Health Awareness - Q1 2024

Until recently, endometriosis remained relatively invisible in the media and essentially ignored by government policy.

Dr Hazel Wallace Former NHS Doctor, Nutritionist, Author and Founder of The Food Medic

Read more on Page 16

Functional electrical stimulation helps patients walk with confidence

A functional electrical stimulation (FES) technique has been shown to improve walking for people with conditions affecting the nervous system.

Functional electrical stimulation can benefit patients such as those with multiple sclerosis (MS), drop foot, spinal cord injury and patients recovering from stroke. Now, a new trial seeks to discover how effective FES can be for Parkinson’s disease.

FES technique for safer walking

The technique has been advanced by Odstock Medical Limited (OML), a company set up by Salisbury NHS Foundation Trust to develop FES devices and clinical services.

Head of Research at the National Clinical FES Centre at Salisbury District Hospital, Paul Taylor, explains that skin electrodes stimulate weakened muscles due to neurological conditions, aiding walking. A pressure pad in the shoe regulates the system’s activation timing.

A typical example is helping those with difficulty walking due to drop foot, which is the inability to lift the foot as they swing forward. “FES stimulates muscles, lifting the foot at the right time and making walking easier and safer,” he says. “People are less likely to trip and fall; there is less energy expenditure; and they can walk faster and further.”

Up to 80% of users say it increases their confidence in walking while OML’s studies show a 72% reduction in falls for people with MS. “This can have a real impact on quality of life,” says Taylor.

Further FES information

The device is accepted by the National Institute for Health and Care Excellence (NICE) for NHS use, and guidance has been updated for upper limb therapies. Meanwhile, the STEPS II trial is currently recruiting 234 participants to a sevencentre UK study to discover how FES can help with Parkinson’s.

OML has FES information packs available. Patient groups, such as the MS Society or the Stroke Association, also offer FES information. MS Society and Different Strokes have campaigned for better funding of FES in the NHS. Taylor adds: “The device is discreet, and the overwhelming majority of people get used to it fairly quickly and use it because it makes a difference to them.”

Neurological Health Pages 02 - 05

Why early dementia diagnosis is essential and how to get one

Dr Hilda Hayo CEO and Chief Admiral Nurse, Dementia UK

Seeking a dementia diagnosis can be daunting. People often worry about losing their independence, having to stop work or going into care. The truth, however, is that receiving a diagnosis can open various avenues of support.

Why early dementia diagnosis is important

The sooner someone who has the symptoms of dementia receives an accurate diagnosis, the sooner they can start planning for the future.

A timely diagnosis can help the person and their family understand what form of dementia they have, how their symptoms affect them and what they can do to manage them. It also enables them and their family to seek out suitable support such as financial assistance, planning and specialist advice.

The route to diagnosis isn’t always straightforward. A person may be reluctant to see a doctor due to fear or denial. There are many conditions with similar signs to dementia (eg. infection, vitamin deficiency, depression). Prompt assessment and diagnosis can lead to the right treatment and support sooner.

Preparing for memory assessment

In some areas, people experience delays due to waiting lists for a memory assessment or diagnosis. However, there are steps you can take while waiting for an assessment.

Keeping a symptom diary is helpful

so that key issues can be listed and passed on to the assessor when the time comes. Starting a life story can also be a good way to record the person’s biography, relationships, needs and wishes to enable better communication between health and social care staff.

Accessing specialist support

Receiving a diagnosis of dementia can be distressing for the person and their family and friends because if you love someone living with dementia, then you’re living with it too.

There are several common challenges people face both during and after a diagnosis, so we have created a series of free bite-sized guides to complement the support and advice our dementia specialist Admiral Nurses offer through our Helpline, clinics and in other healthcare settings.

Five steps to getting a diagnosis of dementia

1. Making an appointment with a GP

2. Explaining symptoms and medical tests and checks

3. Referral to specialist clinics and specialists

4. Memory clinics and tests

5. The timeline of a diagnosis and what to do next

Depending on when you get diagnosed, slowing the condition down is priority number one.

Integrating technology and medical expertise to improve dementia care

Despite being the UK’s leading cause of death, according to a recent dementia conference, accessing a dementia diagnosis and treatment is a frustrating challenge for patients and families alike.

WITH Professor Claude Wischik CEO and Co-founder, TauRx

For Dr Sonya Miller, Head of Medical Affairs at TauRx, addressing dementia as a public health concern has historically been perceived as an immense challenge. However, in reality, it’s too big to ignore.

Challenging access to dementia support “There is perhaps a slight misconception that people with dementia are well-informed, well-supported and well-connected,” she says. “There are certainly amazing organisations within the UK that give people lots of support and information. But getting initial guidance from healthcare professionals to then signpost to those societies and associations is sometimes difficult.”

However, it is an issue that the Government and the medical profession are currently prioritising. “The Scottish Government’s campaign is called ‘everyone’s story’ and highlights that almost everyone knows someone who is affected, but the disease often has a different trajectory for each person.”

before potentially advancing to a consultation with a neurologist, psychiatrist or a memory clinic for a more comprehensive evaluation of brain health. You can’t access treatment without an official diagnosis, and you can’t be diagnosed without seeing multiple medical professionals. “Getting a diagnosis relieves a lot of uncertainty,” says Prof Claude Wischik, CEO and Co-founder of TauRx. “It’s important that people receive reassurance.”

Streamlining the way to accurate diagnosis

“Current diagnostic pathways are a bit long and difficult to access, and it is quite frustrating for the physicians, the patients and families because it takes a lot of time, and the support is often quite variable,” says Dr Miller. However, technology is evolving to streamline this initial diagnosis stage. An app is being developed to empower individuals to self-monitor their condition. “Then, if they are concerned, they are prompted to see their GP, who will have access to an advanced version of the technology to support a thorough diagnosis,” says Prof Wischik.

number one.

Significant scientific developments are happening: in particular, there are new treatments being developed targeting the key pathological processes underlying Alzheimer’s, including amyloid and tau. Amyloid based treatments on market in the US are administered by regular intravenous infusions of a drug designed to reduce the amyloid plaques in the brain. Tau treatments are aimed at reducing tau aggregation and tangles, which are closely associated with cognitive symptoms of the disease.

Recently completed clinical trials by TauRx, focused on the development of a tau-targeting drug, indicate sustained cognitive benefits following announcement of their 24-month data1. “A practical benefit of the experimental treatment is that it can be taken orally,” says Prof Wischik. “It could fit within the current standard care pathway for patients, and it doesn’t need an intravenous treatment clinic or special monitoring for side effects.”

INTERVIEW WITH Dr Sonya Miller Head of Medical Affairs, TauRx

WRITTEN BY Louise Lawless

Paid for by TauRx

Accessing the dementia pathway via GPs Individuals noticing early signs of dementia in themselves or a loved one — such as forgetfulness, communication difficulties or confusion — typically seek assistance from their GP.

Following this, the GP and patient collaborate to monitor signs and manage specific risk factors (including diet, exercise and sleep)

In an ideal future scenario, the process may be comparable to people with high blood pressure, where GPs only refer particularly complex cases to specialists.

Breakthroughs for treatment

When you are diagnosed, treatment then becomes the focus. Depending on when you get diagnosed, slowing the condition down is priority

Ultimately, Prof Wischik wants to project a message of positive progress. We’re seeing the Government take on board what medical professionals are telling them and supporting progress through initiatives such as the Dementia Mission, while potential new treatments and technologies are in development. “I’ve got a very clear sense that we’re on the move now,” Prof Wischik concludes. References 1. TauRx Press release dated 7th March 2024

INTERVIEW

Brain skills empowering the neurology patient community

Empowering neurology patients and caregivers to live optimally is facilitated by an understanding and harnessing of the value of a brain-positive economy.

WRITTEN BY Dr Orla Galvin Executive Director, European Federation of Neurological Associations (EFNA)

The societal and economic impact of living with a neurological condition is vast. For those in the neurology community, the profound impact of both visible and invisible aspects of living with a neurological condition on employment and financial stability is all too familiar.

Challenges facing the neurology patient community

Beyond the symptoms, individuals and families grapple with numerous challenges, including access to healthcare. EFNA’s 2022 report ‘Socioeconomic Impact of Neurological Conditions’ reports the following.

• 69% of people miss days off work

• 76% experienced a negative impact on relationships with colleagues

• 83% experienced a negative impact on their finances

• 85% experienced a negative impact on their relationship with friends

• 86% experienced a negative impact on their relationship with family

• 94% experience a negative impact on their social life

• 99% experience a negative impact on their overall wellbeing

Brain capital opportunity

Under the umbrella of ‘brain capital’ neurology, patient advocates, patient organisations, individual patients and caregivers can advocate and influence change — not only in themselves but also to support research and innovation, access to therapeutics, services and supports.

Brain capital can ultimately improve the quality of life of those affected (patients and caregivers). This, in turn, serves as a foundation for benefits to healthcare systems and the employment sector.

A brain-positive economy

Brain capital prioritises brain skills and brain health — both of which are increasingly valuable in our innovation and knowledge-driven, postcovid economies. With advances in the AI and technologies sector, adaptation and development of brain skills are critical to preserving human employment and regional income (Eyre et al, 2021; Cell Press; NeuroView,Building brain capital).

