least $300 be paid in bitcoin in order to access their contents, disrupting services everywhere from Chinese gas stations to Indian police departments. There’s no sign that the malware copied any data, and U.K. health systems and other affected organizations say that customer data wasn’t stolen. Computers in Europe and Asia were particularly hard hit by the malware, which saw its spread disrupted when a security researcher registered an internet domain that acted as a “kill switch” to disable the attack code. But that didn’t help organizations that had already been struck by the malware, which led U.K. hospital operators including London’s Barts Health NHS Trust to redirect ambulances to other hospitals throughout the weekend. “We are no longer diverting ambulances from any of our hospitals,” the trust said in a Monday statement. “Trauma and stroke care is also now fully operational. However, we continue to experience IT disruption and we are very sorry for any delays and cancellations that patients have experienced.” Anthony Brett, a 50-year-old from east London, was scheduled to have surgery to insert a stent into his liver, but he was told that the procedure would have to be postponed. “To do it to the NHS that does so much good for people, it’s just disgusting,” he told the Telegraph about the unknown hackers. “They should be hung, drawn, and quartered.” Even some U.K. medical providers that weren’t direct victims of the attack still cut back services after shutting down equipment to avoid the risk of infection. “We’re not infected, but we are affected, because we’ve had to turn our computers off as a precautionary measure,” says Danny Hudson, a spokesman for the Sherwood Forest Hospitals NHS Foundation Trust. The move led to four operations being cancelled, and three outpatient clinics closed over the weekend, though services were restored by Monday, according to the hospital system. The attack forced shutdowns at other types of businesses as well, including at European auto manufacturing plants run by carmakers Nissan and Renault. “We took protective measures to immediately stop the spread of the virus and protect the [company],” says a spokesperson for Renault. “It included temporary suspension of industrial activities on some of our sites, depending on situations.” The spokesperson didn’t have a full count of the number of sites affected, and the company had not yet computed the cost of the downtime or restoration efforts Monday. All but one plant had been restarted Monday, with the holdout in the French town of Douai set to resume operations Tuesday. “We had some production impact, but we will make things happen in order to deliver [to] our customers on time,” the spokesperson said. The attack also visibly struck the German railroad Deutsche Bahn, Europe’s largest train operator. While company spokesperson Lutz Müller emphasized in an email to Fast Company that train services weren’t affected and “there have not been any security risks for both our passengers and our staff,” the malware did disable some ticket machines and digital schedule boards at German rail stations. Photos of railroad monitors displaying digital ransom notes atop arrivals and departures were shared on social media over the weekend, and Müller says Deutsche Bahn deployed additional personnel to assist passengers while the systems were down. “We are currently working hard to get all our displays running again, but this will take a few days,” he writes, adding that the railroad’s apps, website, and phone lines are working normally. Fewer systems in the Americas appeared to be affected, though delivery giant FedEx was notably impacted, leading it to suspend money-back guarantees for FedEx Express packages slated for Saturday delivery. “FedEx experienced interference with some of our systems which caused disruptions to the FedEx Express Memphis Hub sort operations,” the company said Saturday. “We immediately implemented contingency plans to minimize the impact to our customers. We regret any inconvenience this has caused.” The Memphis Commercial Appeal, the company’s hometown newspaper, reported that more than 100 FedEx flights appeared to be delayed during the busy Mother’s Day weekend, but by Monday the company said systems had returned to normal. “FedEx has resumed normal operations and systems are performing as designed,” a spokesperson said via email on Monday, declining to comment on the extent of the weekend disruption. The Canadian Broadcasting Corporation also reported that Lakeridge Health, a large Ontario hospital, was struck by the malware. The hospital didn’t respond to multiple requests for comment from Fast Company Monday, and the CBC reported that the hospital was able to restore affected computers without an impact to patient treatment. Universities across the globe were also affected by the attack, including China’s flagship Peking and Tsinghua universities. The Massachusetts Institute of Technology’s IT department warned in a Friday tweet that the ransomware was “affecting MIT folks,” though MIT officials didn’t respond to multiple requests Monday for further details. And Britain’s University of Cambridge also shut down some systems after detecting attempted attacks from the malware, according to a student newspaper, though the university said Monday no systems were ultimately infected. “The University will continue to monitor developments closely,” a spokesperson said. A ransomware spreading in the lab at the university pic.twitter.com/8dROVXXkQv The University of Milano-Bicacco also saw four computers in a student computer lab infected with the malware, and a photo of the machines was widely circulated on social media. But the ransomware was removed without any lasting damage, and the rest of