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New Restrictions on The Use of Epilepsy Drug Epilim in Pregnancy

I wrote a blog last year on 24 October about the harm that Sodium Valproate, a controversial drug used to treat epilepsy, can have on unborn babies if used by mothers during pregnancy.

The drug made headlines in 2017 when it was revealed that drug regulators knew of the drug's problems as far back as the 1970s but did not to include this on patient information leaflets for fear it “could give rise to fruitless anxiety”.

Over the years however there have been numerous attempts to improve the communication of the risks of taking valproate medication during pregnancy to women, and in particular to their unborn child, although recent studies suggest that some women are still unaware of these risks.


Developments over the years

In 2004 The National Institute for Health and Care Excellence (NICE) guidelines on the diagnosis and management of epilepsy were amended. They stated that women and girls of childbearing potential (including young girls likely to need treatment into their childbearing years) and their parents and/or carers if appropriate, should be informed of the risk of anti-epileptic drugs (AED) causing malformations and possible neural developmental impairments in an unborn child, and assess the risk and benefits of treatment with individual drugs.

A study by Bromley et al in 2010 revealed that children exposed to sodium valproate had a statistically significant increased risk of delayed early development, compared to the control group of children. Also in 2010 an article published by Hill et al titled “Teratogenic effects of antiepileptic drugs” noted that foetal malformation linked with sodium valproate was known to be dose related.

In 2012 the NICE guidelines, referred to above, were again updated. Much of the 2004 update remained the same but newly added was that doctors seeking to prescribe sodium valproate should specifically discuss the risk of its continued use to any unborn child, being aware that higher doses of sodium valproate (more than 800 mgs per day) is associated with a greater risk. It also added that doctors needed to be aware of the latest data on the risk to the unborn child associated with AED therapy when prescribing for women and girls of present and future childbearing potential.

In November 2014, the European Medicines Agency’s (EMA) Pharmacovigilance and Risks Assessment Committee (PRAC) conducted a review of the valproate drug and agreed to strengthen warnings and restrictions on the drug’s use in pregnancy, due to the risk of malformations and developmental problems.

After warnings were strengthened in 2014, in 2015 the Medicines and Healthcare Regulatory Agency (MHRA) advised healthcare professionals against prescribing valproate-containing medicines in women and girls of/or nearing childbearing potential unless other treatments were ineffective or not tolerated.

Two years later the MHRA released further resources including a toolkit to help healthcare professionals talk to women with epilepsy about sodium valproate's risks during pregnancy. New safety warnings were also introduced which included written warnings on the drug's packaging.

On April 6 2017, NHS Improvement and the MHRA sent a patient safety alert through the central NHS system to further highlight sodium valproate's risks during pregnancy and published their Drug Safety Update which advised healthcare professionals not to prescribe sodium valproate to females unless other treatments were ineffective or poorly tolerated. Doctors also had to ensure that women and girls taking valproate medications understood the 10% risk of birth defects and the 30–40% risk of neurodevelopmental disorders. It also stated that valproate used in women and girls of childbearing age must be initiated and supervised by specialists in the treatment of epilepsy.

Despite these previous recommendations, women were still not always receiving the right information in a timely manner and my previous blog discussed the public hearing that was held in London on 26 September 2017 by the PRAC as part of a safety review of the drug, where EU citizens spoke of their experiences of Epilim. Nearly eight months on, there have been further developments that have put sodium valproate back in the headlines.

New developments

Sodium valproate must no longer be prescribed to girls and women of childbearing age in the UK unless they have a Pregnancy Prevention Programme (PPP) in place, under new rules brought in by the MHRA. The PPP requires women to complete a signed risk acknowledgement form when their treatment is reviewed by a specialist, which must take place at least annually.

This programme will also be supported by smaller pack sizes to encourage monthly prescribing of the medication, as well as a pictogram/warning image on labelling, similar to the warnings on cigarette packaging.

