Podcasts about nhs foundation trust

Send us a textThis podcast originally ran on October 21, 2023.This week we get down to basics, and basics are exactly what we need in this confusing world right now. This is THE podcast to listen to if you are confused about all things to do with taking hormone therapy.Dr Vikram Sinai Talaulikar is a specialist in reproductive medicine at University College London Hospital's NHS Foundation Trust and an associate professor in Women's Health at the University College London. He graduated in medicine in India in 2003 and completed a postgraduate degree in obstetrics and gynecology in 2007. He is a certified menopause specialist by the British Menopause Society, a menopause trainer and he is constantly educating others on this transition as well, via online webinars, events and through social media. He is also part of the trio who established the Menopause Research Education Fund, alongside medical journalist Fiona Clarke and groundbreaking menopause campaigner Diane Danzebrink.Highlights of our discussion: Hormone therapy (HT) 101WHI: good, bad and what we can learn from it 20 years onEstrogen in the pill vs estrogen in HT All the kinds of estrogen and what they are used for strogen too ethinyl estradiolEstrone, Estriol, Estradiol, and Estetrol.17 beta estradiolGetting to the bottom of body simila, body identical and bioidentical – and why that varies from country to country Pharmaceutical company produced HT vs compounding pharmacy versionsthe big “Catch-22” with compounding pharmacies that keeps their bioidentical hormones out of official recommendationsthe pill, HRT and breast cancer riskwhy problems with the pill don't get flagged and HRT does Evidence over estrogen and breast cancer risk (and randomized trials versus observational data)What's what: progesterone, progestin and progestogens (how they work and which one carries a slight risk for breast cancer)how long you really need to take HRT to see if it's workingwhy HT works for some people and not othersDr Talaulikar's favourite non-hormonal treatmentsWhere to find Dr Talaulikar:X: @VikramSinai Web: Menopause Clinic LondonMenopause Research and Education FundThe Living in Clarity Podcast, with Fish & Coach Do you want to live an awesome life and to also inspire others? Fish is a world...Listen on: Apple Podcasts SpotifyJoin the Hotflash inc perimenoposse: Web: hotflashinc.comNewsletter: Hotflash inc. on SubstackTikTok: @hotflashincInstagram: @hotflashincX: @hotflashinc Episode website: Hotflashinc Listen on: Apple Podcasts | Spotify | Google Podcasts | YouTube | Substack See hotflashinc.com/privacy-policy for privacy information

Women living with a chronic disease who become pregnant will find little information about the impact of their disease on their pregnancy, or about how to manage their condition while they are pregnant. Is it safe to continue taking their medication, or should they stop? The lack of evidence-based data also leaves most physicians in the dark. Two leading lights in women's reproductive health (and mothers themselves), Marie Teil, Global Head, Women of Childbearing Age Program at UCB Biopharma, and Cathy Nelson-Piercy, Professor of Obstetric Medicine at Guy's and St. Thomas's NHS Foundation Trust, say that many women they've talked to would be willing to join research studies. And they want to educate more clinicians, pharma companies, and scientists about the need to enroll pregnant women in clinical trials. This podcast is not available for CME/CE/CPD credits. Please visit the Medscape homepage for accredited CME/CE/CPD activities.

Do you remember what made you want to become a nurse? When things get tough at work, it can be helpful to reconnect with why you came to love nursing in the first place.So as the new year gets going and winter pressures put strain on the workforce, the Nursing Standard podcast brings three nurses together to talk about why they went into the profession and how they maintain their enthusiasm for work.Ana Waddington, a former RCN Nurse of the Year, is the paediatric critical care outreach team lead and Martha's Rule lead at the Royal London Hospital. She discusses how making the most of new opportunities keeps her motivated.Alder Hey Children's NHS Foundation Trust chief nursing officer Nathan Askew talks about how switching off from work and maintaining other passions helps to refresh his love for the job.And Harley Street Clinic lead radiotherapy clinical nurse specialist Jane Ewang describes the support and inspiration she receives from colleagues, both in her day job and in her work with the UK Oncology Nursing Society.The three tell Nursing Standard content editor and podcast host Alistair Mason some of the best advice they've received as nurses and offer tips on staying motivated when work is particularly tough.They also talk about the improvements they have seen in the profession over the course of their careers and highlight the things that are getting them excited for 2025.For more episodes of the Nursing Standard podcast, visit rcni.com/podcast Hosted on Acast. See acast.com/privacy for more information.

Do you remember what made you want to become a nurse? When things get tough at work, it can be helpful to reconnect with why you came to love nursing in the first place.So as the new year gets going and winter pressures put strain on the workforce, the Nursing Standard podcast brings three nurses together to talk about why they went into the profession and how they maintain their enthusiasm for work.Ana Waddington, a former RCN Nurse of the Year, is the paediatric critical care outreach team lead and Martha's Rule lead at the Royal London Hospital. She discusses how making the most of new opportunities keeps her motivated.Alder Hey Children's NHS Foundation Trust chief nursing officer Nathan Askew talks about how switching off from work and maintaining other passions helps to refresh his love for the job.And Harley Street Clinic lead radiotherapy clinical nurse specialist Jane Ewang describes the support and inspiration she receives from colleagues, both in her day job and in her work with the UK Oncology Nursing Society.The three tell Nursing Standard content editor and podcast host Alistair Mason some of the best advice they've received as nurses and offer tips on staying motivated when work is particularly tough.They also talk about the improvements they have seen in the profession over the course of their careers and highlight the things that are getting them excited for 2025.For more episodes of the Nursing Standard podcast, visit rcni.com/podcast Hosted on Acast. See acast.com/privacy for more information.

Learn why attending the ASC Annual Scientific Meeting is essential and the value of ASC. Also, each will discuss the exciting ideas for future ASC Annual Meetings. Dr. Swikrity Upadhyay Baskota interviews five outstanding members of the ASC: Dr. Booth, Dr. Saieg, Ms. Jessica Coyne, Ms. Michele Smith, and Dr. Chandra. Swikrity Upadhyay Baskota, MD, MBBS Chair, The ASC Bulletin and CytoPathPod of Editorial Board Christine N. Booth, MD Cleveland Clinic Foundation ASC President-Elect Mauro A. Saieg, MD, PhD, FIAC McGill University Jessica Coyne, Cytologist Cleveland Clinic Winner - ASC Travel Scholarship Michele A. Smith, MS, SCT(ASCP) University of Wisconsin-Madison Winner - 2024 Cytology Shark Tank Ashish Chandra, MD Guy's & St. Thomas' NHS Foundation Trust, London Winner - 2024 ASC International Achievement Award

Send us a textThis podcast originally ran on October 21, 2023.This week we get down to basics, and basics are exactly what we need in this confusing world right now. This is THE podcast to listen to if you are confused about all things to do with taking hormone therapy.Dr Vikram Sinai Talaulikar is a specialist in reproductive medicine at University College London Hospital's NHS Foundation Trust and an associate professor in Women's Health at the University College London. He graduated in medicine in India in 2003 and completed a postgraduate degree in obstetrics and gynecology in 2007. He is a certified menopause specialist by the British Menopause Society, a menopause trainer and he is constantly educating others on this transition as well, via online webinars, events and through social media. He is also part of the trio who established the Menopause Research Education Fund, alongside medical journalist Fiona Clarke and groundbreaking menopause campaigner Diane Danzebrink.Highlights of our discussion: Hormone therapy (HT) 101WHI: good, bad and what we can learn from it 20 years onEstrogen in the pill vs estrogen in HT All the kinds of estrogen and what they are used for strogen too ethinyl estradiolEstrone, Estriol, Estradiol, and Estetrol.17 beta estradiolGetting to the bottom of body simila, body identical and bioidentical – and why that varies from country to country Pharmaceutical company produced HT vs compounding pharmacy versionsthe big “Catch-22” with compounding pharmacies that keeps their bioidentical hormones out of official recommendationsthe pill, HRT and breast cancer riskwhy problems with the pill don't get flagged and HRT does Evidence over estrogen and breast cancer risk (and randomized trials versus observational data)What's what: progesterone, progestin and progestogens (how they work and which one carries a slight risk for breast cancer)how long you really need to take HRT to see if it's workingwhy HT works for some people and not othersDr Talaulikar's favourite non-hormonal treatmentsWhere to find Dr Talaulikar:X: @VikramSinai Web: Menopause Clinic LondonMenopause Research and Education FundJoin the Hotflash Inc perimenoposse: Web: hotflashinc.comTikTok: @hotflashincInstagram: @hotflashincX: @hotflashinc Episode website: Hotflashinc See hotflashinc.com/privacy-policy for privacy information

More than 500 salvage radical prostatectomies!!! Yep it would be fair enough to describe Dr Paul Cathcart as being "experienced" in the most challenging scenario  we face as prostate cancer surgeons. Surgery for cancer recurrence in the prostate following radiotherapy or various forms of ablative therapy is never easy, and can all too often lead to issues with healing and quality of life recovery due to the impact of prior failed treatments, so we are always keen to see how we can improve outcomes.  Paul dropped into the GU Cast studio when back in Melbourne this week, a little over ten years on from his Fellowship training here. He is a Consultant Urologist at Guy's & St Thomas' NHS Foundation Trust in London, where his main area of expertise is indeed salvage robotic radical prostatectomy. Paul shares his perspectives and tips and tricks for performing this procedure to try and give patients the best possible outcome, and also explains why he prefers the da Vinci Surgical System over the new robot kids on the block. This is a Themed Podcast supported by our Silver Partners, Device Technologies, distributors of the da Vinci Surgical System. Even better on our YouTube channel

