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Warning issued over adrenaline pen fault

Allergy patients are being warned of a potential fault with Emerade adrenaline pens. The Medicines and Healthcare products Regulatory Agency (MHRA) said some have blocked needles, so cannot deliver adrenaline. Around two in every 1,000 pens are thought to be affected and patients are advised to follow the existing advice to carry two pens at all times. If patients follow the advice to carry two pens at all times, the risk of not being able to deliver a dose of adrenaline falls to virtually nothing - 0.23% to 0.000529%.

The MHRA added: "Healthcare professionals should contact all patients, and their carers, who have been supplied with an Emerade device to inform them of the potential defect and reinforce the advice to always carry two in-date adrenaline auto-injectors with them at all times."

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Source: BBC News, 12 July 2019

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Warning issued for staff wearing PPE during warm weather

NHS hospitals have been advised to protect all staff wearing PPE during the warmer weather amid concerns the higher temperatures could increase the risk of heat stress. 

A letter from Public Health England sent across GP surgeries, pharmacies and hospitals, have recommended that staff wearing PPE should be given regular breaks and have a buddy system so that signs of heat stress can be spotted early on. 

The letter describes how PPE may need to be changed more frequently which may increase demand. 

Symptoms of heat stress are similar to heat exhaustion and the necessary actions should be taken to help avoid overheating. 

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Source: The Independent, 10 June 2021

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Warning for parents after rise in hospitalisations for flu in children under 5

Parents are being told to urgently bring their children forward for flu vaccinations as new data reveals the rate of hospitalisation and ICU admission for people with the virus is rising fastest among those under five years old.

New figures published in the UK Health Security Agency’s (UKHSA) National flu and Covid-19 surveillance report show that cases of flu have climbed quickly in the past week, indicating that the season has begun earlier than normal.

According to the UKHSA, vaccination for flu is currently behind last season for pre-schoolers (12.1% from 17.4% in all two-year-olds and 12.8% from 18.6% in all three-year-olds).

It has also fallen behind in pregnant women (12.4% from 15.7%) and under 65s in a clinical risk group (18.2% from 20.7%).

Dr Mary Ramsay, director of public health programmes at the UK Health Security Agency, said: “Our latest data shows early signs of the anticipated threat we expected to face from flu this season.

“We’re urging parents in particular not to be caught out as rates of hospitalisations and ICU admissions are currently rising fastest in children under 5.

“This will be a concern for many parents and carers of young children, and we urge them to take up the offer of vaccination for eligible children as soon as possible.”

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Source: The Independent, 20 October 2022

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Warning as UK coronavirus outbreak leads to sharp rise in deaths at home

The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned.

Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them.

And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived.

The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden.

“People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.”

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Source: The Guardian, 16 April 2020

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Warning as patients hospitalised after taking fake Ozempic weight-loss drug

People have been hospitalised after taking a fake version of the weight-loss control jab Ozempic, with 369 drugs seized by the UK’s medicines safety regulator.

The fake jabs, obtained without prescription through black market suppliers, were seized by the Medicines and Healthcare Products Regulatory Agency.

Ozempic, the brand name for semaglutide, and demand for the medicine has contributed to shortages in the product, which is also used for people with type 2 diabetes.

The watchdog said a low number of patients had been hospitalised and reported serious side effects, including hypoglycaemic shock. Others ended up in a coma, which indicates the pens may have contained insulin rather than semaglutide.

It has urged the public not to buy drugs without a prescription and warned buying prescription-only medicines online “poses a direct danger to health”.

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Source: The Independent, 29 October 2023

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Warning as baby dies and seven more fall critically ill with ‘usually mild virus’

A baby has died and seven others were left requiring intensive care after a “usually mild” virus appeared to trigger a serious heart condition, health officials have said.

The World Health Organization (WHO) said it had been notified of an “unusual” increase in myocarditis –inflammation of the heart – among newborns in south Wales infected with an enterovirus over the past year.

While enteroviruses are common and often asymptomatic, they are known to cause “occasional outbreaks in which an unusually high proportion of patients develop clinical disease, sometimes with serious and fatal consequences – in this instance myocarditis”, the UN health agency said.

While prior to the recent cluster of cases, south Wales had experienced only two similar cases in six years, the 10 months to April saw 10 cases of myocarditis in babies under the age of 28 days who tested positive for enterovirus, according to WHO.

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Source: The Independent, 19 May 2023

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Wards to get ‘star ratings’ under first new NHS cleaning rules for 14 years

The first new hospital cleaning standards for 14 years have been outlined by regulators, including confirmation of new food hygiene-style star ratings.