What do we mean by brain skills?

Brain skills are not elusive but must be fostered and strengthened critically and strategically. Many individuals facing the challenges of living with a neurological condition are not only surviving but also striving to thrive.

Necessity drives them to navigate life with brain skills such as resilience, innovation, imagination, improvisation, critical and analytical thinking, communication, curiosity, creativity, exploration, goal engagement, systems thinking, motivation and opportunity recognition.

Brain skills such as compassion, altruism, emotional intelligence, mindfulness and self-control also manifest in caregivers of individuals with a chronic neurological condition. Seize the opportunity — you own your brain capital.

BY

WRITTEN

Dr Tim Beanland Head of Knowledge Management, Alzheimer’s Society

Ways to promote brain health and why starting young saves your memory

Promoting brain health over the life course offers hope for better cognitive ageing and reduced dementia risk.

The rising prevalence of dementia and its devastating impact can lead to some nihilism, but new diseasemodifying Alzheimer’s treatments and discoveries offer hope. Up to 40% of dementia could be prevented through better brain health.

Improving brain health

The ‘brain health’ agenda has emerged in response to global population ageing coupled with support from advances in neuroscience. Brain health has various definitions, based on cognition, function or (absence of) brain pathology. These often correlate, but not always.

Brain health is affected by lifestyle at all ages, meaning that a dynamic ‘life course’ approach to it is needed. It is never too early to start improving brain health, but benefits accrue from starting at any age.

Dementia is the UK’s biggest killer, and one in three people born today will get it. It’s no surprise there is huge interest in what might help to reduce one’s risk.

Healthy heart, healthy head

The brain is 2% of our body weight but uses 20% of all our energy. Brain health thus tracks cardiovascular health closely. Promoting both means regular physical activity, a healthy balanced diet, not smoking and avoiding excessive alcohol.

Recent research shows the importance of sleep (seven to eight hours a night recommended) and

probably hearing loss (common and correctable) in dementia risk. Traumatic brain injury is another emerging risk factor.

Brain plasticity

A second route to a healthier brain relies on its innate ability to adapt at multiple scales over time. Such neuroplasticity is greatest in childhood but is retained throughout life.

Regular mental and social activity is thought to rely on neuroplasticity to strengthen neural pathways and build up ‘cognitive reserve.’ A more resilient brain can tolerate more pathology before symptoms of dementia break through.

Exercising the brain

Activities that build up cognitive reserve can be linked to a delay in dementia of several years. They include learning a musical instrument or new language, volunteering and playing puzzles. Any regular activity that requires attention and challenges the brain will likely bring benefits.

Challenging different aspects of brain function is thought to be optimal for building a broad-based cognitive reserve. My book ‘Mind Games’ includes puzzles designed to exercise a range of cognitive domains: memory and skills using pictures, words, numbers and logic.

Better brain health and reduced dementia risk require change, as individuals and as a society; the rewards could be huge.

National and international collaboration to improve life after stroke

There have been major advances in the treatment of stroke. Drugs and procedures administered in the first hours following a stroke can be life-saving and life-changing.

Stroke (an interruption of the blood supply to the brain) is a devastating condition and the most common cause of death and disability in the world.

Improving life after stroke

Stroke research has tended to focus on these precious first hours, but for stroke survivors, there is a whole life after the initial stroke. This area has been traditionally under-researched; there are many unanswered questions around longer-term stroke recovery.

Professors Jesse Dawson and Terry Quinn, both doctors and researchers from University of Glasgow, are working to improve life after stroke. They work together but focus their activities on different aspects of stroke recovery.

Reviving movement post-stroke

Prof Dawson is passionate about improving the movement and function that can be taken away by stroke. His research has used medications, robots and devices. He was part of the team that first showed how electronic nerve stimulation, alongside physical therapy, can restore strength and dexterity in stroke survivors, even years poststroke. His research is giving hope to the many people left with long-term physical issues following stroke.

Brain health and stroke

Prof Quinn and his team have an interest in the memory, thinking and mood problems that can follow a stroke. Although conditions like stroke, dementia and depression are all ‘brain diseases,’ clinical practice and research have tended to treat them separately.

Prof Quinn’s work shows that the conditions are closely linked. For example, one in five stroke survivors

are living with dementia, and there is a one-in-three chance that a stroke survivor will experience major depression. Having identified the overlap, potential treatments that could be useful for all three conditions are in development.

Supporting stroke recovery

Stroke recovery is too big an issue for one (or two) researchers to tackle alone. Professors Dawson and Quinn proudly partner with stroke teams across Europe and beyond. The European Stroke Organisation (ESO) is the voice of stroke clinicians and researchers across Europe. ESO are working on several issues related to life after stroke, for example, by supporting the Stroke Action Plan for Europe.

Both professors play important parts in ESO; Prof Dawson is treasurer and member of the executive committee, while Prof Quinn chairs the production of clinical Guidelines. Through this triple-helix of research, clinical practice and international policy, we can look forward to continuously improving life after stroke

WRITTEN BY

Professor

Jesse Dawson Professor of Stroke Medicine, University of Glasgow

WRITTEN BY Professor

Terry Quinn

Professor in Cardiovascular Ageing, University of Glasgow

How pop-up heart health checks in the community can save lives

A local community heart check programme is using pioneering testing technology to identify ‘at-risk’ patients and ensure they have early access to healthcare interventions.

In the UK, it is estimated that up to 1 million people are living with heart failure (HF) with approximately 200,000 people diagnosed every year. It is also thought that 300,000 could be living with unidentified heart failure. However, the condition is treatable if found early, with speedier diagnoses leading to better outcomes. Left too late, it can be fatal or severely reduce quality of life, placing a significant and avoidable burden on the NHS.

Free testing for speedier interventions

To raise awareness, patient-led HF charity Pumping Marvellous Foundation has launched the BEAT HF Healthy Heart Bus initiative. This is a programme of 12 events offering free heart health checks in communities across England, Scotland, Wales and Northern Ireland.

“Think of it as a complimentary ‘heart MOT,’” says Nick Hartshorne-Evans, Pumping Marvellous Foundation’s Founder and Chief Executive. “We want to educate people about their cardiovascular health and find those who are at risk of HF,” he explains. “Intervening early — rather than treating them in hospital when their condition becomes acute — is better for them and prevents pressure building on the healthcare system.”

Advanced point-of-care testing technology

Each BEAT HF Healthy Heart Bus event is managed by local hospital trusts, GP primary care networks, local council teams and other third-sector organisations. It offers members of the public blood pressure, atrial fibrillation and heart murmur checks. Plus, it aims to help people understand HF symptoms through the acronym ‘BEAT’ (if you’re Breathless, Exhausted and have Ankle swelling, it’s Time to speak to your GP).

Every event features pioneering point-of-care testing technology developed in the UK by LumiraDx. “Previously, a phlebotomist blood test would be needed to rule out HF, with blood samples sent away to a lab for 24 or 48 hours,” explains Hartshorne-Evans.

“However, with LumiraDx, we can analyse blood from a simple finger prick test … in just 12 minutes, which indicates if further investigations are necessary. It’s speedy, efficient and offers those who need it a quicker way into the healthcare system.”

Cardiovascular Health

INTERVIEW WITH

Nick Hartshorne-Evans Founder and Chief Executive, Pumping Marvellous Foundation

WRITTEN BY

Tony Greenway

Machine learning and human health — a happy marriage?

Artificial intelligence (AI) used to sound like a distant concept, a pastime of computer tinkerers; today, AI feels like a real companion. So, can it improve healthcare equitably?

Artificial intelligence (AI) offers hope in combating heart conditions, which claim over 20 million lives annually. By rapidly identifying seemingly innocuous symptoms that could indicate a serious condition, such as nausea or muscle aches, AI can help distinguish potential cardiovascular issues like arterial blockages or irregular heart rhythms.

How AI improves heart care

Detection and management tools such as the echocardiogram, EKG, pacemaker, wearable devices for heart rhythm monitoring and implantable cardioversion devices will improve with increasing precision, facilitated by AI. We are seeing AI used to diagnose and monitor at-risk patients, determining patterns and predicting probabilities.

infrastructure and policy frameworks to strengthen patient and caregiver education, promote screening, open access to affordable medication and ensure Universal Health Coverage.

AI equity and data handling

Data collection drives the development of algorithms that underpin AI. To ensure AI tools benefit low to middle-income countries (LMICs), it is crucial to obtain high-quality data that accurately reflects these countries’ unique contexts and challenges. Sharper AI tools in one place contribute to global efforts for high-performing AI that benefits everyone.

AI can enhance the interpretation ofmedical imaging, enabling quicker and more accurate diagnosis.

AI can enhance the interpretation of medical imaging, enabling quicker and more accurate diagnosis. One example is the use of algorithms to analyse data that would pinpoint rare heart diseases such as cardiac amyloidosis. In some places, robotic-assisted interventions are guiding stent placement in patients.

Preventing development of heart conditions

Prevention of risk is the best first line of defence against disease. Awareness is increasing about straightforward lifestyle measures: curbing intake of sugar and processed foods, stopping smoking, reducing harmful use of alcohol, staying active and monitoring blood pressure. AI tools can support positive health outcomes, tracking risk management and encouraging adherence to treatment.