Pharmacogenomics plays a critical role in personalised medicine, as some adverse drug reactions are genetically determined. Adverse drugs reactions (ADRs) account for 6.5% of hospital admissions in the UK, and the application of pharmacogenomics to look at an individuals response to drugs can significantly enhance patient outcomes and safety. In this episode, our guests discuss how genomic testing can identify patients who will respond to medications and those who may have adverse reactions. We hear more about Genomics England's collaboration with the Medicines and Healthcare products Regulatory Agency in the Yellow Card Biobank and our guests discuss the challenges of implementing pharmacogenomics into the healthcare system. Our host Vivienne Parry, Head of Public Engagement at Genomics England, is joined by Anita Hanson, Research Matron and the Lead Research Nurse for clinical pharmacology at Liverpool University Hospitals NHS Foundation Trust, and Professor Bill Newman, Professor of translational genomic medicine at the Manchester Center for Genomic Medicine, and Professor Matt Brown, Chief Scientific Officer at Genomics England.   "I think we're moving to a place where, rather than just doing that one test that might be relevant to one drug, we'd be able to do a test which at the same price would generate information that could be relevant at further points in your life if you were requiring different types of medicine. So, that information would then be available in your hospital record, in your GP record, that you could have access to it yourself. And then I think ultimately what we would really love to get to a point is where everybody across the whole population just has that information to hand when it's required, so that they're not waiting for the results of a genetic test, it's immediately within their healthcare record."   To learn more about Jane's lived experience with Stevens-Johnson syndrome, visit The Academy of Medical Sciences' (AMS) YouTube channel. The story, co-produced by Areeba Hanif from AMS, provides an in-depth look at Jane's journey. You can watch the video via this link: https://www.youtube.com/watch?v=v4KJtDZJyaA  Want to learn more about personalised medicine? Listen to our Genomics 101 episode where Professor Matt Brown explains what it is in less than 5 minutes: https://www.genomicsengland.co.uk/podcasts/genomics-101-what-is-personalised-medicine  You can read the transcript below or download it here: https://www.genomicsengland.co.uk/assets/documents/Podcast-transcripts/Can-genomic-testing-prevent-adverse-drug-reactions.docx   Vivienne: Hello and welcome to Behind the Genes.  Bill: What we've seen is that the limited adoption so far in the UK and other countries has focused particularly on severe adverse drug reactions. They've been easier to identify and there's a clear relationship between some drugs and some genetic changes where that information is useful. So, a good example has been the recent adoption of pharmacogenetic testing for a gene called DPYD for patients undergoing cancer treatment, particularly breast and bowel cancer. And if you have an absence of the enzyme that that gene makes, if you're given that treatment, then you can end up on intensive care and die, so it's a really significant side effect. But as you say, the most common side effects aren't necessarily fatal, but they can have a huge impact upon people and on their wellbeing.  Vivienne: My name's Vivienne Parry and I'm head of public engagement at Genomics England, and today we'll be discussing the critical role of pharmacogenomics in personalised medicine, highlighting its impact on how well medicines work, their safety, and on patient care. I'm joined today by Professor Bill Newman, professor of translational genomic medicine at the Manchester Centre for Genomic Medicine, Anita Hanson, research matron, a fabulous title, and lead research nurse for clinical pharmacology at the Liverpool University Hospital's NHS Foundation Trust, and Professor Matt Brown, chief scientific officer for Genomics England. And just remember, if you enjoy today's episode, we'd love your support, so please like, share and rate us on wherever you listen to your podcasts.  So, first question to you, Bill, what is pharmacogenomics?  Bill: Thanks Viv. I think there are lots of different definitions, but how I think of pharmacogenetics is by using genetic information to inform how we prescribe drugs, so that they can be safer and more effective. And we're talking about genetic changes that are passed down through families, so these are changes that are found in lots of individuals. We all carry changes in our genes that are important in how we transform and metabolise medicines, and how our bodies respond to them.  Vivienne: Now, you said pharmacogenetics. Is it one of those medicine things like tomato, tomato, or is there a real difference between pharmacogenetics and pharmacogenomics?  Bill: So, people, as you can imagine, do get quite irate about this sort of thing, and there are lots of people that would contest that there is a really big important difference. I suppose that pharmacogenetics is more when you're looking at single changes in a relatively small number of genes, whereas pharmacogenomics is a broader definition, which can involve looking at the whole genome, lots of genes, and also whether those genes are switched on or switched off, so the expression levels of those genes as well would encompass pharmacogenomics. But ultimately it's using genetic information to make drug prescription safer and more effective.  Vivienne: So, we're going to call it pharmacogenomics and we're talking about everything, that's it, we'll go for it. So Matt, just explain if you would the link between pharmacogenomics and personalised medicine. And I know that you've done a big Genomics 101 episode about personalised medicine, but just very briefly, what's the link between the two?  Matt: So, personalised medicine's about using the right dose of the right drug for the right individual. And so pharmacogenomics helps you with not only ensuring that you give a medication which doesn't cause problems for the person who receives it, so an adverse drug reaction, but also that they're actually getting the right dose. Of course, people's ability to metabolise, activate and respond to drugs genetically is often genetically determined, and so sometimes you need to adjust the dose up or down according to a person's genetic background.  Vivienne: Now, one of the things that we've become very aware of is adverse drug reactions, and I think they account for something like six and a half percent of all hospital admissions in the UK, so it's absolutely huge. Is that genetically determined adverse drug reactions?  Matt: So, the answer to that is we believe so. There's quite a bit of data to show that you can reduce the risk of people needing a hospital admission by screening genetic markers, and a lot of the very severe reactions that lead to people being admitted to hospital are very strongly genetically determined. So for example, there are HLA types that affect the risk of adverse drug reactions to commonly used medications for gout, for epilepsy, some HIV medications and so on, where in many health services around the world, including in England, there are already tests available to help prevent those leading to severe reactions. It's likely though that actually the tests we have available only represent a small fraction of the total preventable adverse drug reactions were we to have a formal pre-emptive pharmacogenomics screening programme.  Vivienne: Now, I should say that not all adverse drug reactions are genetic in origin. I mean, I remember a rather nasty incident on the night when I got my exam results for my finals, and I'd actually had a big bee sting and I'd been prescribed antihistamines, and I went out and I drank rather a lot to celebrate, and oh my goodness me, I was rather ill [laughter]. So, you know, not all adverse drug reactions are genetic in origin. There are other things that interact as well, just to make that clear to people.  Matt: Yes, I think that's more an interaction than an adverse drug reaction. In fact frankly, the most common adverse drug reaction in hospitals is probably through excess amounts of water, and that's not medically determined, that's the prescription.  Vivienne: Let me now come to Anita. So, you talk to patients all the time about pharmacogenomics in your role. You've been very much involved in patient and public involvement groups at the Wolfson Centre for Personalised Medicine in Liverpool. What do patients think about pharmacogenomics? Is it something they welcome?  Anita: I think they do welcome pharmacogenomics, especially so with some of the patients who've experienced some of the more serious, life threatening reactions. And so one of our patients has been doing some work with the Academy of Medical Sciences, and she presented to the Sir Colin Dollery lecture in 2022, and she shared her story of having an adverse drug reaction and the importance of pharmacogenomics, and the impact that pharmacogenomics can have on patient care.  Vivienne: Now, I think that was Stevens-Johnson syndrome. We're going to hear in a moment from somebody who did experience Stevens-Johnson's, but just tell us briefly what that is.  Anita: Stevens-Johnson syndrome is a potentially life threatening reaction that can be caused by a viral infection, but is more commonly caused by a medicine. There are certain groups of medicines that can cause this reaction, such as antibiotics or anticonvulsants, nonsteroidal anti-inflammatories, and also a drug called allopurinol, which is used to treat gout. Patients have really serious side effects to this condition, and they're often left with long-term health complications. The morbidity and mortality is considerable as well, and patients often spend a lot of time in hospital and take a long time to recover.   Vivienne: And let's now hear from Jane Burns for someone with lived experience of that Stevens-Johnson syndrome. When Jane Burns was 19, the medicine she took for her epilepsy was changed.  Jane: I remember waking up and feeling really hot, and I was hallucinating, so I was taken to the Royal Liverpool Hospital emergency department by my parents. When I reached A&E, I had a temperature of 40 degrees Celsius. I was given Piriton and paracetamol, and the dermatologist was contacted. My mum had taken my medication to hospital and explained the changeover process with my epilepsy medication. A decision was made to discontinue the Tegretol and I was kept in for observation. Quite rapidly, the rash was changing. Blisters were forming all over my body, my mouth was sore and my jaw ached. My temperature remained very high. It was at this point that Stevens-Johnson syndrome, or SJS, was diagnosed.  Over the next few days, my condition deteriorated rapidly. The rash became deeper in colour. Some of the blisters had burst, but some got larger. I developed ulcers on my mouth and it was extremely painful. I started to lose my hair and my fingernails. As I had now lost 65 percent of my skin, a diagnosis of toxic epidermal necrolysis, or TEN, was made. Survivors of SJS TEN often suffer with long-term visible physical complications, but it is important to also be aware of the psychological effects, with some patients experiencing post-traumatic stress disorder. It's only as I get older that I realise how extremely lucky I am to have survived. Due to medical and nursing expertise, and the research being conducted at the time, my SJS was diagnosed quickly and the medication stopped. This undoubtedly saved my life.  Vivienne: Now, you've been looking at the development of a passport in collaborating with the AMS and the MHRA. Tell me a bit more about that.  Anita: Yes, we set up a patient group at the Wolfson Centre for Personalised Medicine approximately 12 years ago, and Professor Sir Munir Pirmohamed and I, we wanted to explore a little bit more about what was important to patients, really to complement all the scientific and clinical research activity within pharmacogenomics. And patients recognised that, alongside the pharmacogenomic testing, they recognised healthcare professionals didn't really have an awareness of such serious reactions like Stevens-Johnson syndrome, and so they said they would benefit from having a My SJS Passport, which is a booklet that can summarise all of the important information about their care post-discharge, and this can then be used to coordinate and manage their long-term healthcare problems post-discharge and beyond. And so this was designed by survivors for survivors, and it was then evaluated as part of my PhD, and the findings from the work suggest that the passport is like the patient's voice, and it really does kind of validate their diagnosis and raises awareness of SJS amongst healthcare professionals. So, really excellent findings from the research, and the patients think it's a wonderful benefit to them.  Vivienne: So, it's a bit like a kind of paper version of the bracelet that you sometimes see people wearing that are on steroids, for instance.  Anita: It is like that, and it's wonderful because it's a handheld source of valuable information that they can share with healthcare professionals. And this is particularly important if they're admitted in an emergency and they can't speak for themselves. And so the passport has all that valuable information, so that patients aren't prescribed that drug again, so it prevents them experiencing a serious adverse drug reaction again.   Vivienne: So, Stevens-Johnson, Bill, is a really scary side effect, but what about the day to day benefits of pharmacogenomics for patients?  Bill: So, what we've seen is that the limited adoption so far in the UK and other countries has focused particularly on severe adverse drug reactions. They've been easier to identify and there's a clear relationship between some drugs and some genetic changes where that information is useful. So a good example has been the recent adoption of pharmacogenetic testing for a gene called DPYD for patients undergoing cancer treatment, particularly breast and bowel cancer. And if you have an absence of the enzyme that that gene makes, if you're given that treatment, then you can end up on intensive care and die, so it's a really significant side effect. But as you say, the most common side effects aren't necessarily fatal, but they can have a huge impact upon people and on their wellbeing.   And it's not just in terms of side effects. It's in terms of the effectiveness of the medicine. Because if a person is prescribed a medicine that doesn't or isn't going to work for them then it can take them longer to recover, to get onto the right medicine. That can have all sorts of detrimental effects. And so when we're thinking about introducing pharmacogenetics more broadly rather than just on a single drug or a single gene basis, we're thinking about that for common drugs like antidepressants, painkillers, statins, the drugs that GPs are often prescribing on a regular basis to a whole range of patients.  Vivienne: So, to go back to you, Anita, we're really talking about dose here, aren't we, whether you need twice the dose or half the dose depending on how quickly your body metabolises that particular medicine. How do patients view that?  Anita: Well, the patient in question who presented for the Academy of Medical Sciences, I mean, her take on this was, she thinks pharmacogenetics is wonderful because it will allow doctors and nurses to then prescribe the right drug, but also to adapt the dose accordingly to make sure that they get the best outcome, which provides the maximum benefit while also minimising any potential harm. And so from her perspective, that was one of the real benefits of pharmacogenomics. But she also highlighted about the benefits for future generations, the fear of her son taking the same medicine and experiencing the same reaction. And so I think her concerns were, if we have pharmacogenetic testing for a panel of medicines, as Bill mentioned then, then perhaps this would be fantastic for our children as they grow up, and we can identify and predict and prevent these type of reactions happening to future generations.  Vivienne: And some of these drugs, Bill, are really very common indeed, something like codeine. Just tell us about codeine, ‘cos it's something – whenever I tell this to friends [laughter], they're always completely entranced by the idea that some people don't need nearly as much codeine as others.  Bill: Yeah, so codeine is a drug that's very commonly used as a painkiller. To have its real effect, it needs to be converted in the body to a different drug called morphine, and that is done by an enzyme which is made by a gene called CYP2D6. And we all carry changes in CYP2D6, and the frequency of those variants, whether they make the gene work too much or whether they make it work too little, they vary enormously across the world, so that if you go to parts of Africa, about 30 percent of the population will make more of the CYP2D6, and so they will convert the codeine much more quickly, whereas if you go to the UK, maybe up to ten percent of the white population in the UK just won't be converting codeine to morphine at all, so they won't get any benefit from the drug. So at both ends, you have some people that don't respond and some people that respond a little bit too much so that they need either an alternative drug or they need a different dose.  Vivienne: So, all those people who say, you know, “My headache hasn't been touched by this painkiller,” and we say, “What a wimp you're being,” actually, it's to do with genetics.  Bill: Yeah, absolutely. There's a biological reason why people don't – not for everybody, but for a significant number of people, that's absolutely right, and we can be far more tailored in how we prescribe medication, and get people onto painkillers that work for them much more quickly.  Vivienne: And that's so interesting that it varies by where you come from in the world, because that means we need to give particular attention – and I'm thinking, Anita, to working with patients from different community groups, to make sure that they understand the need for pharmacogenomics.  Anita: I think that's really important, Vivienne, and I think we are now having discussions with the likes of Canada SJS awareness group, and also people have been in touch with me from South Africa because people have requested the passport now to be used in different countries, because they think it's a wonderful tool, and it's about raising awareness of pharmacogenomics and the potential benefits of that, and being able to share the tools that we've got to help patients once they've experienced a serious reaction.  Vivienne: So, pharmacogenomics clearly is important in the prevention of adverse drug reactions, better and more accurate prescribing, reduced medicines wastage. Does this mean that it's also going to save money, Bill, for the NHS?  Bill: Potentially. It should do if it's applied properly, but there's lots of work to make sure that not only are we using the right evidence and using the right types of tests in the laboratory, but we're getting the information to prescribers, so to GPs, to pharmacists, to hospital doctors, in a way that is understandable and meaningful, such that they can then act upon that information. So, the money will only be saved and then can be reused for healthcare if the whole process and the whole pathway works, and that information is used effectively.  Vivienne: So, a lot of research to make sure that all of that is in place, and to demonstrate the potential cost savings.  Bill: Yes. I mean, there are very nice studies that have been done already in parts of the world that have shown that the savings that could be accrued for applying pharmacogenetics across common conditions like depression, like in patients to prevent secondary types of strokes, are enormous. They run into hundreds of millions of pounds or dollars. But there is an initial investment that is required to make sure that we have the testing in place, that we have the digital pathways to move the information in place, and that there's the education and training, so that health professionals know how to use the information. But the potential is absolutely enormous.  Vivienne: Matt, can I turn now to the yellow card. So, people will be very familiar with the yellow card system. So, if you have an adverse reaction, you can send a yellow card in – I mean, literally, it is a yellow card [laughter]. It does exactly what it says on the tin. You send a yellow card to the MHRA, and they note if there's been an adverse effect of a particular medicine. But Genomics England is teaming up with the MHRA to do something more with yellow cards, and we're also doing this with the Yellow Card Biobank. Tell us a bit more.  Matt: So, yellow card's a great scheme that was set up decades ago, initially starting off, as you said, with literally yellow cards, but now actually most submissions actually come online. And it's important to note that submissions can come not just from healthcare providers, but majority of submissions actually come from patients themselves, and that people should feel free, if they feel they've had an adverse drug reaction, to report that themselves rather than necessarily depending on a medical practitioner or the healthcare provider to create that report. So, Genomics England is partnering with the MHRA in building what's called the Yellow Card Biobank, the goal of which is to identify genetic markers for adverse drug reactions earlier than has occurred in the past, so that we can then introduce genetic tests to prevent these adverse drug reactions much sooner than has occurred previously.   So, what we're doing is basically at the moment we're doing a pilot, but the ultimate plan is that in future, patients who report a serious adverse drug reaction through the Yellow Card Biobank will be asked to provide a sample, a blood sample, that we then screen. We do a whole genome sequence on it, and then combine these with patients who've had like adverse drug reactions and identify genetic markers for that adverse drug reaction medication earlier, that can then be introduced into clinical practice earlier. And this should reduce by decades the amount of time between when adverse drug reactions first start occurring with medications and us then being able to translate that into a preventative mechanism.  Vivienne: And will that scheme discover, do you think, new interactions that you didn't know about before? Or do you expect it to turn up what you already know about?  Matt: No, I really think there's a lot of discovery that is yet to happen here. In particular, even for drugs that we know cause adverse drug reactions, mostly they've only been studied in people of European ancestry and often in East Asian ancestry, but in many other ancestries that are really important in the global population and in the UK population, like African ancestry and South Asian ancestries, we have very little data. And even within Africa, which is an area which is genetically diverse as the rest of the world put together, we really don't know what different ethnicities within Africa, actually what their genetic background is with regard to adverse drug reactions.  The other thing I'd say is that there are a lot of new medications which have simply not been studied well enough. And lastly, that at the moment people are focused on adverse drug reactions being due to single genetic variants, when we know from the model of most human diseases that most human diseases are actually caused by combinations of genetic variants interacting with one another, so-called common disease type genetics, and that probably is similarly important with regard to pharmacogenomics as it is to overall human diseases. That is, it's far more common that these are actually due to common variants interacting with one another rather than the rare variants that we've been studying to date.  Vivienne: So, it's a kind of cocktail effect, if you like. You know, you need lots of genes working together and that will produce a reaction that you may not have expected if you'd looked at a single gene alone.  Matt: That's absolutely correct, and there's an increasing amount of evidence to show that that is the case with medications, but it's really very early days for research in that field. And the Yellow Card Biobank will be one of many approaches that will discover these genetic variants in years to come.  Vivienne: Now, Matt's a research scientist. Bill, you're on the frontline in the NHS. How quickly can this sort of finding be translated into care for people in the NHS?  Bill: So, really quickly is the simple answer to that, Viv. If we look at examples from a number of years ago, there's a drug called azathioprine that Matt has used lots in some of his patients. In rheumatology, it's used for patients with inflammatory bowel disease. And the first studies that showed that there was a gene that was relevant to having bad reactions to that drug came out in the 1980s, but it wasn't until well into this century, so probably 30-plus years later that we were routinely using that test in clinical medicine. So, there was an enormous lot of hesitancy about adopting that type of testing, and a bit of uncertainty. If you move forward to work that our colleague Munir Pirmohamed in Liverpool has done with colleagues in Australia like Simon Mallal around HIV medicine, there was this discovery that a drug called abacavir, that if you carried a particular genetic change, that you had a much higher risk of having a really severe reaction to that. The adoption from the initial discovery to routine, worldwide testing happened within four years.   So, already we've seen a significant change in the appetite to move quickly to adopt this type of testing, and I see certainly within the NHS and within other health systems around the world, a real desire to adopt pharmacogenetics into routine clinical practice quickly and at scale, but also as part of a broader package of care, which doesn't just solely focus on genetics, but thinks about all the other parts that are important in how we respond to medication. So, making sure we're not on unusual combinations of drugs, or that we're taking our medicine at the right time and with food or not with food, and all of those other things that are really important. And if you link that to the pharmacogenetics, we're going to have a much safer, more effective medicines world.  Vivienne: I think one of the joys of working at Genomics England is that you see some of this work really going into clinical practice very fast indeed. And I should say actually that the Wolfson Centre for Personalised Medicine, the PPI group that Anita looks after so well, they've been very important in recruiting people to Yellow Card Biobank. And if anyone's listening to this, Matt, and wants to be part of this, how do they get involved? Or is it simply through the yellow card?  Matt: So at the moment, the Yellow Card Biobank is focusing on alopurinol.   Vivienne: So, that's a medicine you take for gout.  Matt: Which I use a lot in my rheumatology clinical practice. And direct acting oral anticoagulants, DOACs, which are used for vascular disease therapies and haemorrhage as a result of that. So, the contact details are available through the MHRA website, but I think more importantly, it's just that people be aware of the yellow card system itself, and that if they do experience adverse drug reactions, that they do actually complete a report form, ‘cos I think still actually a lot of adverse drug reactions go unreported.  Vivienne: I'm forgetting of course that we see Matt all the time in the Genomics England office and we don't think that he has any other home [laughter] than Genomics England, but of course he still sees some patients in rheumatology clinic. So, I want to now look to the future. I mean, I'm, as you both know, a huge enthusiast for pharmacogenomics, ‘cos it's the thing that actually, when you talk to patients or just the general public, they just get it straight away. They can't think why, if you knew about pharmacogenomics, why you wouldn't want to do it. But it's not necessarily an easy thing to do. How can we move in the future, Bill, to a more proactive approach for pharmacogenomics testing? Where would we start?  Bill: Yes, so I think we've built up really good confidence that pharmacogenetics is a good thing to be doing. Currently, we're doing that predominantly at the point when a patient needs a particular medicine. That's the time that you would think about doing a genetic test. And previously, that genetic test would only be relevant for that specific drug. I think we're moving to a place where, rather than just doing that one test that might be relevant to one drug, we'd be able to do a test which at the same price would generate information that could be relevant at further points in your life if you were requiring different types of medicine. So, that information would then be available in your hospital record, in your GP record, that you could have access to it yourself. And then I think ultimately what we would really love to get to a point is where everybody across the whole population just has that information to hand when it's required, so that they're not waiting for the results of a genetic test, it's immediately within their healthcare record. That's what we'd call pre-emptive pharmacogenetic testing, and I think that's the golden land that we want to reach.  Vivienne: So for instance, I might have it on my NHS app, and when I go to a doctor and they prescribe something, I show my app to the GP, or something pops up on the GP's screen, or maybe it's something that pops up on the pharmacist's screen.  Bill: I think that's right. I think that's what we're looking to get to that point. We know that colleagues in the Netherlands have made some great progress at developing pathways around that. There's a lot of public support for that. And pharmacists are very engaged in that. In the UK, the pharmacists, over the last few years, have really taken a very active role to really push forward this area of medicine, and this should be seen as something that is relevant to all people, and all health professionals should be engaged with it.  Vivienne: And on a scale of one to ten, how difficult is it going to be to implement in the NHS?  Bill: So, that's a difficult question. I think the first thing is identifying what the challenges are. So I have not given you a number, I've turned into a politician, not answered the question. So, I think what has happened over the last few years, and some of our work within the NHS Network of Excellence in pharmacogenetics and some of the other programmes of work that have been going on, is a really good, honest look at what it is we need to do to try to achieve pharmacogenetics implementation and routine use. I don't think the challenge is going to be predominantly in the laboratory. I think we've got phenomenal laboratories. I think we've got great people doing great genetic testing. I think the biggest challenges are going to be about how you present the data, and that data is accessible. And then ensuring that health professionals really feel that this is information that isn't getting in the way of their clinical practice, but really making a difference and enhancing it, and of benefit both to the healthcare system but more importantly to the patients.  Vivienne: Now, when I hear you both talk, my mind turns to drug discovery and research, and Matt, I'm quite sure that that's right at the top of your mind. Tell us how pharmacogenomics can help in drug discovery and research.  Matt: So, pharmacogenomics, I think actually just genetic profiling of diseases in itself just to start off with is actually a really good way of identifying new potential therapeutic targets, and also from derisking drug development programmes by highlighting likely adverse drug reactions of medications that are being considered for therapeutic trials, or targets that are being considered for therapeutic development. Pharmacogenomics beyond that is actually largely about – well, it enables drug development programmes by enabling you to target people who are more likely to respond, and avoid people who are more likely to have adverse drug reactions. And so that therapeutic index of the balance between likely efficacy versus likely toxicity, genetics can really play into that and enable medications to be used where otherwise they might have failed.  This is most apparent I think in the cancer world. A classic example there, for example, is the development of a class of medications called EGFR inhibitors, which were developed for lung cancer, and in the initial cancer trials, actually were demonstrated to be ineffective, until people trialled them in East Asia and found that they were effective, and that that turns out to be because the type of cancers that respond to them are those that have mutations in the EGFR gene, and that that's common in East Asians. We now know that, wherever you are in the world, whether you're East Asian or European or whatever, if you have a lung adenocarcinoma with an EGFR mutation, you're very likely to respond to these medications. And so that pharmacogenomic discovery basically rescued a class of medication which is now probably the most widely used medication for lung adenocarcinomas, so a huge beneficial effect. And that example is repeated across multiple different cancer types, cancer medication types, and I'm sure in other fields we'll see that with expansive new medications coming in for molecularly targeted therapies in particular.  Vivienne: So, smaller and more effective trials rather than larger trials that perhaps seem not to work but actually haven't been tailored enough to the patients that are most likely to benefit.  Matt: Yeah, well, particularly now that drug development programmes tend to be very targeted at specific genetic targets, pharmacogenetics is much more likely to play a role in identifying patients who are going to respond to those medications. So, I think many people in the drug development world would like to see that, for any significant drug development programme, there's a proper associated pharmacogenomic programme to come up with molecular markers predicting a response.  Vivienne: We're going to wrap up there. Thank you so much to our guests, Bill Newman, Anita Hanson, Matt Brown, and our patient Jane Burns. Thank you so much for joining us today to discuss pharmacogenomics in personalised medicine, and the benefits, the challenges and the future prospects for integrating pharmacogenomics into healthcare systems. And if you'd like to hear more podcasts like this, please subscribe to Behind the Genes. It's on your favourite podcast app. Thank you so much for listening. I've been your host, Vivienne Parry. This podcast was edited by Bill Griffin at Ventoux Digital and produced by the wonderful Naimah. Bye for now. 

