Publisher Health

Sprinting “like a jet plane taking off” will help produce Premier League star strikers of tomorrow, new research has revealed.
A University of Essex study of Tottenham Hotspur’s academy has shown that just a few words can instantly boost sprinting speed by 3 per cent over 20 metres.
It would normally take weeks of targeted training to achieve such a large increase.
These short bursts of acceleration are largely seen in goal-scoring situations and could be the difference in beating a defender and finding the net.
Dr Jason Moran, from the School of Sport, Rehabilitation and Exercise Sciences, discovered simple analogies increased performance in this key area.
The study showed elite young players ran faster when focusing on their environment rather than their body.
Dr Moran said: “The words we speak to athletes have a demonstrable and instant effect on their performance.

“It’s long been known that it’s better to direct an athlete’s attention to the environment around them rather than focusing on their body positions which seems to interfere with the fluidity of movement.
“This could be enhanced even further by using certain analogies, for example, asking a player to ‘accelerate like a Ferrari’ may create a more evocative image in their mind instead of simply telling them to run fast.”
The research used 20 members of the North London side’s academy, all between 14-15-years-old.
Before taking part in sprint drills the promising players were given different directions before running.
External analogies telling them to “push the ground away’ achieved better results than “driving their legs into the ground.”
And top performances were encouraged by players being urged to “sprint as if you are a jet taking off into the sky ahead.”
In coaching, analogies can make it easier for someone to learn how to move their body in the right way by hiding complicated instructions within in simple spoken words.

For example, by using analogies, a coach can tell an athlete how fast and in what position their body needs to be, without using hard-to-understand technical terms.
It is thought that this could be particularly advantageous in young learners who may show relatively lower levels of focus.
Away from elite sport it is thought these cues and coaching tactics could be used in PE lessons and at the grassroots.
Dr Moran added: “Although these findings focus on the highest level of youth football, it could easily be used in schools or on a Saturday morning.
“By using a simple analogy teachers and parents might be able to get the most out of their kids whatever the sport.”

Researchers have developed a new catheter-based device that combines two powerful optical techniques to image the dangerous plaques that can build up inside the arteries that supply blood to the heart. By providing new details about plaque, the device could help clinicians and researchers improve treatments for preventing heart attacks and strokes.
Atherosclerosis occurs when fats, cholesterol and other substances accumulate on the artery walls, which can cause these vessels to become thick and stiff. A heart attack or stroke may occur if an atherosclerotic plaque inside the blood vessels ruptures or parts of it break off.
“Atherosclerosis, leading to heart attacks and strokes, is the number one cause of death in Western societies — exceeding all combined cancer types — and, therefore, a major public health issue,” said research team member leader Laura Marcu from University of California, Davis. “Better clinical management made possible by advanced intravascular imaging tools will benefit patients by providing more accurate information to help cardiologists tailor treatment or by supporting the development of new therapies.”
In the Optica Publishing Group journal Biomedical Optics Express, researchers describe their new flexible device, which combines fluorescence lifetime imaging (FLIM) and polarization-sensitive optical coherence tomography (PSOCT) to capture rich information about the composition, morphology and microstructure of atherosclerotic plaques. The work was a collaborative project with Brett Bouma and Martin Villiger, experts in OCT from the Wellman Center for Photomedicine at Massachusetts General Hospital.
“With further testing and development, our device could be used for longitudinal studies where intravascular imaging is obtained from the same patients at different timepoints, providing a picture of plaque evolution or response to therapeutic interventions,” said Julien Bec, first author of the paper. “This will be very valuable to better understand disease evolution, evaluate the efficacy of new drugs and treatments and guide stenting procedures used to restore normal blood flow.”
Gaining an unprecedented view
Most of what scientists know about how atherosclerosis forms and develops over time comes from histopathology studies of postmortem coronary specimens. Although the development of imaging systems such as intravascular ultrasound and intravascular OCT has made it possible to study plaques in living patients, there is still a need for improved methods and tools to investigate and characterize atherosclerosis.