All women and girls who are currently prescribed valproate are advised to contact their GP and arrange to have their treatment reviewed. Doctors will need to weigh up with their patients the benefits and risks in any change to their epilepsy medication or a reduced dosage. Women should be adequately informed of risks and benefits of available treatment in their circumstances to enable them to be in a position to choose the risk they are willing to accept. They should not stop taking valproate without medical advice.

Spinal Cord Injury Awareness Day - Friday 18 May

“Every eight hours someone is told they will never walk again due to a spinal injury”. Despite this statistic, with the initial amazing care offered by specialist spinal units, the personal dedicated care provided by the nursing team, physiotherapists, occupational therapists and specialist case managers, a positive and fulfilling future can be achievable.

Despite all of the support available, we understand that it is incredibly hard for our spinal injury clients not just physically but emotionally too, especially during those first few initial weeks in hospital. It should not be forgotten that it can be extremely difficult for the immediate and extended family to come to terms with the injury too. To say it’s an enormous change, is an underestimation.

Important to get the right support

It is so important to get a supportive team on board right from the start, whether it’s a legal team dealing with a potential claim, signing up to an early multi-disciplinary treatment team and obtaining bespoke rehabilitation or getting support from the fantastic peer support officers, it all makes a difference, this is not a journey to tread alone.

There will be dark days, but there is also a wealth of opportunity, knowledge, technology and potential achievement available to help. We see clients who go on to have marvellously rewarding lives, and it is an honour and privilege to be part of their incredible journeys.

To read our Understanding Spinal Injury brochure, click here.

If you or a loved on have been affected by a spinal injury. Speak to one of our personal injury team as you could be entitles to make a Serious Injury Claim

Warning To Landlords/Agents – Gas Safety Certificates

Landlords are already aware of regulations which require that for all Assured Shorthold Tenancies (AST) entered into after 1 October 2015 certain prescribed documents must be served upon the tenant. These include the “How to Rent” Guide, the EPC and Gas Safety Certificate, the Deposit Certificate and Prescribed Information*.

The Gas Safety Regulations 1998** specify that a copy of the Gas Safety Certificate must be given to an existing tenant within 28 days of the inspection, and to any new tenant before the tenant occupies the premises S36(6)(b).

On 2 February 2018, in Caridon Property Ltd v Monty Shooltz, HHJ Luba QC decided that if the Gas Safety Certificate was not given to the tenant before they took up occupation of the premises, this amounts to a breach of the regulations which cannot be rectified.

What are the implications of this decision?

This effectively means that, for tenancies created after 1 October 2015, a landlord cannot serve a valid Notice seeking possession under Section 21 HA 1988 unless a Gas Safety Certificate was served before the tenant took up occupation.

If there are no other grounds for possession (for example rent arrears) the landlord cannot recover possession at the end of the fixed term.

What options are available to landlords?

Landlords could try to avoid the implications of this decision by persuading the tenant to enter into a new AST and make sure the Gas Safety Certificate (and other prescribed documents) is properly served before the new tenancy begins. This option depends on the tenant’s co-operation which cannot be guaranteed.

An alternative is to serve the Gas Safety Certificate after the fixed term has expired, before a new statutory periodic tenancy arises, but there is no guarantee a court will be persuaded that the regulations have been complied with.

This decision is going to have significant implications; tenants may well try to use it as a means to defend a claim for possession. The position will need to be clarified by a Court of Appeal decision, or new legislation.

In the meantime all landlords should ensure they take steps to serve the tenant with the prescribed documents before they enter into occupation of the premises, and obtain a receipt signed by the tenant as they have only once chance to comply.

*The Assured Shorthold tenancy Notices and Prescribed Requirements (England) Regulations 2015

** The Gas Safety (Installation and Use) Regulations 1998

Missed Breast Cancer Screenings Scandal

Media outlets have reported news of a major IT error in the NHS occurring as far back as 2009, which may have resulted in up to 450,000 missed breast cancer screenings. Experts have apparently estimated that up to 270 women may have even died as a result of this computer error, although only broad estimates as to the numbers of affected women have been given, it seems because of mixed opinion about how effective breast cancer screening in older women actually is. Please see our previous blog where we considered ‘Do we need more transparency about breast density

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The NHS screening programme

Under the NHS breast cancer screening programme, all women between ages 50 – 70 are invited for screening by way of a mammogram scan every three years, which should be by way of an automatic letter from their GP. This would mean that a woman should receive a final invitation between the age of 68 and 71.