A judge has allowed the identity of Axel Rudakubana to be reported as the 17-year-old was charged with the murder of three young girls in a knife attack.  A 17-year-old boy has appeared in an English court charged with the murder of three young girls in a knife attack at a dance class that has shocked the United Kingdom and sparked two nights of violent protests.  Axel Rudakubana first appeared at Liverpool Magistrates' Court over the incident at a “Taylor Swift yoga and dance workshop” summer holiday event for children in the seaside town of Southport.  He is charged with three counts of murder, 10 counts of attempted murder and one of possession of a bladed article.  His case was later heard at Liverpool Crown Court, where he sat in the dock covering his face with a grey sweatshirt and did not speak to confirm his name.  Judge Andrew Menary did not impose reporting restrictions on Rudakubana's identity, which had not previously been reported as he is under 18.  Rudakubana was remanded in custody ahead of a further hearing in October. He has been charged with three counts of murder and 10 counts of attempted murder.  Large disturbances broke out in Southport, a town in England's northwest, after false information was spread on social media that the suspect in the stabbings was a radical Islamist migrant, with anti-immigrant protesters descending on Southport town from elsewhere.  Police have said the attack was not terrorism-related and that the suspect was born in the UK, quashing speculation on his origins.  Tributes to the victims are left by wellwishers in Southport, England. Photo / Getty Images  Prime Minister Keir Starmer met with police leaders to offer them the government's full backing following violent clashes with protesters in Southport and London.  ”As far as the far-right is concerned, this is co-ordinated, this is deliberate,” Starmer told a press conference. “This is not a protest that just got out of hand. It is a group of individuals who are who are absolutely bent on violence. Our country is coming to terms with an act so inexplicably vile.  “Our thoughts are with the families at the heart of this unimaginable pain.  “Let me be clear: the tiny, mindless minority in our society who provoked violent disorder on our streets will be made to face the full force of the law.”  Starmer said the government was establishing a national unit across police forces to tackle violent disorder including shared intelligence, wider deployment of facial recognition technology and preventative action such as orders to restrict the movement of persistent offenders.  He also warned social media companies: “Violent disorder, clearly whipped up online, that is also a crime and it is happening on your premises and the law must be upheld everywhere.”  Thousands gathered near Starmer's Downing Street office and residence in London on Wednesday evening, shouting: “Save our kids”, “We want our country back” and “Stop the boats”.  Protesters also threw flares and smoke canisters towards Downing Street.  London's Metropolitan Police said 111 people had been arrested for offences including violent disorder and assaults on police officers.  Five officers were injured.  On Tuesday, more than 50 police officers were hurt in protests in Southport, when demonstrators set police vans on fire and dismantled garden walls to hurl bricks at officers.  As well as the killing of three girls aged six to nine, the attack in the normally quiet town left eight other children and two adults with stab wounds.  Alder Hey Children's NHS Foundation Trust said in a statement that two of the children had been discharged from hospital.  ”We continue to treat five children involved in the devastating incident in Southport on Monday, including one recently transferred to us from Aintree University Hospital,” the trust said.  ”All the children in our care are currently in a stable condition.”  Hundreds of people in the community have taken part in vigils to mourn the slain children and laid bouquets of flowers at the site of the incident. See omnystudio.com/listener for privacy information.

Join me as we embark on a fascinating journey with Anna Hodgkinson, a consultant pharmacist specialising in diabetes, as she shares her career progression from community pharmacy to becoming a consultant pharmacist.  Anna is a Consultant Pharmacist for Diabetes and works across primary care, intermediate care and secondary care. She joined the Lambeth diabetes team over 10 years ago and has been working in the Lambeth diabetes and renal community clinic for over 6 years. Anna is also part of the Guys and St Thomas' NHS Foundation Trust diabetes team and works in the multi-disciplinary diabetes complications clinic. She has a keen interest in cardiovascular renal and metabolic disease. In addition to her clinical role, Anna works in the NHS South East London (SEL) Integrated Medicines Optimisation Team and leads on the development of consistent diabetes and obesity prescribing guidance and pathways across SEL Integrated Care System. Anna has previously held roles in commissioning and service redesign and has worked on a number of diabetes transformation projects. Anna is currently the co-chair of the UK Clinical Pharmacy Association Diabetes and Endocrinology Committee.  Listen in as Anna recounts how her initial experiences in community pharmacy opened doors to clinical opportunities in primary care trusts and GP practices. Discover the various roles she undertook in medicines optimisation and service redesign, focusing on heart failure and long-term condition pathways. Encouraged by mentors, Anna decided to specialise in diabetes, pursue an MSc, and engage in numerous improvement projects, highlighting the significance of continuous education and professional development in her pathway to success. BEHIND THE MIC! Have you been thinking about starting your own podcast? We know that starting a podcast can feel daunting and overwhelming. But guess what? You're not alone.  We are on a mission to create a fantastic community of individuals just like you! Together, we'll break down the entire podcasting process—from ideation to recording, editing, technology, publishing, social media, marketing, branding, sponsorship and more. Sign up to our FREE community called Behind The Mic!  We are excited to engage with you and provide you with the support & guidance you need to get started.  Register here: https://behindthemic.circle.so/  SIGN UP to my NEWSLETTER below so you'll be the first to know when new episodes are being released. You'll also receive regular inspiration, tips, tools, and free content. https://pharmacistdiaries.ck.page/newsletter PARTNERSHIPS: The Naked Pharmacy is offering my podcast listeners a 20% discount on all their products. Use discount code PD20 at checkout to receive the offer. https://www.thenakedpharmacy.com/ CONNECT WITH ANNA: X: https://x.com/annamhodgkinson Follow me on⁠⁠⁠ My Website⁠⁠⁠,⁠⁠⁠ YouTube⁠⁠⁠,⁠⁠⁠ Instagram⁠⁠⁠,⁠⁠⁠ Facebook⁠⁠⁠,⁠⁠⁠ LinkedIn⁠⁠⁠, and/or⁠⁠⁠ Twitter⁠⁠⁠. Feel free to subscribe to the podcast on your favourite podcast platform so you can be notified when a new episode is released or leave a review on apple podcasts. If you have any suggestions for guests you want me to talk to or if you'd like to come on yourself, please feel free to contact me via social media, or email at info@pharmacistdiaries.com.

Is the perception of too many managers in the NHS is a myth?  Ben Falk, a director of operations at Guy's and St. Thomas's NHS Foundation Trust, shares his journey into healthcare and his role as a director. He discusses the day-to-day responsibilities of a director of operations and the challenges of workforce planning. Ben also addresses the perception of too many managers in the NHS and emphasises the importance of collaboration and valuing all roles within the organisation. Ben & Tara's key takeaways from this episode: Workforce planning in the NHS involves attracting and recruiting the right talent, highlighting the benefits of working in the NHS, and showcasing the diverse range of roles available. Creating a culture of collaboration involves fostering communication, recognising and valuing all roles within the organisation, and breaking down barriers. Personal experiences and backgrounds can help leaders relate to and understand the challenges faced by different roles within the organisation. Managing stress is important in healthcare, and individuals can find different strategies that work for them. Building a network and seeking peer support can be valuable for career development. Work with THC Primary Care I'm Tara Humphrey and I'm the founder of THC Primary Care, a leading healthcare consultancy. I provide project and network management to Primary Care Networks and consulting support to clinical leads.  To date, I've worked with 11 Training Hubs and supported over 120 Primary Care Networks and 3 GP Federations.  I understand and appreciate the complexity of healthcare and what it takes to deliver projects across multiple practices. I have over 20 years of project management and business development experience across the private and public sector and have an MBA in Leadership and Management in Healthcare. I'm also published in the London Journal of Primary Care and the author of over 250 blogs. For more weekly insights and advice sign up to my newsletter. Improving the Business of Healthcare – One episode at a time… Thanks for tuning into this week's episode of the Business of Healthcare Podcast. If you enjoyed this episode, head over to Apple Podcasts to subscribe, leave your honest review, and share your favourite episodes on social media.  Find us on Twitter, Instagram and LinkedIn or visit our website: THC Primary Care.

This week on the podcast, Dr Louise is joined by Osama Naji, a Consultant Gynaecologist who is an expert in advanced gynaecological scanning at Guy's and St Thomas' NHS Foundation Trust. In this episode Osama shares his vast knowledge on fibroids – common, benign growths that usually develop during a woman's reproductive years when oestrogen levels are at their highest. He explains the impact menopause can have on fibroids, treatment options and the possibility of HRT. Finally, Osama advises on things to consider if you've recently been diagnosed with fibroids: Find out all the facts about your fibroid - number, location and size – as knowledge is power. You can usually get this from an ultrasound scan. Use that knowledge to get professional guidance about managing your fibroids. HRT is safe. The benefits of it usually outweigh the risks. The only thing to consider is if the fibroid is causing problems before starting HRT but even in this scenario, HRT may worth trying. If you experience rapid growth in the fibroids or accelerated symptoms seek help to determine the right treatment. Find out more about Osama here and read his feature on balance on fibroids and the menopause here. Click here to find out more about Newson Health.

Evidence-Based Perioperative Medicine (EBPOM)'s World Congress in London is an vital point in the perioperative calendar. This year was no exception. In this piece we speak to some of the poster presenters about hypotension and also, an app that helps with preparation for major surgery. Presented by Andy Cumpstey with Alexander (Sandy) Jackson, Clinican Data Scientist, Royal College of Anaesthetists, NIHR Doctoral Fellow, Anaesthetics and Intensive Care Doctor, University of Southampton, NHS Foundation Trust and Miriam van der Velde, Researcher at the Innovation of Exercise Care Lectorate & University Lecturer in Master of Geriatric Physiotherapy.

At Round the Table on Friday, Ben John shared about an unprecedented case that has reached national news: 26 female nurses complained about harassment from a male, who identifies as a woman, in their changing room. He had been taking cross-sex hormones but then stopped doing so and was trying to get his girlfriend pregnant. These nurses have launched legal action against the NHS Foundation Trust with the help of the Christian Legal Centre. Andrea Williams shared updates on Aaron Edwards' case, as we have been in Sheffield supporting him during the week. The former lecturer in theology has just finished giving evidence at Tribunal against the Methodist Bible College who sacked him over a biblical tweet: "Homosexuality is invading the Church...". A commemorative casebound edition of "Beyond the Odds – Providence in Britain's Wars of the 20th Century" has been released to mark the 80th Anniversary of D-Day. Tim Dieppe, who contributed two chapters to the book co-authored by John Scriven, spoke about God's remarkable providence in Britain's history.

Dr Philip Smith, Deputy Editor and Associate Editor of FG and Honorary Consultant Gastroenterologist at the Royal Liverpool Hospital, Liverpool, UK interviews Dr Sandeep Joshi, Specialist Registrar in Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London and Dr Joel Mawdsley, Consultant Gastroenterologist and IBD specialist in the Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London on the paper 'Oral manifestations of inflammatory bowel disease: a guide to examination' published online in Frontline Gastroenterology in March 2024 - https://fg.bmj.com/content/early/2024/04/25/flgastro-2023-102619  Listen to our regular podcasts and subscribe in Apple Podcasts, Google Podcasts, Stitcher and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on iTunes: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