Wards and theatres will be given ratings from one to five stars – based on audits which score the cleanliness of areas against safe standards – and these ratings will be made visible to patients.

The plans for the new star ratings, which are expected to be easier for patients to understand than the current cleanliness percentage scores, were first revealed by HSJ in 2019.

The ratings are also designed to encourage a more collaborative approach, by reflecting the cleanliness score for whole areas, as opposed to the performance of individual parties responsible for cleaning certain elements.

Areas rated one to three stars would require improvement plans and be automatically placed under review, with “immediate action” being required in one-star rated areas.

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Source: HSJ, 6 May 2021

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Wards at trust facing patient deaths inquiry downgraded to ‘inadequate’

Wards at a trust facing an inquiry over the deaths of vulnerable patients have been downgraded to ‘inadequate’ over fresh patient safety concerns. 

The Care Quality Commission said five adult and intensive wards across three hospitals run by Tees, Esk and Wear Valleys (TEWV) Foundation Trust “did not manage patient safety incidents well”. It also criticised the trust’s leaders for failing to make sure staff knew how to assess patient risk.

The watchdog rated the trust’s acute wards for adults of working age and psychiatric intensive care units as “inadequate” overall as well as for safety and leadership. The trust was also served a warning notice threatening more enforcement action if the patient safety issues are not urgently addressed. At the previous inspection in March 2020, the service was rated “good”.

TEWV said it has taken “immediate action” to address the issues, including a rapid improvement event for staff and daily safety briefings, and will also spend £3.6m to recruit 80 more staff. The trust’s overall rating of “requires improvement” remains unchanged after this inspection.

Brian Cranna, CQC’s head of hospital inspection for the North (mental health and community health services), said: “We found these five wards were providing a service where risks were not assessed effectively or managed well enough to keep people safe from harm."

“Staff did not fully understand the complex risk assessment process and what was expected of them. The lack of robust documentation put people at direct risk of harm, as staff did not have access to the information they needed to provide safe care."

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Source: HSJ, 26 March 2021

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Wards at Royal London Hospital mothballed amid concerns over fire safety

Six wards in a busy London Hospital, added at a cost of £24 billion during the pandemic, are lying empty because the builders did not install sprinklers. 

With the NHS in crisis, the Royal London Hospital in east London, has had to mothball the space, which is large enough to take 155 intensive care beds, while officials work out what to do with it. They have no patients in it since last May.

Source: The Sunday Times, 29 January 2023

Shared by Shaun Lintern on Twitter

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Ward staff ‘must accept extra workload to help A&E’

Hospitals are being prevented from adopting models which spread risk away from emergency departments because other teams refuse to take on the extra work, according to a top accident and emergency doctor.

In a recent interview with HSJ, North Bristol Trust chief executive officer Maria Kane praised her trust’s risk-sharing approach to emergency care, which involves moving patients each hour from accident and emergency to the most appropriate ward for their needs and where a discharge is expected, even if it is full.

Commenting on the article, Royal College of Emergency Medicine president Adrian Boyle said: “The NBT trust leadership deserve significant credit for maintaining this. All too often there is an acceptance of unacceptable delays (and risk) in ambulance handovers and long ED stays.

“Where this fails, it is usually because inpatient teams (both nursing and medical) have objected to the extra workload, without appreciating the real harm elsewhere. The more interesting question is why isn’t this being done more widely?”

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Source: HSJ, 15 November 2023

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War veteran, 99, left 'crying out in pain' on A&E trolley for 10 hours

A 99-war-old war veteran was left in agony on an A&E trolley in a hospital for almost 10 hours.

Brian Fish, a former captain in the Royal Engineers, was left “crying out in pain” as he endured the long wait at Margate’s Queen Elizabeth Queen Mother Hospital, his daughter said. Mr Fish had been urgently admitted to hospital with gall bladder problems.

Details of his ordeal emerged as figures showed the queues at NHS emergency departments are now the longest on record, with one in four patients at major A&Es waiting longer than four hours to be seen or treated in October.

His daughter Hilary Casement, who witnessed her father’s hospital ordeal, said: “It was traumatic for him. He lay for hours crying out in pain on a hard trolley. Eventually, with much pleading from me, he was transferred, actually tipped, on to a slightly more comfortable hospital bed and eventually seen by the kind, but overworked, medical team".

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Source: The Independent, 19 November 2019

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Wall Street Journal: How the Swiss Cheese Model can help us beat COVID-19

No single solution will stop the virus’s spread, but combining different layers of public measures and personal actions can make a big difference.