To address this need, the researchers embarked on a multi-year research project to develop and validate multispectral FLIM as an intravascular imaging modality. FLIM can provide insights into features such as the composition of the extracellular matrix (the protein scaffolding between cells), the presence of inflammation and the degree of calcification inside an artery. In earlier work, they combined FLIM with intravascular ultrasound, and in this new work they combined it with PSOCT. PSOCT provides high-resolution morphological information along with birefringence and depolarization measurements. When used together, FLIM and PSOCT provide an unprecedented amount of information on plaque morphology, microstructure and biochemical composition.
“Birefringence provides information about the plaque collagen, a key structural protein that helps with lesion stabilization, and depolarization is related to lipid content that contributes to plaque destabilization,” said Bec. “Holistically, this hybrid approach can provide the most detailed picture of plaque characteristics of all intravascular imaging modalities reported to date.”
Getting two imaging modalities into one device
The development of multimodal intravascular imaging systems compatible with coronary catheterization is technologically challenging. It requires very thin — less than 1 mm — flexible catheters that can operate in vessels with sharp twists and turns. A high imaging speed of around 100 frames/second is also necessary to limit cardiac motion artifacts and ensure proper imaging inside an artery.
To integrate FLIM and PSOCT into a single device without compromising the performance of either imaging modality, the researchers used optical components previously developed by Marcu’s lab and other research groups. Key to achieving high PSOCT performance was a newly designed rotary collimator with high light throughput and a high return loss — the ratio of power reflected back toward the light source compared to the power incident on the device. The catheter system they developed has similar dimensions and flexibility as the intravascular imaging devices that are currently in clinical use.
After testing the new system with artificial tissue to demonstrate basic functionality on well characterized samples, the researchers also showed that it could be used to measure properties of a healthy coronary artery removed from a pig. Finally, in vivo testing in swine hearts demonstrated that the hybrid catheter system’s performance was sufficient to support work toward clinical validation. These tests all showed that the FLIM-PSOCT catheter system could simultaneously acquire co-registered FLIM data over four distinct spectral bands and PSOCT backscattered intensity, birefringence and depolarization information.
Next, the researchers plan to use the intravascular imaging system to image plaques in ex vivo human coronary arteries. By comparing the optical signals acquired using the system with plaque characteristics identified by expert pathologists, they can better understand which features can be identified by FLIM-PSOCT and use this to develop prediction models. They also plan to move forward with testing in support of clinical validation of the system in patients.

Each year, approximately 2,000 people die annually of gallbladder cancer (GBC) in the U.S., with only one in five cases diagnosed at an early stage. With GBC rated as the first biliary tract cancer and the 17th most deadly cancer worldwide, pressing attention for proper management of disease must be addressed. For patients diagnosed, surgery is the most promising curative treatment. While there has been increasing adoption of minimally invasive surgical techniques in gastrointestinal malignancies, including utilization of laparoscopic and robotic surgery, there are reservations in utilizing minimally invasive surgery for gallbladder cancer.
A new study by researchers at Boston University Chobanian & Avedisian School of Medicine has found that robotic-assisted surgery for GBC is as effective as traditional open and laparoscopic methods, with added benefits in precision and quicker post-operative recovery.
“Our study demonstrates the viability of robotic surgery for gallbladder cancer treatment, a field where minimally invasive approaches have been cautiously adopted due to concerns over oncologic efficacy and technical challenges,” say’s corresponding author Eduardo Vega, MD, assistant professor of surgery at the school.
The researchers conducted a systematic review of the literature focusing on comparing patient outcomes following robotic, open and laparoscopic surgeries. This involved analyzing studies that reported on oncological results and perioperative benefits, such as operation time, blood loss and recovery period.
According to the researchers, there has been reluctance to utilize robotic surgery for GBC due to fears of dissemination of the tumor via tumor manipulation, bile spillage and technical challenges, including liver resection and adequate removal of lymph nodes. “Since its early use, robotic surgery has advanced in ways that provide surgeons technical advantages over laparoscopic surgery, improving dexterity and visualization of the surgical field. Additionally, robotic assistance has eased the process of detailed dissection around blood vessels as well as knot tying and suturing, and provides high-definition, three-dimensional vision, allowing the surgeon to perform under improved ergonomics,” said Vega.