the 120 computers in the lab were unaffected, wrote associate professor Claudio Ferretti in an email to Fast Company. “All the machines in the didactic laboratories normally are replicas of a single image, with no personal/single student data, and therefore no data was lost and the infected machines where immediately restored from the common clean image,” he wrote. Cybersecurity experts also continued to warn Monday that computers running versions of Windows prior to Windows 10 that haven’t been updated to fix the vulnerability could still fall victim to copycat attacks. Experts urged anyone who had not yet installed Microsoft’s security fixes, issued in March, to do so immediately. Microsoft released patches over the weekend for older, unsupported versions of Windows, including Windows XP, in an unusual move for the company. And Microsoft president Brad Smith critiqued the NSA and other spy agencies for “stockpiling” vulnerabilities that can be leaked to do damage. The identity of who was behind the malware apparently still remained unknown on Monday. Russia, widely blamed for recent hacks on government agencies and political parties around the world, denied responsibility, reporting that about 1,000 computers in the country’s Interior Ministry were struck by the attack. About $56,000 in ransom was sent to bitcoin addresses associated with the malware, a number that trickled upward throughout Monday, according to bitcoin security firm Elliptic. It was unclear, though, whether the software’s creators would be able to claim the bounty without identifying themselves. Experts still warned that creators of the original malware, or independent hackers, could tweak the code to allow the attack to continue despite the “kill switch” domain. “Companies should issue a special alert to employees today to be especially careful with opening emails and attachments even if they know the person sending the email,” said Michael Patterson, CEO of security firm Plixer, in a Monday statement. “This ransomware is evolving and there may be more to this as the week continues.” Additional reporting by Marcus Baram This story has been updated
News Article | April 28, 2017
(Reuters Health) - Instead of eating less saturated fat and worrying about so-called bad cholesterol, a group of doctors suggests an alternative approach for preventing heart disease. More important, they say, is to focus on decreasing insulin resistance and inflammation in the body by targeting diet, exercise and reducing stress. "If we target all those three things together (plus) a reduction of smoking then we’ll combat 80 percent of all heart disease," said Dr. Aseem Malhotra of Lister Hospital in Stevenage, UK, who coauthored an editorial in the British Journal of Sports Medicine. Saturated fats are mostly found in animal products like beef, pork, butter, cheese and other dairy. Blaming coronary artery disease on saturated fat that clogs arteries is "just plain wrong," according to Malhotra and his two coauthors, Dr. Rita Redberg of the University of California, San Francisco and Dr. Pascal Meier of University College London, UK. In their editorial, the three experts cite a 2015 review of past research that found no link between a diet full of saturated fats and an increased risk of coronary heart disease, type 2 diabetes, stroke due to clogged arteries, death from coronary heart disease, or death from any cause. Furthermore, Malhotra told Reuters Health, the traditional advice to reduce levels of "bad" low-density lipoprotein (LDL) cholesterol through diet and exercise "is flawed." He and his colleagues point to studies in which people who replaced saturated fat with vegetable oils containing omega-6 fatty acids did lower their LDL and total cholesterol levels but still ended up with a higher rate of death. They also cite the well-known PREDIMED trial, in which people eating a Mediterranean diet with fats from olive oil or nuts were at lower risk of heart problems than people following a low-fat diet. Another trial found better outcomes in people following a Mediterranean diet than in people eating a typical French diet, despite similar LDL levels in both groups. The best way to predict heart disease risk, they write, is to look at patients' ratio of total cholesterol to "good" high-density lipoprotein (HDL) cholesterol. A high ratio is linked with insulin resistance, which leads to high blood sugar and higher risks for heart disease, type 2 diabetes and obesity. Malhotra said insulin resistance is worsened when low-fat dieting leads people to eat more refined carbohydrates like white bread and white rice, which are not found in Mediterranean diets. He and his colleagues say Mediterranean diets, exercise and reducing stress all help combat inflammation. "I think the best way to reduce risk of heart disease and stay healthy is to concentrate on a heart-healthy Mediterranean style diet, regular physical activity and not smoking," Redberg told Reuters Health by email. Dr. Stephen Kopecky, a cardiologist at the Mayo Clinic in Rochester, Minnesota, agrees with the experts' inflammation theory but isn't ready to remove the emphasis on LDL cholesterol. Kopecky told Reuters Health that LDL levels are still an important measure to watch and treat with medications. Dr. Dariush Mozaffarian, dean of the Tufts Friedman School of Nutrition Science and Policy in Boston, also says LDL levels are still important. "I think the message is correct that we need more focus on diet and reducing inflammation," Mozaffarian told Reuters Health. "It doesn’t mean we should throw out an additional tool focusing on LDL cholesterol and treatment." Prevention doesn't involve a choice between lifestyle changes or lowering cholesterol, Mozaffarian added. "It's both," he said.