Ethical considerations are essential in genomic medicine and clinical practice. In this episode, our guests dive into the details of ethical principles, highlighting how they can be brought into practice in the clinic, whilst considering the experiences and feelings of patients and participants. Our host, Dr Natalie Banner, Director of Ethics at Genomics England, speaks to Professor Sir Jonathan Montgomery and Dr Latha Chandramouli. Jonathan is the Chair of the Genomics England Ethics Advisory Committee, and a Professor of Health Care Law at University College London. Latha is a member of the Ethics Advisory Committee and the Participant Panel at Genomics England, and is a Consultant Community Paediatrician working with children with complex needs.   "You asked why ethics is important and how it operates, I suppose the main thing for me is that these are tricky questions, and you need all the voices, all the perspectives, all the experience in the room working through at the same time. You don't want to have separate discussions of things."   You can read the transcript below or download it here: https://files.genomicsengland.co.uk/documents/Podcast-transcripts/Why-are-ethical-considerations-crucial-in-genomics-research-and-clinical-practice.docx Natalie: Welcome to Behind the Genes.   Jonathan: The first difference is that the model we've traditionally had around clinical ethics, which sort of assumes all focus is around the patient individually, is not enough to deal with the challenges that we have, because we also have to understand how we support families to take decisions. Families differ enormously, some families are united, some families have very different needs amongst them, and we have to recognise that our ethical approaches to  genomic issues must respect everybody in that.  Natalie: My name is Natalie Banner and I'm the Director of Ethics here at Genomics England. On today's episode, I'm joined by Chair of our Ethics Advisory Committee, Professor Sir Jonathan Montgomery and Dr Latha Chandramouli, member of the Ethics Advisory Committee and the Participant Panel, who's also a community paediatrician working with children with complex needs.  Today we'll be discussing why ethical considerations are crucial in genomics research and clinical practice and what consent means in the context of genomics. If you enjoy today's episode, we'd love your support. Please like, share and rate us wherever you listen to your podcasts.  At Genomics England, we have an Ethics Advisory Committee, which exists to promote a strong ethical foundation for all of our programmes, our processes, and our partnerships. This can mean things like acting as a critical friend, an external group of experts to consult. It can mean ensuring Genomics England is being reflective and responsive to emerging ethical questions, especially those that arise as we work with this really complex technology of genomics that sits right at the intersection of clinical care and advancing research. And it can also ensure that we are bringing participant voices to the fore in all of the work that we're doing.   I'm really delighted today to welcome two of our esteemed members of the ethics advisory committee to the podcast. Professor Sir Jonathan Montgomery, our Chair, and Dr Latha Chandramouli, member of our Participant Panel. So, Jonathan, if I could start with you, could you tell us a little bit about your background and what you see as the role of the ethics advisory committee for us at Genomics England?  Jonathan: Thanks very much, Natalie. My background professionally is I'm an academic, I'm a professor at University College London, and I profess healthcare law the subject that I've sort of had technical skills in. But I've also spent many years involved in the governance of the National Health Service, so I currently chair the board of the Oxford University Hospital's NHS Foundation Trust.   I've spent quite a lot of time on bodies trying to take sensible decisions on behalf of the public around difficult ethical issues. The most relevant one to Genomics England is I chaired the Human Genetics Commission for three years which was a really interesting group of people from many backgrounds. The commission itself primarily combined academics in ethics, law and in clinical areas, and there was a separate panel of citizens think grappling with things that are really important. Genomics England has a bit of that pattern, but it's really important that the ethics advisory committee brings people together to do that. You asked why ethics is important and how it operates, I suppose the main thing for me is that these are tricky questions, and you need all the voices, all the perspectives, all the experience in the room working through at the same time. You don't want to have separate discussions of things. My aim as Chair of the advisory committee is essentially to try and reassure myself that we've heard all the things that we need to hear and we've had a chance to discuss with each other as equals what it is that that leads us to think, and then to think about how to advise within Genomics England or other people on what we've learnt from those processes.  Natalie: Fantastic. Thank you, Jonathan. And as you mentioned, the necessity of multiple different perspectives, this brings me to Latha. You have lots of different hats that you bring to the Ethics Advisory Committee, could you tell us a little bit about those?  Latha: Thank you, Natalie, for that introduction. I'm Latha Chandramouli, I'm a Consultant Community Paediatrician and I'm based in Bristol employed by Siron Care & Health. I'm a parent of twins and from my personal journey, which is how I got involved, my twins are now 21 so doing alright, we had a very, very stormy difficult time when they were growing up with our daughter having epilepsy, which just seemed to happen quite out of the blue sometimes. It started to increase in frequency the year of GCSE, to the point that she would just fall anywhere with no warnings and hurt herself. This was difficult for me because as a clinician, I was also treating patients with epilepsy. I also was looking at the journeys of other people and was able to resonate with the anxiety as a parent. Worry about sudden death in epilepsy, for example, at night, these were the kind of difficult conversations I was having with parents, and I was now on the other side of the consultation table.  I was also doing neurology in those jobs in a unit where there was epilepsy surgery happening, so it was, in very simple terms, very close to home. It was quite hard to process, but equally my job I felt was I should not separate myself as a parent but also as a clinician because I had information, I had knowledge, and we had conversations with my daughter's clinician.   We were then recruited into the 100,000 Genomes Project which had just started, so we were just a year after it had started. That was an interesting experience. We were in a tertiary centre with a lovely clinical geneticist team, we had the metabolic team, we had loads of teams involved in our daughter's care. We could understand as a clinician, but there was also my husband, although a clinician, not into paediatrics and was in a different field. It was important that it was the whole family getting recruited into the journey. My daughter also was quite young, so obviously we have parenting responsibility, but we were very keen to make sure they knew exactly what they were getting into in terms of the long-term issues. Despite being informed, at times there were things that we went in with without understanding the full implications because life happens in that odyssey.   I think that was my biggest learning from those exercises when I began to question certain other things because I then had a breast cancer journey, but obviously I was not recruited as part of that process for the 100k. Those were kind of some of the questions coming in my head, how does the dynamic information sharing happen, and that's how I got involved, found out a bit more about the participant panel, and that's how I got involved from 2018 which has been an interesting experience.   Firstly, I think with Genomics England they are probably one of the groups of organisations having a big panel of people, genuinely interested in wanting to make a difference and represent thousands of participants who have got their data saved in the research library, recruited under the two broad arms of cancer and rare disease. We were under the rare disease arm, although I could resonate with the cancer arm because of my own experience.  At various times there were lots of opportunities to think about how data is accessed, are we getting more diverse access to data, all those different issues. At various points we have been involved in asking those questions. We all have different skillsets, you see, in our group. Some have got information governance hats; some have got data hats and PR hats. I've got a clinical hat and a clinical educator hat. I am a paediatrician, so I have recruited people for the same, for the DDD, for CGH etc, and I've always gone through the principles of consenting, confidentiality, the ethics. I also work in a field, Natalie, where there is a huge, as you are aware with the NHS resource issues, there's huge gaps and waiting lists, so it's trying to make sense of what is the best thing to do for that patient or that family at that point in life. Are we obsessed by a diagnostic label? Are we going down a needs-based approach? It's having always those pragmatic decisions to be made. That's one of my clinical hats.  I also am an educator so I'm very keen that young medical students, be it nursing students, everybody understands genomics and they're signing up to it so that we can mainstream genomics. Those are some of my alternative hats which kind of kick in a bit.  Natalie: Fantastic, thank you, Latha. As you say, there are so many different perspectives there. You talk about kind of the role of the whole family as part of the journey. You talked about consent, confidentiality, data access issues, lots of questions of uncertainty. Perhaps, Jonathan, I can come to you first to talk a little bit about what is it about the ethical issues in genomics that may feel a little different. Are they unique or are they the same sorts of ethical issues that come across in other areas of clinical practice and research? Is there something particularly challenging in the area of genomics from an ethical perspective? Jonathan: Thanks, Natalie. I think all interesting ethical issues are challenging, but they're challenging in different ways. I'm always nervous about saying that it's unique to genomics because there are overlaps with other areas. But I do think there are some distinctive features about the challenges in genomics and I suppose I would say they probably fall in three groups of things that we should think about. The first you've touched on which is that information about our genomics is important not just for the individual person where you generate that data but it's important for their families as well. I think the first difference is that the model we've traditionally had around clinical ethics, which sort of assumes it all focuses around the patient individual, is not enough to deal with the challenges that we have, because we also have to understand how we support families to take decisions and families differ enormously. Some families are united, some families have very different needs amongst them, and we have to recognise that our ethical approach is genomic issues must respect everybody in that, so I think that's the first difference.  I think the second difference is that the type of uncertainty involved in genomics extends much further than many other areas. We're talking about the impact on people's whole lives and it's not like a decision about a particular medication for a problem we have now or an operation. We're having to help people think about the impact it has on their sense of identity, on things that are going to happen sometime in the future.   And then thirdly, I think the level of uncertainty is different in genomics from other areas of medicine, and the particular thing I think is different that we have to work out how to address is that we can't really explain now all the things that are going to happen in the future, because we don't know. But we do know that as we research the area, we're going to find out more. So, what are our obligations to go back to people and say, “we worked with you before and you helped us out giving data into the studies. We couldn't tell you anything then that would be useful to you, but actually we can now.”. Now, that's different. That continuity sometimes talked about, you know, what are our obligations to recontact people after a study. You don't usually have those in the ethical areas we're familiar with; you're usually able to deal with things in a much more focused way.   I think those differences, that it's not just the individual, it's the family, that it's not just about a specific intervention but it's about an impact on people's lives and that we will need to think about what we had to do in the future as well as what we do immediately. They make it different in genomics. Some areas of healthcare have those as well, but I'm not aware of anywhere that has all of that in the same position.  Natalie: Latha, I'm wondering if that kind of resonates with your experience, particularly the navigating of uncertainty over time?  Latha: Yes. I would say that's exactly what you've said, Jonathan. I think it's the whole process of consenting with the view that you do not know much more beyond what you know about the situation here and now. Part of that is like any other situation, that's why we have evolved from I would say penicillin to the SMA gene therapy. If we did not do this, we wouldn't reach frontiers of medicine and kind of that's how I explained to families when I'm recruiting and I'm also very clear that it's not all about research but it's combination of the tool and focusing on your, but it's also helpful for research even if you do not get answers. I think it's very important at that stage, Natalie, that we have to be clear we may not get many answers at the very outset and also when do we really look at data, do we have that kind of realistic pragmatic resources to be able to relook every time? Is there a method of dynamically having that information from our NHS spine if somebody of the trio has contracted a condition, would that be fed in.   Those are the kind of questions parents and families ask. I cannot honestly answer that, and I often say that is optimal plan. If things go to plan, that will be the area we'd be heading towards, but currently I can't give you timelines. I think it's important we are honest at the outset and manage expectations. That's how you engage families and, in my case, it's more these children and families, so engaging is crucial. As you mentioned, it's also the question that gets asked is very simply in my mind, you know, sometimes there is that conflict because of my own personal recruitment to the 100k project, I have an interest in genomics and, therefore, I would be very keen to embark on that journey and I feel that is the way forward.   I also understand as a member of my clinical team, for example, where I know there's a huge waiting list, how am I best using the taxpayers' money that's been entrusted to us. If I think the waiting list is so high, can I see two further patients in that time that I'm using to consent which is not going to add much more to that child's journey, for example, with autism or ADHD. It's trying to be careful where is the ethics in doing an investigation, and that's like in any situation as a clinician. I think that's not much different, but it is kind of similar, but it opens up a huge area of uncertainty. As you would with any investigations, if you just went and did scans on everybody, you might pick things up which you don't need to do anything about. It's being sensible and being honest.  Jonathan: And for me, Latha, that raises two areas which I think are really interesting about genomics. The first of those is the language we've tended to use about consent I don't think captures all the ethical issues that we raise, because we've tended to think about consent of something that happens once and then gives people permission to do things. Whereas what you've described, and what we find ourselves often thinking about, is that we have to get a respectful relationship with people, so the consent is not to doing certain things, it's to agree to part of what I think about as a common enterprise. So, patients and families are partners with the clinicians and the researchers, and it's not that they sign a form and then the consent issue goes away, which is how lawyers tend to think about it, it's that we're starting something together and then we need to think about how do we keep the conversation going with mutual respect to make sure that everybody's values are there.   I think the second thing you picked up is a sense of the need for a better explanation of how research and care interact with each other. Because the care we get now is built on the evidence that people have contributed to in the past, so we're benefitting from our predecessors, and we want to contribute to our successors and our family getting better care in the future. I think one of the things about genomics is that the gap between those two things is really non-existent in genomics, whereas if you take a medicine, the research that's been done to make sure that medicine is safe and effective will have been done on a group of people some time in the past that I'll never meet, whereas in genomics I'm part of the production of that. I may get some benefit now, my friends or family may get some benefit, but there isn't this sort of separation between the care and the research bit that we're used to being able to think about. This is a much more mutual exercise and the stakes that we all have in it are therefore intertwined much more closely than they are in some areas of medicine.  Latha: I agree totally. In our case, for example, I went in in thinking we might get a targeted medication. I know there are certain levels of epilepsy medications anyway, so in principle it wouldn't have mattered a lot. However, it was important to know what the outcome was going to be because we had various labels, potential mitochondrial disease, potentially some susceptibility disorder, so we were on a spectrum from something very minimal to the other end on neurodegenerative situation. We were left dangling and we thought it would be good to embark on this journey, at least there'll be some outcome, some prognostic outcome, and more importantly we don't have any answers, but we actually can be a hopeful story for someone else in that same position, and I think that's how we've embarked on it. That's kind of my personal experience. But in just harking back to some of the ethical issues, it's again very clear educating the clinicians, as you said, it's that relationship; it's not just a piece of paper, it's that development of relationship with your families, some of whom have got very complex issues going on in their lives themselves. I work in a very, very deprived part of Bristol, which is the highest deprivation index, so they have got lots of intergenerational things going on, there is poverty, there is learning issues and crime, lots of things going on. You've got to time it right, what is important for this family here and now, and then work on it. There's also the other issue that we may not continue to remain their clinicians after recruiting. I think that's so important to recognise because the results might come back but you kind of discharge them and it may take a few years by the time the results come. How do you then cross that bridge if some unexpected results come, which then means contacting various other extended family members. I think that's the bit we all do because that's part of the journey we've embarked on, but it's also thinking is there someone else who's probably better placed, like a GP or a primary care person who's actually holding the entire family and not just one person, not just the adult who has been the index patient. It's just trying to think the ethics of it because it's all about engagement and being transparent with families.  Jonathan: I think you've put your finger on another element that's really important about the ethics. In the same way as in relation to the position of the individual patient, and we need to see them in families, which doesn't fit very easily with lots of the clinical ethics that we've been used to. It's also the case that a lot of the traditional clinical ethics has focused on the individual responsibilities of clinicians, whereas what you've just described is that we have to work out what the system's responsibilities are, because it may not be the same clinician who is enabling good ethical practice to be pursued. These are both ways in which our paradigm of ethics has to be expanded from other areas of medicine.  Latha: Yes, I agree. And the other bit I think we can probably reassure quite nicely is about the ethics about information governance and we as data custodians storing information, how do we give with great ethics and discussion the access to research and being mindful that it is again thinking along the same principles GMC kind of had about the good for the common good and using resources equitably, but again being sensible with equality issues that a single condition doesn't get forgotten. It's that right balance that whilst we are doing common good, we might have a condition which might have a treatable medication, but we have to focus on that as well as research. I think it's interwoven, all these ethical questions.  Jonathan: I completely agree, Latha. That interwoven bit is something where we need to be able to think through, “what is the role of Genomics England to improving that?”. I think we've got issues around the good stewardship of information which can't be left with an individual clinician, they can only do that effectively if the system supports them and their colleagues in doing that. But we've also got to be proactive, we've got to recognise the limitations of the system, so one of the really important initiatives from Genomics England is the Diverse Data initiative because we know that without aiming to solve the problem, we will get a skewed dataset and clinicians can't properly look after people. That tells us that the ethics in this area has to do more than avoid things going wrong, it also has to work out what it means to do things right, and what systems we have to put in place to do that. I think that's a particular example of a shift we need to do across our ethics around healthcare.   If speak to the sort of things that lawyers have got wrong around this in the past and some of our history, we focused a lot of our effort on stopping things going wrong. That has meant that we haven't spent as much time as we need to on thinking about how to make things go right, because stopping things going wrong is almost always too late. What we have to do if we're being proactive is work out how to set things up in a way that will make sure that the chances of it going wrong are quite small and the chances of doing good are much increased. I think that's one of the key challenges that we have in Genomics England and as an Ethics Advisory Committee. The things we've inherited tell us quite a lot about things that have gone wrong, but actually what we're trying to do is to get our heads around what could go right and how to make sure it does.  Latha: Also, you mentioned about Diverse Data, I think that's another important thing as we noticed in COVID as well. There were lots of disparities in the social model and the inequalities that have resulted in death, but also potentially HLA or epigenetic issues which could have contributed. We do have the COVID-19 genomic datasets, but it's again important to make sure that we don't perceive certain ethnic minority populations. Just not accessing or considering them to be hard to reach, I would say for them Genomics England is hard to reach. It's looking at it slightly differently and thinking, “how can we reach them? how do we maybe use community workers and maybe even clinicians?”, I think they've got the best trusting relationships with their clinicians and using them to recruit. As you say, even before things get more complicated, you recruit them earlier so that you'd go down the prevention route rather than the gone wrong route and then look for answers later.  Jonathan: Latha, I think you put your finger on something really challenging for a group like the Ethics Advisory Committee at Genomics England, which is that however hard we try to get a range of experiences and voices, that's not a substitute for getting out and hearing from people in real world situations. I think one of the things I've learnt over the years from my national health service work is that you cannot expect people to come to you, you need to go to them. In COVID when we were trying to understand why some groups were more reluctant to take up vaccines than others, there was no point in doing that sitting in your own places, you had to listen to people's concerns and understand why they were there. One of the things we're going to have to be able to do as the Ethics Advisory Committee is work out when we need to hear more from people outside of the Genomics England system, and I'm a great believer that if it's right that we need to go where people are, you have to try not to reinvent mechanisms to do that. You have to try and learn where are people already talking about it and go and listen to them there. Latha: Absolutely, yeah. I think they listen because I do work as a paediatrician with a safeguarding hat, and I think the same principles resonate in child death work. For example, simple messages about cot deaths, you would think that if a professional tells the same message to a parent or a carer it's better received if it's another family, a younger person, another layperson giving the same message. It comes back to who's more receptive. It could be a community worker. As you mentioned about vaccination, during the vaccination initiative I decided early on that I'm probably not going to do a lot because I'm not an intensivist, how do I do my bit in the pandemic. I decided to become a vaccinator and I thought with my ethnic minority hat on, if I went out there to the mass centres and actually vaccinated there or in mosques or wherever else, without even saying a word I'm giving the message, aren't I, that, look, I'm fearlessly coming and getting vaccinated and vaccinating others, so please come. I think that has helped to some extent, just trying to reach out. Other than saying these people are not reaching us, it's got to be the other way around.  [Break for advertisements]  Natalie: I'm really enjoying this conversation. In part because I think it highlights just how valuable it is to sort of think about ethics a little bit differently. Historically, and certainly I think within the research community, ethics can just be associated with consent. Consent is the ethics issue and if you solve for consent, then you don't have any other issues to think through. I think what this conversation is really highlighting is just how much broader the ethical considerations are. Beyond that, it's still very important that consent can be that sort of anchor point for communication and engagement, but it's not simply a one-off. And to be able to think through ethics not just in terms of risk or moving forward when things have gone wrong in the past, there is actually a really positive aspect to it which I think is critically important.   It's great to hear your thoughts about that different approach to ethics that I think does embed it much more in community thinking, in questions of equity; it's not just the individual. I want to follow-up by just asking where do you think the future lies in thinking about ethics both for Genomics England and the Ethics Advisory Committee, but in the space of genomic research and medicine more broadly, given that it sits in this kind of very interesting and quite complex space between research and care in the clinic.  Jonathan: I mentioned earlier in the conversation I think about this as a common enterprise that we have shared stakes in. Academic researchers have a stake in trying to build a better more robust evidence base, clinicians have a stake in being able to offer something to the people that they're looking after. Families have stakes not just in their own immediate care, but they worry about their siblings, they worry about their children, their grandchildren. There are also of course industrial players, so people trying to build a business out of making better medicines in the future. There are government players trying to use public resources more effectively. I think what we have to try to create is a mutual process where we recognise that everybody has overlapping but slightly different values that they're pursuing and trying to get out of it, and how can we make sure that we govern our work in a way that reflects all of those stakeholders and recognises the respect that's due to them. I think this is more like a sort of membership of a common project. And the problem with consent is it risks us saying you can be a member of this club but only if you accept the terms and conditions that the committee has decided is there. That's not going to be adequate going forward. I think we need to make sure that everybody feels that they are respected, that they feel they can place their trust in the system that we're designing. As an Ethics Advisory Committee, we have to ask ourselves what justifies us suggesting to people that this is trustworthy. We need to make sure we have good information governance that people are not going to expose themselves to breaches of privacy if they take part in this. But we also need to make sure that we don't waste people's efforts. If people are prepared to be part of the research project, we shouldn't have rules coming down on the data usage that say that we're going to reduce the value of that contribution by saying it can only be used for one project and can't be used for others, because actually that would not respect properly people's contribution to the process.   We need to ask ourselves not just about the protective element of trustworthiness but that element that says we will make sure that you get as much as we can design of the things that you think are important from this project. They won't be identical for each group, and they won't be identical within each group. Different family members of participants will have different balances, but they all have to believe that this is a good club to be part of and that they have been part of agreeing ways of working that they think will produce a better future that they want to be part of and that they want to be proud of saying we have helped create this future.  Latha: I kind of agree with all that you've said. I think it's most important not to forget because I'm also a participant, like my trio sample is there in the pipeline, and I know my data is sitting there. I also have trust that there is good information governance, the data is secure, so it's reinforcing that, but it's also being very honest that it's obviously the data is there, but we can't forget the person or the persons at the centre of it, so it's not just alphabets or sequences of alphabets, but it is that whole person, and that person represents a group of individuals, family members, different generations, and they have embarked on it. Even if they know they may not get hope they might provide hope for others. It's being therefore respectful. I think that is the first thing I think is the principle of it and if you respect. If you think it could be the same principle that we use in clinical practice, the friends and family test, because I've been on both sides of the consultation table, I think I've become a better doctor because I've been an anxious mum, and my anxieties were dismissed as being an anxious mum and I don't care. As far as my child is concerned, my anxiety was valid and so I would do everything to reach an outcome as to what's best for that person. It's made me a better doctor because I can see it from both the perspectives. Most of us are human beings, apart from AI technology looking at the dataset, so we all have conditions ourselves, we've got doctors with health conditions, we've got clinicians, academics, technicians, nurses everybody who's got a friend or a family member or themselves having a health condition. I think its fundamental principle is that friends and family test. How would I like my data stored? How would I like my data analysed? Could it do this, could it give me some information on how I would get cured or treated or be managed? How would it affect my insurance, or will it find out data about who's the father of this child, for example? It's being honest and being honest about the uncertainties as well.   When I'm recruiting, I'm very clear that these are what I know that I can tell you about the risks. But then there may be other risks that I do not know about. If you're honest about it and acknowledge what is the limit of the knowledge of science at this point in time, because you said there are so many stakeholders, there are researchers and academics who've got interest in some areas, it could have developed because of a family member having that problem, but whatever it is that is a great interest because that intelligent mind is thinking ahead and we need to encourage that. It could be for writing up papers, it doesn't matter. Whatever be the reason, if it's for the common good, that's fine. It's also thinking how are we keeping our families in the loop, so you have newborns, you've got young people sometimes with significant disabilities so they are relying on a parent or a carer to consent for them, but some are not so disabled but they have needs, they've got rare conditions, but they can make their consenting issues known when they turn 16, for example. It's the changing policies and they can withdraw at some point in life or there may be a member of the family who doesn't want to be part of that journey anymore. It's allowing that to happen. Jonathan: I think that's a really interesting example you've just touched on, Latha, where I may diverge a bit in terms of what I think is the key issue. The right to withdraw I think is a really interesting challenge for us going forward, because we developed the right to withdraw in the ethics of research studies that had physical interventions. It's really clear that someone who is being put to discomfort and is having things done to her body, if she wants to stop that, we can't justify continuing on the basis of it being a research project. But I'm less clear whether that applies to withdrawing data from data pools. I think there are a few dimensions to that which I hope as an Ethics Advisory Committee we'll have a chance to think through a bit more. One is the mutual obligations that we owe to each other. I'm not in these particular studies but I do try and take part in research studies when I'm eligible and invited to because I think research is important. When I take part in things and when our participants have taken part, they're doing something in which they rely on other people participating because the aggregation of the data is what makes it power. One of the things we have to be honest about is what are our mutual expectations of each other, so I think we absolutely have to hold on to the fact that people should be able to withdraw from further interventions, but I'm not convinced that you should have the right to say the data I've previously contributed that other people have relied on can suddenly be sucked out and taken out of it, because I think it's reasonable for us to say if this is a sort of part of an enterprise. While you're part of it, you've made some commitments as well as, and that's part of the mutuality of the respect. I think I personally would want to argue you can withdraw from new things, but provided that your privacy is not intruded on, so we're talking about data health anonymously, you shouldn't be able to say don't process it anymore. Latha: No, no, no. What I meant was from my perspective I would like to be constantly involved and get information through trickling. I don't know what my daughter feels years down the line, she might say I'm happy for my data to be used for research, but I don't want to know anymore. There are two aspects of that, and I think if we are clear with that and say continue with my data being used for research, but I don't want to get anymore letters. I think those are the kind of questions I face when I tell them families that these are the uncertainties, you can have your blood stored, you may not be approached again for a resampling unless you have some other issues, but are we happy with this? I think that's what I understand, and I try and recruit with that intention. Jonathan: And that makes lots of sense to me. As you say, you probably can't speak for your daughters now, and you certainly can't speak for them when they become parents for themselves and those things, but we do need to create an ethical framework which recognises that people will change their mind on things and people will vary about what they want to do. But because we have mutual obligations, what that means and the control we can give, we have to be open and honest about what choices we can give people without undermining the enterprise and what choices we say, “you don't have to do this, but if you want to be part of it, there are some common mutual obligations that are intrinsic”, and that's true of researchers, it's true of clinicians, it's true of anyone who works in Genomics England or the NHS.   But I don't think we've been very good at explaining to people that there's an element of this which is a package. A bit like when I bank, I allow the bank to track my transactions and to call me if they see something that looks out of the ordinary as a part of the protections from me. I can't opt out of that bit. I can opt out of them sending me letters and just say do it by email or whatever and I have some choices, but there's an infrastructure of the system which is helping it to function well and do the things it's able to do. I don't think we've been very good at explaining that to people, because we've tended to say, “as long as you've signed the consent form at the beginning of the process, it doesn't really matter what happens after that, you've been told.”. That's not enough I think for good ethics.  Latha: And I think that comes back to the other issue about training those who are consenting. I speak from personal experience within my own teams I can see somebody might say, “I don't do whole genomic sequencing consenting; I don't have the time for it.”. I might even have my organisational lead saying when we had a letter come through to say now we're no longer doing this, we're going to be doing this test for everybody, there's a whole gasp because it's at least two hours' worth of time and how are we going to generate that time with the best of intentions. I think that's where I think the vision and the pragmatic, you know, the grounding, those two should somehow link with each other. The vision of Genomics England with working with NHS England and with the future, Health Education England arm that is not amalgamated with NHS England, is trying to see how do we train our future clinicians who will hopefully consider it as part of their embedded working thinking and analysis, but also, how do we change the here and the now? The more senior conservative thinking people, who are worried about how do they have to generate time to manage, we're probably already a bit burnt out or burning out, how do they generate time? If you then discover new conditions whether there is already bottleneck in various pathways, how are we ethically managing the new diagnosis and how will they fit in in the waiting list criteria of those people on the journey who are symptomatic. I find that bottleneck when I have conversations with colleagues is the anxiety, how is that going to be addressed.  Jonathan: Latha, you've sort of taken us around in a circle. We started off thinking what was special about genomics, and we've reflected on ‘we have to solve the problems of the health service'. I think that there's some wisdom in that, because we are learning how to do things that are not unique to genomics, but there's an opportunity in genomics to do it better and an opportunity for us to help other areas of the health service do better, too. I think we've come around in full circle in a sense.  Natalie: Which feels like a lovely way to wrap up our conversation. I feel like we've gone into some of the deep ethical principles but also really shown how they can be brought into the practice, into the clinic and brought to bear the thinking and the feelings, the hopes the anxieties of participants. There's a very, very important range of different voices so a very rich discussion.   I'd just like to thank you both very much for joining us on the podcast. Thank you to our guests, Professor Sir Jonathan Montgomery and Dr Latha Chandramouli for joining me today as we discussed ethics in genomics research and practice. If you would like to hear more like this, please subscribe to Behind the Genes on your favourite podcast app. Thank you for listening. I've been your host, Natalie Banner. This podcast was edited by Bill Griffin at Ventoux Digital, and produced by Naimah Callachand.