The researchers believe these findings are significant since they suggest robotic surgery is a safer and potentially less painful option for gallbladder cancer treatment, with a faster recovery time. Clinically, it could lead to the adoption of robotic surgery as a standard care option for gallbladder cancer, improving patient outcomes and potentially reducing healthcare costs due to shorter hospital stays,” he added.
These findings appear online in the American Journal of Surgery.

Published13 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, PA MediaBy Michelle RobertsDigital health editorA 62-year-old man from Germany has, against medical advice, been vaccinated 217 times against Covid, doctors report. The bizarre case is documented in The Lancet Infectious Diseases journal. The shots were bought and given privately within the space of 29 months.The man appears to have suffered no ill effects, researchers from the University of Erlangen-Nuremberg say.’Very interested'”We learned about his case via newspaper articles,” Dr Kilian Schober, from the university’s microbiology department, said.”We then contacted him and invited him to undergo various tests in Erlangen. He was very interested in doing so.” The man provided fresh blood and saliva samples.The researchers also tested some frozen blood samples of his that had been stored in recent years. About Covid vaccination – NHSDr Schober said: “We were able to take blood samples ourselves when the man received a further vaccination during the study at his own insistence.”We were able to use these samples to determine exactly how the immune system reacts to the vaccination.” Evidence for 130 of the jabs was collected by the public prosecutor of the city of Magdeburg, who opened an investigation with the allegation of fraud, but no criminal charges were brought. Covid vaccines cannot cause infection but can teach the body how to fight the disease. Immune systemMessenger ribonucleic acid (mRNA) vaccines work by showing the body’s cells a bit of genetic code from the virus. The immune system should then recognise and know how to fight Covid should they encounter it for real. Dr Schober worried hyper-stimulating the immune system with repeated doses might have fatigued certain cells.But the researchers found no evidence of this in the 62-year-old. And there was no sign that he had ever been infected with Covid.’Favoured approach’The researchers said: “Importantly, we do not endorse hyper-vaccination as a strategy to enhance adaptive immunity.”And the results of their tests on the 62-year-old were insufficient for making far-reaching conclusions, let alone recommendations for the general public. “Current research indicates that a three-dose vaccination, coupled with regular top-up vaccines for vulnerable groups, remains the favoured approach,” they say on the university’s website. “There is no indication that more vaccines are required.”The NHS says Covid vaccines are normally given seasonally but some people with a severely weakened immune system may need additional protection at other times – and it will contact those whose NHS record suggests may be eligible. Covid vaccines can have side effects. A common one is a sore arm from the injection. More on this storyFormer actress fears end of Covid booster jabsPublished31 JanuaryCovid jab skipped by 44%, entire UK study findsPublished16 JanuaryRelated Internet LinksThe Lancet Infectious DiseasesThe BBC is not responsible for the content of external sites.

Coronary artery calcium scoring with CT can identify symptomatic patients with a very low risk of heart attacks or strokes, according to a new study published today in Radiology, a journal of the Radiological Society of North America (RSNA). Researchers said the findings may one day help some patients with stable chest pain avoid invasive coronary angiography.
Coronary artery calcium scoring with CT was developed to noninvasively measure the amount of calcium in the arteries of the heart. Higher scores are linked with atherosclerosis, a buildup of plaque in the arteries. A score of 1 to 399, for instance, suggests a moderate amount of plaque, while 400 or higher indicates a large plaque burden.
“Coronary artery calcium is a strong and independent predictor of cardiovascular events,” said study first author Federico Biavati, an M.D./Ph.D. candidate in the BIOQIC research training group and a radiology resident at Charité — Universitätsmedizin Berlin, Germany. “The presence of coronary artery calcification indicates that atherosclerosis may have been present for some time.”
The complete absence of coronary calcifications, on the other hand, is a good indicator of the absence of advanced atherosclerosis. However, the role of coronary artery calcium in patients with stable chest pain is less clear. Stable chest pain is a temporary but recurring condition triggered by stress, exercise or cold weather.