Alongside AI advancements, we must bolster

Protecting data and ensuring patient privacy are crucial. Regulations and protocols, such as those detailed by WHO, will help create trust in appropriate data use. This includes addressing privacy and data protection in the design and development of systems.

If we can teach machines, surely, we can overcome health challenges, making the best of all worlds — AI, prevention, equity, privacy protection — and ensuring access for everyone.

WRITTEN BY Daniel José Piñeiro President of the World Heart Federation and Professor of Medicine at the University of Buenos Aires,

How AI-powered wearable tech has helped improve the arrhythmia care pathway

Stroke doctors redesign arrhythmia pathways with an advanced AI heart monitor that detects arrhythmias more effectively.

INTERVIEW WITH Dr Saeedur Rahman Consultant Stroke Physician, Darent Valley Hospital, Dartford and Gravesham NHS Trust

WRITTEN BY Tony Greenway

Atrial fibrillation (AF) is the most common type of arrhythmia, a condition where the heart rhythm is either irregular, too fast or too slow. It’s a leading cause of stroke — and can be difficult to diagnose.

Wearable monitoring devices for arrhythmia

“We ask patients with suspected AF to wear heart monitoring devices to pick up abnormal rhythms,” explains Dr Saeedur Rahman, Consultant Stroke Physician, Darent Valley Hospital, Dartford and Gravesham NHS Trust.

“However, this can be complicated by a type of AF called paroxysmal atrial fibrillation because symptoms can come and go.”

Conventional ECG monitors (holter monitors) are usually only

worn for 24 hours or up to seven days; so, if patient does not develop abnormal rhythm during that time, the condition could be missed. Plus, holters are cumbersome, so patient compliance can be low. For hospital staff, it’s labour-intensive, as a cardiac physiologist has to manually assess large ECG datasets recorded by the devices.

Dr Rahman and team following an internal review of pathway, felt that in between a 12 lead ECG and an implantable loop recorder, there need to be an intermediary duration of rhythm monitoring. The team decided to redesign their pathway to provide another option before ILR, “We needed a monitoring device that was somewhere between a traditional monitor and loop recorder,” says Dr Rahman.

Varied benefits of monitoring for longer

The team identified an advanced, AI-enabled ECG monitoring service, Zio XT from iRhythm Technologies, which consists of the Zio monitor worn for up to 14 days, AI analysis and an ECG report. “Longer monitoring times are better because the pick-up rates are higher, and there are fewer false readings,” notes Dr Rahman.

Darent Valley experienced several other benefits through the redesigned pathway. First, Zio is smaller and showerproof, unlike traditional holter monitors, resulting in improved patient compliance. Second, datasets are analysed by AI and Zio’s team of Cardiac Physiologists, leading to faster diagnosis and reduced burden on hospital staff.

This is good for patients who need treatment quickly since they are diagnosed faster; potentially reducing secondary strokes and the associated costs. It’s also good for the NHS by increasing capacity and productivity through reduced need to repeat tests.

“Clinicians need to use it in the right context and embed it in a very structured pathway,” says Dr Rahman. “We succeeded because we planned well and partnered with iRhythm to ensure we had the right staff training and evaluated our progress throughout.”

Political willpower needed to tackle heart disease crisis

In 2022, an average of 750 people died weekly from conditions including heart attacks, coronary disease and stroke before their 75th birthday.

WRITTEN BY Charmaine Griffiths Chief Executive, The British Heart Foundation

Recent British Heart Foundation (BHF) analysis shows that the number and rate of people dying before 75 in England from heart and circulatory diseases is at its highest for over a decade.

Rising cardiovascular disease mortality

It’s the third successive year the premature death rate has risen and the first time in almost 60 years that we’ve seen the reversal of hard-won progress to reduce early death from cardiovascular disease.

These stark statistics are heartbreaking evidence of a crisis many years in the making. Ultimately, we don’t know exactly what is driving the rise in early deaths from cardiovascular disease.

Disruption caused by the pandemic and ongoing, increasing pressure on the NHS has undoubtedly had a significant impact. People living with heart disease must contend with long waits for tests and treatment; intervals between their medical reviews are becoming too long. The direct impact of Covid-19 illness on the heart has also likely played a part. However, warning signs of lost progress have been present for over a decade.

Closing heart health disparities

Since 2010, the health gap between rich and poor has significantly widened. Meanwhile, there hasn’t been enough action over the last decade to address cardiovascular risk factors like high blood pressure, raised cholesterol, type 2

diabetes and obesity — storing up huge challenges for the future.

Despite the efforts of hard-working NHS staff, heart care services are struggling at every step — from prevention, diagnosis, treatment and recovery to crucial research that could give us faster and better treatments.

We can’t let this tragedy continue. With urgent and longoverdue intervention, we can regain lost progress and save more lives from cardiovascular disease.

Stopping the heart care crisis

Three main courses of action are needed:

1. Improving prevention of cardiovascular disease causes, focused on the drivers of health inequalities such as obesity and smoking;

2. Making NHS heart care a priority, with specific plans for cardiovascular disease that identify and address NHS cardiac staffing gaps, so patients get necessary care more quickly;

3. Supercharging cardiovascular research to unlock groundbreaking treatments and cures.

Reducing deaths from cardiovascular disease was once the nation’s big success story, thanks to bold public health measures and groundbreaking science. With immediate, sweeping action and enough political willpower, it can be that way again.

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How new implant tech is changing coronary artery disease treatment

1.

First symptoms of coronary artery disease

Monitoring of symptoms and regulator follow up to monitor progression of disease

New arterial implants are revolutionising atherosclerosis treatment. Unlike stents, they promote normal vessel function and decrease the risk of major adverse coronary events.

INTERVIEW WITH Dr Joaquin Azpilicueta Medical Director Iberia and Latin America, Elixir Medical

WRITTEN BY Tony Greenway

Coronary artery disease, caused by atherosclerosis, can be fatal. It occurs when fatty material (atheroma) builds up inside the arteries, which transport blood around our bodies. If this plaque blocks or narrows an artery and restricts blood flow, it can result in heart attack.

Modifiable vs unmodifiable atherosclerosis risk factors

Various risk factors increase a person’s chances of developing atherosclerosis, explains Dr Joaquin Azpilicueta, Medical Director, Iberia and Latin America at cardiovascular technologies company, Elixir Medical. “Some of these are modifiable, such as eating a healthier diet, stopping smoking and ensuring hypertension is well-treated,” he says.

“Other risk factors are unmodifiable. For example, genetic factors can play a part in progression of atherosclerosis. So does being male. Then there’s the ageing process because, just as our skin gets dry and thin with age, our vessels deteriorate in their own way.”

Stent technology advantages and drawbacks Thankfully, significant medical advances have helped patients with coronary artery disease. These include a minimally invasive procedure known as a percutaneous coronary angioplasty (PTCA), which holds blocked or narrowed arteries open with a wire mesh tube called a stent, improving blood flow.

Yet, as groundbreaking and lifesaving stent technology has been, it does have drawbacks. “It’s not a perfect solution,” admits Dr Azpilicueta. “After the procedure, the healing process in the inside of the artery leaves a scar, which can further restrict blood flow. This is why drugs are put into stents to prevent excessive scar tissue growth — an extremely successful development.”

Addressing stent limitations to preserve arterial physiology

Another, more subtle, problem is that stents are rigid structures. “They act like a corset,” notes Dr Azpilicueta. They ‘cage’ and constrain the normal functions of an artery and affect its ability to dilate, pulse, twist and flex. Unfortunately, this unnatural rigidity can affect the function of hormoneproducing cells, which have a positive impact on an artery’s function and health.

“As a result, a stented artery is more prone to develop atherosclerosis than a native artery,” says Dr Azpilicueta. “This increases the risk of the patient experiencing further major adverse coronary events (MACE) over time. So, the cardiovascular community has been seeking to develop implant solutions that preserve the physiological nature of an artery, thus improving its vital cell function and overall health.”

2.

Non-invasive diagnostic imaging

Innovation in medical technology and diagnosis is enabling the treatment of coronary artery disease more proactively and with greater precision.

We now have non-invasive imaging modalities like CT scanners that let us identify blockages and plaques before they become so severe that they cause a heart attack or death.

Introduction of a groundbreaking vascular implant

That’s why there is excitement about a new, recently approved technology called a bioadaptor, developed to replace stents in an important number of patients. Like a stent, a bioadaptor is implanted via the same minimally invasive procedure and left behind in the artery to hold it open.

However, it is fundamentally different in composition because it’s made of three separate helical strands, which are temporarily interlocked and joined by a bioabsorbable material. This disappears in six months as new artery muscle and hormone producing cells grow around it; then, as the strands separate and become a flexible and dynamic structure of the vessel wall, the artery is able to recover its pulsatility, flexibility and plasticity (adaptability of an organism to change in its environment).