The screening programme aims to identify breast cancer as early as possible. Early detection is much more likely to improve prognosis and chances of survival. See my previous blog for further information about the programme. Millions of women take up the offer of breast cancer screening upon receipt of the invitation letter.

Inquiry

The issue first came to light in January this year because of an IT upgrade to the breast screening invitation programme, but it now seems that the error had gone undetected for nearly a decade.

Health secretary, Jeremy Hunt, apologised unreservedly for the error and is reported to have told the House of Commons that women aged between 68 and 71 were not invited to attend their final breast screening between 2009 and the start of 2018, because of a “computer algorithm failure”.

The government has ordered an independent inquiry into the matter which will seek to establish exactly how many women have been affected by the computer error. It is anticipated that this will take around six months, during which time the entire breast screening programme will be scrutinised.

Jeremy Hunt has said his department would be contacting the families of women who had died, potentially because of a missed screening, and whether this resulted in a delay in diagnosis which may have ultimately led to a shortening of life expectancy or a worse prognosis.

What now?

The priority should now be for the NHS to ensure that there are measures in place to make sure eligible women, who should have received an automatic screening invite but didn’t because of the error, are now invited for breast cancer screening as soon as possible.

It is very concerning that women have not been invited to attend such a potentially important screening appointment, and even more so that this is because of an administrative error which has gone on for such a long period of time.

The NHS needs to make sure it has robust systems in place, particularly in light of ever increasing demand on its resources and with continuous developments in IT and technology, to make sure that its administrative systems are designed and used to deliver safe and efficient care to patients and service users. It is hoped that news of this scandal will encourage heightened scrutiny and a thorough review in other administrative areas of the healthcare system.

If you suspect you have been affected

Many women are likely to receive a letter towards the end of the month if they have missed a screening, but if you are at all concerned by this news story, the NHS are inviting people to go to the NHS Choices website, or to contact their local units to book an appointment, particularly if you suspect you may have been affected by this issue, or if you are aged over 50 and haven’t had a mammogram in the last three years and would like to have one.

As a final point, it is reassuring to note that many breast cancers are now identified by women themselves because of increased awareness and the importance of self examination amongst other things, and it is also important to note that breast cancer does not only affect women, it can affect men too.

May Fair Memories

As the May Fair gets set to descend upon the streets of Hereford for its annual three day visit following the Bank Holiday, no doubt we’ll be complaining about the road closures and the noise.

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Today’s May Fair bears no resemblance to its origins back in the 12th Century, when it was known as St Ethelbert’s Fair and lasted for nine days.

It has evolved as technology has evolved and every generation of fair goer will have their own memories of it. For my part, it brings back memories of candyfloss and toffee apples. As a young child in the late 1960s my parents would take my brother and I ‘to the Fair’ on one of the three evenings, and we would walk from one end of it to the other taking in the sights – and smells! I don’t recall going on any of the ‘big’ rides. Instead we would go on the Carousel, throw darts, hook ducks (patience required) and try to win a coconut – I think my mother usually ended up having to buy one!

In the same way that technology has speeded up everyday living, so over the years the Fair rides have got bigger and faster, and today’s generation seek the thrill of it all. But in amongst all the fast rides you can still find the gentler, more traditional pursuits, so if you go ‘to the Fair’ this spring – whether it be Hereford May Fair or some other – why not pause for a while amidst the noise and the bustle and simply hook-a-duck!

Child Arrangements Orders – “Live With” and “Spend Time With”

The question of which parent is more likely to get a Live With Child Arrangements Order (custody in old money) is an ever evolving one. Historically there was a presumption that young children needed to be with their mothers in their early, developmental years. But now, the courts have realised that the question is much more difficult to determine.

