'There's a lot of tasks that can be done by any': Findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services

Treatment resistant depression in primary care: Co-constructing difficult encounters

Impact Factor:1.137 | Ranking:21/36 in Social Sciences, Biomedical | 81/136 in Public, Environmental & Occupational Health | 5-Year Impact Factor:1.396Source:2012 Journal Citation Reports® (Thomson Reuters, 2013)
Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients’ atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings.

© 2013 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC

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New TB treatment study

A microscope

A team of researchers, led by Professor Juraj Ivanyi at King’s, have identified potential new means to treat tuberculosis (TB). 

They have developed a monoclonal antibody which was found to offer protection against tuberculosis infection in experimental models when combined with interferon, a modulator of the immune system.

The study was carried out by researchers from King’s College London, University of Dundee, and St George’s, University of London, and the findings were published in the most recent edition of Journal of Immunology.

TB remains a recognised global emergency, claiming around two million lives across the world each year, and 2010 saw the largest number of new cases of TB in the UK for over a decade.

Approximately one-third of the world's population is infected with Mycobacterium tuberculosis, the bacterium responsible for this huge public health problem. Unfortunately, the BCG vaccine used in some countries does not protect against disease in all adults, and drugs need to be delivered for several months.

The problem has been compounded by a dramatic rise in TB strains displaying multiple drug resistance. As a result, new ways to prevent and control tuberculosis are urgently required, and the strategy developed by the London/Dundee teams paves the way toward a previously unexplored form of treatment.

With a team of collaborators, Dr Sucharitha Balu in Professor Ivanyi’s team at King’s produced the human monoclonal antibody, which is of the IgA type and can specifically recognise Mycobacterium tuberculosis. IgA antibodies are proteins normally used by the immune system to identify and neutralise foreign microbes like bacteria and viruses within the lungs and intestinal tract.

The human monoclonal antibody generated in the research is a homogeneous antibody preparation with the capability to specifically attach to the Mycobacterium tuberculosis bacterium and trigger immune processes that prevent bacterial growth. Although human monoclonal antibodies are widely used to treat various forms of cancer and inflammatory disorders, this is the first demonstration that they might have applicability against tuberculosis.

Dr Woof from the University of Dundee explained the need to develop new treatments and vaccines for TB, and the potential to develop this research further. 'The number of cases of TB remains very high, and so this is clearly a major problem,' she said. 'Across the world, there are millions of people falling victim to infectious diseases such as TB, so the implications of this research could be considerable'. 

'Antibodies exist as five different types in humans, with those of the IgG type already being used in some clinical treatments. Antibodies of the IgA type are slightly different. They possess properties that we believe may be important in governing how this IgA antibody works against TB infection'.

The study, funded in part by the Wellcome Trust and the Dunhill Medical Trust, was the result of a productive collaboration with each team bringing a different sphere of expertise. Professor Juraj Ivanyi at King’s is an international expert in tuberculosis research, while Dr Woof's team in Dundee brought experience in human IgA antibodies. Dr Reljic at St George’s has expertise and special facilities for experimental models of TB infection.

Several years of previous research by Professor Ivanyi, Dr Reljic and their collaborators at the HPA Salisbury and Palermo, Italy provided general ‘proof of concept’ for this sort of approach, while this study opens the road for translating it toward human application.

Professor Ivanyi is based at the Dental Institute at King’s, which has a long history of pioneering research into mucosal immunology and vaccines. He said: 'This study brings us much closer to finding new ways to treat tuberculosis, although further research is needed before we can begin to trial this approach in patients.

'I am excited about where this project can lead us in terms of potential new treatments for this devastating disease.'

Notes to editors

King's College London

King's College London is one of the top 25 universities in the world (2010 QS international world rankings), The Sunday Times 'University of the Year 2010/11' and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,000 students (of whom more than 8,600 are graduate students) from nearly 140 countries, and some 5,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org

For further information please contact Emma Reynolds, Press Officer at King’s College London, on 0207 848 4334 or email emma.reynolds@kcl.ac.uk

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Stem cell treatment to prevent leukaemia returning is a step closer