Bioadaptors help prevent major adverse coronary events

“This solution is strong enough to keep the artery open but gentle enough for its physiology to play a significant role in expanding the life and health span of our patients,” says Dr Azpilicueta. Plus, it offers another major gain. “In a controlled trial, we observed that, with a bioadaptor implant, plaque volume decreases in patients with lipid-rich lesions,” reveals Dr Azpilicueta. “In comparison, stented arteries record an increase in plaque volume. Taking all these benefits into consideration, we expect bioadaptor technology to contribute to a significant reduction of MACE in the mid to longterm compared to stents.”

AI-powered analysis and severity type of 3.

Patient decision appropriate

Medical tech revolutionises coronary disease care

AI-powered imaging analysis to identify location severity of obstruction, plaque

5.

4.

Patient empowered decision to determine appropriate treatment

5.

Lifestyle and treatment with medication Procedure to unblock the artery(ies), such as angioplasty

Return to normal activities, healthier lifestyle choices and use of preventative medication

Medical technologies enabling diverse cardiovascular care options

Timely AI-enabled interventions could significantly impact heart patients by potentially preventing cardiac events before they occur.

INTERVIEW WITH Alex Nepogodiev Executive Vice President, Elixir Medical

WRITTEN BY Mark Nicholls

Medical device innovations are expanding cardiovascular disease treatments, offering better long-term outcomes for patients.

From lifestyle adjustments to novel treatment and prevention, possibilities are enhancing both longevity and wellbeing.

Cardiovascular devices are increasingly vital, bridging the gap between therapy and prevention, not only post-cardiac events but also in proactive healthcare approaches.

Implantable therapy for cardiovascular disease

Alex Nepogodiev is Executive Vice President of Elixir Medical, a Silicon Valley-based medical technology and therapeutics company bringing highquality engineering to resolve the challenges of cardiovascular care.

Nepogodiev points to how artificial intelligence (AI) — coupled with evolving scanning modalities, techniques and diagnostic software — is changing how patients may benefit from implantable medical devices as part of comprehensive treatment pathway.

He explains that medical technologies are driving a better understanding of cardiovascular disease (CVD), which remains a leading cause of death; in the US, for example, there are 805,000 annual heart attacks, and 200,000 are recurrent — which points to an opportunity to improve treatment of CAD.

AI-enhanced scans aid prevention

Non-invasive scans, such as CT angiograms interpreted by AI, can

look inside the arteries and heart structure. They also examine the cellular and tissue level of diseases. This capability potentially highlights scenarios where a heart attack may be prevented with timely therapy.

“These insights are giving us better ways of understanding the disease, what stage of progression cardiovascular disease is at and how it can be most appropriately treated,” explains Nepogodiev.

Revascularisation implant restores arterial function

Elixir’s latest advancements in treating vascular disease mainly target cardiovascular and peripheral conditions via revascularisation (unblocking furred up arteries and restoring blood flow) procedures.

Among its products is the Coronary Bioadaptor System, an implant designed to reopen blocked arteries and restore arterial function.

“Bioadaptor is a smart prosthesis that implants in the artery like a stent but unlocks and enables the artery to pulsate and restore more normal function,” says Nepogodiev. “It helps reduce repeat heart attacks or repeat procedures for patients.”

He underlines the importance AI can play in the process, analysing information from scans to reconstruct 3D models of arteries. These technologies help identify blockages, determine their location and severity, and define treatment protocols.

Tailored treatment optimises outcomes

That may mean intervening with lifestyle and dietary changes, pharmaceuticals, bypass surgery or angioplasty and introducing devices

sooner that restore vessel function and prevent a heart attack.

Such information enables clinicians to use the technology and implants, like bioadaptor, with precision. “We know exactly the best location in the artery for it to be implanted, so it has the best value for restoring heart function. Based on that information, we can start the process earlier in the disease journey,” suggests Nepogodiev. “Physicians can better tailor treatments that are specific and unique to that patient.”

Bioadaptor also has drug-eluting properties. The company is working on multiple drugs that can be placed in the bioresorbable polymer, including anti-clotting medication to prevent thrombus formation post-procedure. This has the potential to reduce the pharmacology burden on a patient.

Stringent regulations and evolving healthcare approaches

The field of medical devices has grown over the last 30–40 years, and Nepogodiev emphasises that such technologies are still developed with high levels of rigour and research to meet stringent regulatory requirements across the globe. “That is important to note,” he urges. “The regulatory process truly validates the safety and efficacy of these devices.”

Healthcare in the cardiac arena is evolving. More recently, there has been a convergence of cardiology specialists collaborating to treat CVD patients with a ‘Heart Team approach.’ These specialists aim to develop the best clinical strategy while positioning patients as decision-makers and advocates.

Addressing shortfalls within the ‘hidden’ cancer care workforce

It is increasingly vital to boost the cancer care workforce in the NHS and encourage new students to take up training.

Medical physicists, technologists and clinical engineers are the backbone of cancer care delivery. These highly trained scientists diagnose and treat patients and are an essential part of the healthcare team alongside radiographers, oncologists and nurses.

Medical physicists, technologists and clinical engineers

Dr Anna Barnes, Consultant Clinical Scientist and President of the Institute of Physics and Engineering in Medicine (IPEM), says: “These roles are both multifaceted and crucial for the safe and effective delivery of a multitude of services underpinning the NHS.”

They carry out technical assurance tests, radiation safety checks, implementing quality control measures and optimising machinery with the use of computer-aided design. “They programme how treatment delivery machines provide the exact amount of radiotherapy needed while avoiding non-cancerous cells,” she adds.

Referring to their role as ‘the oil in the wheel,’ Dr Barnes explains they are a vital part of designing and planning treatment schedules within radiotherapy, molecular radiotherapy and nuclear medicine while translating research into clinical workflow. According to IPEM, medical physicists and clinical engineers contribute to 45% of all treatments within NHS hospitals.

Challenges of the workforce

Dr Barnes explains: “The UK does not have enough healthcare scientists, engineers and technologists to deliver essential services.” While those currently in the workforce are asked to ‘do more and more with less and less,’ it is also increasingly difficult to train new members of staff.

“To maintain this extraordinary level of expertise, it is essential that we have enough new people coming through science, technology, engineering and mathematics (STEM) education and into training routes now,” she insists.

Supporting healthcare scientist roles

Dr Barnes, passionate about addressing these challenges, speaks of IPEM’s role as the workforce’s professional body. “We provide a community for healthcare scientists, industry and academic colleagues to share ideas and best practices, to promote the profession and encourage more people to consider it as a career,” she says. Additional funding and student uptake can help tackle workforce shortages and recruitment issues, helping this ‘hidden workforce’ to be recognised.

Paid for by IPEM Find out more at ipem.ac.uk

Innovations in Oncology and Imaging

Personalising breast cancer care: ways to minimise negative impacts of treatment

Discover the latest in personalised breast cancer care and treatment options. Learn about imaging advancements and targeted therapies for improved outcomes.

Breast cancer, the most prevalent cancer globally, has seen enhanced survival rates following collaborative efforts and targeted therapy breakthroughs. Personalised care tailors treatment and prevention to individuals, considering genetic tumour variations, lifestyle factors and health conditions.

Imaging increasingly guides decision-making and treatment planning — from diagnosis to management of advanced disease, reducing the extent of surgical treatment and minimising cosmetic impact and potential long-term sequelae.

Personalised breast screening and early diagnosis

Breast screening has traditionally been via mammogram with geographical variations in the intensity and age groups screened. Variations in breast density, even in postmenopausal women, increasing use of HRT and rising incidence of breast cancer in perimenopausal women question the validity of this approach and the need for densitystratified/adapted breast screening.

The BRAID trial is evaluating modalities such as MRI, CESM and ABUS. High-risk surveillance using MRI for those with genetic alterations facilitates earlier diagnosis.

Imaging is crucial for breast screening in developed nations, yet, it is impractical in many countries. Early diagnosis through patient education and adequate healthcare resources are key to reducing breast cancer mortality.

Oncoplastic treatment choices and de-escalation of treatment

Targeted therapies must be cost-effective for global access

The development and adoption of genomic assays for ER-positive and HER2-negative cancers to assess chemotherapy benefits has been a big step forward for personalised care. The advent of targeted therapies (anti-HER2) and immunotherapy (for ER-positive and triple-negative cancers) can potentially improve outcomes for breast cancers. The cost of these therapies must be decreased to allow ‘all-inclusive’ global access to minimise variation.

Role in advanced disease management

PET-CT enhances distant disease assessment over standard imaging, identifying oligometastatic disease treatable with modalities such as SABR, potentially improving curative outcomes and duration of progression-free survival.

The rising incidence of breast cancer, coupled with better treatment, means more people are living longer. Individualising cancer care, minimising morbidity and maximising benefits through early diagnosis and tailored therapies can lead to optimised, evidence-based breast cancer management.

INTERVIEW WITH Dr Anna Barnes FIPEM CSci, President, IPEM

BY

WRITTEN

Bethany Cooper

DBT, CESM and MRI enhance surgeons’ confidence in extending breast conservation through wider adoption of oncoplastic breast conservation surgery techniques, improving patient quality of life.

Wire-guided localisation of impalpable lesions has broadly been replaced by modern techniques like RFID, magnetic and radar localisation for increased patient comfort and theatre efficiency.

De-escalating axillary surgery, supported by evidence, can reduce complications such as lymphoedema; and MRI has been shown to predict response to neoadjuvant chemotherapy, driving down the need for mastectomy.