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The court has a presumption that it is better for a child to have the involvement of both parents in their life and that will further their welfare. The starting point is often the child will live with the parent they stayed with when the parties separated and spend time with the other parent.

How do the courts decide?

The courts will ask themselves a series of questions when faced with the decision of who the child should live with and spend time with, this is known as the Welfare Checklist.

Does the child have a particularly strong emotional bond with either parent? Is the child capable of conveying their views to a Court Advisor?

  • How old is the child, does the child have any special needs either physically, emotionally or educationally?

  • What will be the effect on the child of any change in the current arrangements?

  • Which parent is most financially and physically able to provide for a child's essentials, like food, medical care, shelter, and clothes?

  • What is the mental and physical health history of each parent? Is there any information that may affect the child (e.g., excessive drinking, history of violence, mental health issues of either parent)?

  • Will the child have to adjust to a new school, city, quality of life, and friends if living with one parent versus the other?

After asking these types of questions, the court will decide which parent should be given primary care via a Live With Order and how much time should the other parent have. As you can see, the questions are gender neutral, so no preference is given under the law to either parent.

What happens when both parents granted a Live With Order?

In some instances it may be appropriate for the parents to share care – they both have a Live With Order allowing the child to spend large blocks of time at one parent's home (like summer and winter breaks), and the rest of the year with the other parent.

  • If the child is able to convey their wishes and feelings then their views are relevant to the determination of their living arrangements and are routinely considered in a number of different ways.

  • At what age may their views be considered?

  • The court has to consider the views of the child conceivably from as soon as they can talk. The level of consideration and influence those views may have over a Judge however will be very much affected by the degree of maturity the child is assessed as having.

  • Their views are weighed in balance with the other factors in the Welfare Checklist

What rights do other family members have?

People frequently ask what are other member of the family’s rights, e.g. grandparents when the parents separate and they have been denied time with the child. The sad truth is that family members do not have an automatic right to contact with the child. However, family courts do recognise the invaluable role that relatives (especially grandparents) have to play and it is very rare that the court would refuse a grandparent permission to make an application to spend time with the child unless there is evidence that it would not be in the child’s best interests.

Even if the separation is amicable it is often advisable to have the arrangements recorded in a Parenting Agreement or Court Order. This provides both parents with a secure framework for the Child Arrangements to be recorded and to avoid any disagreements.

If you have are facing similar challenges to any of the points raised in our blog above, please contact the Child Law Solicitors at Lanyon Bowdler for further advice and assistance

Sexual Abuse Is Never Acceptable

In England and Wales there are 85,000 female rape victims and 12,000 male victims every year; shockingly only 15% of those victims can face reporting their abuse to the police (figures based on statistics from Rape Crisis England and Wales 2016-17). There were 202,666 help line calls to Rape Crisis Centres for the year 2016-17, amounting to 4,000 per week which is a 16% increase on the figures for 2015-16. In addition 42% were adult survivors of child sexual abuse and, where the age was known, 2651 were aged 15 years or under.

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Warning signs ignored

Unfortunately abuse continues to be heard on the news on a regular basis and more so recently, with the staggering figures of over 1,000 girls allegedly being abused over a 40 year period in Telford. I have read the recent report on the level of abuse in Telford; I found the results to be extremely shocking and disappointing. The report suggests people in power were aware but failed to act or chose not to see the warning signs, which if found to be true is absolutely disgusting and outrageous.

As a senior litigation assistant I know more than most about the immense courage and strength it takes for a victim to firstly, face up to what has happened to them and to then come forward and speak. Often, as the recent reports seem to suggest, the victims become trapped in a cycle of abuse, groomed with gifts or threats of harm to their family members, which means they may endure many years of suffering in silence. The recent reports into the abuse in Telford suggest that some victims had attempted to come forward, but they were not believed or supported. If they find such courage and then are not believed or supported, I question how the circle can ever be broken.

Mistakes need to be identified

I believe a stand needs to be taken to show that any type of sexual abuse, rape or assault, on a child or otherwise, is a crime that will be punished. The Telford and Wrekin Councillor should unite around plans to hear victims of child sexual abuse as part of a national inquiry.

