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USA: Dentist found guilty of damaging patients’ teeth to boost profits

A Wisconsin dentist was found guilty of healthcare fraud and other charges after he intentionally damaged his patients’ teeth to boost profits, raking in millions from his scheme.

Scott Charmoli, 61, was convicted of five counts of healthcare fraud and two counts of making false claims about his clients’ treatment last Thursday, according to the Milwaukee Journal Sentinel.

With his sentencing scheduled for June, Charmoli faces up to 10 years for each healthcare fraud charge and a maximum of five years for each of the two other charges.

Prosecutors say that Charmoli had routinely drilled or broken his clients’ teeth on purpose, charging them for additional treatment services to fix the damage he had just done. As a result, Charmoli’s profits ballooned, with the dentist going from making $1.4m and installing 434 crowns in 2014 to $2.5m in 2015, installing over 1,000 crowns, reported the Washington Post.

According to prosecutors, in 2015, Charmoli began pressuring his clients into getting unnecessary crowns, a dental procedure where a tooth-shaped cap is placed on a damaged tooth. Charmoli would drill or break his client’s teeth and send X-rays of the intentional damage to insurance as “before” photos to justify the crown procedures.

One client, Todd Tedeschi, testified that Charmoli pressured him into getting two crowns in one appointment, despite Tedeschi believing that his teeth were fine.

“It seemed excessive, but I didn’t know any better,” said Tedeschi. “He was the professional. I just trusted him.”

Some of the patients that Charmoli badgered into unnecessary procedures were also vulnerable, said prosecutors.

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Source: The Guardian, 16 March 2022

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Focus on acutes has left mental health facing ‘significant uncertainties’ say trust leaders

A large mental health trust has highlighted a lack of additional funding for the sector, in contrast to the £8bn earmarked for acute providers to tackle elective waiting lists.

Tees, Esk and Wear Valleys Foundation Trust expects demand for its services to be 20% higher than pre-covid levels, but says uncertainties around funding could “impede” progress and “wider service sustainability”.

In an interview with HSJ last week, TEWV’s chief executive Brent Kilmurray said: “Quite often, we are facing the challenge of trying to find beds and meet demand. What we’ve seen is an increase in occupancy and an increase in length of stay. And we are relating that to an increase in acuity.

“We really welcome the investment that goes into the long-term plans on the specialist services that are coming through. [But] what we want to do with our work is give greater transparency to the backlogs that have developed and some of the additional pressures.

Asked about the trust’s actions to address multiple concerns around safety and quality, Mr Kilmurray said staffing had improved in forensics, although the vacancy rate is still higher than the trust average, and that a leadership development programme is aiming to improve the culture of the organisation. He said he hopes the CQC “would see significant improvement” when they are inspected again.

He added that “a lot has changed” since the high-profile deaths of two teenagers under the care of the trust, which are subject to an ongoing inquiry

He said: “We will be able to build on the legacy of those young women in terms of the learning that we want to embed within the organisation.”

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Source: HSJ, 16 December 2022

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Ban on home abortions increases risks to women, Government told

Banning home abortions could increase risks to women and waste NHS resources, leading doctors have warned.

The “pills by post” system is set to be dismantled in England by September, having been introduced as a temporary measure at the start of the pandemic.

However, the plans, disclosed by The Telegraph last month, have sparked outrage from medical organisations and women’s groups.

The decision by ministers to return to pre-pandemic abortion systems in England has sparked fierce debate and could be subject to a vote in Parliament on Wednesday.

Writing for The Telegraph, the leaders of the Academy of Medical Royal Colleges, the British Medical Association and the Royal College of Obstetricians and Gynaecologists have urged ministers to reconsider their intentions.

They said that the current system has meant terminations take place earlier in the pregnancy, reducing the risk of complications, and that the most vulnerable women, including domestic abuse victims, are able to get help.

Baroness Sugg of Coldharbour, a former operations chief to David Cameron, said that the UK should “stand strongly against the rollback of women’s rights”. She has also tabled an amendment to the Health and Care Bill seeking to maintain the current system in England.