News Article | April 25, 2017
Best form of prevention and treatment are 'real' food and a brisk 22 minute daily walk The widely held belief among doctors and the public that saturated fats clog up the arteries, and so cause coronary heart disease, is just "plain wrong," contend experts in an editorial published online in the British Journal of Sports Medicine. It's time to shift the focus away from lowering blood fats and cutting out dietary saturated fat, to instead emphasising the importance of eating "real food," taking a brisk daily walk, and minimising stress to stave off heart disease, they insist. Coronary artery heart disease is a chronic inflammatory condition which responds to a Mediterranean style diet rich in the anti-inflammatory compounds found in nuts, extra virgin olive oil, vegetables and oily fish, they emphasise. In support of their argument Cardiologists Dr Aseem Malhotra, of Lister Hospital, Stevenage, Professor Rita Redberg of UCSF School of Medicine, San Francisco (editor of JAMA Internal medicine) and Pascal Meier of University Hospital Geneva and University College London (editor of BMJ Open Heart) cite evidence reviews showing no association between consumption of saturated fat and heightened risk of cardiovascular disease, diabetes, and death. And the limitations of the current 'plumbing theory' are writ large in a series of clinical trials showing that inserting a stent (stainless steel mesh) to widen narrowed arteries fails to reduce the risk of heart attack or death, they say. "Decades of emphasis on the primacy of lowering plasma cholesterol, as if this was an end in itself and driving a market of 'proven to lower cholesterol' and 'low fat' foods and medications, has been misguided," they contend. Selective reporting of the data may account for these misconceptions, they suggest. A high total cholesterol to high density lipoprotein (HDL) ratio is the best predictor of cardiovascular disease risk, rather than low density lipoprotein (LDL). And this ratio can be rapidly reduced with dietary changes such as replacing refined carbohydrates with healthy high fat foods (such as nuts and olive oil), they say. A key aspect of coronary heart disease prevention is exercise, and a little goes a long way, they say. Just 30 minutes of moderate activity a day three or more times a week works wonders for reducing biological risk factors for sedentary adults, they point out. And the impact of chronic stress should not be overlooked because it puts the body's inflammatory response on permanent high alert, they say. All in all, a healthy diet, regular exercise, and stress reduction will not only boost quality of life but will curb the risk of death from cardiovascular disease and all causes, they insist. "It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat," they write. "Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 minutes a day and eating real food." But, they point out: "There is no business model or market to help spread this simple yet powerful intervention."
Gale N.K.,University of Birmingham |
Heath G.,University of Birmingham |
Cameron E.,Aston University |
Rashid S.,Lister Hospital |
Redwood S.,University of Birmingham
BMC Medical Research Methodology | Year: 2013
Background: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research. © 2013 Gale et al.; licensee BioMed Central Ltd.