WRITTEN BY Professor PG Roy Consultant Oncoplastic Breast Surgeon at Gloucestershire Royal Hospital

WRITTEN BY

Abigail Tomlins Consultant Breast Surgeon at Gloucestershire Royal Hospital

Time to test: 6 steps for meeting cancer testing needs

Learn what needs to be done to tackle NHS cancer testing challenges, including addressing workforce capacity and rising demand for pathology services.

WRITTEN BY David Wells Chief Executive, Institute of Biomedical Science

There are growing concerns that the current model for cancer testing (and the workforce) is unable to keep up with the increasing demand for pathology services across the NHS. The Institute of Biomedical Science and AstraZeneca teamed up to develop a six-step framework for creating the capacity the NHS needs for the future of cancer testing:

1. Grow the workforce

As well as investing in and training a pipeline of talent, the NHS should support pathologists in playing a key role in multidisciplinary teams. Enable biomedical and clinical scientists to operate at the top of their licence — developing and using specialist and expert skills and knowledge.

2. Bring cancer testing together

We should ensure testing is organised according to the needs of patients and multidisciplinary teams, delivering commonly used or established tests closer to patients and at the quality and scale required.

3. Enable providers to deliver

Services should be patient and clinician-focused. When centralised testing services are unable to provide a timely, high-quality service, other providers should be supported to lend additional capacity — providing the right test at the right time. Where this happens, it will be important that tests are delivered according to the necessary criteria, as well as in line with appropriate quality measures and at a comparable cost.

Why is innovation important for people living with cancer?

As new innovations emerge, cancer care is constantly evolving. Learn how a leading cancer charity is supporting and spreading best practice for people living with cancer.

BY

WRITTEN

Professor Richard Simcock Chief Medical Officer, Macmillan Cancer Support

In the modern world of cancer care and support, innovations bring new hope on a daily basis.

At Macmillan Cancer Support, we work to support a range of innovation projects and pilots, to help spread best practice and ensure the best possible care and support for people living with cancer.

An explosion of knowledge

When I first started out in my career, cancer care developed through a slow evolution; most progress used to be based on new ways of using old treatments, like different combinations of chemotherapy drugs and improved delivery of radiotherapy.

Nowadays, we seem to be in a revolution, as ‘90% of what we know

4. Improve data

Ensuring data is collected consistently and can be shared across systems is vital to improving quality and unlocking capacity. The publication of a genomics informatics implementation plan, as committed to in NHS England’s genomic medicine strategy, is a vital first step. Data on cancer testing is also vital for enabling accountability, supporting timely and joined-up patient care and informing research.

5. Develop a cancer testing accountability framework

Quality measures should be established — to which all NHS cancer testing providers adhere, with comparable data published on performance. The framework should inform future commissioning decisions and be used to identify good practices across the system.

6. Invest in the fundamentals

Testing advances can be inaccessible due to outdated or inadequate physical infrastructure. Unsuitable use of buildings, overstretched courier services and inefficient information transfer hinder cancer testing services. Investing properly in the fundamentals of infrastructure and logistics would enable services to deliver highquality tests with rapid turnaround times and support the expansion of services.

about cancer was published in the last five years,’ according to US oncologist Larry Norton. Cancer treatments include synthetic antibodies (with or without chemotherapy payloads attached), immunotherapy and multiple targeted biological therapies and custom-designed immune T cells. In my own specialty of breast cancer, we have seen 19 new NICE approvals since 2018, guided by more precise knowledge of tumour biology. These developments have huge potential for delivering a better experience and outcomes for people living with cancer in the near future, if not now.

Innovations transforming cancer care Innovation extends far beyond new treatments. While innovation brings some operational challenges —

around finding ways to accommodate new treatments in an already stretched system, for example — they are not impossible to overcome, and innovation offers potential solutions once again. Macmillan is partnering with organisations like 52 North Health, where the team has been developing technologies enabling people to carry out important blood tests at home, aiming to restore their autonomy while freeing up much-needed capacity in hospitals.

The potential of artificial intelligence

Artificial intelligence is another advance impacting all aspects of life. It is being used increasingly in cancer treatment, spanning everything from drug development to radiotherapy planning.

Macmillan has supported the work of Lucida Medical to enhance the diagnosis of prostate cancer using MRI scans, which is a good example of this. This work aims to deliver more rapid reassurance and earlier diagnosis while freeing up time for cancer professionals, which is in great demand and short supply.

From diagnostic urgency to genomically selected therapy, all aspects of cancer care are seeing rapid innovation. As a leading cancer charity, we have a vital role to play in encouraging and enabling this potential.

Accelerating development of critical cancer drugs

Clinical trials of novel therapies for leukaemia, breast and lung cancer are showing promising signs in treating these cancers in patients today.

Anumber of cancer therapies in development are showing promising results in clinical trials and emerging as potential alternatives when existing treatments falter or fail.

Ellipses Pharma, a precision drug development company focused on oncology and aiming to accelerate the development of new cancer medicines and treatments, is developing next-generation targeted therapies for patients with leukaemia, breast and lung cancer.

Rigorous testing and assessment in global clinical trials

SPREAD WRITTEN BY Mark Nicholls

Chairman and Co-Founder Prof Sir Chris Evans OBE explains how the company acquires promising new drugs from other organisations before they go into human testing and then develops them into potential new treatments in clinical trials so that patients have more options on their cancer journey.

“The drugs being developed at Ellipses are nextgeneration therapies to effectively target genetic abnormalities found in certain tumours. Each potential medicine undergoes rigorous testing and assessment in specialist cancer centres around the world,” he says.

Next-generation selective RET inhibitor for lung and other cancers

One of the new drugs for lung and other cancers targets a dysfunctional protein called RET (rearranged during transfection). Prof Tobias Arkenau, Chief Medical Officer and Global Head of Drug Development, outlines how the drug inhibits the protein, stops the uncontrolled division of the cells and destroys cells that are part of a tumour.

“By inhibiting the RET protein that is driving the cancer’s growth, it is stopping the cancer from growing,” he says.

The drug is a next-generation selective RET inhibitor and has completed a phase 1 trial in patients with RET positive cancers, ascertaining what the most effective doses look like, and is now entering phase 2 studies having acquired orphan drug and fasttrack designation in the US, which should accelerate the process towards wider patient use.

Prof Arkenau says it is showing encouraging results in patients who have become resistant to first-generation RET inhibitors or whose cancer has spread from the lungs to the brain and other organs.

New drug for patients with hormone receptor-positive breast cancer

In the area of advanced breast cancer that has returned or progressed after initial treatment and moved outside of the breast,

Spread paid for by Ellipses Pharma

“This works by ‘fuelling’ the androgen receptors, almost starving the cancer of its oestrogen signalling and subsequently leading to cancer cell death,” he adds. “We expect to combine this new SARM with existing therapies to see even better responses in patients and for longer,” continues Prof Arkenau. The drug is now going into combination studies in the US, Europe and the UK.

Leukaemia drug for patients not responding to current treatment

A third drug under development is for patients with acute myeloid leukaemia (AML), where leukaemia cells growing in the bone marrow replace healthy red and white blood cells and subsequently result in bone marrow failure.

By inhibiting the RET protein that is driving the cancer’s growth, it is stopping the cancer from growing.

Prof Arkenau believes there remains a ‘high unmet need’ for specific patient groups.

The company is currently enrolling breast cancer patients who have progressed on current hormonal therapies into their new selective androgen receptor modulator (SARM) trial that has returned promising results in patients whose cancer expresses both oestrogen and androgen receptors.

“AML is a very complicated blood cancer,” says Prof Arkenau. “Often driven by multiple genetic abnormalities.” He notes that leukaemic cells can become resistant to standard therapies even after stem cell therapy, and relapse is common. The drug being trialled is a dual inhibitor targeting a specific set of proteins that are known to be involved in cancer resistance and progression.

Patients at the relapsed-refractory stage, where standard treatment has consistently failed, have been participating in a phase 1 trial. The results were very encouraging to now allow progression of the study to combine Ellipses’s drug with other approved therapies in a phase 2 trial.

It marks yet another stage of the company’s ongoing development of drugs aiming to improve the quality of life for cancer patients.

INTERVIEW WITH Professor Tobias Arkenau Chief Medical Officer & Global Head of Drug Development, Ellipses Pharma

INTERVIEW WITH Professor Sir Christopher Evans Chairman and Co-Founder, Ellipses Pharma

Streamlined drug development process can meet patient needs quicker

Using holistic approaches is helping a major drug developer create and test drugs more quickly and cost effectively to benefit patients.

Often, years of research can result in failure, with millions of pounds spent without a new drug making it to patients.

Drug development company Ellipses Pharma believes its business model streamlines the process and enables pharmaceutical companies to get tried and tested compounds to market quicker.

Patient and drug manufacturer advantage

Focusing on oncology and a core purpose to accelerate development of cancer treatments, CEO and Co-Founder Dr Rajan Jethwa believes the company’s efficient approach has clear benefits to patients and drug manufacturers.

His company acquires drugs in their infancy from other developers and refines them through rigorous testing, research, trialling and problemsolving. They aim to prepare them for sale to pharmaceutical companies.