Questions need answers in particular; how had this been happening for such a prolonged period of time? Why were some of the girls allowed, sometimes on repeated occasions, to be administered with the morning after pill without questions or investigations? How could they have abortions and not be supported in such a way that they could speak out about their situations?

These are serious questions which require serious responses. For many of the victims it is too late for blame but the mistakes need to be identified to ensure that this can never happen again. It will also encourage current victims to come forward.

Support for victims is needed

Abuse cannot be fixed like a broken bone, and suffering for the victim continues long after the abuse has stopped. It can impact on all areas of a victim’s life, affecting their ability to trust people, form relationships and even being capable of holding down employment.

It is everyone’s responsibility to look out for vulnerable people in our community, but this has to be supported with the bodies in power such as the police. It is never right for anyone, of any age, race, colour or religion to be forced into any sort of sexual act.

It’s important the victims of abuse are offered the support they need, not only in getting justice for what they have been through, but through the appropriate organisations who are able to offer the emotional and practical support they are going to need to get their lives back on track. Victim Support and AXIS Counselling Service have experience in helping victims and can offer practical support.

Investigation into Mesh

Urogynaecological mesh is used to treat stress incontinence and pelvic organ prolapse. Stress incontinence is very common after childbirth and at the stage of menopause. Pelvic organ prolapse often occurs following childbirth. Both can significantly impact everyday life.

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Can slice through organs

Reconstructive surgery using mesh has been used to treat symptoms in hundreds of thousands of women. There are different brands and manufacturers but it is a net-like implant used to give support to weakened organs and repair damaged tissue.

Many women have experienced problems following the procedure. Campaign group ‘Sling the Mesh’ outline that women have suffered chronic pain and constant urinary infections, which in some cases has led to sepsis. They call it a ‘ticking time bomb’ as problems can begin years after implantation. Some women can experience severe life-changing complications. One of the problems is that mesh, which is made out of polypropylene plastic, can erode, stiffen and slice through organs such as the bladder.

Retrospective audit

Labour MP Owen Smith set up an all-party parliamentary group to look into the safety of mesh devices and this has led to a full retrospective audit being launched by the Government in February 2018.

Mr Smith said ‘The mesh scandal shows what can go wrong when devices are aggressively marketed to doctors and then used in patients for whom they were unsuited or unnecessary.’

New Zealand have banned the use of mesh

There has been great criticism over many types of mesh not being subject to proper clinical trials. Two weeks after the death of campaigner Chrissy Brajcic in November 2017, New Zealand became the first country to ban the use of mesh for the repair of prolapse and stress urinary incontinence. It has also been heavily restricted in Australia.

The National Institute for Health and Care Excellence (NICE) updated its guidance in December 2017 to say that mesh implants for prolapse should now only be used in the context of research. ‘Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns. Evidence of long-term efficacy is inadequate in quality and quantity.’

Legal claims

A large number of women are in the process of making legal claims against the NHS and the manufacturers of the mesh. Kath Sansom of ‘Sling the Mesh’, says many women were fobbed off for many years, being told that their problems were not related to the mesh and are therefore time-barred from bringing a legal claim.

We await the outcome of the Government review.

If you have suffered problems from the use of mesh, then feel free to give our experienced clinical negligence team a call to discuss things further.

Bail Changes…A Year On

I wrote a blog just over a year ago (3 April 2017) highlighting the changes to police bail.

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When introduced, the belief was that the changes would prevent people from being kept on police bail for any longer than was necessary and that matters would be concluded with greater expedition.

A year on, my experience is that the removal of bail has been beneficial for a very small minority who have had their matters concluded faster than they would have done before.

Unfortunately, as I anticipated would happen, the vast majority are now ‘RUI’d’ (Released Under Investigation) and will have to wait weeks or more likely months to see if they are going to be re-interviewed by the police, summonsed to court or told that no further action will be taken against them.

This continued uncertainty is simply not fair on people who’s lives are put on hold in the meantime.