This episode features a conversation about bias in healthcare AI models with Dr Xiao Liu- Senior Clinician Scientist in AI & Digital Health, University Hospitals Birmingham NHS Foundation Trust. Discussion topics include: How does AI bias arise?  How can we tell whether AI algorithms are biased? Who should be held accountable for bias in AI systems? Is AI the solution for AI bias? Papers referenced during the discussion: Ethical Machine Learning in Healthcare: https://pubmed.ncbi.nlm.nih.gov/34396058/ Standing together recommendations: https://www.datadiversity.org/about

The historian Michael Taylor looks back at the past tug of war between religion and science, and how the discovery of ancient bones challenged religious orthodoxy. Impossible Monsters: Dinosaurs, Darwin and the War Between Science and Religion is the story of a group of people whose insights tested beliefs about creation and cosmology, and ushered in the secular age.But Nick Spencer from the thinktank Theos dismisses the idea that science has rightly relegated religion to the margins. In his new book Playing God: Science, Religion and the Future of Humanity (co-authored with Hannah Waite) he argues that religious belief is uniquely placed to help people navigate a world dominated by scientific breakthroughs – from AI to aliens, gene editing to the treatment of mental health.Professor Frances Flinter has been at the forefront of innovations in the treatment of genetic conditions for decades in her role at Guy's & St Thomas' NHS Foundation Trust. She is also a member of the Nuffield Council on Bioethics and says that medical decisions are rarely based purely on science, but involve thinking about what it means to be human. Producer: Katy Hickman

How soon should we start taking our dementia risk seriously?In today's episode of ZOE Science & Nutrition, Jonathan is joined by Prof. Claire Steves to explore the multifaceted world of dementia. They delve into the significance of dental health, genetics, diet, and physical activity — plus, they unpack the latest research — to give you practical strategies for preventing dementia.Claire is a consultant physician in geriatric medicine at Guy's and St Thomas' NHS Foundation Trust. She's also a senior clinical lecturer at King's College London and deputy clinical director of the institution's Department of Twin Research and Genetic Epidemiology where she leads research on the characterization of physical and mental aging traits and frailty.If you want to uncover the right foods for your body, head to zoe.com/podcast, and get 10% off your personalized nutrition program.Get the FREE ZOE gut health guide — download hereFollow ZOE on Instagram.Timecodes:00:00 - Introduction01:26 - Quickfire questions on dementia02:42 - Main discussion: understanding dementia04:18 - Control over fate with dementia06:52 - Why older people get more fractures08:32 - Warning signs of dementia09:55 - Unique aspects of dementia12:12 - Cellular level discussion on dementia15:49 - Risk factors for dementia16:07 - Inheritance and dementia18:29 - High-risk factors for dementia19:15 - Fetal development and dementia risk21:47 - Brain reserves and mental health24:24 - New advances in dementia treatment30:47 - Medications and life expectancy33:21 - Diet and dementia prevention35:58 - The role of physical activity39:45 - Oral health and dementia42:10 - Social interaction and brain health44:02 - Diabetes and dementia45:36 - Women, HRT, and dementia49:09 - Recap: Types of dementia53:39 - Hearing aids and dementia prevention55:39 - Episode sign-offStudies related to today's episode:Brain-age is associated with progression to dementia in memory clinic patients from NeuroImage ClinicalFind our top 10 tips for healthier living: Download our FREE guide.Are you interested in a specific aspect of dementia? Email us at podcast@joinzoe.com, and we'll do our best to cover it.Episode transcripts are available here.

It is imperative that children and young people are central to the co-design and co-production of our patient safety improvement interventions. In this episode, we speak with Dr Jane Runnacles, consultant paediatrician at St. George's Hospital, and Dr Victoria Dublon, paediatric diabetes consultant at the Royal Free Hospital. Both are champions of improvement work that puts the young person and their needs first. As Jane and Victoria describe, involving children, young people and their families in improvement work improves the experience and outcome for all involved. There are fantastic examples of co-creating and co-producing safety improvements in healthcare. We discuss the practicalities of how to do this and who to involve in your healthcare setting, and we hear about some of Jane and Victoria's successes. Thank you for listening. Dr Natalie Wyatt, RCPCH Clinical Fellow and Jonathan Bamber RCPCH Head of Quality Improvement  Produced by 18Sixty Please be advised that this podcast series contains stories relating to child death and harm. All views, thoughts and opinions expressed belong to the guests and not necessarily to their employer, linked organisations or RCPCH. Download transcript (PDF)  About the patient safety series As doctors we ‘first, do no harm'. However, the systems in which we work are rife with safety issues and resultant harm. In thinking about how to improve this, we have brought together leaders in the field to discuss challenging and thought-provoking issues around keeping our children safe in healthcare settings. We hope you will be entertained, educated and energised to make strides in improving the safety of the children that you care for. The RCPCH Patient Safety Portal has lots of resources. And our engaging children and young people web pages can help you get started on your engagement journey to effectively work with children and young people to improve their healthcare.  Dr Victoria Dublon is based at the Royal Free Hospital and part of the Trust-wide diabetes team. She has been a paediatric diabetes consultant for eight years, working primarily at the Royal Free Hospital as well as running clinics at Barnet Hospital and Chase Farm Hospital. As a registrar, she trained in adolescent health as well as endocrinology and diabetes and this continues to be a big part of her work. Victoria is involved in improvement work within the department as well as being a champion of ‘Me First', striving to put the young person and their needs first. Dr Jane Runnacles is a consultant in ambulatory paediatrics at St George's hospital NHS Foundation Trust, London and clinical governance lead for her department. She has an interest in acute paediatrics, simulation and quality improvement. During her postgraduate training in London, she was awarded distinction in her MA in clinical education and spent a year as a Darzi clinical leadership fellow at Great Ormond Street Hospital. Jane is a Training Programme Director for the London School of Paediatrics and leads their leadership and QI education programmes. Topics/organisations/papers referenced in this episode Great Ormond Street Hospital Royal Free Hospital Darzi Fellowship Peter Lachman RCPCH SAFE Collaborative RCPCH QI Central Don Berwick Whiteboard communication project (on QI Central) Yincent Tse NHS blog - Asking "What Matters To You?" NHS - Co-production Paediatric Early Warning System (PEWS) St George's Hospital St George's Hospital - Children and Young People's Council Wac Arts WHO World Patient Safety Day (17 September) ‘Listening to you' project at Birmingham Children's Hospital NHS Patient Safety Incident Response Framework Safety huddles (part of Situation Awareness for Everyone)  

As a member of the Parkinson's Disease guideline committee of the National Institute for Health and Care Excellence, Clare Johnson explains the vast number of ways Occupational Therapists help patients and their families cope with the everyday motor and non-motor challenges of living with Parkinsons. We hear about the benefits of multi-disciplinary clinics and why standard measurement scales can fall short compared to individualised evaluation.