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Stem cells

Cancer Research UK-funded researchers at King’s College London have identified a way of eliminating leukaemic stem cells, which could in the future lead to new treatments that may enable complete remission for leukaemia patients.    An early study in mice has shown that leukaemic stem cells can be abolished by suppressing two proteins found in the body.  Leukaemic stem cells sustain the disease and are likely to be responsible for relapse, so elimination of these cells is believed to be key for achieving complete remission.  These encouraging findings highlight the two proteins as potential therapeutic targets to prevent the most aggressive forms of leukaemia returning.  
The study, funded by Cancer Research UK and Leukaemia Lymphoma Research, is published today in the journal Cell Stem Cell.  King’s scientists looked at leukaemic stem cells found in a type of leukaemia that involves mutations of the MLL gene. This accounts for around 70 per cent of infant leukaemias and 10 per cent of adult acute leukaemias. The prognosis for MLL in children is not good – only 50 per cent survive past two years after receiving standard treatment. The protein Bmi1 was already known to play a key role in the survival and proliferation of various cancer stem cells. But this study has for the first time shown that, although the protein is needed for survival of various Acute Myeloid Leukaemia (AML) cells, in MLL leukaemia the cancer stem cells actually survive independently of Bmi1.  This shows that for these MLL patients, targeting Bmi1 alone would not have a major impact on eradicating leukaemic stem cells, as was previously thought.  However, the team also found high levels of another protein called Hoxa9 in the MLL mice and human patients. Similar to Bmi1, a major role of this protein is to ensure leukaemia cells divide and grow by allowing their escape from the inherent surveillance system, which will otherwise cause cell death. They found that in mice with MLL leukaemic stem cells (that can proliferate without Bmi1), suppression of both Bmi1 and Hoxa9 completely abolishes the ability of MLL mutation to induce leukaemia.  These findings provide evidence for the different pathways involved in the development of different types of leukaemic stem cells, and highlight the importance of targeting Bmi1 and Hoxa9 together to abolish MLL leukaemic stem cells in particular.  Professor Eric So, Head of the Leukaemia and Stem Cell Biology group at King’s, said: ‘These findings take us a step forward in our understanding of how this devastating disease can return in patients after they have received the standard treatment. ‘Now we know that leukaemic stem cells in certain types of leukaemia, such as MLL, can survive and proliferate independently of the Bmi1 protein, we need to consider more carefully the future of stem cell therapy to treat the disease. It’s not as easy as people originally thought it might be.  ‘But these findings provide us with vital information that will help us look at alternative ways of combating different forms of the disease, which will ultimately allow patients to achieve long-term complete remission. ‘What we need to do now is to find out exactly how Bmi1 and Hoxa9 proteins sustains the growth of cancer cells in order to develop an effective treatment to stop the disease returning.’ Professor Peter Johnson, Cancer Research UK’s chief clinician, said: ‘This study builds on previous Cancer Research UK-funded work trying to pinpoint the molecules responsible for driving the development of MLL-related leukaemia stem cells. ‘Cancer stem cells appear to be more resistant to radiotherapy and chemotherapy than the other leukaemia cells, so understanding how they originate – and how we can kill them – will be a major step in being able to help even more people survive leukaemia in future.’ For further information please contact Emma Reynolds, Press Officer at King’s College London, on 0207 848 4334 or email emma.reynolds@kcl.ac.uk  A copy of the Cell Stem Cell paper is available on request • Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research • The charity’s groundbreaking work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.  This work is funded entirely by the   public. • Cancer Research UK has been at the heart of the progress that has already seen survival rates double in the last forty years. • Cancer Research UK supports research into all aspects of cancer through the work of over 4,000 scientists, doctors and nurses. • Together with its partners and supporters, Cancer Research UK's vision is to beat cancer. For further information about Cancer Research UK's work or to find out how to support the charity, please call 020 7121 6699 or visit www.cancerresearchuk.org Leukaemia & Lymphoma Research is the only UK charity solely dedicated to research into blood cancers, including leukaemia, lymphoma and myeloma. These cancers are diagnosed in around 28,500 children, teenagers and adults in the UK every year. As it receives no government funding and relies entirely on voluntary support, it needs to raise £120 million in the next five years to continue this lifesaving research. Further information, including patient information booklets, is available from http://www.beatbloodcancers.org/ or on 020 7405 0101. Atom Feed

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Fastcase Gets Negative Treatment

By Sean Doherty All Articles 

Law Technology News

April 26, 2013

Fastcase Bad Law Bot logo
Image: Fastcase

Product of the week ending April 26: Bad Law Bot

Manufacturer: Washington, D.C.-based Fastcase, Inc.

Description: The Bad Law Bot is a software algorithm designed to find negative case citation history. The algorithm enhances Fastcase's Authority Check feature to show subscribers where courts have noted that a case has been treated negatively (i.e., reversed or overruled on any grounds). Bad Law Bot flags cases that have negative citation history and provides links to those cases.

Target market: from solo practitioners to large law firms.

Competitive landscape: LexisNexis Shepard's Citations Service and Thomson Reuters KeyCite in Westlaw and Westlaw Next.

Price: Starts at $65 per month or $695 per year, per user.

Press release. See the Fastcase blog for more information.

The product of the week is gleaned from the many press releases Law Technology News receives to lawtech@alm.com for publication. Each week, on Friday, we will select a product or service that was newly released or upgraded within the previous four weeks of the publication date. The product or service must be of use to lawyers or law firms and help support the practice or business of law. The product must be available to readers on or before the publication date.

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