Under the direction of Marc Dewey, M.D., professor and vice chair of radiology at Charité, Biavati and colleagues assessed the prognostic value of coronary artery calcium scoring for major adverse cardiovascular events in 1,749 individuals, mean age 60. The participants were drawn from the DISCHARGE trial, a research project involving 26 centers in 16 European countries. Participants had stable chest pain and had been referred for invasive coronary angiography, a procedure in which a catheter is threaded to the heart under X-ray guidance. A contrast agent is then injected through the catheter to help doctors visualize the arteries of the heart.
The researchers stratified the patients into low-, intermediate- and high-risk categories based on their coronary artery calcium scores. They followed the participants for an average of 3.5 years and recorded any major adverse cardiovascular events.
People with a coronary artery calcium score of zero showed very low risk of major adverse cardiovascular events at follow-up. Only four of the 755 participants in the group, or 0.5%, had a major adverse cardiovascular event during the follow-up period. The group also had a low risk of only 4.1% for obstructive coronary artery disease.

“This finding may indicate that a zero coronary artery calcium score can play a larger role in patient management strategies,” Dr. Dewey said. “The findings suggest that patients with stable chest pain and a coronary artery calcium score of zero may not require invasive coronary angiography using cardiac catheterization because the risk of cardiovascular events is so low.”
There were 14 events in the 743 participants with a 1 to 399 coronary artery calcium score, for a risk of 1.9%. The 251 participants in the 400 and higher coronary artery calcium score group had 17 events for a significantly higher risk of 6.8%. The researchers found no evidence of a difference between sexes for major adverse cardiovascular events.
Despite the findings, the researchers said that further study is needed before coronary artery calcium scoring can be used to exclude patients from coronary CT angiography.
This is the second article published in Radiology from the DISCHARGE trial, the largest cardiac trial on chest pain. The first article, Effect of Body Mass Index on Effectiveness of CT versus Invasive Coronary Angiography in Stable Chest Pain: The DISCHARGE Trial, found that when patients suspected of having coronary artery disease were stratified by body mass index category, no differences in clinical outcomes were observed between those who underwent initial management with CT and those who underwent invasive coronary angiography.

Published14 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, PA MediaBy Nick TriggleHealth correspondentUnions representing senior doctors in England have given their backing to a improved pay offer in England.But it will now be put to consultant members of the British Medical Association and smaller Hospital Consultants and Specialists Association to see if they are willing to accept.The deal put forward includes an extra £3,000 for those a few years into their consultant careers.Consultants have staged four strikes in their pay dispute so far.The BMA said the new deal includes an extra 2.85% – worth £3,000 – for those between four and seven years into their consultant careers, on top of the 6% all consultants got in April.The previous offer meant those at this stage got no additional uplift, while other consultants were getting up to an extra 12.8%.BMA consultants committee chair Dr Vishal Sharma said it was a “hard fought-for offer”.He said alongside the extra money, the government has agreed to reform the body which makes recommendations about doctor pay.”Ultimately, each consultant will have their own decision to make, but the BMA’s consultants committee believes the offer marks significant progress in reaching our aims of reforming the pay review process and preventing further pay cuts,” Dr Sharma said.