It’s im­por­tant to un­der­stand that a vac­cine, on its own, won’t be enough to rapidly ex­tin­guish a pan­demic as per­ni­cious as Covid-19. The pan­demic can­not be stopped through just one in­ter­ven­tion, be­cause even vac­cines are im­per­fect. Once in­tro­duced into the hu­man pop­u­la­tion, viruses con­tinue to cir­cu­late among us for a long time. Fur­ther­more, it’s likely to be as long as a year be­fore a Covid-19 vac­cine is in wide-spread use, given in­evitable dif­fi­cul­ties with man­u­fac­tur­ing, dis­tri­b­u­tion and pub­lic ac­ceptance.

 Con­trol­ling Covid-19 will take a good deal more than a vac­cine. For at least an­other year, the world will have to rely on a mul­ti­pronged ap­proach, one that goes be­yond sim­plis­tic bro­mides and all-or-noth­ing re­sponses. In­di­vid­u­als, work-places and gov­ern­ments will need to con­sider a di­verse and some­times dis­rup­tive range of in­ter­ven­tions. It helps to think of these in terms of lay­ers of de­fence, with each layer pro­vid­ing a bar­rier that isn’t fully im­per­vi­ous, like slices of Swiss cheese in a stack.

 The ‘Swiss cheese model’ is a clas­sic way to con­cep­tu­al­ize deal­ing with a haz­ard that in­volves a mix­ture of hu­man, tech­no­log­i­cal and nat­ural el­e­ments.

This article can be read in full on the WSJ website, but is paywalled. 

The illustration showing the swiss cheese pandemic model is hyperlinked to this hub Learn post.

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Walking 25 minutes a day keeps elderly patients strong in hospital

Older patients should walk around hospital wards and along corridors to prevent their muscles weakening, research suggests.

Lying in a hospital bed for several days can cause a sharp deterioration in strength, leaving some elderly patients struggling to walk or live independently when they are discharged.

New research shows this decline can be prevented if patients are helped to walk for at least 25 minutes a day while in hospital.

The best effect was observed when patients walked around the hospital for at least 50 minutes a day. The study suggested that a mixture of physical activity, such as 20 minutes working with resistance bands while seated and 20 minutes of walking, also helped.

The authors said patients who remained active during their stay in hospital were less likely to suffer “adverse events” after they were discharged.

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Source: The Times, 4 August 2023

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Wales NHS: Prioritise patients waiting longest

The NHS in Wales needs to "speed up the process" of treating people waiting over two years for hospital treatment, the health minister said.

Eluned Morgan said health boards need to prioritise the "longest waiters and they're not always doing that".

There are 59,350 people waiting over two years in Wales, although the number has fallen for a fifth month in a row.

The Welsh NHS Confederation, which represents NHS health organisations, has been asked to comment.

In Wales, there are 183,450 operations and procedures waiting more than a year.

Overall waits - from referral to treatment - have passed 750,000.

Scotland has 7,650 patients waiting more than two years, England has 2,646.

Asked on BBC Politics Wales why so many more people are waiting longer in Wales, Ms Morgan said: "Our health boards need to make sure that they're taking people from the longest waiters and they're not always doing that."

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Source: BBC News, 23 October 2022

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Wales Covid families want answers as inquiry arrives

Accountability is top of the wishlist from the Covid inquiry as it comes to Wales, say bereaved families and those charged with protecting vulnerable people.

Over the next three weeks the focus will largely be on the decisions made by the Welsh government during the pandemic.

From the timings of lockdowns to the rationale of doing things differently to the UK government, the hearings will scrutinise actions taken in Wales.

For many, it will be a chance to hear the justifications for policies that they say left them feeling unsupported and alone.

Ann Richards did not get to say a final goodbye to her husband Eirwyn before he died from hospital-acquired Covid in January 2021.

Ann still wonders if non-urgent healthcare had been fully up and running, could Eirwyn have been discharged sooner, or perhaps even avoided a hospital admission altogether?

Additional rules put in place to reduce the spread of the virus meant there were delays in getting a purpose-built wheelchair – delaying his discharge from hospital.

"I understand there had to be rules in place," said Ann. "But it's the wellbeing of the patients I think they lost a lot of."

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Source: BBC News, 26 February 2024

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Wales coroner rules nurses’ Covid deaths as industrial disease

The deaths of two nurses from Covid-19 in the early days of the pandemic have been ruled as industrial disease.

Gareth Roberts, 65, of Aberdare, and Domingo David, 63, of Penarth, were found to have been most likely to have contracted the virus from colleagues or patients while working for hospitals under the Cardiff and Vale University Health Board.