In this instalment of The G Word, our guests engage in a compelling discussion centred around a recently published paper that supports the integration of whole genome sequencing into standard cancer care.  Our guests shed light on the transformative potential of combining health data with whole genome data. Discover how this innovative approach empowers doctors to deliver more personalised and effective care. Our guests delve into the findings of a landmark national study, unravelling the significance of identifying inherited cancers for patients and their families. The episode explores not only the scientific advancements but also the real-world impact on individuals facing a cancer diagnosis.  Our host Naimah Callachand is joined by Dr Nirupa Murugaesu, a Consultant in medical oncology at Guy's and St Thomas' NHS Foundation Trust, and the Principal Clinician for Cancer Genomics and Clinical Studies at Genomics England.  And by Professor Sir Mark Caulfield, a Professor of Clinical Pharmacology at Queen Mary University of London, and who previously served as Chief Scientist for Genomics England and was instrumental in the delivery of the 100,000 Genomes Project.    "In cancer we were sequencing sections of the tumour and comparing them to DNA inherited from your mum and dad, and that comparison allows us to work out what is driving the cancer, what may be affecting its potential for treatment and how we might choose treatments for patients.  So this is a real opportunity to create precision cancer care."     You can read the transcript below or download it here: https://files.genomicsengland.co.uk/documents/Podcast-transcripts/Whole-genome-sequencing-in-cancer-care.docx   Naimah: Welcome to the G Word.  What does it mean if we can test for inherited genes?    Nirupa: It can influence how their cancer is treated.  So it means that there may be certain types of therapy that are available if they have a specific inherited cancer gene, number one.  It also can impact in terms of preventing further or other cancers related to those genes, and it may impact the type of surgery they have, and also the type of overall cancer treatment.  And then finally, if they have got an inherited cancer, then, as I mentioned before, it may impact in terms of testing and screening for their family members.  Naimah: I'm your host Naimah: Callachand.  Today, I'm delighted to be joined by Dr Nirupa Murugaesu, who's a consultant in medical oncology at Guy's and St Thomas' NHS Foundation Trust, and the principal clinician for cancer genomics and clinical studies here at Genomics England.  And Professor Sir Mark Caufield, who's a Professor of Clinical Pharmacology at Queen Mary University of London, and who previously served as chief scientist for Genomics England and was instrumental in the delivery of the 100,000 genomes project.  Today, Mark and Nirupa are going to discuss key findings from a recent paper that's just been published in Nature.  If you enjoy today's podcast, we'd really love your support.  Please like, share and rate us on wherever you listen to your podcasts.  Now, let's get into the interview.  So first of all, Mark, I wondered if you could give me a bit of background on the 100,000 genomes project?  Mark: So the 100,000 genomes project started in July 2013 following an announcement by the then prime minister, David Cameron, that the UK would be the first health system in the world to sequence 100,000 whole genomes, which is as much as you and I can read of the genetic code.  In the case of cancer, which we focused on here, in cancer we were sequencing sections of the tumour and comparing them to DNA inherited from your mum and dad, and that comparison allows us to work out what is driving the cancer, what may be affecting its potential for treatment and how we might choose treatments for patients.  So this is a real opportunity to create precision cancer care.  Naimah: And Nirupa, can you tell me what the 100,000 genomes project meant for these patients with cancer?   Nirupa: I think, firstly, we're very grateful for all of the participants in the programme, because what it's allowed us to do is to look at the data as a whole, and having all of that sequencing data alongside clinical information has been incredibly valuable, it has also developed the infrastructure for testing.  And really I think for patients with cancer, they participated in this programme as a research project, and unusually for a research project these results were returned back to treating clinicians to clinical teams, if there may have been a result that would impact or change their management.  But I think, importantly, what it enabled is the implementation of standardised cancer testing in the NHS, and really enabling that for a wider range of patients, not just those that participated in the project.  And because of patients participating, this then allowed all of the data to be stored in a single place, and this has been incredibly valuable for clinical academics and researchers.    Naimah: And can I ask what specific types of cancer that were looked at in 100,000 genomes project?   Nirupa: Again, the project was set up such that we allowed a number of different types of cancers to be sequenced and, therefore, very permissible, because we also wanted to ensure that some of the less common and rarer cancers were also sequenced and, as you would expect, more of the common cancers as well.  In addition, I think the opportunity to sequence paediatric cancers, as well as haematological malignancies, or blood cancers, was also key as part of the cancer programme.  Here, we focus on the solid cancers, but obviously there was a much wider range of cancers that were sequenced.    Naimah: And next, can we move on to talk about the findings of the study?  Nirupa: I think, firstly, by undertaking sort of a pan-cancer analysis, it really gave us an overview of the number of target and genes that were found to be actionable.  And what I mean by that is that they have a, well, clinically relevant, and we can see that in certain cancer types, such as in brain cancers, in colon cancers, lung cancers, there were within the genome sequence more than 50% of these cancers had something that was what we would call actionable.  So there was a mutation in a gene for which this would influence treatment.  And as we started to look more across the entire cohort of patients, you can really get an idea of the fact that the more that we sequence, and the more comprehensive the testing is, the number of different types of mutations that we were able to discover.     Naimah: And when you mentioned that these findings were actionable, what does that mean?  Nirupa: So what that means is that has an impact in how the patient will be managed and treated.  It may influence, firstly, the type of surgery they have, it may influence the type of cancer treatment that they receive.  And all of this, I suppose, comes back to the point that Mark mentioned, of precision oncology, so we more precisely treat patients based on their individual cancers.     Naimah: And could you give me some examples of maybe some of these genes that were found in the study that were actionable?  Nirupa: Yes, so the types of genes also matter, or the type of mutations.  So some of them were in known cancer genes, and if you have, for example, a mutation in lung cancer, in a gene called the EGFR gene, we know that there are cancer therapies that can be provided that target specifically this mutation.  So that's one example, and this is quite well characterised and understood in oncology care.  But what we were also able to do with whole genome sequencing, is identify different types of mutations that are harder to characterise routinely.  And these are often included things that we call pan-genomic markers, where we can see what the mutational landscape is of the cancer, the different patterns of mutations can be gleaned from this, and often this can then give you an idea of the underlying biology of the cancer.  But importantly, in certain types of cancers, such as high grade serious ovarian cancer, it highlights which patients may have a particular marker that means they may or may not benefit from a particular type of therapy.  So in this particular case, the class of therapy is called PARP inhibitors.  Naimah: And how did the study compare to other similar stuff studies in the genomics area?  Nirupa: That's a really good question, and I think we looked at this from other large sequencing endeavours, such as the ICGC, TCGA, so these are big studies where have been whole genomes sequencing.  Also within the Hartwig Institute in the Netherlands, they've also undertaken whole genome sequencing for cancer patients.  And what we were able to identify is that the patterns of mutations were as expected, we found, you know, a lot of similarities.  I think the difference, the main difference is not just identifying the type of mutations across the different cancers.  But the fact that we were then able to look at the longitudinal outcome, and correlate some of these genomic markers with outcomes related to both therapies, as well as survival impact of having certain mutations in terms of prognosis.    Naimah: Mark, do you have something you'd like to add there as well?  Mark: Yeah.  So one of the things that we did in the 100,000 genomes project, was to evaluate the best way of measuring the whole of your or my genetic code.  And we discovered that very early on that if you expose the tumour to a preservative, which is called formalin which keeps the tumour preserved, that actually you could get quite a number of misleading findings.  And so to address that, the distinctiveness from former programmes, such as Nirupa mentioned, like the Cancer Genome Atlas, is that all of the tumours that we studied in this paper were actually produced under fresh tissue conditions, and have not been exposed to a preservative.  And that means that what we have is a really accurate reflection of the variation within the tumours.  And the other thing about this particular resource is it's the biggest resource.  We were able to look at 13,000 people with solid tumours, but we also had blood cancers and other cancers which also feature of this paper.    And a further remarkable thing about this is early on, Nirupa and the team and I decided that we would longitudinally life-course follow the patients and by accruing data from multiple sources in the health system.  So, every attendance at the hospital, what chemotherapy was had, we've been able in this paper to recapitulate signatures that clearly show that certain mutations are harmful.  And many of the findings that we've made are absolutely, if you look at the survival of patients particularly, you can see almost identical patterns to those in clinical trials.  What this means is that by the really rich data set which is now many billions of clinical data points on these patients, we can actually look for long-term signals of benefit and harm that perhaps would not be detected by a clinical trial that might last for six months or a year.  So this is a really valuable resource, and the really great thing is we can use what's called real-world data, which is where we take routine health data, and we can recapitulate the findings from tightly controlled clinical trials.  And I think that's quite an important finding.    Naimah: That kind of brings me onto the next question, Mark, where I want to talk about the value and benefit of genomics sequencing for cancer patients.  I wondered if you could expand?  Mark: Well, what we know from one of the genomics medicine centres which were regional hubs, is that they use the information that we return, that Nirupa outlined earlier in a report, for 25% of their patients.  Which means that they concluded having evaluated that as the clinical team locally, that there was something the patients could benefit from.  Now, what we think is this makes the case for certain cancers being part of the national genomics test directory whole genome sequencing, but it's still the case that the majority of testing for cancer is now very large focused panels that are focused on specific gene features.  But in some measure, this work is also able to reassure us that those gene features are the right ones to focus on, so this work has been very useful in that respect, even where the NHS today cannot make the financial or clinical case for using whole genomes in specific cancers.  So I think the programme's made a massive difference.    The biggest thing it's done for patients, which Nirupa was very actively involved in, is it's allowed us to create a national genomics test directory.  So when we started this, cancer genomic testing was completely random and would vary from one postcode to another, one hospital to another.  And what Nirupa and the cancer team created is a national cancer genomic test directory, which now means that standard of care, that's the basis for reimbursement, and it's available across the landscape of 56 million people.  And given that one in two of us will have cancer, this is a massive advance.    Naimah: Yeah, you've really highlighted the impact of having access to such a large database.  And I just wanted to ask as well, what are the challenges associated with implementing routine whole genome sequencing into clinical care?  Nirupa: I think as with all of these things when implementing something new within a healthcare system, it requires a level of education, upskilling and also, as Mark has touched on, how we handle the tumour tissue, so that it's handled in a genomic-friendly way to enable the best results if you like, because we want to ensure that their DNA is not damaged so that we can get accurate read-outs on the results.  So there are challenges and there is also cost implications in weighing up the pros and cons.  And I think what we were able to show, and by undertaking this sort of pan-cancer analysis, is where there are those cancer type where there is a real need for whole genome sequencing, or where it can be justified, because there are a number of different types of mutations both within the tumour.  And also from a blood sample that is also taken, so this is your constitutional DNA, so this is if there is a risk of an inherited cancer.  So we are able to pull together all of this information, and obviously that's important, not just for the patient, and their management, but also for family members.  So I think really what this shows is that where you have to identify many of these different types of mutations, whole genome sequencing enables that through a single test.   Naimah: Mark, would you like to add something else there?  Mark: One thing I think which Nirupa's very much part of, is the distinctiveness of the Genomics England approach has been to involve the NHS at every stage.  Now, what that means is we estimate that at the peak of the 100,000 genomes project, 5,000 frontline NHS staff touched the project at some point in their working week.  What that does mean is that Nirupa and the cancer team could realign the cancer tissue handling pathways.  But it also meant that we were able to upskill the frontline workforce, such that at the end of the programme, when we produced a genomic test directory, they were really up for it because they did not want all the hard work they'd put in to stop.  And so what we've done is produce the national test directory within five years of starting, that wasn't a deliverable for the project, but it was nonetheless obvious to all of us working in it, including NHS England, that there needed to be service transformation, and we've managed to effect it.    Now, if you look at other settings where perhaps Nirupa and I might have a research team, we might do it some distance from the health system, it would be in the health system, but not with the health system, then it takes between nine and 16 years to get these things into clinical practice.  And that was achieved here in five years.  So there is a lesson from this, the cancer programme particularly, because the cancer programme testing was very limited when we started, but you can take an entire workforce on a journey and leave them with the legacy of an entirely transformed system for patients.  And thankfully because we got, Nirupa and I, the NHS to agree to reimburse for the testing directory being used, we have eliminated a lot of randomness that was in the system previously.  So it's quite an important advance in that respect, and it really does show in the beautiful work that Nirupa was describing exactly how you can use this information to change an entire system.  And the NHS is not the easiest system to change in the world.  Naimah: Nirupa, you mentioned the findings show that there was potentially inherited genes.  Can you tell me what does that really mean for patients, if we're able to diagnose these inherited genes sooner in life?  Nirupa: It can influence how their cancer is treated, so it means that there may be certain types of therapy that are available if they have a specific inherited cancer gene, number one.  It also, can impact in terms of preventing further or other cancers related to those genes, and it may impact the type of surgery they have, and also the type of overall cancer treatment.  And then, finally, if they have got an inherited cancer, then, as I mentioned before, it may impact in terms of testing and screening for their family members.  And that's really key as well, because this means that their cancer can be diagnosed, if they do develop a cancer, because they're being monitored, because it's much more targeted, their approach in terms of screening for a particular type of cancer, they can potentially have their cancer treated much earlier.  Or even better, before it becomes what we call an invasive cancer but at the pre-cancerous stage.  So this has huge implications, and what we're finding actually with more and more testing – and this is not just... our study was consistent with other studies that have been published – is that when you undertake more routine testing, then you are able to identify this.  It is not common amongst the population, but in those patients where it is relevant, it really can impact their care.  Naimah: Mark, do you have something to add there?  Mark: Well, I think Nirupa's just highlighted a really important point.  So to bring that into a little bit more ways of which people listening to this can relate to it, we have a family where there was a women who had no family history of breast cancer, she developed breast cancer, and in the tumour we found that she had a BRCA 2 mutation.  We also found that she'd probably acquired that or inherited it, we don't know.  That for her meant that she could enter the Olympia trial, which was running at the time, which Nirupa alluded to earlier, was a study of PARP inhibitors.  But without that genetic makeup she'd never have got into that trial, and she probably wouldn't have been tested for BRCA at that time in the NHS because she had no family history, I think that's probably right, Nirupa.    And then there was a family-wide consequence for that, because she had a brother and son, and she also had a daughter, and the daughter was under 30 at the time and underwent BRCA testing and was BRCA 2 positive.  But she has the opportunity now to enter intensive breast screening from the age of 30, and that's what's happened.  And her brother, and this is the lady who had the breast cancer, her brother and her son may be at risk of prostate cancer, so they can consider testing.  So Nirupa makes a really important point, that when people have inherited a previous disposition to cancer, that can have a family-wide impact.  And one test in one family member can open the doors to opportunity for others to understand their risk and to be screened more actively and intensively, hopefully with meaning that if they do develop cancer it will be detected very early, or maybe we can just prevent it altogether.     Naimah: Thanks, Mark, a really good example of the impact that this testing has had.  I just wanted to touch back on your point, Mark, that you'd made about real-world data.  And I wondered actually, Nirupa, if you could kind of explain to me why it's important to link real-world data to the genomic data?  Nirupa: Yeah.  So I think the work we've done here really does emphasise this, because when we refer to real-world data, we're talking about different types of healthcare data across the population.  And we had the opportunity to link the genomic data to a number of key data sets that are curated by the cancer registry, the national cancer registry database.  And this includes things like all of the population base systemic anti-cancer therapy, so we know that for each of the participants the type of cancer therapy they receive, and also, as Mark has mentioned previously, the hospital episode.  So when patients needed to be... we can see their data in terms of admissions, investigations, and so on.  And these are really valuable data points, because you get an indication of when patients may have had to then have further testing, or if there is a risk of recurrence and importantly survival data, because a lot of this has been, in terms of a lot of the cancer genes have been well characterised and tested.    But what we were able to do here at a pan-cancer level on a large cohort of patients over a period of time, is to look at if you had a particular mutation, what is the impact of that in terms of outcome for a particular cancer type, and even more broadly, on a pan-cancer level?  And actually, as this type of data accumulates, I think the real value, and if you've got a larger number, you know, what is the value for patients who've participated in this programme going forwards, is that as that data accumulates and the numbers go up, we are able to then ask more detailed questions.  What is the impact of a particular type of mutation, or a particular type of variant within a gene?  And, importantly, what happens when you get a different sequence or a combination of genes?  And how does that impact?  And this, I feel, is the way that we are going to move more towards precision oncology, because we are beginning to understand the cancer in more detail, how it is going to behave, and then try and tailor therapies accordingly.   Naimah: And Nirupa, I wondered if you could tell me as well if the findings from this study have benefited directly those patients that were involved in the 100,000 genome project?  Nirupa: It has benefited some of the patients because, as Mark has mentioned, there are findings that we weren't expecting in terms of potentially inherited cancers and, therefore, this has had implications.  The way that the project was set up from the outset, is that we were obtaining tumour samples from patients who had not received any previous cancer therapy.  And what this meant is that this was predominantly in patients, so they were treatment naïve with early stage disease that were having surgery to treat their cancers.  And as such, what we know is that fortunately most of those patients did not require further therapy, because their cancers were treated successfully with surgery.  But what it did tell us, and what it's really highlighted, is the number of important genes that were identified.  And so whilst it may not have impacted patients directly, it's enabled us to study the biology of the different types of cancers, how they behave, along with the longitudinal clinical data.    But what it is doing now, is through the national test directory through the genomic medicine service, is enabling testing for patients that unfortunately now have more advanced cancers, but where these genomic findings are more likely to impact directly in terms of therapy.  So, for instance, as we've mentioned, the ability to have whole genome sequencing for patients with high grade serious ovarian cancers, means that this will impact the type of treatment they have.  And this also was the tumour type where we found the highest number of patients with BRCA mutations, so we have a potential inherited risk of a cancer as well.  So now what we have learnt and the infrastructure that we have developed has enabled this to have a real impact, not just for patients in the project now, but wider within the NHS.  Naimah: Mark, would you like to add something else there?  Mark: I think Nirupa's encapsulated it very well.  There were a range of benefits, so I mentioned earlier that in one centre 25% we have evidence got a benefit for their treatment for their cancer in some way shape or form.  So an example to what there might be is that some people got a medicine they wouldn't have received from routine care, and that might have been licensed for the treatment of that tumour, but it wouldn't have been the first line treatment choice.  Some people got medicines that they wouldn't have got because we don't normally associate using that medicine with that cancer, but they had a signature that showed that they were very likely to benefit.  Quite high numbers got an opportunity to get into a clinical trial, which is really important because if you look, over 50% of global oncology trials now have some kind of biomarker or diagnostic, or something like this alongside, what better than to have a comprehensive inventory of the variants and the cancer, and to be able over time to use that library to understand better the treatment course of that patient.  And that's what I think a whole genome adds, rather than the single, look at a single part of the genetic makeup.   And then finally, some had lots of mutations, really high rates of mutations, and maybe they should receive specific advance therapies, like immunotherapies.  Or alternatively, they had a feature in their genetic makeup which it looks like they inherited, as Nirupa absolutely correctly said earlier, these people need to be followed-up and they need more intensive screening, because this is how you detect cancer at an earlier stage.  And the final way people benefited is we could detect genetic changes in  their DNA that meant that if they were exposed to certain medicines, they were likely to suffer harm. And there's a particular, two medicines, 5-fluorouracil capecitabine, where possibly about 5% of people will need either a reduced dose or a completely different medicine, because it will be very harmful.  And so this is about getting the right medicine to the right patient first time, and getting the right outcome for that patient downstream.    And I think, you know, Nirupa's encapsulated it perfectly, there's a whole range of benefits that the patients can accrue from this.  And I think we should probably, Nirupa, say that people were quite cynical when we started, about what it would be that you would get over and above, for example, the cancer genome map that's at the international cancer genome consortium.  And, you know, I'd had leading cancer scientists in Britain say, "Oh well, we've discovered it all, there's nothing to find here."  And I think what this paper shows is that's not entirely true.    Nirupa: I would agree with that Mark, but I would also probably add that it highlights the value of having a large data set alongside that clinical information.  And what we were also able to do,  is whilst we very much talked about what were the gene targets that had a direct impact or genomic markers that impact care now, for which there is an approved therapy.  What we've also been able to do through this analysis, is actually highlight the number of mutations that have been identified for which there is a licence therapy in another cancer type, but not in that particular cancer type.  And what that means, is that specially now, as we have more and more biomarker-driven therapies, I mean, if we look at that compared to when the project started and now, that has increased dramatically.  And what that means is then there are sort of licensed medications that actually can be used in non-licensed indications via a clinical trial, via these very, you know, these basket studies which are across cancer types and are actually based on different types of molecular markers.  And really, we're able to show this at a pan-cancer level across the 13,000 tumours through the results from whole genome sequencing.  Naimah: You've both kind of touched on this throughout and, you know, we've talked about the development of personalised medicine.  And where do you see the future of cancer treatment in the next five years?  Maybe, Nirupa, we can go to you first?  Nirupa: That's a very good question.  I think and what I hope is that with more comprehensive and equitable and standardised testing for patients, especially within the NHS, that this will enable more personalised and targeted therapy alongside, you know, systemic chemotherapy.  And as well as that, better selection of patients that are likely to benefit from the newer immunotherapies.  And also where sequencing is very exciting, is that once we begin to understand more about the individual tumours, you know, going forwards there are a number of cancer vaccine trials, and the aim of those are to have specific vaccines that are going to target an individual's tumour.  So I think in the next five years, this is I think a very exciting space, I hope so, because we need to keep doing more in the space for our patients to try and improve therapy and precision oncology for them.  Naimah: And Mark, do you have anything to add to that point?  Mark: I think Nirupa's right, that there are new therapy extractions coming on, vaccination's one way.  But I think that what will become clear is whether we can use any molecular mechanisms for early detection of cancer.  The battleground here is that we all too often detect cancer late, when it's already outside of the organ it originated in and may be spread in other parts of the body.  It's very hard to effect a cure, almost impossible in that setting.  But what if we could detect cancer earlier?  And then what if we could place a whole genome or detailed molecular characterisation alongside that?  And then, as Nirupa suggested, give someone a vaccine tailored to their tumour that would eliminate it.  The real problem is all too often we detect cancer late, so maybe some of these new molecular diagnostics, such as cell-free tumour DNA will usher in an era of early detection.    And one of the things, and particularly before we did this project but also up until the beginning of the last decade, there were very few good biomarkers of cancer that were usable in the health system.  So we have for the first time opened the vista of having early detection, if we combine early detection with detailed molecular characterisation, possibly a whole genome, possibly another test, then I think we really can usher in the era of precision medicine.  And so I think Nirupa's absolutely right, there will be new treatments, there always will be, but what we have to do is to get detection at an earlier stage.  Naimah: We'll wrap up there.  Thank you to our guests, Dr Nirupa Murugaesu and Professor Sir Mark Caulfield for joining me today.  If you'd like to hear more about this, please subscribe to the G Word on your favourite podcast app.  Thank you for listening.   