“If we do it well,” says Dr Jethwa, “we have a much higher chance of those drugs being successful. We improve our chances by engaging specialist cancer doctors and scientists at an early stage and designing the preclinical and clinical development plans, taking their guidance into account.”

De-risking drug development

Given the time-limited span of a patent, which can start well before the drug is commercially available, time saved in medicine development gives pharmaceutical companies a longer

exclusive window to sell the product.

That is against a backdrop of changed public perceptions in drug development timescales following the Covid-19 pandemic where a vaccine was developed quickly. The company ethos is designed to de-risk a drug’s development while saving time and money.

Properly funding the development stage is pivotal. “That is our core pillar. We call it uninterrupted development capital, an uninterrupted flow of money that allows us to ensure each drug is funded properly without adding delays by having to stop and restart development with intermittent funding,” Dr Jethwa explains.

“That can save 3–6 years of additional patent life for the drug and leads to patients getting the drug sooner and for longer.” With seven out of every eight potential cancer drugs never reaching patients, de-risking chances of failure increases chances of success.

Designing trials with clinician support

Before acquiring a drug, the company consults its Scientific Affairs Group of 300 global key opinion leaders — doctors, experts, peer reviewers — engaged anonymously via a bespoke digital platform developed by Ellipses for their views on the science and potential development gaps.

“The aim is to get consensus around how good the science behind a drug is,” explains Prof Tobias Arkenau, Global Head of Drug Development.

“The next stage is designing the clinical trial in the right way; patient stratification, making sure the right

patients go into the right trial for the right drug at the right time … is hugely important,” he adds.

“These two things help to de-risk drug development; we are selecting a drug that already has support from clinicians and designing a trial that ensures the drug is tested in the right patient population. All of that should lead to a better success rate.”

Processes to help patients survive longer

Ellipses follows defined processes to tackle various challenges: determining the right amount of active compound, assessing environmental impact, scalability, patient-friendliness, regulatory compliance and evaluating toxicity and side effects. “We navigate these processes in parallel to get to a point in advance of first-in-human trials, knowing all the problems have been solved,” says Dr Graeme Horne, Head of CMC.

“The pillars of de-risking, asset selection and how a trial is built and designed, coupled with uninterrupted flow of capital and executing a clinical trial efficiently and effectively leads to more drugs developed in a faster timeline with a higher rate of success,” adds Dr Jethwa.

Moreover, he points to a plethora of benefits for patients who get a drug sooner. “The drugs have been rigorously tested, are shown to be safer and efficacious in treating disease for longer. Ultimately, we want patients to survive longer with a better quality of life.”

INTERVIEW WITH

INTERVIEW WITH

Dr Rajan Jethwa CEO and Co-Founder, Ellipses Pharma

Graeme Horne Head of CMC Ellipses Pharma

Women’s Healthcare

Pages 14 - 17

Could your next smear test be done from the comfort of your own home?

One-third of eligible women across the UK do not attend their smear test, resulting in the development of at-home cervical cancer screening kits to address the gap.

According to Cancer Research UK, 1 in 130 UK females will be diagnosed with cervical cancer in their lifetime, with around 99.8% of cases being preventable. The NHS urges eligible women to schedule potentially lifesaving cervical screening, yet nearly a third fail to respond.

Barriers to cervical screening attendance

Randolf Ten Cate, from Rovers Medical Devices, highlights the barriers to attendance. “At-risk women are not attending appointments due to a variety of reasons; they are worried, embarrassed, fear discomfort, have cultural reasons or potential previous trauma or simply do not have enough time,” he explains.

“We strongly encourage women to visit their appointments. However, it is also important to be able to address their unmet needs, through the use of an at-home self-testing kit.” Since the NHS recently pledged to eliminate cervical cancer by 2040, they have started their HPValidate pilot study of such a tool, to address screening attendance barriers.

Reliable, comfortable HPV screening

Ten Cate outlines the essential criteria, which must be met for an at-home screening programme to be adopted nationally. “The test must be reliable, consistent across all demographics, have stability across all seasons and, last but certainly not least, it must be comfortable for women.”

Rovers Medical Devices have developed their Evalyn Brush, in conjunction with a panel of women and gynaecologists. It is a comfortable and reliable at-home cervical cancer screening device. Collected samples are sent to a laboratory to detect human papillomavirus (HPV), which is responsible for over 90% of cervical cancer cases.

“The Evalyn Brush is already used in numerous other countries,” Ten Cate adds. The tool gives women testing autonomy and bridges the critical gap between smear test non-attendance and cervical cancer rates throughout the UK.

WRITTEN BY Dr Ranee Thakar President, The Royal College of Obstetricians and Gynaecologists (RCOG)

Bleak barriers women face in accessing vital gynaecology care

Learn about the urgent need to prioritise women’s health in the UK. Explore challenges, impacts and solutions for equitable gynaecological care provision.

For decades, women’s health has been deprioritised, underfunded and underresearched. The impact has been devastating, particularly for gynaecological care provision in this country. The Covid-19 pandemic exacerbated existing challenges in NHS gynaecology services, with waiting lists growing faster than other specialties.

Gynaecology care shortages persist

As of December 2023, there were nearly 600,000 women and people on gynaecology waiting lists across England with over 33,000 waiting over a year. Moreover, there is a postcode lottery when accessing gynaecological care; women living in the Midlands wait longer, on average, than any other region in England.

Serious gynaecology conditions are too often overlooked when prioritising NHS capacity. In part, this relates to the misconception that conditions such as endometriosis, PCOS, fibroids, prolapse and incontinence are ‘benign.’ This could not be further from the truth.

Gynaecological conditions impacting daily life

The people I see in my clinic are grappling with symptoms such as severe pelvic pain, heavy menstrual bleeding and incontinence. Their conditions affect their physical and mental wellbeing and ability to work or even leave their house.

These conditions can also be progressive. Nearly three-quarters of Royal College of Obstetricians and Gynaecologists’ members surveyed in 2021 felt long waits meant they were seeing women with complex care needs. In 2024, this will only be worse.

Finding solutions to gynaecological concerns

The introduction of the Government’s women’s health strategy a year ago is positive, including the creation of Women’s Health Hubs to help women access care in the right place, at the right time. However, progress still feels frustratingly slow for gynaecologists working on the frontline and women waiting for treatment.

To help deliver solutions faster, this year, the College will be undertaking work to identify effective policies and initiatives to address gynaecology waiting lists. An important part will be listening to women living with these conditions to help design solutions for the future.

Call for joint taskforce and holistic care

The College also believes there needs to be a Government and NHS-led joint taskforce to address the issues unique to the specialty and ensure the effective and equitable recovery of elective gynaecology services. It is time for health services to meet the needs of women (who make up half of the population) across the country by delivering timely, compassionate and holistic care.

WRITTEN

Wound care solution benefits at-risk mothers after a C-section

Wound care technology is helping reduce the risk of surgical site infections in caesarean section (or C-section) procedures in at-risk patients, leaving mothers able to focus on their newborns.

Surgical site infections after mothers give birth by C-section can cause a range of health concerns. It can lead to emotional stress and wound complications requiring further medical intervention. It can also interrupt the natural bonding process between mother and baby.

Proactive healing strategies

Dr Mendinaro Imcha, consultant obstetrician and gynaecologist at University Hospital Limerick in Ireland, says surgical site infections (SSIs) may interfere with breastfeeding or the patient’s wellbeing. “Infections slow down the healing process, hindering the mother’s ability to care for her newborn and resume daily activities.”

Quick healing of the incision requires a multifaceted approach, involving both medical professionals and patients. Dr Imcha says that includes pre-operative screening for high-risk factors and regular checks for infection after the C-section. Proactive strategies for avoiding SSIs have a ripple effect that benefits individual patients, healthcare providers and the wider public health system,” she adds.

Patients report comfort and less pain compared to care with standard dressing.5,6 Highlighting mother-baby bonding, she adds: “It is not merely a warm and comforting experience but a critical period that can significantly influence the psychological, emotional and physical trajectory of the child and the mother.” Immediate skin-to-skin contact encourages breastfeeding, providing the newborn with essential nutrients and antibodies.

Availability of wound care tech

In the UK, around one in four pregnant women every year give birth via C-section7 (around 150,000), with data suggesting 10% are at risk of developing a SSI.8 Kate Backshell, Vice President, Advanced Wound Management, UKINOR division at Smith+Nephew shares her experience of the PICO™ dressing after her children — now aged 4 and 6 — were delivered by C-section. She says women should know that effective wound care technologies are available. “Dressings are just one part of the pathway for reducing the risk of surgical site complications, but choosing an appropriate dressing can make a significant difference.”

People at risk of infection

The active therapy, rather than a passive absorbent dressing, is NICErecommended for patients who are at risk of developing an SSI9 and is available on the NHS. Backshell says the solution can reduce infection risk by over 50% by creating gentle pressure across the incision line.10 It can be applied immediately after the C-section and has particular benefits for women identified at the pre-op stage as at risk of SSI. This includes people who have had a previous C-section, have diabetes or a body mass index of 30+.8,10

Secure healing

Backshell says the first weeks with a new baby are all-consuming, with mothers needing time and space to bond with their baby. “When you have an SSI, you can be in great pain and discomfort, and that can affect your physical ability to pick up the baby.”

