Monday, 26 November 2018

BCCT Award Winners 2018 - Kensington International School

I'm proud to feature Kensington International School where my wife has been Head Teacher for over three years...

Saturday, 24 November 2018

Online tool can help men make prostate cancer treatment choices

A web-based tool can let a man with prostate cancer see how thousands of other men in his situation have chosen to be treated, which may help him better understand his own options, a US study suggests.
Early-stage prostate cancer may not need treatment right away, or ever, because these tumors often don't grow fast enough to cause symptoms. Because treatment can have side effects like impotence and incontinence, doctors sometimes advise men to put off surgery or radiation and instead get regular screenings to reassess whether the cancer warrants intervention.
"There is often no one correct treatment option because the choice of prostate cancer treatment depends on personal preferences around treatment benefits and risks," said senior author Dr Karandeep Singh of the University of Michigan in Ann Arbor.
"There are already a number of great resources available to the prostate cancer patient community to support this shared decision-making process," Singh said by email. "However, there are no tools that help patients discover what treatments similar men chose when faced with a similar decision."
Singh and colleagues set out to develop a tool that fit the bill. They used data on treatment choices made by 5,016 men diagnosed with prostate cancer to develop a web-based tool that predicts the most likely treatment choice based on what other men in similar circumstances have chosen.
Then, they asked another 2,527 men with prostate cancer to try out the tool and see how often the program predicted the treatment choice these men would pick for themselves. The tool, it turned out, was highly accurate.
"This tool is not meant to replace the shared decision-making process but rather to augment that process by helping patients focus their preparation on likely treatment options prior to meeting with their urologist," Singh said.
Patients and doctors can use the tool here:
It's only meant for men with early-stage tumors that haven't spread to other parts of the body. It won't predict treatment decisions for men with more complex cases.
For men who do have early-stage tumors, the tool focuses on aspects of the prostate cancer diagnosis, patients' age and weight, and any history of heart attack or diagnosis of diabetes.
When men are only 45 years old with lower-risk tumors, they will probably see that similar patients are pretty evenly divided between opting for radical prostatectomy surgery and choosing active surveillance, that is, skipping treatment in favor of periodic reassessments to see if cancer warrants intervention.
By age 55, men with low-risk tumors might see that more than half of similar patients choose active surveillance and less than 40 percent opt for a radical prostatectomy. And by 65, men with low-risk tumors might see that about two-thirds of similar patients pick active surveillance.
One limitation of the study is that it wasn't designed to prove whether or how the web-based tool might help men make treatment decisions or see how happy patients are afterward with the choices they made, the study authors note.
Even when men seem similar on paper in terms of their demographics and the particulars of their tumor, how well the web-based tool predicts what's best for them might vary from one man to the next, said Dr. Kari Tikkinen of the University of Helsinki and Helsinki University Hospital in Finland.
"Sure, this data can be reassuring to those whose own values and preferences concur with the option machine learning is suggesting as the most common choice," Tikkinen, who wasn't involved in the study, said by email.
"However, even in this kind of excellent situation it may not help patients," Tikkinen said.
A man who is very opposed to surgery because of the risk of incontinence or impotence, for example, may not want to choose surgery just because that's what the tool says most similar men would do, Tikkinen said.
But tools like the one tested in the study can still help men have more focused and nuanced conversations with their doctors about what treatment may be ideal for them, Tikkinen said.

SOURCE: European Urology, online October 11, 2018.