Changes to Punishments for Arson and Criminal Damage Crimes

We asked our work experience placement student Nicola Corby to write a blog as part her time in the criminal law team. Nicola undertook research on a topic I gave to her and wrote the following blog. 

"Whilst Magistrates’ Courts are equipped with guidelines relating to the sentencing of arson and criminal damage offences, no such guidance currently exists for Crown Courts.

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This is set to change: the Sentencing Council have issued a new consultation, set to close on the 26th June 2018. As part of this consultation, tougher sentences are being considered where “aggravating” features exist.

Resources impacted

“Aggravating” factors include instances where there is a "significant impact" on emergency services. Where large numbers of police, ambulance and fire vehicles are required to respond to an event, there is a knock-on effect on the resources available for other public incidents.

The proposed guidelines reflect the fact that the consequences of criminal damage and arson offences are often long-lasting. Damage to schools, community buildings or train stations can have a “real impact” on local communities. The proposed guidelines make it clear that the courts should consider the economic or social impact of such crimes.

Ensure consistency in sentencing

The guidelines cover arson, criminal damage or arson with intent to endanger life, criminal damage valued at above and below £5,000, threats to destroy or damage property, and racially or religiously aggravated criminal damage.

Sentencing Council member Judge Sarah Munro QC has said: "The guidelines we are proposing will help ensure consistency in the sentencing of these extremely varied offences […] They can range from very minor damage to property up to an intent to endanger lives, and the guidelines set out an approach to sentencing that will help ensure appropriate sentences according to the seriousness of each offence."

The consultation is open now and closes on 26 June 2018."

www.sentencingcouncil.org.uk/consultations/

Cancer - The F Word

Back in February, I read in the news about one of the latest scientific breakthroughs of human eggs being matured in the lab for the first time. I was interested to read about the potential implications of this, particularly what it might mean for fertility treatments for those who have been diagnosed with cancer at a young age. The recent blog by my colleague, Lucy Small, highlights the devastating impact a cancer diagnosis at a young age can have on a woman’s fertility. Focus tends to be on treatment, and understandably so, but we must not forget about the potential impact of a cancer diagnosis on fertility, particularly for younger people who receive a diagnosis. The F word is a big deal for many younger cancer sufferers, and not everybody gets a chance to talk about it.

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How old is “young”?

The risk of a “young” person getting a cancer diagnosis is of course quite low, statistically speaking, but exactly how old is “young”? The American Cancer Society suggests that for the purposes of statistics, “young adults” are generally regarded as between 20 and 39 years old. I think it depends on the type of cancer, but with people living longer and with women often deciding to have children at older ages, this might alter our perception of what “young” is. In breast cancer for example, “young” seems to mean under the age of 45. A family history of this in relatives under the age of 50 does increase a person’s risk of developing this disease and would generally warrant enhanced screening in accordance with NHS guidelines. With cervical cancer, the highest incident rates seem to be in the 25 – 29 age group and according to Cancer Research, more than half of cervical cancer cases in the UK each year are diagnosed in women under the age of 45. For young men (aged 25-49), testicular cancer is the most common cancer in the UK, accounting for around 14% of all cases in 2013-2015. These are all ages where people might be planning to start a family.

Cancer Treatment

Undergoing chemotherapy and radiotherapy carries a risk of reducing fertility. This may not have such a big impact for “older” patients but for younger people who have not yet had, and may want to have children in the future, this impact can be life changing.
For hormonal driven cancers, such as breast or womb, the treatment does not end after the initial chemotherapy and/or radiotherapy and patients may have to undergo hormonal therapies for years afterwards. For example, tamoxifen, a breast cancer drug, can often be prescribed for up to 10 years following active treatment. This carries the risk of inducing early menopause and will have a massive impact on couples considering adding to or starting a family.