In this episode Haris Shuaib- Head of Clinical Scientific Computing at Guy's and St Thomas'​ NHS Foundation Trust shares his vision of what is needed to build an AI-ready NHS. Haris shares the story of how he created the first-ever NHS specialist medical AI team and discusses the unique value that individuals with a dual skillset of clinical and technical expertise bring to the NHS, allowing it to become: - an intelligent AI customer - a learning healthcare system - a developer of in-house algorithms to solve problems that wouldn't be tackled by commercial AI companies. Haris also shares the importance of 3 key factors in the success of AI at scale: People, Policy and Platforms

If you're reading this, there's a good chance that you or someone you love has recently received some unwelcome news: you've got cancer. Those are three words that nobody wants to hear. There are 375,000 cancer diagnoses in the UK every year and if you're one of them, no doubt you'll have a lot of questions. The first of which is likely, “now what?” Now What? Your Cancer Support Podcast is hosted by Julia Bradbury and features personal testimony from over a dozen patients from Guys and St Thomas' NHS Foundation Trust, all of whom have been through the cancer journey. Across a variety of topics, such as coping with a diagnosis and building a support network, they'll offer advice and first-hand experience with a disease that will at some point, either directly or indirectly, affect us all. Think of them as your cancer support group…just in audio form. Hosted on Acast. See acast.com/privacy for more information.

I feel twice fortunate to be speaking to my guest on this episode of the DiepCJourney podcast on two topics, her specialty of performing DIEP Flap breast reconstruction and her role as conference scientific chair for the London Breast Meeting. It was a phenomenal experience for me to meet her in person at the London Breast Meeting where I learned a great deal from the game-changers in breast surgery, oncology, and breast reconstruction. This gives me the ability to bring more in-depth information to the listeners and breast cancer community we serve at DiepCFoundation. I am speaking with Marlene See, a consultant in plastic and reconstructive plastic surgery at Guys and St. Thomas Hospital, part of the NHS Foundation Trust in London. Marlene's specialists interests are breasts and microsurgical breast reconstruction. She trained in London at East Grinstead before embarking on her plastic surgery training. She completed her training in microsurgery at Guys and St. Thomas Hospital. Marlene is a published author on the topic of breast reconstruction, facial analysis, and lower limb reconstruction. Marlene shares with us the history of when DIEP flaps were introduced in microsurgery. She outlines the reason it is often called the “gold standard” in breast reconstruction, and what area of the body microsurgeons use to reconstruct the breast for those affected by breast cancer. Who is a candidate for DIEP flap and what concerns do patients have about recovery for this surgery? She shares with us the importance of using ERAS protocol to enhance recovery. We then switch topics and discuss the origins of the London Breast Meeting. Marlene and I glimpse into the celebration of the tenth anniversary of the conference and what the focus will be. It all began ten years ago with an invitation from colleague and friend Jian Farhadi while she was completing her microsurgical fellowship. Jian wanted to begin a conference on breast cancer treatment, breast surgery, breast reconstruction, and aesthetic breast surgery. It has evolved into one of the premier breast meetings to attend and be part throughout the world. With that, I invite you to listen to the podcast as Marlene shares the goals and theme of the London Breast Meeting 2024. You can find Marlene See and her colleague Jian Farhadi on Social Media accounts here: Marlene See: Instagram: seemarlene LinkedIn: Marlene See Jian Farhadi: Instagram: plasticsurgeryfroup_by_farhadi LinkedIn: Jian Farhadi        

This week we get down to basics, and basics are exactly what we need in this confusing world right now. This is THE podcast to listen to if you are confused about all things to do with taking hormone therapy.Dr Vikram Sinai Talaulikar is a specialist in reproductive medicine at University College London Hospital's NHS Foundation Trust and an associate professor in Women's Health at the University College London. He graduated in medicine in India in 2003 and completed a postgraduate degree in obstetrics and gynecology in 2007. He is a certified menopause specialist by the British Menopause Society, a menopause trainer and he is constantly educating others on this transition as well, via online webinars, events and through social media. He is also part of the trio who established the Menopause Research Education Fund, alongside medical journalist Fiona Clarke and groundbreaking menopause campaigner Diane Danzebrink.Highlights of our discussion: Hormone therapy (HT) 101WHI: good, bad and what we can learn from it 20 years onEstrogen in the pill vs estrogen in HT All the kinds of estrogen and what they are used for strogen too ethinyl estradiolEstrone, Estriol, Estradiol, and Estetrol.17 beta estradiolGetting to the bottom of body simila, body identical and bioidentical – and why that varies from country to country Pharmaceutical company produced HT vs compounding pharmacy versionsthe big “Catch-22” with compounding pharmacies that keeps their bioidentical hormones out of official recommendationsthe pill, HRT and breast cancer riskwhy problems with the pill don't get flagged and HRT does Evidence over estrogen and breast cancer risk (and randomized trials versus observational data)What's what: progesterone, progestin and progestogens (how they work and which one carries a slight risk for breast cancer)how long you really need to take HRT to see if it's workingwhy HT works for some people and not othersDr Talaulikar's favourite non-hormonal treatmentsWhere to find Dr Talaulikar:X: @VikramSinai Web: Menopause Clinic LondonMenopause Research and Education FundJoin the Hotflash Inc perimenoposse: Web: hotflashinc.comTikTok: @hotflashincInstagram: @hotflashincX: @hotflashinc Episode website: Hotflashinc See hotflashinc.com/privacy-policy for privacy information

This month, Dr. Rachel Agbeko, Senior Editor of ADC, is joined by Dr. Ian Sinha (1) and Dr. Alice Lee (1) to discuss their review, "Child poverty and health inequalities in the UK: a guide for paediatricians." They provide insight into the varying definitions of poverty, and how paediatricians can make the most difference in their communities. Read the paper: https://adc.bmj.com/content/108/2/94  (1)  Alder Hey Children's NHS Foundation Trust, Liverpool, UK The ADC Spotlight podcast is the Archives of Disease in Childhood podcast covering areas that don't usually get much attention or might be taken for granted in children's health. This series is produced by Letícia Amorim and edited by Brian O'Toole. Please listen to our regular podcasts and subscribe to Apple Podcasts, Google Podcasts, Stitcher, and Spotify to get episodes automatically downloaded to your phone and computer. And if you enjoy the podcast, please leave us a review at https://podcasts.apple.com/gb/podcast/adc-podcast/id333278832 

Blair and Ian are joined on the Breakfast Show by Peter Wilson, chief medical officer for University Hospitals Dorset NHS Foundation Trust. FIRST BROADCAST: 08/08/2023

A new editorial paper was published in Oncotarget's Volume 14 on July 20, 2023, entitled, “Multiclonality of ER expression in DCIS – Implications for clinical practice and future research.” Estrogen receptor (ER) expression is not routinely evaluated in ductal carcinoma in situ (DCIS). This may be because the prognostic role of ER in DCIS was unclear until the UK/ ANZ DCIS trial in 2021 showed that lack of ER expression in DCIS was associated with a greater than 3-fold risk of ipsilateral recurrence. This was the largest (to date) case-control study nested in a DCIS randomized trial. The meticulous study design eliminated treatment allocation bias as well as treatment-related confounding. This was also the first-ever study to show that ER expression in DCIS is multi-clonal — having very important clinical and research implications. A small proportion of otherwise ER-positive DCIS also contained carcinoma in situ (CIS) duct/s that completely lacked ER expression. “This admixture of clearly ER-positive and ER-negative ducts is not the same as heterogeneity in ER expression and I labeled such DCIS cases as multiclonal DCIS even if just one CIS duct in the entire section lacked ER expression.” In his new editorial, Dr. Mangesh A. Thorat from Guy's and St Thomas' NHS Foundation Trust, Queen Mary University of London and King's College London discusses this study in greater detail, the clinical implications of ER status in DCIS, the potential for avoiding overtreatment and undertreatment based on ER expression, and the importance of simple clinical observations in research. “In summary, ER is a strong and independent prognostic biomarker in DCIS and our novel clonal method is a more accurate method to assess ER status in DCIS.” DOI - https://doi.org/10.18632/oncotarget.28450 Correspondence to - Mangesh A. Thorat - thoratmangesh@gmail.com; m.thorat@qmul.ac.uk Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28450 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, ductal carcinoma in situ (DCIS), invasive breast cancer, ER, recurrence, clonality About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

Welcome to this exciting episode of the Pharmacist Diaries Podcast! In this episode, I had the pleasure of speaking with Richard Goodwin, a pharmacist who I immediately connected with as both our current roles are split between paediatrics and education. Richard is the current Principal Education & Training Pharmacist with Great Ormond Street Hospital (GOSH). He is also Co-Chair of the Neonatal and Paediatric Pharmacy Group (NPPG) (London Interest Group) and will be completing a Masters of Business Administration (MBA) later in 2023. He started his career as a STEP Pharmacist with Guys and St Thomas' NHS Foundation Trust. This 3-year program allowed Richard to build a solid foundation as a clinical pharmacist and allowed him to identify the diverse opportunities within the field of pharmacy. During this time he was exposed to paediatrics and identified an opportunity to spend some time at the Evelina London Children's Hospital. His life as a pharmacist in paediatrics evolved from here... Throughout the episode you will hear Richard share many examples of how he integrated education and training into various roles. His dedication to training the next generation of pharmacists is truly admirable, and I believe that his efforts will have a profound impact on the future of the pharmacy profession. One of the key takeaways from this episode was the importance of integrating students into the workplace early on in their education. By providing them with hands-on experiences and allowing them to work alongside experienced professionals, we can help them develop the professional skill and mindset needed to excel in their careers. I also appreciated Richard's insights on the importance of reflection and journaling in personal and professional growth. As pharmacists, we often get caught up in the day-to-day tasks of our jobs, but taking the time to reflect on our experiences can help us identify areas for improvement, set goals, and ultimately become better practitioners. I was pleased to hear Richard's opinion about the importance of supporting pharmacists' emotional and mental health, especially in high-pressure work environments. The field of pharmacy is not immune to burnout, stress, and other mental health challenges, and it is encouraging to see a growing emphasis on addressing these issues and providing support for those who need it. Overall, this episode was a fantastic reminder of the many opportunities available within the field of pharmacy. Whether you're interested in research, business, paediatrics, or education, there is a place for you in pharmacy. Thank you, Richard, for sharing your journey with us and for your dedication to the profession. Tune in to this episode of Pharmacist Diaries and be inspired! PARTNERSHIPS: The Naked Pharmacy is offering my podcast listeners a 20% discount on all their products. Use discount code PD20 at checkout to receive the offer. SUPPORT THE PODCAST: As I continue to grow and evolve this podcast, I am committed to bringing you inspiring and empowering content. But in order to do that, I need your support. I've set up a Buy Me a Coffee donation page where you have the opportunity donate a coffee (£5). You'll be helping us invest in the infrastructure, equipment, and team needed to take Pharmacist Diaries to the next level. With your help, we can continue to inspire and empower pharmacists around the world, and create a community that supports and uplifts one another. FOLLOW RICHARD: LinkedIn: Richard Goodwin Follow me on My Website, YouTube, Instagram, Facebook, LinkedIn, and/or Twitter. Feel free to subscribe to the podcast on your favourite podcast platform so you can be notified when a new episode is released or leave a review on apple podcasts. If you have any suggestions for guests you want me to talk to or if you'd like to come on yourself, please feel free to contact me via social media, or email at info@pharmacistdiaries.com.

The NHS England National Patient Safety Team has produced a third podcast to provide an overview of the feedback from the testing phases for the national Maternity Early Warning Score (MEWS) tool. This is the third of three podcasts from the NHS England National Patient Safety Team. In this podcast, Tony Kelly, National Clinical Advisor Maternity & Neonatal Safety Improvement Programme (MatNeoSIP) NHS England; Hannah Rutter, Senior Improvement Manager, MatNeoSIP NHS England; Louise Page Consultant Obstetrician and Gynaecologist, West Middlesex University Hospital and Chelsea and Westminster Hospital NHS Foundation Trust; Anita Banerjee, Consultant Obstetric Physician, Guys and St Thomas's NHS Foundation Trust; and Rebecca Wilson-Crellin, Clinical Lead, Culture and Leadership in the Maternity Transformation Programme discuss the feedback received during testing and the importance of reducing unwarranted variation by implementing the new national MEWS tool.

Our coverage of Euroanesthesia 2023 continues; The European Society of Anaesthesiology and Intensive Care (ESAIC) is the leading European Organisation for Anaesthesia, Intensive Care, Pain and Perioperative Medicine. TopMedTalk is proud to bring you 'as live' coverage of their annual conference. For more information on the work ESIAC do check out their website here https://euroanaesthesia.org/ This piece covers a conversation about hemodynamics and fluid management as Desiree Chappell, Monty Mythen and Andy Cumpstey speak with their guest Marlies Ostermann, Consultant in Critical Care and Nephrology at Guy's and St Thomas' NHS Foundation Trust.

It can be overwhelming as a trainee pharmacist to pick the right job when you qualify. You also feel like you need to make decisions about this 6 months into the training year as this is when employers tend to start advertising positions. We all go through the anxiety of making the right decision for ourselves amongst all the competition of every other trainee pharmacist securing a role for themselves alongside you. Here is a clip where you get insight into Stephanie's thought processes when she was looking for her first role. We dive deeper into this discussion during the episode too. This is from Episode 76 of the podcast with Stephanie Tyler. As a reminder, Stephanie is a highly specialist pharmacist in HIV, Sexual and Reproductive Health, currently working at Guys and St Thomas' NHS Foundation Trust in a very exciting and innovative role related to HIV PrEP implementation and Sexual Health. To watch the full version of this episode, read more about Stephanie, AND access full show notes, click here Follow me on YouTube, Instagram, Facebook, LinkedIn, and/or Twitter. Feel free to subscribe to the podcast on your favourite podcast platform so you can be notified when a new episode is released or leave a review on apple podcasts. If you have any suggestions for guests you want me to talk to or if you'd like to come on yourself, please feel free to contact me via social media, or email at info@pharmacistdiaries.com.

Hi friends! Welcome to one of first of many 'daily dose' episodes of the podcast. I will be selecting my favourite sections of previous episodes of the Pharmacists Diaries Podcast. On today's daily dose, we get insight into the day to day life of a super awesome pharmacist working in HIV, Sexual and Reproductive Health. This is from Episode 76 of the podcast with Stephanie Tyler. As a reminder, Stephanie is a highly specialist pharmacist in HIV, Sexual and Reproductive Health, currently working at Guys and St Thomas' NHS Foundation Trust in a very exciting and innovative role related to HIV PrEP implementation and Sexual Health. To watch the full version of this episode, read more about Stephanie, AND access full show notes, click here Follow me on YouTube, Instagram, Facebook, LinkedIn, and/or Twitter. Feel free to subscribe to the podcast on your favourite podcast platform so you can be notified when a new episode is released or leave a review on apple podcasts. If you have any suggestions for guests you want me to talk to or if you'd like to come on yourself, please feel free to contact me via social media, or email at info@pharmacistdiaries.com.