Saturday, 10 November 2018

Harry Patch - An amazing man

Pte HJ Patch, number 29295, C Company, 7th Battalion, Duke of Cornwall’s Light Infantry, took his place within the fighting force at the bottom of a long and complex chain of command that ended, by way of a regiment, company and platoon, in a section of some 14 men. 
Patch, who was called up in October 1916 at the age of 18, served as a private and became part of a Lewis machine-gun team when he arrived in France the following year. At this time, companies tended to be allotted four Lewis guns each. Gun crews were special, excused the everyday duties to which most rankers were subjected, and were expected instead to spend their time keeping their weapons in good working order. They operated as an individual unit under the command of the “No 1”, in Patch’s case a man called Bob Haynes. Patch always knew, and later could only remember, the three other members of the team by their nicknames. No 3 was known as Maudy (“There was an actress of that name. He had a good sense of humour,” Patch recalled), while Nos 4 and 5 were known as Jack and Jill. 
The bonds between Lewis gun team members were particularly strong. “We were just that little body alone and we shared everything,” Patch recalled. “You could talk to them about everything and anything. I mean, those boys were with you night and day, you shared everything with them and you talked about everything.” Such camaraderie helped men endure the harsh conditions at the front. 
The son of a master stonemason, Henry John Patch was born in the village of Combe Down, near Bath, on June 17 1898, and his family’s roots were buried deep in the Somerset soil. His father, whose family came from a village near Glastonbury on the other side of the county, had been born at Claverton, a mile or so from Combe Down, while his mother was from the neighbouring village of Monkton Combe. The Patches had thoroughly colonised this small corner of England, and by the outbreak of the war there were 14 different Patch families in Combe Down. Harry was 16 and an apprentice plumber when war broke out in 1914, and was anything but enthusiastic. 
“While a lot of the local lads went and joined up in the local regiment, the Somerset Light Infantry,” he recalled, “I never gave it a second thought. I never felt the need to get myself into khaki and go out there fighting before it was 'all over by Christmas’. I’m not saying I knew any different, but at my age I was keen to continue my apprenticeship.” 
By 1916, however, Britain could no longer rely on volunteers to fill the ranks. Conscription was introduced at the start of the year and Patch was drafted into the Duke of Cornwall’s Light Infantry (DCLI) in October. 
The following July, he and the other four members of his close-knit Lewis-gun team were pitched into the Third Battle of Ypres, otherwise known as Passchendaele, the last major battle of attrition fought on the Western Front. The offensive began on July 31 1917 in heavy rain – the heaviest for 30 summers – and they soon got bogged down in the Flanders mud. When it ended on November 6, with the capture of the ruined village of Passchendaele, Britain and her Empire had suffered some 310,000 casualties. 
During the four months, from June to September, that he spent in the trenches, Patch never had a bath or a change of clothes. Body-lice were a constant irritant, as were the rats, grown fat on the plentiful corpses, which gnawed their way through equipment, devoured rations, and ran across the faces of sleeping soldiers. “It doesn’t matter how much training you’ve had,” Patch recalled, “you can’t prepare for the reality, the noise, the filth, the uncertainty and the calls for stretcher-bearers. Anyone who tells you that in the trenches they weren’t scared, he’s a damned liar. You were scared all the time.” 
Patch first went into battle on August 16 in an action subsequently named the Battle of Langemarck, after the village that was its chief objective. “I’m told we attacked on August 16,” he remarked, “but the date doesn’t mean much to me. I know it was about six weeks before I was wounded, so I suppose the middle of August is about right. I remember the names – Pilckem Ridge was one and the other was Langemarck – but it is such a long time ago that I can’t quite connect them up in my head.” 
Patch may have forgotten the exact dates and places, but he knew what a battlefield was like. It was during his unsteady progress through a hellish landscape, ruptured by countless artillery shells, that he came across a young soldier from A Company of the 7th DCLI, which had led the attack. Of all the terrible sights he encountered, it was this that would remain with him throughout his extraordinarily long life. The soldier, Patch recalled, “was ripped open from his shoulder to his waist by shrapnel, and lying in a pool of blood”. Seeing men from his own battalion, he begged to be put out of his misery. In Patch’s terse but eloquent phrase, “he was beyond all human help”, and died before anyone could draw a revolver and comply with his desperate request. “It is an image that has haunted me all my life,” Patch said some 90 years later, “seared into my mind”. 