The senior coroner Graeme Hughes concluded on Friday that although they were given appropriate personal protective equipment (PPE), Roberts and David were “exposed to Covid-19 infection at work, became infected and that infection caused” their deaths. He made a finding of industrial disease.

Roberts’ family had argued for a conclusion of industrial disease, while the health board had made the case for ruling that both deaths were from natural causes.

Unions are campaigning for Covid-19 to be considered an industrial disease by the UK government so workers affected by it would receive greater financial support.

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Source: The Guardian, 13 January 2023

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Wales ‘displaying a dangerous and growing reliance’ on agency nurses

The NHS in Wales could move to a model in which most or all nursing care is outsourced to private companies, if its increasing reliance on agency staff continues, a union report has claimed.

According to the Royal College of Nursing, the Welsh health service risks moving to a situation where it no longer directly employs staff to provide patient care. NHS Wales spent between £133m and £140m on agency nursing during 2021-22, based on different freedom of information (FOI) requests and official figures, the RCN’s report suggested.

RCN Wales said, “If this trend continues, Wales will move to a situation where NHS Wales no longer directly employs staff to provide patient care and instead moves to a model in which most or all nursing care is outsourced to private companies.”

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Source: Nursing Times, 4 December 2022

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Waits for diagnosis and decision rise to over 38 weeks

Waiting times to diagnosis and decision rose by more than a week in December, reaching 38.6 weeks at month end. This matters because many urgent conditions are only detected when the patient reaches diagnosis, including nearly a quarter of all cancers, and such very long waits put those patients at risk.

Looking at the whole referral-to-treatment waiting list, which includes patients who have a diagnosis and decision, waiting times remained roughly steady at 43.4 weeks, compared with the standard of 18 weeks that is still required by legislation. Waiting times are a function of both the size and shape of the waiting list, and in December the former got worse and the latter improved.

There were 6,067,326 patients on the waiting list as December ended, which is the first time the official figures have topped six million. As many as 310,813 of them had waited over a year (strictly, 52 weeks), and 20,065 over two years (104 weeks). The NHS’s backlog recovery plan has committed that “By July 2022, no one will wait longer than two years for an elective treatment”.

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Source: HSJ, 10 February 2022

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Waiting times focus ‘overshadows misconduct’, finds NHSE review

Ambulance trusts have often prioritised capacity and response times over dealing with cases of misconduct, a review of culture in the sector for NHS England has found.

The review says ambulance trusts need to “establish clear standards and procedures to address misconduct”.

The work was carried out by Siobhan Melia, who is Sussex Community Healthcare Trust CEO, and was seconded to be South East Coast Ambulance Service Foundation Trust interim chief from summer 2022 to spring last year.

Her report says bullying and harassment – including sexual harassment – are “deeply rooted” in ambulance trusts, and made worse by organisational and psychological barriers, with inconsistencies in holding offenders to account and a failure to tackle repeat offenders.

She says “cultural assessments” of three trusts by NHSE had found “competing pressures often lead to poor behaviours, with capacity prioritisation overshadowing misconduct management”, adding: “Staff shortages and limited opportunities for development mean that any work beyond direct clinical care is seen as a luxury or is rushed.

“Despite this, there is a clear link between positive organisational culture and improved patient outcomes. However, trusts often focus on meeting response time standards for urgent calls, whilst sidelining training, professional development, and research.”

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Source: HSJ, 15 February 2024

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Waiting lists: 53% wait more than a year to see consultant

According to reports, more than half of patients waiting for a first consultant appointment in Northern Ireland are still waiting longer than a year.

Health Minister Robin Swann has apologised for the long waiting lists, with the Royal College of Surgeons describing the figures as "devastating". Data has revealed 348,867 people are currently  waiting for a first appointment, with fifty-three percent (184,873) found waiting 52 weeks or more. 

"It's not where we want them to be - we don't want people waiting that long because it actually increases demand on our health service the longer people are waiting. This is about changing the direction of the underinvestment, not just in the health service but also in our workforce, so it takes time." Said Mr Swann. 

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Source: BBC News (Northern Ireland), 26 August 2021

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Waiting list jumps as A&E chaos persists

The NHS has recorded its largest monthly increase in the waiting list for 10 months, as unprecedented challenges in urgent and emergency care continue to disrupt recovery.

The elective figures published today for March presented mixed results, but much of the good news – a drop in the number of two-year waiters – had already been announced by NHS England in unvalidated figures for April.