Is the NHS really full of ‘overpaid pen pushers'? Jo Vigor talks to Dr Seema Srivastava, Deputy Medical Director at University Hospitals Bristol and Weston NHS Foundation Trust, Emma Challans-Rasool, Founder and Chair of the Proud2bOps operational network and Director of Organisational Development, Culture and Talent at Nottingham and Nottinghamshire Integrated Care System and Rachel Burnham, Director of Performance and Information at Guy's and St Thomas's NHS Foundation Trust, about the critical role of NHS managers and what it means to bring your humanity to work. Related resources Leading well for staff health and wellbeing in the NHS (free online course) Tenth annual leadership and workforce summit (event) What is compassionate leaderships? (explainer)

S1E6 Awash with Data, but Does the NHS have the Leadership and Analytical Expertise to Make a Difference in People's Lives? Host Julian Tyndale-Biscoe talks to Dr. Marc Farr, Chief Analytical Officer, East Kent Hospitals NHS FT. Tune in to hear how the UK government's COVID-19 Collection of Patient Information (COPI) has changed the way that UK NHS data is shared how there is now an opportunity to create even more powerful community insights by combining this health data with other data sets held by local authorities and other partners in Integrated Care Systems. Dr Farr tackles the question of how we can make this happen and also whether the NHS has the analytical capabilities and skills to develop this level of insight. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

I am incredibly excited to launch this week's episode! I am thrilled to introduce Stephanie Tyler to the podcast. She is a highly specialist pharmacist in HIV, Sexual and Reproductive Health, currently working at Guys and St Thomas' NHS Foundation Trust in a very exciting and innovative role related to HIV PrEP implementation and Sexual Health. She has experience working at a national level with the HIV Pharmacy Association (HIVPA) as the regional representative for London and the Patient Information Lead. She is extremely passionate about her role and her curiosity to improve patient care through research and publication is truly inspiring. Our conversation covered a variety of topics: - An in depth discussion about why she chose certain hospitals and locations and the advantages and disadvantages of a large teaching hospital vs smaller district general hospital. - How she found this specialist area and what she loves about it - How to make your job rewarding - The challenges around talking to patients in such a sensitive specialist area and tactics she uses to ensure patients have a positive experience. - Service improvement and why we both adore this aspect of pharmacy - How she manages her time to achieve as much as she has! One example being how she managed to complete 6 posters and 1 oral presentation in one year! - Transiting from a band 6 pharmacist up to a band 8 and how these roles have differed There is so much more to this conversation than what I've stated above. I cannot wait for you to watch/listen! Social media Linkedin: @Stephanie Tyler Follow me on YouTube, Instagram, Facebook, LinkedIn, and/or Twitter. Feel free to subscribe to the podcast on your favourite podcast platform so you can be notified when a new episode is released or leave a review on apple podcasts. If you have any suggestions for guests you want me to talk to or if you'd like to come on yourself, please feel free to contact me via social media, or email at info@pharmacistdiaries.com.

Diversity and inclusion are a key part of the discussion about how to run effective public services. The Cabinet Office's ‘Declaration on Government Reform' reinforced the need for the civil service to draw on a more diverse range of experiences, skills and backgrounds, and set the standard for inclusive workplaces where people achieve their full potential. The new prime minister will need to make decisions about the government's approach to managing diversity and inclusion in the public sector. Such key decisions will be: How can current leaders create public sector workforces that reflect wider society? How can organisations support diverse groups of future public sector leaders and how can diverse public sector institutions deliver more inclusive policies and services? This panel event will draw on insights from the three previous private roundtables in the IfG and PwC's Future Leaders Series. This series has brought together a mix of current and future public sector leaders to consider how the public sector can best reflect and serve society in a more inclusive way. On our panel to discuss these questions: Paul Cleal, Adviser and non-executive board member for the Premier League, Guy's & Thomas' NHS Foundation Trust and the Metropolitan Police Cllr Georgia Gould, Leader of Camden Council and Chair of the Leaders' Committee of London Councils Rupert McNeil, former Government Chief People Officer Ming Tang, Chief Data and Analytics Officer at NHS England Bernadette Thompson, Associate Director of Inclusion at Barts Health NHS Trust and former Deputy Director for Inclusion, Wellbeing and Employee Engagement at DLUHC The event was chaired by Alex Thomas, Programme Director at the Institute for Government. #IfGfutureleaders We would like to thank PwC for kindly supporting this event as part of their Future of Government research programme.

Host: Mario R. Nacinovich, Jr., MSc Guest: Julia Bilinska, MD Guest: Aatish Patel, MD Monkeypox continues to spread around the globe, and its clinical manifestations can differ from what we've seen. What are the newest symptoms of this disease? Learn more about these manifestations from Drs. Aatish Patel and Julia Bilinska from Guy's and St. Thomas' NHS Foundation Trust in London as they talk about their research with Host, Mario Nacinovich.

The NHS England National Patient Safety Team has produced two podcasts to provide an overview of the background and development of the new National Maternity Early Warning Score (MEWS) tool.This is the second of two podcasts from the NHS England National Patient Safety Team. In this second podcast, Tony Kelly, National Clinical Advisor Maternity & Neonatal Safety Improvement Programme (MatNeoSIP) NHS England; Hannah Rutter, Senior Improvement Manager, MatNeoSIP NHS England; Louise Page Consultant Obstetrician and Gynaecologist, West Middlesex University Hospital and Chelsea and Westminster Hospital NHS Foundation Trust; Anita Banerjee, Consultant Obstetric Physician, Guys and St Thomas's NHS Foundation Trust; and Katherine Edwards, Director of Patient Safety and Clinical Improvement, Oxford Academic Health Science Network; discuss the the benefits of implementing the new national MEWS tool.

In this week's episode we are joined by Arron who shares his journey from doctor to coder, and his philosophy of living outside the box. We delve into the early years of his career, his love and passion for coding. Arron shares how he developed his coding skills from scratch while an FY1 to building an antibiotic calculator app to more recently an EPR simulator. We delve into the founding story of CodeMed and their vision to equip healthcare professionals the skills to be at the forefront of digital innovation in the NHS.  Arron shares his insights into why being a doctor has incredible value and the opportunities that arise as a result, advising us to avoid developing a limited mindset.  Dr Arron Thind is a GP trainee at Guy's and St Thomas' NHS Foundation Trust, an NHS Clinical Entrepreneur, DigitalHealth.London Fellow and a clinical tutor at Kings College London. Prior to entering GP training, he was Deputy Lead of Emerging Technology for the UK Government's Department of Health and Social Care.  Arron is the co-founder of Code Med: a startup which teaches clinicians and medical students across the UK how to code, empowering them with the skills to transform healthcare services using digital technology. Learn more about Arron Twitter: @ArronThind LinkedIn: @arron-thind https://codemed.co.uk/course/ ------------------------------------- Episode Sponsor: Locum's Nest The Locum's Nest app has been revolutionising the way NHS doctors are supported by technology since 2015 and is now wired across all NHS professions. On a mission to remove barriers to workforce mobility across the NHS, Locum's Nest has pioneered the formation of digital collaborative workforce banks across the country, enabling cross-covering of shifts across an ever-growing number of NHS Trusts. Currently the best-rated app for flexible working in the NHS, Locum's Nest is transforming shift work in the NHS into a more inclusive and fulfilling experience by giving healthcare professionals ownership and control of their work life balance. Download the app Now: Apple App Store & Google Play Store Manage your shifts, your rosters and your pay all from one secure place! https://locumsnest.co.uk/healthcare-professionals ------------------------------------- Check out our latest platform Peerr Where healthcare professionals learn from the best educators - your peers! ✍️ Make your own quizzes for revision - An invaluable learning tool

Nicola Horlick discusses with Ivan six things which should be better known. Nicola Horlick is CEO of Money&Co. She has been a leading fund manager in the City of London for over thirty years. During that time, she has set up and managed several investment businesses. She now chairs a private equity business, is CEO of a film development company, and is a director of an NHS Foundation Trust. Black Comedy by Peter Shaffer https://chicagocritic.com/black-comedy/ Joseph II of Austria https://www.lrb.co.uk/the-paper/v10/n10/william-doyle/despots Many Lives, Many Masters by Dr Brian Weiss https://www.compulsivereaders.com/reviews/many-lives-many-masters-brian-l-weiss/ Pictures at an Exhibition https://www.youtube.com/watch?v=Sq7Qd9PSmR0 Orlanda Broom https://orlandabroomartist.com/ La Perriere https://www.tripadvisor.co.uk/Tourism-g1189181-La_Perriere_Orne_Basse_Normandie_Normandy-Vacations.html This podcast is powered by ZenCast.fm

TopMedTalk's essential series on acute kidney injury continues, supported by the "Know AKI campaign" – a bioMérieux global campaign to raise awareness about AKI. For part one of the series follow this link: https://topmedtalk.libsyn.com/part-1-know-aki-and-say-no-to-acute-kidney-injury-for-patients-perioperative-renal-injury In this podcast you will discover how The Perioperative Quality Initiative (POQI) focuses upon renal injury. How do we identify patients early? How do we treat the condition? What should out approach to biomarkers be? What are we looking for when it comes to urine output? Make sure you check out POQI's website here: https://www.thepoqi.org/ While you're online why not book tickets for the next EBPOM conference: www.ebpom.org Presented by Andy Shaw, Chairman, Department of Intensive Care and resuscitation at The Cleveland Clinic, Fellow of the Royal College of Anaesthetists (UK), the American College of Critical Care Medicine and the Faculty of Intensive Care Medicine (UK), Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton, John Prowle, Senior clinical lecturer, intensivist nephrologist, Royal London Hospital in East London, Marlies Ostermann, Consultant in critical care and nephrology, Guy's and St Thomas's NHS Foundation Trust and Sandy Kane-Gill, Professor, Pharmacy and Theraputics, Univeristy of Pittsburgh School of Pharmacy.

BIO I have worked at the Tavistock Clinic in London for over 20 years, an internationally renowned NHS Foundation Trust which provides clinical services and trains therapists and other professionals. I teach on the child psychotherapy and other psychological therapy courses at the Tavistock, and supervises therapists there. I also lead on training in child development, neuroscience and attachment theory, and have a particular interest in linking cutting-edge developmental findings with therapeutic practice. My clinical work in the NHS is primarily with issues of trauma and the effect of maltreatment on children as well as on the families and other adults in the lives of such children. After having done a variety of jobs and activities in my early adulthood, including buying and selling antiques, working in housing advice, community support services and various adventures, in the late 1980s I trained as a humanistic and integrative adult psychotherapist, a year with IPSS and 4 years with the Minster centre in London. I then went on to train in psychoanalytic observational studies for a further 3 years at the Tavistock before undertaking the four year Tavistock training in psychoanalytic psychotherapy with children, young people and parents. In addition, I have trained in a variety of other ways of delivering therapeutic work, most recently in Mindfulness. I have worked as a psychotherapist in private practice for over 25 years, and also in a variety of voluntary and statutory sector settings. These include Open Door, a psychotherapy service for young people in North London, GP Practices including Stamford Hill Group Practice, and for NHS Child mental health services in Enfield and also in Redbridge and Waltham Forest. A passion of mine has been developing new services for children and young people, for example in over 35 schools in Camden and East London and setting up Hear and Now, a counselling service for young people in Redbridge working in community locations as part of the local NHS Mental Health Trust. Until recently, I was an Associate Clinical Director at the Tavistock, responsible for a range of clinical services. I also teach on a range of other courses and psychotherapy trainings in Britain and abroad, for example in Bologna, Istanbul and for 12 years, in Palermo, Sicily. Sign up for 10% off of Shrink Rap Radio CE credits at the Zur Institute

Continuing our special series, What's New In: Dr. Wheatley Price discusses new advances in Radiotherapy with Dr. Corinne Faivre-Finn of the NHS Foundation Trust and Dr. David Palma of the London Health Sciences Centre. This webinar aired on December 1, 2021,

The Perioperative Quality Initiative (POQI) focuses upon renal injury. How do we identify patients early? How do we treat the condition? What should out approach to biomarkers be? What are we looking for when it comes to urine output? Make sure you check out POQI's website here: https://www.thepoqi.org/ While you're online why not book tickets for the next EBPOM conference: www.ebpom.org Presented by Andy Shaw, Chairman, Department of Anesthesiology and Pain Medicine at The University of Alberta, Alberta and Zone Clinical Department Head for Anesthesia, Alberta Health Services Edmonton Zone, a Fellow of the Royal College of Anaesthetists (UK), the American College of Critical Care Medicine and the Faculty of Intensive Care Medicine (UK), Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton, John Prowle, Senior clinical lecturer, intensivist nephrologist, Royal London Hospital in East London, Marlies Ostermann, Consultant in critical care and nephrology, Guy's and St Thomas's NHS Foundation Trust and Sandy Kane-Gill, Professor, Pharmacy and Theraputics, Univeristy of Pittsburgh School of Pharmacy.

This week, Jonathan sits down with Professor Wendy Tindale, OBE, Director of Innovation, Sheffield Teaching Hospitals, NHS Foundation Trust. They delve into the world of innovation, considering what ‘value' means, the benefits and burdens of working within the NHS, and discuss the national differences within innovation. Professor Tindale also shares her experience of being awarded an OBE.

In this episode, Jenny Hanlon, Executive Director of Finance at Liverpool Women's NHS Foundation Trust, talks about the challenges and opportunities facing finance in the NHS at the moment, and we get an insight into how finance helps to foster innovation.

Is COVID more dangerous if you are on benzos? What if you are in withdrawal? What about the vaccine? Will it elevate my symptoms? In today's episode, we explore some questions about COVID, listen to a hopeful story from New England, and discuss prescribing practices for long-term use. Please join us for our weekly discussion of all things benzo. https://www.easinganxiety.com/post/covid-and-benzos-immunity-vaccines-symptoms-bfp080Video ID: BFP080 Chapters 00:00 Introduction10:40 Benzo Story19:58 FEATURE: COVID and Benzos32:15 Closing  Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein. BENZO NEWS Medicating Normal Website — https://www.medicatingnormal.comMedicating Normal YouTube Channel — https://www.youtube.com/medicatingnormalBenzodiazepine Action Work Group (BAWG) — https://corxconsortium.org/work-groups/benzodiazepine FEATURE: COVID and Benzos Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual.NHS Camden and Islington, NHS Foundation Trust. “COVID-19 and Benzodiazepines.” https://www.candi.nhs.uk/sites/default/files/COVID-19%20and%20Benzodiazepines%20-%20CI.pdf. Ostuzzi, Giovanni et al. “Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations.” BMC Medicine 2020; 18:215. July 15, 2020. https://dx.doi.org/10.1186%2Fs12916-020-01685-9.  The PodcastThe Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata). WEBSITE: https://www.easinganxiety.comMAILING LIST: https://www.easinganxiety.com/subscribe YOUTUBE: https://www.youtube.com/@easinganx DISCLAIMERAll content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. CREDITSMusic provided / licensed by Storyblocks Audio — https://www.storyblocks.com Benzo Free Theme — Title: “Walk in the Park” — Artist: Neil Cross PRODUCTIONEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com ©2022 Denim Mountain Press – All Rights Reserved

Share this post with others: Is COVID more dangerous if you are on benzos? What if you are in withdrawal? What about the vaccine? Will it elevate my symptoms? In today's episode, we explore some questions about COVID, listen to a hopeful story from New England, and discuss prescribing practices for long-term use. Please join us for our weekly discussion of all things benzo.   Welcome to Episode #80 Today's episode is focused more on a few different topics. First off, in our introduction, we recap this week's screening of "Medicating Normal" and post-film discussion panel, which I moderated. We discuss the question of long-term prescribing of benzodiazepines for any reason. We then share a wonderfully insightful benzo story from Boston, Massachusets. For our feature, we take a look at COVID and benzos. We explore the effect of benzos on immunity, how that might affect our protection against the virus, and what side effects vaccines may create. Video ID: BFP080 Chapters 00:00  Introduction10:40  Benzo Story19:58  FEATURE: COVID and Benzos32:15  Closing Episode Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. INTRODUCTION Medicating Normal Website — https://www.medicatingnormal.comMedicating Normal YouTube Channel — https://www.youtube.com/medicatingnormalBenzodiazepine Action Work Group (BAWG) — https://corxconsortium.org/work-groups/benzodiazepine FEATURE: COVID and Benzos Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual.NHS Camden and Islington, NHS Foundation Trust. “COVID-19 and Benzodiazepines.” https://www.candi.nhs.uk/sites/default/files/COVID-19%20and%20Benzodiazepines%20-%20CI.pdf. Ostuzzi, Giovanni et al. “Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations.” BMC Medicine 2020; 18:215. July 15, 2020. https://dx.doi.org/10.1186%2Fs12916-020-01685-9. Site Links VISIT US ONLINE— WEBSITE: https://www.easinganxiety.com— YOUTUBE (Easing Anxiety): https://www.youtube.com/easinganxiety— YOUTUBE (Benzo Free): https://www.youtube.com/benzofree— INSTAGRAM: https://www.instagram.com/easinganxiety PLEASE LET US KNOW WHAT YOU THINK— COMMENT: On this video in YouTube— COMMENT: On the blog post on our website— FEEDBACK FORM: https://www.easinganxiety.com/feedback— EMAIL: feedback@easinganxiety.com SUPPORT US— Make a Donation: https://www.easinganxiety.com/donate Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedbackEmail us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer The Benzo Free Podcast is for informational purposes only, and should not be considered medical advice. Never dis­regard medical advice or delay in seeking it. Withdrawal, tapering, or any change in dosage of benzodiazepines, nonbenzo­diazepines, thienodiazepines, or any other prescription drugs should only be done under the direct supervision of a licensed physician. Please visit our official disclaimer for more information: https://www.easinganxiety.com/disclaimer. Music Credits Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross— Provided by: Storyblo...