INTERVIEW WITH Dr Mendinaro Imcha

Clinical Lead for Obstetrics & Gynaecology at UL Hospitals Group

INTERVIEW WITH Kate Backshell

Vice President, Advanced Wound Management UK, Ireland and Nordics (UKINOR)

Smith+Nephew

WRITTEN BY Mark Nicholls

If you’re a HCP, scan the QR code to find out more

Immediate skinto-skin contact encourages breastfeeding, providing the newborn with essential nutrients and antibodies.

Therapy for faster wound healing

Single-use negative pressure wound therapy (sNPWT), such as Smith+Nephew’s PICO™ sNPWT solution, can aid recovery,1 particularly in obese women undergoing C-section.2 Dr Imcha explains the proposed mechanism of NPWT. “The negative pressure facilitates cell proliferation and the formation of granulation tissue, which is essential for wound healing and improves blood circulation. The sealed environment, created by the dressing, minimises external contamination risks, effectively shielding the wound from bacteria.”3,4

Benefits of mother-baby bonding

Dr Imcha says her experience of NPWT in the clinical setting has been positive.

With the birth of both of her children, she was grateful to have access to the PICO™ system, which enabled her to focus on being a new mum. “With the PICO™ dressing, I had the confidence that the incision would just heal,” she says. “The way the dressing bolsters the incision together makes it feel very secure.”

The clinician testimonial in this article represents the individuals’ own opinions, findings and/or experiences. Individual results will vary.

™Trademark of Smith+Nephew. 40793.

If you’re a patient, scan the QR code to find out more

5. Gilchrist B, Robinson M, Jaimes H. 2020; Virtual.

6. Hurd T, Trueman P, Rossington A. 2014;60(3):30-36.

2001002.

7. NHS Choices. Available at: https://www.nhs.uk/conditions/caesarean-section/ (accessed September, 2023)

8. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. 2012 Oct;119(11):1324- 33.

9. NICE, 2019. [Last accessed: Sept 2023]

10. Hyldig N, Vinter CA, Kruse M, Mogensen O, Bille C, Sorensen JA, et al. 2019 Apr;126(5):628-3

WRITTEN BY Dr Paula Briggs British Menopause Society Chair and Consultant

MCommon menopause myths and how to find the right support

Get evidence-based information that addresses menopause myths and offers alternatives to suit your needs. Find support for your symptoms today.

enopause is a hot topic. Our grandmothers would probably be shocked to hear current conversations about menopause and while considerable progress has been made, there are downsides. Increased awareness has led to confusion and anxiety for many women, with misinformation and conflicting advice often shared widely on social media.

As the specialist authority for menopause and post-reproductive health in the UK, the British Menopause Society (BMS) aims to tackle misconceptions associated with menopause and provides evidencebased, peer-reviewed information.

Myth: I’m missing out if I can’t have HRT Some women are concerned that Hormone Replacement Therapy (HRT) is dangerous and increases the risk of cancer. Others believe they’re missing out if they don’t get it. The truth is that the risk of developing breast cancer from HRT is low and, for most women taking HRT, the benefits outweigh the risks.

The use of HRT should be considered in the context of its overall benefits, including improved quality of life, bone health and cardiovascular risk reduction. However, for women who can’t have or choose not to take HRT, there are alternative treatment options available. The most important thing is that whatever your symptoms, advice and support are available.

Myth: menopause kills your sex life Interest in sex can change through the menopause transition and beyond, but it doesn’t need to be game over. Sexual desire can alter for different reasons, and various treatment options are available depending on individual circumstances.

Vaginal dryness, itching and burning are common symptoms affecting more than 50% of menopausal women. Treatments include vaginal moisturisers, lubricants and vaginal hormone therapy. Some women find that psychosexual counselling and specialist pelvic floor physiotherapy offer additional benefits.

Myth: testosterone will help every woman – I need it too

While there’s been media coverage about testosterone therapy, addressing persistent low sex drive in women is the only proven benefit of this treatment. HRT can have a beneficial effect on sexual function; the addition of testosterone, if necessary, can help when low libido does not improve with HRT alone. However, testosterone is not always the answer. Sexual desire is complex, and other treatment options may be more effective. There is currently not enough evidence to recommend testosterone for low energy, low mood, fatigue or brain fog.

Challenges in endometriosis care: why we need to diagnose women

Endometriosis affects 10% of people who menstruate globally. Uncover the challenges, disparities and urgent need for prioritised research.

Globally, around 1.9 billion people menstruate and, on average, have a period from age 13 to 51 every 28 days (give or take). This equals 456 periods over 38 years of their life.1 Approximately 10% of those people (178 million) experience debilitating symptoms monthly, including chronic pelvic pain, heavy bleeding, painful sex and infertility, caused by the disease endometriosis.2

Endometriosis neglect and racial disparities

Until recently, endometriosis remained relatively invisible in the media and essentially ignored by government policy. Moreover, even though more women are affected by endometriosis in the UK than diabetes — taking, on average, 7.5 years to get a diagnosis3 — it is even worse for black women. Research suggests they are 50% less likely to be diagnosed with endometriosis compared to white women.4

Reasons for diagnosis delay Delays have largely been attributed to the current gold-standard diagnosis method, which is laparoscopic (keyhole) surgery to see inside the pelvic cavity, visualising the endometriosis. However, I suspect that the normalisation of menstruation pains also plays a part. A recent inquiry found that before receiving

a diagnosis, over 58% of women visited their GP 10 or more times with symptoms; 53% visited A&E with symptoms; and 21% visited doctors in hospital 10 or more times with symptoms.5 Many expressed a feeling of dismissal and disbelief of their symptoms by health professionals.

Improving endometriosis care

As a doctor, I can confirm that endometriosis receives disproportionately less attention in medical school — and clinical practice (except specialist centres) — compared to diseases with similar or lower prevalence in our population.

For too long, endometriosis has been neglected on the health agenda, with insufficient funding and research. We must do better. Quoting researcher Nicky Hudson: “The wilful ignorance around women’s lived experiences of endometriosis and long-standing silencing of their claims have shaped, and continue to shape, the ways in which the condition has come to be defined, indelibly marking it as a disease which is complex, difficult and enigmatic.”

Learn more about endometriosis from Royal College of Obstetricians and Gynaecologists, Endometriosis UK or NHS.

About Efemia

Efemia Bladder Support is a reusable, comfortable and effective device for women with Stress Urinary Incontinence. Efemia was developed to reduce or prevent bladder leakage as an alternative to surgery and disposable products. By equally prioritising reliability, functionality and emotional aspects, we aspire to bring forward dependable and effective products that fit well into women’s everyday lives.

Dr Irena Hreljac Clinical Affairs Manager, Fotona

TBreakthrough laser therapies are improving women’s pelvic health

Find out how precision laser therapy benefits women’s pelvic health, offering non-invasive solutions for pelvic floor issues.

he women’s health landscape is fraught with hidden struggles that can disrupt day-to-day life.

Many struggles arise from impaired function of the pelvic floor muscles and tissues, which cradle the pelvic organs and ensure their proper function. When balance is disrupted, symptoms like urinary leakage, intimacy issues and pelvic organ prolapse may occur. Unfortunately, solutions offered are scarce, and some may even exacerbate the issue.

Precision laser pelvic therapy

With today’s technology, lasers can emit precisely engineered thermal pulses that trigger the body’s regenerative response without damaging the tissue. Particularly, a new class of non-ablative Fotona SMOOTH® laser treatments offer therapeutic options for several

Tackling barriers to early breast cancer diagnosis

faced by ethnic communities

Identify and dismantle barriers to early detection and diagnosis of breast cancer amongst ethnic minority communities and help empower and inform women about the importance of regular breast checking.

WRITTEN BY Manveet Basra Associate Director of Public Health, Inclusion and Awareness, Breast Cancer Now

Breast cancer is the most common cancer in the UK, with one woman diagnosed every 10 minutes and incidence rates rising. At Breast Cancer Now, we want to remind anyone affected by breast cancer that we’re here to provide information and support — in every way we can, all year round.

Breast cancer diagnosis and disparities

In the UK, breast cancer is less common in women from ethnic minority communities than in white women. However, women from these minority groups tragically face a greater risk of late-stage diagnosis, lower survival rates and poorer levels of care.

problems impacting women’s pelvic floor health.

The Fotona SMOOTH® erbium laser works by triggering regeneration within the pelvic floor tissues, making them firmer and healthier and restoring their supportive function. The treatment has been proven to reduce symptoms of stress urinary incontinence,1 vaginal atrophy2 and more.

Advanced therapy for Lichen sclerosus

Besides pelvic floor dysfunction, women are commonly faced with symptoms potentially connected to chronic inflammation. One example is Lichen sclerosus, a debilitating condition impacting women of all ages; symptoms range from vulvar itching to pain during sexual intercourse.

A recently published clinical study from Switzerland3 shows that

a combined therapy of erbium and neodymium laser treatment with Fotona’s unique Piano and PLLT TM pulse modes bring even more benefit than standard topical corticosteroid treatment. The laser treatment’s effects lasted several months with only a few sessions performed.