Ibogaine, a formidable hallucinogen made from the root of a shrub native to Central Africa, is not for the timid. It unleashes a harrowing psychedelic trip that can last more than 24 hours, and the drug can cause sudden cardiac arrest and death.But scientists who have studied ibogaine have reported startling findings. According to a number of small studies, between a third and two-thirds of the people who were addicted to opioids or crack cocaine and were treated with the compound in a therapeutic setting were effectively cured of their habits, many after just a single session.Ibogaine appears to provide two seemingly distinct benefits. It quells the agony of opioid withdrawal and cravings and then gives patients a born-again-style zeal for sobriety.Now, after decades in the shadows, and with opioid overdose deaths exceeding 100,000 a year, ibogaine is drawing a surge of fresh interest from researchers who believe it has the potential to treat opioid use disorder.“It’s not an exaggeration to say that ibogaine saved my life, allowed me to make amends with the people I hurt and helped me learn to love myself again,” said Jessica Blackburn, 37, who is recovering from heroin addiction and has been sober for eight years. “My biggest frustration is that more people don’t have access to it.”That’s because ibogaine is illegal in the United States. Patients have to go abroad for ibogaine therapy, often at unregulated clinics that provide little medical oversight.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Some researchers hope the drug, still illegal in the United States, may be considered as a treatment for addiction, PTSD and brain injuries.What is ibogaine?A naturally occurring psychoactive compound, ibogaine comes from the iboga tree, a rainforest shrub native to Central Africa. The drug comes from the bark of the root, which is crushed and consumed as a powder or given in an extracted form.Iboga has long been used for medicinal and ritual purposes in Gabon, Cameroon and the Republic of Congo. After its discovery by French and Belgian explorers in the 19th century, it was sold as a stimulant in France. In recent decades, ibogaine has shown promise for treating opioid addiction, with several small studies suggesting that a third to two-thirds of patients who undergo treatment achieve sobriety after a single session. Some researchers have been studying ibogaine’s potential to treat traumatic brain injuries and PTSD.How does ibogaine work?Ibogaine quells the agonizing symptoms of opioid withdrawal and also appears to reduce the desire to use drugs, at least initially. Scientists are still trying to understand how it works against addiction, but many believe ibogaine fosters the creation of new neurons and neuroplasticity, a rewiring of the brain that gives patients fresh perspectives on self-destructive behavior and the unresolved trauma that sustains it.“Ibogaine seems to be resetting the brain pharmacologically, and at the same time, it’s producing deep psychological insight into the underlying drivers of addiction,” said Dr. Joseph Peter Barsuglia, a clinical and research psychologist who advises ibogaine clinics in Mexico.Is it legal?No. In the United States, ibogaine is classified as a Schedule I controlled substance like heroin and other drugs that are deemed as having “no currently accepted medical use and a high potential for abuse,” according to the Drug Enforcement Administration. Americans who want access to ibogaine therapy must travel to countries where it is either legal or unregulated, among them Mexico, Brazil, New Zealand, Canada and South Africa.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Published1 hour agoShareclose panelShare pageCopy linkAbout sharingBy Nigel Slater & Dan MartinBBC News, East MidlandsA hospital trust has told an inquest its “failure” to offer antibiotics to a mother during labour is “likely to have contributed” to the death of her baby.Zachary Taylor-Smith developed breathing problems and died at Royal Derby Hospital in November 2022 just 14 hours after he was born.His parents Hannah and Tim Taylor-Smith said they had serious concerns about the care he received.A three-day inquest into Zachary’s death began on Monday.The hearing was read a statement from University Hospitals Derby and Burton NHS Foundation Trust, which said a failure to offer antibiotics to Mrs Taylor-Smith during her labour “is likely to have contributed” to the baby’s death.The trust also admitted a “failure to escalate care” after Zachary’s birth, which could have “prevented death”, the Local Democracy Reporting Service (LDRS) said.Zachary was born at 36 weeks after his mother was induced because of recurrent asthma attacks, the inquest heard.He was initially in a healthy condition but soon became unwell, suffering a low temperature and poor feeding, the LDRS said.The couple, from Lichfield, Staffordshire, previously said they were not listened to when they alerted hospital staff to Zachary’s deterioration.They claim doctors told them their son had died from Group B Strep, otherwise known as GBS, but they were not made aware of the life-threatening condition until after his death.They say if had been made aware of the disease, and if Mrs Taylor-Smith was given antibiotics, their son’s death could have been avoided. ‘Real-life horror movie’Mr and Mrs Taylor-Smith told the hearing, at Derby and Derbyshire Coroner’s Court, of the impact Zachary’s death had had on them.”My world is full of darkness now. None of this will never make sense,” Mrs Taylor-Smith.Image source, Submitted”Taking my baby to the mortuary will be something I never forget. I had to walk past happy families taking their newborn babies into their cars. On the school run I now have to pick up my children from the school office because happy families in the playground is too much to bear.”I had never been told about Group B Strep before. If I had been told I would have gone to have been privately screened for it.”Mrs Taylor-Smith told the BBC she still finds herself unable to visit Zach’s graveside in Lichfield as it is too upsetting.She added: “I can’t fathom he is below ground and I can’t get to him. It is too painful to go to the graveside.”Mr Taylor-Smith said losing his son, the couple’s fifth child, had been like “living in a real-life horror movie”.In November the trust’s maternity services were rated inadequate by the Care Quality Commission.The Taylor-Smiths have called for Donna Ockenden, who is leading the biggest ever investigation into NHS maternity failings, to expand her review to Derby and Burton-upon-Trent.The inquest continues.Follow BBC East Midlands on Facebook, on X, or on Instagram. Send your story ideas to eastmidsnews@bbc.co.uk or via WhatsApp on 0808 100 2210.More on this storyBereaved parents call for Derby maternity inquiryPublished4 December 2023NHS trust’s maternity services rated inadequatePublished29 November 2023Around the BBCLocal Democracy Reporting ServiceRelated Internet LinksUniversity Hospitals of Derby and Burton NHSDerby Coroners’ ServiceThe BBC is not responsible for the content of external sites.