The battle was not over, however. At one point during the advance a German emerged from a trench, bayonet fixed, and ran towards Patch. The 19-year-old drew his service revolver and shot the German in the shoulder. Still he came on. 
The gun team had made an unusually humane and highly irregular pact that they would not shoot to kill unless absolutely necessary, and Patch remembered this code as he again took aim. “I couldn’t kill him. He was a man I never knew, I couldn’t talk to him. I shot him above the ankle, above the knee. He went down. He said something to me in German – God knows what it was – but for him the war was over.” 
When C Company reached the German trenches at around midday, they found them empty. By the harsh standards of Passchendaele, the attack had gone reasonably well. Patch and his comrades had emerged unscathed, but their luck would last only another month. On the night of September 22, the Lewis-gun team were making their way back into the reserve trenches, walking across open ground because there were no communication trenches in this area of the front line. They were waiting in a huddle while No 1 was “attending to the call of nature”, when a shell exploded above them in a flash of light. Patch was thrown to the ground, and lay there conscious but “incapable of anything” for a couple of minutes before realising that he had been hit in the groin by shrapnel. He applied the field dressing that all soldiers carried with them and waited for the stretcher-bearers. 
Taken to a casualty clearing station, he had his wound cleaned and dressed by a doctor, but the shell fragment that had caused it remained in place. The anaesthetising effects of shock were wearing off, and he began to feel acute pain. Since his injury was less serious than many of those at the clearing station, he was obliged to wait until the following evening before being seen by another doctor. 
He was told that the shrapnel could be removed but warned that no anaesthetic was available. Patch decided it was worth enduring two minutes of further pain, so four men held him down while the shell splinter was cut out of him and the wound stitched. Patch declined to accept the two-inch-long metal fragment as a souvenir, and was relieved to learn that his wound had been classed as “a Blighty one”, meaning he would be invalided back to Britain. 
He was taken initially to hospital in Liverpool, where he received a letter from Bob Haynes informing him that the three other members of the Lewis team had been killed by the shell that had wounded him. “There was nothing left, nothing left to bury. My reaction was terrible; it was like losing part of my life.” Patch’s physical wounds would heal, but the death of these men was something from which he never really recovered. 
Following his discharge from hospital he was sent to a convalescent camp at Sutton Coldfield, near Birmingham. There, he met his future wife, Ada Billington. 
It was not until August 1918 that he was deemed fit enough to resume training, at Tidworth camp in Wiltshire. He dreaded being sent back to the front, but an additional chest injury, suffered when he was shelled, had not healed and prevented him from carrying heavy equipment, so he was ordered back to hospital. This delay, lasting several weeks, may well have saved his life. When the guns fell silent on 11 November 1918, Patch was still in training on the Isle of Wight. 
“The war might have been over,” he recalled, “but its effects were never far away.” 
Like most of those who had survived the war, Harry Patch simply returned to his former life as a civilian and settled down to married life. But he returned to Combe Down “thoroughly disillusioned”: “I could never understand why my country could call me from my peacetime job and train me to go to France and try to kill a man I never knew. Why did we fight? I asked myself that, many times.” 
He never spoke about the war – not even to his wife of 57 years. In this regard, he was not unusual. As Dennis Goodwin, founder, along with his son, of the World War One Veterans’ Association, puts it, these men “simply retreated into their own shell hole of memories”. 
Patch was haunted, in particular, by the dreadfully wounded soldier who had begged to be finished off. The young man had cried out “Mother!” as he died, and Patch believed this cry was one of greeting rather than despair. “I’m positive that when he left this world, wherever he went, his mother was there,” Patch wrote towards the end of his life. “From that day I’ve always remembered that cry, and that death is not the end.” 
He left the Army with his faith in the Church of England “shattered”. In an attempt to revive it, he joined the church choir. “In the end, I went because I enjoyed the music and had friends there. But the belief? It didn’t come. I felt shattered, absolutely, and didn’t discuss the war with anyone from then on, and nobody brought it up if they could help it.” 
This attitude persisted well beyond the immediate aftermath of the war. Patch refused to join veterans’ associations, had no wish to revisit battlefields, never attended a regimental reunion and avoided all war films. He did, however, keep in touch with his old “No 1”, Bob Haynes, until he died in the 1970s. 