Meanwhile, the system recorded its largest monthly rise in the overall list for 10 months, with the number of patients growing by 174,847 to hit a new record 6.36 million. This is the biggest month-on-month increase since the number jumped between April and May 2021 when it rose by 181,708 to hit 5.3 million.

The overall list has risen every month since May 2021, but the rises in the last four months have all been under 80,000.

The NHS warned in February it expects the waiting list to continue rising until March 2024, with patients now seeking care after various covid lockdowns.

Meanwhile, the number of patients waiting 12 hours from a decision to admit in accident and emergency departments reached a new high in data published today, covering April. 

Ambulance response times also improved slightly last month from March’s all-time low. Average category one performance – for immediately life-threatening conditions, such as cardiac or respiratory arrest - was 9:02 minutes against a seven-minute target, but still an improvement on last month’s 9:35 minutes. 

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Source: HSJ, 12 May 2022

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Waiting list hits new record high as attention shifts to 65-week breaches

The NHS waiting list hit a record 7.3 million incomplete pathways in March, according to new official data, as trust bosses gear up to clear the circa 95,000 patients who have waited over 65 weeks.

NHS England also confirmed in its monthly statistical update that there remained around 10,000 patients on the waiting list who had breached 78 weeks despite a target to clear this cohort by April, as HSJ revealed would be the case in March. It instead hoped these will be cleared by June or July.

Ten trusts are responsible for around half of the 78-week breaches, with Manchester University Foundation Trust recording the most on 969, University Hospitals Leicester Trust reporting 837 and Royal Devon University Healthcare FT on 695.

NHSE chief executive Amanda Pritchard said the NHS “is making great strides on long waits… in the face of incredible pressure [and this] is testimony to the hard work, drive and innovation of frontline colleagues”.

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Source: HSJ, 11 May 2023

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Wait-and-see policy on heart devices puts lives at risk, says UK charity

Patients are needlessly being put at risk of dying from heart problems because they have to wait months to be fitted with lifesaving implantable defibrillators, experts have said.

Two million people in the UK live with coronary heart disease, which is a leading cause of heart failure. Those at the highest risk of dying as a result of heart failure may be offered an implantable cardioverter defibrillator device (ICD). These can kickstart the heart and may save their life.

Patients have to wait at least 90 days before they can be fitted with an ICD while doctors wait to see if stents and medication might improve their health. However, a large study funded by the British Heart Foundation suggests there is little or no benefit to waiting, and the charity says lives are needlessly being put at risk as a result.

Dr Sonya Babu-Narayan, an associate medical director at the BHF, said the results had significant implications.

“The findings suggest that the current ‘wait and see’ approach to find out whether a patient’s heart function improves with medication and stents isn’t always best, and that an unnecessary wait could even be the difference between life and death,” she said.

“The results from this large UK-wide trial could lead to re-evaluation of how best to treat people living with severe heart failure due to coronary heart disease.”

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Source: The Guardian, 11 September 2023

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Vulnerable women are being failed by maternity services, report finds

Current models of maternity care in the UK are failing to reach pregnant women living in adverse social circumstances, research commissioned by the Royal College of Obstetricians and Gynaecologists has found.

Georgina Jones, one of the report’s authors and professor of health psychology at Leeds Beckett University, told The BMJ, “Women are often living in a tangled web of complex inequalities that is beyond their control, and this impacts on the care they receive and the outcomes of that care . . .We’ve really been letting down these women in the way that our maternity and reproductive health services are currently delivered, and strategies and care pathways need to be identified and put in place to remedy this.”

A number of recommendations have been made in the paper including:

  • Understanding it is the vulnerable, minoritised and disadvantaged women in society that have an increased risk of maternal death. These women are often living in an entangled web of complex inequalities that is beyond their control, which impacts on the care they receive and the outcomes of that care.
  • Strategies and care pathways need to be identified and put in place to improve their situation. These women have been let down in the way that our maternity and reproductive health services are currently delivered.
  • We need to find a better way of recording social determinant data. The current way of doing this is inadequate and not fit for purpose, and it doesn’t provide us with enough information to really understand how the complex circumstances of the woman impacts on her maternal outcomes.
  • The research shows current models of care are still failing pregnant women who have lived in adverse social circumstances prior to, during and after pregnancy. Maternal outcomes are particularly poor for socially disadvantaged women affected by pre-existing physical or mental health problems; those who misuse substances; those who have a lower level of education; those who are overweight, undernourished or poorly sheltered; and those who are at increased risk due to the threat of abusive and unsupportive partners, families and peers.

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Source: BMJ, 10 February 2022

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