Published33 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Family handoutBy Gem O’ReillyBBC NewsMedical leaders support a planned increase in the number of physician associates (PA) in the NHS.But the British Medical Association (BMA) is concerned about a new law allowing the General Medical Council (GMC) to regulate PAs, who must be supervised by a fully qualified doctor.The doctors’ union says it blurs the lines between doctors and PAs and could risk patient safety.Two families whose relatives were seen by PAs want the roles defined.The NHS has 3,286 PAs, who assist healthcare teams and are not authorised to prescribe or request scans. PAs and anaesthetic associates (AA) qualify after a funded two-year master’s degree. They often have a science undergraduate degree, but that is not a prerequisite.Their role includes taking medical histories, conducting physical examinations and developing treatment plans.Like PAs, AAs are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor.The Academy of Medical Royal Colleges said on Tuesday that it welcomes a push to increase the number of PAs in the NHS, but that it is “vital” that there are clear guidelines on how they are deployed.’Breathless, light-headed and difficulty walking’Emily Chesterton, from Salford, died aged 30 after a blood clot was missed in two appointments with a PA she believed was a GP.She had called her GP practice complaining of pain in her calf, which had become hard. Then she saw a PA in person, who recommended paracetamol.But she got worse, Emily’s mother Marion Chesterton told the BBC: “She was breathless, light-headed and she had difficulty walking.”In the second appointment, the PA diagnosed her with a calf sprain, long-Covid and anxiety.”But the PA did not examine Emily’s calves, and did not make it clear that she was not a doctor, Marion said.Emily had a blood clot in her left leg which led to her dying of a pulmonary embolism, which is when a blood clot gets stuck in an artery in the lung.The coroner’s conclusion was that Emily “should have been immediately referred to a hospital emergency unit”. If she had been seen, it is likely that she would have survived.Emily’s GP surgery, The Vale Practice in London, told the BBC that it is “deeply saddened” by her death and now only provides appointments with GPs, nurses and pharmacists after a “thorough” review.It added that staff have been told to ensure that “a patient understands their role at the start of each appointment”.Ben Peters’ case was not one of misdiagnosis and all correct procedures were followed, but it did highlight that a patient under the care of a PA could be discharged without being seen in person by a doctor.Ben, from Cheadle, went to the emergency department at Manchester Royal Infirmary on 11 November 2022, with chest pain and shortness of breath, and also was severely vomiting.The 25-year-old was looked at by a PA, who ordered an ECG and all other appropriate tests, according to the Manchester Foundation Trust (MFT)’s letter to the coroner.They also said that the PA was being supervised by an experienced consultant physician in acute medicine.The PA took an X-ray of Ben’s chest, which appeared normal, and he was discharged with a panic attack and gastric inflammation diagnosis after a discussion between the PA and the duty consultant, who also prescribed medication. The consultant did not see Ben in person.Ben’s father Steve found him dead the following morning in their home. The inquest found that Ben suffered from a very rare condition called an acute aortic dissection, a tear of the body’s main artery. Image source, Family handoutReview into deathBen’s family have now all been screened for the same condition from which he died. Steve was found to have a faulty aortic valve and enlarged aorta, which resulted in surgery in 2023.”Ben’s chest pains were put down as anxiety so he was sent home with tablets to calm him down,” Ben’s mother Anna Peters told the BBC.MFT told the coroner on the case that an acute aortic dissection is an “extremely rare condition” and none of the investigations performed on Ben revealed it.The trust also said that Ben’s case was reviewed by several emergency medicine, acute medicine and cardiology consultants, who agreed on the approach that was taken.There had been no misdiagnosis, it told the BBC, and had Ben been seen in person by a doctor, this would sadly have not made any difference to the outcome.The coroner’s report of Ben’s death said it was a “matter of