News Article | October 26, 2016
“PEOPLE have told me what I do is dangerous. They have walked away from me at meetings,” says David Unwin, a doctor practising in Southport, UK. Unwin suggests to his patients with type 2 diabetes or who want to lose weight that they do the opposite of what official health advice recommends. He advises them to stop counting calories, eat high-fat foods – including saturated fats – and avoid carbohydrates, namely sugar and starch. Telling people to avoid sugar is uncontroversial; the rest is medical heresy. But crazy as it sounds, Unwin has found that most of his diabetes patients who follow this advice are getting their blood sugar back under control, and that some are coming off medication they have relied on for years. Those who are overweight are slimming down. This might seem like just another controversial fad diet, but a growing number of researchers, doctors and nutritionists around the world are backing it, and reporting their findings in peer-reviewed medical journals. Last month, the National Obesity Forum, a UK body for health professionals involved in weight management, made headlines when it overhauled its advice, telling people to ditch calorie-counting, low-fat foods and carbs in favour of fats. The recommendations provoked a furious backlash from mainstream scientists and dieticians, but they should concern us all. If the advice is to be believed, starchy food isn’t just bad for diabetes, it makes us fat and causes heart attacks. This is analogous to finding that smoking protects people from lung cancer, says David Haslam, an obesity specialist at the Lister Hospital in Stevenage, UK, and head of the
Bretherton C.P.,Lister Hospital |
Parker M.J.,Peterborough City Hospital
The bone & joint journal | Year: 2015
There has been extensive discussion about the effect of delay to surgery on mortality in patients sustaining a fracture of the hip. Despite the low level of evidence provided by many studies, a consensus has been accepted that delay of > 48 hours is detrimental to survival. The aim of this prospective observational study was to determine if early surgery confers a survival benefit at 30 days. Between 1989 and 2013, data were prospectively collected on patients sustaining a fracture of the hip at Peterborough City Hospital. They were divided into groups according to the time interval between admission and surgery. These thresholds ranged from < 6 hours to between 49 and 72 hours. The outcome which was assessed was the 30-day mortality. Adjustment for confounders was performed using multivariate binary logistic regression analysis. In all, 6638 patients aged > 60 years were included. Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality. Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality. ©2015 The British Editorial Society of Bone & Joint Surgery.
Farrington K.,Lister Hospital
Kidney International | Year: 2013
This post hoc analysis of the recently reported Frequent Hemodialysis Network Trials suggests that frequent nocturnal treatment, unlike frequent daily treatment, may be associated with more rapid loss of residual kidney function than conventional hemodialysis. Differences in blood pressure control, among other factors, may be implicated. The study invites reflection on our current concepts of the importance of preserving residual kidney function and on the indications for frequent treatments, particularly nocturnal. © 2013 International Society of Nephrology.
Wierzbicki A.S.,Guys And St Thomas Hospitals |
Viljoen A.,Lister Hospital
Expert Opinion on Biological Therapy | Year: 2013
Homozygous lipoprotein lipase (LPL) deficiency is an ultra-orphan disease associated with increased rates of pancreatitis. Current treatments based on acute plasmapheresis allied with ultra-low fat diets are inadequate as responses to fibrates or other triglyceride-lowering therapies tend to be poor. Alipogene tiparvovec is an adeno-associated virus type I (AAV1) gene therapy using a hyper-functional LPL serine447-stop (S447X) insert administered intramuscularly under general anaesthetic with allied immunosuppression. Treatment results in histological muscle expression of LPL allied with a transient 40% reduction in triglycerides and improvements in postprandial chylomicron triglyceride content. Alipogene tiparvovec is the first possibly curative treatment for LPL deficiency. © 2013 Informa UK, Ltd.
Smith A.H.,Lister Hospital
Emergency medicine journal : EMJ | Year: 2013
Massive haemorrhage still accounts for up to 40% of mortality after traumatic injury. The importance of limiting blood loss after injury in order to prevent its associated complications has led to rapid advances in the development of dressings for haemostatic control. Driven by recent military conflicts, there is increasing evidence to support their role in the civilian prehospital care environment. This review aims to summarise the key characteristics of the haemostatic dressings currently available on the market and provide an educational review of the published literature that supports their use. Medline and Embase were searched from start to January 2012. Other sources included both manufacturer and military publications. Agents not designed for use in prehospital care or that have been removed from the market due to significant safety concerns were excluded. The dressings reviewed have differing mechanisms of action. Mineral based dressings are potent activators of the intrinsic clotting cascade resulting in clot formation. Chitosan based dressings achieve haemostasis by adhering to damaged tissues and creating a physical barrier to further bleeding. Acetylated glucosamine dressings work via a combination of platelet and clotting cascade activation, agglutination of red blood cells and local vasoconstriction. Anecdotal reports strongly support the use of haemostatic dressings when bleeding cannot be controlled using pressure dressings alone; however, current research focuses on studies conducted using animal models. There is a paucity of published clinical literature that provides an evidence base for the use of one type of haemostatic dressing over another in humans.