RACS revises its Code of Conduct
The Royal Australasian College of Surgeons (RACS) has revised its Code of Conduct after recent exposure of bullying, harassment and sexual harassment throughout the profession. A press release from the College said the purpose of revising the Code was to “promote respect in surgery, through high standards of surgical performance and clear expectations of professionalism”. “The Code defines professional behaviour for surgeons and reflects the values – of service, integrity, respect, compassion and collaboration – and the College Pledge that all new Fellows make. It requires surgeons to demonstrate objectivity and compassion, place patients’ interests first and always respect a patient’s dignity and autonomy.” President of the RACS, Dr Philip Truskett, AM, said: “There is no room for discrimination, bullying or sexual harassment in our profession and we have revised our Code of Conduct to make our expectations very clear. The consultation process strengthened the Code and assured individual surgeons that it reflected the standards expected of them by their peers.” The revised Code defines professional conduct, makes clear that all Fellows are accountable for their conduct in the workplace, and reaffirms the RACS commitment to ensuring an inclusive surgical culture in Australia and New Zealand. Discrimination, bullying and sexual harassment are specifically identified as breaches of the Code. Fellows found to have breached the Code may be subject to sanctions, including loss of privileges and in the most serious proven cases, loss of College Fellowship. Revising the Code is part of the RACS Action Plan: Building Respect, Improving Patient Safety, which details the work the College is doing in education, complaints management and culture and leadership. As part of the action plan, the College has also reviewed its sanctions policy.   

Gene editing cold sores away
A study published in PLOS Pathogens suggests that attacking herpes virus DNA with CRISPR/Cas9 genome editing technology can suppress virus replication and, in some cases, lead to elimination of the virus. Robert Jan Lebbink, from the University Medical Center in Utrecht, The Netherlands, and colleagues reasoned that CRISPR/Cas9 could target and mutate latent herpes virus DNA in infected human cells and so potentially prevent herpes virus-associated diseases. To test this, the researchers devised specific guide (g)RNAs — sequences that are complementary to vital parts of the viral genome and function as “molecular addresses”. These gRNAs, combined with the “molecular scissors” part of the CRISPR/Cas9 system, should induce specific cuts and subsequent mutations in the herpes virus DNA, and so cripple the virus by affecting replication and clearance of latent infection. The researchers looked at three different members of the herpes virus group: herpes simplex virus type 1, which causes cold sores and herpes keratitis; human cytomegalovirus, the most common viral cause of birth defects (when the virus is transmitted from mother to fetus); and Epstein-Barr virus (EBV), the cause of infectious mononucleosis and multiple types of cancer. They showed that introduction of gRNAs that target specific EBV DNA sequences can introduce mutations at the targeted sites. Such mutations can eliminate essential functions of the virus as well as destabilise the viral DNA molecules. Consistent with this, the researchers reported that by using two different gRNAs targeting an essential EBV gene, they could induce loss of over 95% of EBV genomes from the host cells.

Artificial pancreas available by 2018
The artificial pancreas – a device which monitors blood glucose in patients with type 1 diabetes and then automatically adjusts levels of insulin entering the body – is likely to be available by 2018, according to the authors of an article in Diabetologia. Currently available technology allows insulin pumps to deliver insulin to people with diabetes after taking a reading or readings from glucose meters, but these two components are separate. It is the joining together of both parts into a “closed loop” that makes an artificial pancreas, wrote authors Dr Roman Hovorka and Dr Hood Thabit from the University of Cambridge. “In trials to date, users have been positive about how use of an artificial pancreas gives them ‘time off’ or a ‘holiday’ from their diabetes management, since the system is managing their blood sugar effectively without the need for constant monitoring by the user,” they said. Issues such as speed of action of the forms of insulin used, reliability, convenience and accuracy of glucose monitors plus cybersecurity to protect devices from hacking, are among the issues that are being addressed. A number of clinical studies have been completed using the artificial pancreas in its various forms, in various settings such as diabetes camps for children, and real life home testing. Many of these trials have shown glucose control as good as or better than using existing technologies (with success defined by time spent in a target range of ideal blood glucose concentrations and reduced risk of hypoglycaemia). “Significant milestones moving the artificial pancreas from laboratory to free-living unsupervised home settings have been achieved in the past decade,” wrote the authors. “Given the challenges of curative cell based and immunological therapies, closed-loop technologies provide a viable alternative for pancreatic endocrine replacement therapy and have a continuing innovation potential.”

New board chairman for SANE Australia
SANE Australia has appointed Ms Marg O’Donnell, AO, as the Chair of the Board of Management. Most recently, Ms O’Donnell was Chair of the Breast Cancer Network of Australia for 6 years and prior to that a number of senior roles including acting Director for the Human Rights Commission. SANE Australia CEO Jack Heath said Ms O’Donnell’s passion for the helping Australians affected by mental illness combined with her strong government background would be invaluable to the organisation as it looks to release its new 3-year strategy in September. Ms O’Donnell succeeds Stan Wallis, AC, who has retired after 8 years in the role.

Zika vaccines show promising signs in mice
US researchers say that mice given a single shot of one of two experimental Zika vaccines were completely protected when exposed to the virus 1 to 2 months later, a promising sign that similar vaccines under development for humans will protect against Zika. “This is an encouraging first step in Zika vaccine design and pre-clinical testing,” said Professor Adrian Hill, director of Oxford University’s Jenner Institute, which did not conduct the mouse study but is also developing Zika vaccines. Separately, US scientists said they have developed a model of the Zika virus in monkeys, a close proxy for human disease. In the mouse study, published in the journal Nature, a team led by Dr Dan Barouch of Beth Israel Deaconess Medical Center and Harvard Medical School tested two different vaccine candidates in a strain of mice that develops Zika symptoms. Mice given either type of vaccine were 100% protected from Zika after a single shot. Unvaccinated mice that were exposed to the virus all developed symptoms of Zika. The team also showed that antibodies taken from immunised mice could be used to protect other, unvaccinated mice, offering proof that the antibodies produced by the vaccines were specific to Zika. For more on this story visit doctorportal.

Folate in bread reduces birth defects
The rates of spina bifida and other neural birth defects in Australian babies have declined since the mandatory introduction of folate to bread, according to a review conducted by the Australian Institute of Health and Welfare (AIHW). Mandatory fortification of bread with folic acid and iodine was introduced in Australia in 2009 under the Australia New Zealand Food Standards Code. The review found that there had been a statistically significant decline of 14.4% in the overall rate of neural tube defects (NTDs) since implementation – in line with predictions. What wasn’t expected was the even bigger decrease of NTDs among babies born to teenagers and Aboriginal and Torres Strait Islander women. The rate of NTDs among teenagers decreased by almost 55%, and by 74% among Aboriginal women. For more on this story, visit doctorportal.

At-risk women should get pre-emptive surgery
The number of cases of ovarian cancer could be reduced if more at-risk women were offered pre-emptive surgery, according to the UK authors of a study published in the Journal of Medical Genetics. Surgery to remove the ovaries and fallopian tubes is the “best method” for preventing ovarian cancer among women deemed to be at high risk of getting the disease, they wrote. At present, under the National Health Service only those deemed to have a 10% risk or higher are eligible for an operation. The study examined the cost effectiveness of the current 10% threshold and looked to see whether lowering it would save additional money. If women aged over 40 who have a 4% chance of getting ovarian cancer in their lifetime were offered the surgery, money would be saved and there would be a decrease in the number of women diagnosed with the disease, the authors argued. It would also help compensate for the current lack of a reliable test to screen for the disease. For more on this story, visit doctorportal.

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