concern” that despite his reported symptoms, age and “extensive” family history of cardiac problems, he was discharged without being examined in person by a doctor.But the report acknowledged that all appropriate procedures were followed and investigated, and that neither the hospital or the PA were responsible for Ben’s death.Image source, Family handout’PAs hard to tell apart from doctors’In response to a BBC Freedom of Information request, NHS England said that as of 30 September 2023 there were 3,286 PAs in primary and secondary care in England and 76 AAs in secondary care.The government says it wants to increase the number of PAs to 10,000 by 2036 to 2037 and the number of AAs to 2,000 over the same period. An NHS England spokesperson told the BBC that PAs “play an important role in supporting the NHS”.Adam Skeen started working as a PA in 2021 before going to medical school. He is a BMA representative, but not speaking on behalf of them.He said his day-to-day tasks were “difficult for the untrained eye to distinguish from that of the team of doctors” with whom he worked.”Physician associates are not doctors and have not completed a medical degree. Patients deserve to be treated by those with more experience and training.”For patients, because these tasks look like those of a doctor, it may have been difficult for them to appreciate that I was not a doctor. This is worrying.”Now as a medical student, Adam said his training is distinctly different.Some doctors argue that, when used correctly, PAs can be largely beneficial to healthcare settings. Prof David Strain, a consultant based in Exeter who chairs the BMA’s board of science, said that PAs’ basic training puts them in a good position to do rudimentary clinical examinations, which eases the load on wards. However, Prof Strain said that he is “incredibly worried about missed diagnoses” because of a lack of training.The Faculty of Physician Associates makes it clear that PAs “are not doctors” and “do not replace medical roles”.What will regulation mean?On 26 February, the regulation, called the Anaesthesia Associates and Physician Associates Order 2024, was debated in the House of Lords.Both houses of Parliament have approved the new law, meaning regulation can be made into law.Once it begins, PAs and AAs will go on the register of the GMC, which will oversee their work.The GMC says this will mean that it can set conditions for PA and AA course providers to meet to ensure adequate training.Regulation will also mean they will have to go through a revalidation, which the GMC uses to make sure those on the register remain fit to practise. The GMC and Royal College of Physicians (RCP) make it clear that there needs to be additional education, a defined scope of practice and guidance for PAs and AAs, which they hope regulation will bring.Currently there is a curriculum for them, but no overseeing regulator.Donya Mighty has been working as a PA since 2018, while studying to become a doctor herself. She says the key benefit of the role is continuity of care for patients.Donya is in favour of the regulation but says her colleagues would “welcome further clarity on their scope for progression.” Adam and Prof Strain echo this sentiment and say they support regulation, but not by the GMC, as it “blurs the lines between doctors and PAs”.An anaesthetics trainee in the Midlands told the BBC he was concerned that an AA in his area was added to the registrars’ list.”If you haven’t been to medical school and studied the anatomy, how can you be giving informed advice?” the trainee added, calling the move “dangerous”.Image source, Family handout’Patients deserve to know who they’re seeing’Ben’s family is now trying to raise awareness of aortic dissections and underlying conditions by working with Cardiac Risk in the Young.The family told the BBC they want the distinction between doctors and PAs to be clearer for patients.Emily’s family is also trying to raise awareness and believe “all patients should have the right to know who is treating them and have the choice to see a fully-qualified doctor”.Marion, Emily’s mum, said: “If I had my time over, I would have taken her straight to A&E. That is the biggest regret of my life. “My advice to anyone is always ask who you are seeing.” More on this storyCall for physician associate clarity after deathPublished15 July 2023Unqualified medics given senior hospital rolesPublished21 November 2023Government wants to regulate NHS associate rolesPublished11 December 2023