Merging medical expertise and patient preference

The biggest benefit of these novel laser treatments is the ‘menu’ of available therapeutic options. A recently published study on patient preference in pelvic floor dysfunction treatments4 suggested that 85% of women preferred non-surgical treatments with moderate improvement rates and fewer associated risks.

Only 15% of women experiencing more severe symptoms were inclined to choose surgical procedures despite higher risks. Factors such as treatment efficacy, complications and recovery time influenced decisions significantly. Evidently, women want the freedom to choose the right treatment for their needs.

References

1. O’Reilly BA, Viereck V, Phillips C, Toozs-Hobson P, Kuhn A, Athanasiou S, et al. Vaginal erbium laser treatment for stress urinary incontinence: A multicenter randomized sham‐controlled clinical trial. Int J Gynecol Obstet. 2023;

2. Gambacciani M, Levancini M, Russo E, Vacca L, Simoncini T, Cervigni M. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric 2018 Mar 4;21(2):148–52.

3. Viereck V, Gamper M, Regauer S, Walser C, Zivanovic I. Nd: YAG/Er: YAG dual laser vs. topical steroid to treat vulvar lichen sclerosus: study protocol of a randomized controlled trial. Arch Gynecol Obstet. 2023;1–7.

4. Shah GS, Phillips C. What women want now! Eur J Obstet Gynecol Reprod Biol. 2023;286:118–20.

For example, in black African, black Caribbean and Asian communities, there can be fears, myths and taboos around breast cancer, which can deter women from breast checking, talking about cancer or sharing their diagnoses. When it comes to breast screening, Breast Cancer Now research found that women from certain ethnic minority groups were less likely to be aware of the screening programme and the pros and cons of breast screening than their white counterparts.

Dismantling barriers and empowering women

Touch, look, check your breasts

Early detection of breast cancer is key; the sooner it’s diagnosed, the more likely treatment will be successful. All women must know the signs and symptoms of breast cancer and get to know their ‘normal’ through regular breast checking. It’s as simple as ‘Touch, Look, Check (TLC)’ — touch your breasts, look for changes and check out any new or unusual changes with a GP.

Breast screening saves women’s lives from breast cancer

Women from ethnic minority groups are less aware of breast cancer symptoms than white British women. There can also be barriers that stop women from detecting symptoms and seeing their GPs as soon as possible.

Given the importance of early detection, we’re raising awareness among ethnic minority communities of the signs and symptoms of breast cancer, plus the importance of breast checking and attending breast screening appointments when invited. We deliver public health talks in workplaces and community groups, provide resources in multiple languages to help break down information barriers and run targeted awareness campaigns.

We work collaboratively with the NHS and coalition groups, such as The Richmond Group of Charities and National Voices, sharing good practices and learnings. In England, we’re calling on the Government and NHS to deliver a national breast screening awareness campaign focusing on areas and communities where screening uptake is lowest.

Elevating patient care with synergy between radiologists and AI

As AI makes waves in medicine, radiologists must position themselves to embrace this new technology, safeguard their profession and redefine the future of medical imaging.

WRITTEN BY Professor Carlo Catalano President of the European Society of Radiology

Artificial intelligence (AI) is revolutionising radiology. It is the new kid on the block — a disruptor in the field. For some, this is a tool to be feared. For others, it offers a wealth of opportunity. Unlike many other medical fields, radiology has its origins rooted in technology. The radiologist has always embraced the latest innovations to diagnose the patient more effectively and efficiently. The rise of AI should be treated no differently.

AI enhancing radiology practice

To give the cold shoulder to this emerging technology at this crucial moment would be to let a huge opportunity slip through our fingers — an opportunity to create a symbiotic relationship with AI. This symbiosis has the potential to strengthen, not weaken the radiologists’ role in medicine and, ultimately, take medical imaging to the next level.

imaging if we are open to adaptation.

To remain the key stakeholders in radiology, we must use our wealth of knowledge and experience to ensure we control the direction of our field. Radiologists can ignore the elephant in the room — or we can embrace it, shape it and harness its extraordinary power.

The radiologist has always embraced the latest innovations to diagnose the patient more effectively and efficiently.

AI will not replace radiologists; it will enhance their practice. Just as a plane would never be left on autopilot without the oversight of an actual pilot, we cannot leave AI to its own devices when it comes to providing accurate diagnosis and effective treatment paths for the patient. This technology is here to stay and will only grow more powerful with time, but radiologists can become the captains of AI in

How the women’s health gap is costing you and your business

Unlock a 1 trillion-dollar opportunity by addressing the women’s health gap. Learn how investment in women’s health improves lives and boosts global economies.

The impact of the extensive lack of research and investment in women’s health is finally being understood and quantified on a global scale. A January report from the McKinsey Health Institute estimates that ‘women spend 25% more time in poor health than men’ as a result of the sex and gender inequities in research, diagnosis, treatment and care.

This ‘gap’ has a cost to the quality of life and life expectancy of women, as well as workforces, communities, and families globally. Addressing the women’s health gap presents an astonishing $1 trillion-dollar annual opportunity for the global economy.

Collaboration to strengthen radiology

How do we cultivate and grow this symbiotic relationship and ensure that it is fit for purpose? Radiologists must act now, collaborating with industry partners, international organisations, governments, our medical colleagues and the patient to establish efficient workflows, clear guidelines and revised training programmes to help integrate AI into our daily working lives.

At the European Congress of Radiology 2024, attendees had one of the best opportunities for such collaboration. With its theme of ‘Next Generation Radiology,’ the congress brought many of these stakeholders together under one roof, offering radiologists and health partners from across the world a unique chance to interact, learn and define the future of our profession together.

Economic impact of women’s health gap

Almost half the health burden and impact McKinsey identifies is of women in working age (20–64). Before the pandemic, we may not have thoroughly considered the impact of health on economic productivity. The events since 2020 spotlighted the intricate link, revealing how women’s higher likelihood of ill health hinders economic participation and productivity. This includes direct absences and ‘presenteeism’ — an inability to show up as your ‘best self’ at work due to poor health.

Addressing menopause to support workforces

One area that demonstrates this

impact for women and businesses in the UK is menopause and perimenopause. Menopause affects 100% of women, has over 40 known symptoms and can be felt for over 15 years. With little support, solutions and ongoing stigma surrounding this life stage, menopause represents a high unmet need.

Peppy, a disruptive health benefits provider for employers, cites that 59% of women have taken time off work due to menopause symptoms, and a staggering 1 in 10 leave their jobs. As women of menopausal age become the fastest-growing demographic in the UK workforce, it’s a priority for businesses to address — minimising productivity losses and securing top talent.

Collaborative effort and business benefit Efforts to close the women’s health gap are gaining momentum, not only from private sector businesses and investors but also from governments and the public sector. It will take the efforts of everybody to close this gap.

For businesses — however big or small — prioritising access, breaking taboos, offering support and flexibility and allowing women to bring their best selves to work will have an enormous impact on employee health, culture, talent opportunities and bottom line.

WRITTEN BY Rebecca Baldwin Portfolio Director, Women’s Health Innovation Series

Ignored, dismissed, belittled: why patients deserve faster diagnosis for endometriosis

EDespite being such a common disease, securing an endometriosis diagnosis can be an uphill battle. A report reveals severe diagnosis delays and calls for urgent action.

ndometriosis UK, the charity I lead, champions the rights of all those impacted by endometriosis: a disease affecting 1 in 10 women, and those assigned female at birth, from puberty to menopause — with an impact that may be felt for life.

Debilitating diagnosis delays in endometriosis

A lack of diagnosis means no access to treatment, potentially allowing the disease to progress, with the risk of worsening physical symptoms and mental health. Our new report, published as part of Endometriosis Action Month, shows that the average time to diagnosis in the UK is now 8 years and 10 months. This is an increase of 10 months from 2020.

Nearly nine years is a long time to wait for anything, but it must feel like an eternity when you’re waiting to get answers about a disease that can affect so many aspects of life — from work and education to relationships, fertility and more.

47% of the people surveyed visited their GP 10 or more times with symptoms prior to receiving a diagnosis.

Endometriosis diagnosis challenges

The route to securing a diagnosis can often be circuitous, tortuous and lengthy, as 47% of the people surveyed visited their GP 10 or more times with symptoms prior to receiving a diagnosis. Half had visited A&E at least once, with less than a fifth of those receiving referral to gynaecology as a result.

Most concerningly, nearly 80% of those who later received a diagnosis experienced doctors telling them they were making a ‘fuss about nothing’ — or similar — and many had the severity of their symptoms questioned by health practitioners.

Call to cut endometriosis diagnosis times

We know that the pandemic has had a significant impact across the NHS, with gynaecology waiting times increasing by the highest percentage among health specialties. Decision-makers have historically not prioritised menstrual health, resulting in inadequate allocation of resources. Now is the time to reverse that trend and drive down diagnosis times. We call on the four Governments of the UK to commit to a target of an average diagnosis time for endometriosis of one year or less by 2030. Urgent action is needed from NHS commissioners and providers to commit the resources needed to make that happen. We know it won’t be easy, but it is necessary — and possible.

WRITTEN BY Emma Cox CEO, Endometriosis UK