Patch did his best to repress all memories of the trenches. It was only at the age of 98, when he moved to Fletcher House, a residential care home in the Somerset city of Wells, that a minor incident brought those memories back. The door to his room was opposite a linen cupboard, and one night someone switched on the fluorescent light inside. Flashes of light came through the glass panel above the door to Patch’s room. Half asleep, he was transported in an instant back to Passchendaele. “It was the flash of a bomb,” he recalled. “That flash brought it all back.” He had been suffering from bad dreams about the war, and decided that the time had come to face his demons. 
In the autumn of 2004, aged 106, he was persuaded to travel to Flanders for a BBC documentary, The Last Tommy. He was filmed at Tyne Cot, the largest British war cemetery, containing almost 12,000 graves, many of them holding unidentified bodies. 
“Some of the boys buried here,” he remarked, “are the same age as me, killed on the same day I was fighting. Any one of them could have been me. Millions of men came to fight in this war, and I find it incredible that I am now the only one left. Just like them, when I went over the top I didn’t know whether I would last longer than five minutes. We were the PBI – the Poor Bloody Infantry – and we were expendable. What a waste. What a terrible waste.” 
The documentary makers also persuaded Patch to meet one of Germany’s last-surviving veterans on September 22, the anniversary of the loss of his three comrades in the Lewis-gun team. A year older than Patch, Charles Kuentz had also fought at Passchendaele. He, too, had suffered the loss of a close friend, killed by shrapnel beside him in a trench. Like Patch, Kuentz had never talked about his experiences until being asked to do so after reaching his centenary. When the veterans laid a wreath together, Patch leaned out of his wheel-chair to pick up an acorn, and presented it to Kuentz. The German died a few months later. 
Patch never courted publicity and occasionally complained that he was tired of talking about the war, but it was inevitable that he would attract attention as he became one of the very last survivors. Even towards the end of his 111-year-long life, when he was widely recognized as a spokesman for his generation, he was not in the least afraid to state his opinions. “For me, November 11 is just show business,” he once said of Armistice Day, and he rarely lost an opportunity to express his abhorrence of warfare. 
Last year, he returned to Flanders to unveil a stone plaque at the spot where he went into action for the first time. It would be the final visit to the Western Front by someone who had fought there. In recognition of his status as the last surviving soldier who had fought in defence of Belgium, he was appointed Knight of the Order of Leopold. He was also made an Officer of the L├ęgion d’honneur. 
“I greatly appreciate the way your people respect the memory of those who fell, irrespective of the uniform they wore,” Patch told the French ambassador. “I will wear this medal with great pride and when I eventually rejoin my mates it will be displayed in my regimental museum as a permanent reminder of the kindness of the people of France.” 
On June 17 this year Patch celebrated his 111th birthday with a party in the garden of Fletcher House. The following day, his portrait went on display at the National Portrait Gallery. 
At 9am on July 25, only a week after the death of Henry Allingham, aged 113, Harry Patch died. At the time of his death, Britain’s last veteran was also the oldest man in Europe and the third-oldest in the world. He remained alert and articulate until the end. 
Following his death, much was made of the example he set as a soldier, joining up “to defend the nation”; but this ignored the facts. “I didn’t want to go and fight anyone,” he wrote in his autobiography, “but it was a case of having to. When it came, army life didn’t appeal to me at all, and when I found out how rough-and-tumble it could be, I liked it even less. I had no inclination to fight anybody. I wasn’t at all patriotic. I went and did what was asked of me and no more.” 
When asked what he thought about the idea of a state funeral for the last veteran, Patch had replied: “Overall, the idea was all right, I suppose, wanting to honour the generation who fought, but I wasn’t interested. I want to be buried in Monkton Combe alongside my family in the churchyard.” After a public funeral at Wells Cathedral, this wish was granted. 
The poet Charles Hamilton Sorley, killed in the Battle of Loos in 1915, wrote of the “millions of the mouthless dead”, but until now those dead have always had a spokesman. Now that Last Post has sounded for the last veteran, there is no one left to say: “I know what it was like. I was there.” 
'The Last Veteran: Harry Patch and the Legacy of War’ by Peter Parker (Fourth Estate) is available from Telegraph Books for £12.99 + £1.25 p&p. To order, call 0844 871 1515 or visit