Fertility Preservation

Sometimes patients can be offered fertility preservation options before beginning their treatment, but there is no one size fits all approach and much will depend on the individual’s particular circumstances and type of cancer, and even local health care provider (the familiar case of post code lottery). Women can sometimes freeze their eggs before starting treatment, or even ovarian tissue, and men could undergo sperm banking for example. If this is not available on the NHS for a particular patient, some people may have to pay for the cost of going private.
At what is already an incredibly difficult time, it is just another thing for cancer patients to have to think and worry about, particularly for those young adults who have not even contemplated or yet thought about having children. Time may also be of the essence in starting treatment, and patients may have to make the difficult decision to delay treatment to explore and undergo fertility preservation, with the possibility that this could increase cancer risk and impact on their prognosis.

Hope for the future?

Fertility is often something young people take for granted and so may be the last thing a young person receiving a cancer diagnosis thought they might have to think about.
As I understand it, the eggs that have been matured in the lab are technically ready to be fertilised and, if this leads to healthy embryos, this could in theory be used to help women who have had cancer at a young age. There is also potential for the technique to be used to preserve fertility in children having cancer treatment. More investigation is needed before this could be a potential clinical option but hopefully this is a positive step forward for fertility preservation and treatment, particularly for those whose fertility is affected by a cancer diagnosis at a young age.

Surviving Spinal Injury – The Journey

After the success of the Brain Injury Conference in 2016, Lanyon Bowdler hosted another event entitled Surviving Spinal Injury – The Journey which was held at the Robert Jones and Agnes Hunt Hospital, Oswestry.

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Arriving to refreshments, the day of informative talks started off with a welcome from host, and partner at Lanyon Bowdler, Dawn Humphries followed by a brief a history of the development of spinal injury services in from Professor Waigh El-Masri. One of Professor El-Masri’s many achievements was to found and set up Transhouse which is an organisation that offers transitional housing for patients with spinal cord injuries (SCI) and provides them with the skills they need to live a more independent life after being in hospital. We were lucky enough to hear from Transhouse’s CEO Fae Dromgool later in the day.

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A moving talk was given by David Chapple, Trustee of Horatio’s Garden. Mr Chapple set up the charity, which creates beautiful and accessible gardens in NHS spinal centres across the country, in memory of his son Horatio. The RJAH look forward to having a garden designed by the charity at the hospital.
The morning programme took on a clinical angle regarding spinal injuries with talks from Dr Clive Bezzina, who spoke about rehabilitation, Mr Naveen Kumar gave a most thorough and in-depth talk on the management of spinal cord injuries. Mr Aheed Osman provided a very detailed presentation on the recent advances in SCI management, covering worldwide research projects.

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Michelle Bunyan provided an informative overview of case management and how it requires a specialist approach when a client has a spinal injury. Jonathan Fogerty, Trustee of the charity SPIRIT spoke about the charity’s international reach which aims to improve the treatment and care of those with SCI, having sustained a SCI himself in his teenage years.

After lunch, host and associate at Lanyon Bowdler, Emma Broomfield welcomed Fae Dromgool from Transhouse to start the afternoon of talks.

Attendees were captivated by the story of Yu Guo who is also a former patient of the RJAH and whose case was successfully won by Lanyon Bowdler’s Dawn Humphries and No5 Chambers’ barrister Chris Bright QC. After a complicated case involving a dancing move, Dawn and Chris secured her a settlement to provide for her future care. Yu Guo took the time to thank Dawn and Chris for all their hard work and expressed how pleased she was with the way they conducted her case.

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Attendees were further treated to a talk from another former RJAH patient, guest speaker Darren Edwards. After being involved in a serious fall on 6 August 2016, whilst rock climbing in North Wales, Darren was left paralysed from the chest down. He shared his journey from being airlifted to Stoke hospital, to founding the charity Strength Through Adversity, which aims to provide opportunities for disabled people in Shropshire to take part in sporting activities.

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A day of enlightening, educational and at times both emotional and entertaining talks, was rounded off by a Q&A chaired by Mr Chowdhury.

I think I can say on behalf of all who attended that the day was a great success and provided an important insight into the legal, medical and practical help that exists for those with spinal injuries. A particular highlight was the demonstration of a robotic walking aid and an insight into how these can assist those with spinal injuries by Stephen Ruffle of ReWalk Robotics.

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