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Source: The Telegraph, 15 March 2022

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Somerset care home staff continue working with Covid

Some care homes have "no choice" but to allow workers who have Covid to deliver care, a public health official said.

According to Public Health England cases are rising the fastest in Somerset.

As a result, care homes in the county are struggling to safely staff their services and schools are seeing a rise in staff sickness.

Somerset Council said ensuring vulnerable residents received care was "lower risk" than them being infected.

Health officials advised care workers to continue working only if they wore PPE and felt well enough.

Council public health consultant Alison Bell said: "In some cases, we have no choice but to have people who are testing positive delivering care to people in Somerset.

"That risk is actually less than that person not receiving care."

She said the Omicron variant was more transmissible and people were getting re-infected with it, some within a matter of weeks.

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Source: BBC News, 16 March 2022

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‘Cinderella’ postnatal care leaves women ‘forgotten’ after birth

Women and NHS staff have warned that mothers are being “forgotten” after giving birth, with a staff crisis only making matters worse.

Kate, a 32-year-old from Leeds, says she has been left in “excruciating” pain for nine years after horrifying postnatal care.

Other women have told The Independent stories of care ranging from “disjointed” to “disastrous”.

It comes as midwives warn there are “horrendous” shortages in community services, which have prevented women from accessing adequate antenatal and postnatal care.

Mary Ross-Davie, the Royal College of Midwives’ director for professional midwifery, said that with each Covid wave midwifery staffing has been hit worse than the last.

To provide safe care during labour, antenatal and postnatal care, teams are sent into wards putting “huge pressure on care”.

She said this could mean clinicians end up “missing things”, such as women struggling emotionally after birth.

The warnings over poor antenatal and postnatal care come after experts at the University of Oxford said in November there were “stark” gaps in postnatal care, despite the highest number of deaths being recorded in the postnatal period.

Dr Sunita Sharma, lead consultant for postnatal care at Chelsea and Westminster Trust, said that when NHS maternity inpatient staffing overall is in crisis “often the first place staff are moved from is the postnatal ward, which is clinically very appropriate, but it can come at a cost of putting more pressure on postnatal care for other mothers”.

Dr Sharma said postnatal teams were doing their best to improve services but need national drivers and funding to sustain improvement.

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Source: The Independent, 16 March 2022

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Is the CQC giving the NHS an easy ride?

The purpose of Care Quality Commission (CQC) ratings has been a hotly contested question since the creation of the four category classifications in the last decade.

The original idea was to give the public a sense of how good their local hospital was, as well as providing commissioners, system managers and government with an idea of whether the local, regional or national health services they had responsibility for were getting better or worse.

The practicality of the first aim was always questionable given the public’s inability and unwillingness, in most cases, to take their custom elsewhere. The second ran into the lack of desire and/or courage on behalf of most commissioners to challenge their local provider, but it did seem to have traction at the top of the shop.

Jeremy Hunt, told HSJ, once they had been dished out across the sector, that their CQC classification now mattered much more then whether or not it had achieved foundation status or not.

Another function, whether intended or not, was that by splashing “inadequate” and unsafe care on the front pages, in the wake of the Francis report, CQC ratings fuelled a drive to put more staff on the wards (forcing the Treasury to pay for the consequent agency bills and deficits, and curtailing Simon Stevens’ transformation funds).

Whatever your take on their purpose, however, they only make sense if they accurately reflect the state of the service. And the latest data suggests that may not be the case.

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Source: HSJ, 17 March 2022

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Dying patients living longer than expected lose NHS funds

More than 1,300 patients a year are having NHS funding for their palliative care withdrawn after living longer than expected, BBC analysis shows.

Terminally ill or rapidly-declining patients are given fast-track support, allowing them to live outside hospital.

From 2018 to 2021, a total of 9,037 people had this funding reviewed in England and Wales, with 47% of them losing all support.

A further 15% of patients had their continuing healthcare support replaced with the more limited NHS-funded nursing care.

Sandra Hanson was referred to the fast-track pathway of the NHS continuing healthcare scheme in mid-2020, after her needs were judged by a clinician to be "end of life".

She was diagnosed with end-stage dementia, and had been in hospital eight times in the previous year following multiple falls and bouts of pneumonia.

The funding covered the costs of a nursing home, where she suffered fewer falls. But in March 2021, this funding was reviewed by her local Clinical Commissioning Group (CCG).

These assessments, usually undertaken by a multi-disciplinary team including health and social care professionals, consider the severity of a person's needs in areas such as mobility, cognition and behaviour.

Sandra's daughter, Charlotte Gurney, said the family was represented by a social worker they had not previously met, and describes the meeting as "traumatic" as she tried to explain her mum's needs.

"We just felt not listened to... we were treated as if we were trying to swindle the system.

Sandra's support was withdrawn, and she had to be moved to a new nursing home, financed by her husband Malcolm.

Shortly afterwards, she broke her wrist following a fall and injured her face. The family believe had the review correctly identified Sandra's needs and risks, this could have been avoided.

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Source: BBC News, 17 March 2022

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NHSE director calls out trust over ‘speak English’ rule

An ‘outstanding’ London trust has come under fire for asking staff to communicate ‘only in English’ when around other people.

A document published under the ‘trust values’ section of Homerton University Hospital Foundation Trust’s website, says: “I will only communicate in English in the presence of others.”

The document has been widely shared on social media in the last 24 hours, with many criticising the trust for its wording. The document itself is dated 2014, but was reposted by the trust in 2019, and remained on its website as of midday today.

NHS England’s director of equality – medical workforce, Partha Kar, who is also NHSE’s diabetes lead, questioned the document on Twitter. He also said: “I am not aware of any NHS England ‘diktat’ suggesting we must all only speak in English to uphold NHS values.”

It follows a separate notice being posted on Twitter yesterday signed simply by “Matron”, by a doctor who claimed her friend saw it at her “hospital placement”. It seemingly threatened staff with “disciplinary action” if they spoke any other language other than English.

It reads: “English is the only language to be spoken in the ward area – this includes the kitchen. Disciplinary action will be taken against staff who do not comply, including agency and bank.”

The documents have prompted a backlash on Twitter, with many criticising them and raising concerns about racism and inclusivity of staff. NHSE’s chief nursing officer, Ruth May, has publicly queried where the document is from.

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Source: HSJ, 16 March 2022

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IHI's Patient Safety Awareness Week

This week is Patient Safety Awareness Week (13-19 March) and is an annual recognition event intended to encourage everyone to learn more about healthcare safety. During this week, the US Institute for Healthcare Improvement (IHI) seeks to advance important discussions locally and globally, and inspire action to improve the safety of the health care system — for patients and the workforce.

Patient Safety Awareness Week serves as a dedicated time and platform for growing awareness about patient safety and recognising the work already being done.

Find out more here.

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Surgery and cancer care in England will have long delays for years

Patients waiting for surgery and cancer care in England will face long delays for years to come, MPs have warned in a new report that is highly critical of both ministers and NHS bosses.

The already-record 6.1 million-strong waiting list for vital treatment will keep growing and officials are “too optimistic” that plans to tackle it will succeed, the public accounts committee (PAC) said in a report on Wednesday.

“For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow,” it said.

The committee of MPs, which monitors spending across Whitehall, acknowledges Covid-19’s role in contributing to the ballooning backlog and lengthening waiting times. But it singled out years of inaction by the Department of Health and Social Care (DHSC) for particular blame.

Patients waiting for surgery and cancer care in England will face long delays for years to come, MPs have warned in a new report that is highly critical of both ministers and NHS bosses.

The already-record 6.1 million-strong waiting list for vital treatment will keep growing and officials are “too optimistic” that plans to tackle it will succeed, the public accounts committee (PAC) said in a report on Wednesday.

“For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow,” it said.

The committee of MPs, which monitors spending across Whitehall, acknowledges Covid-19’s role in contributing to the ballooning backlog and lengthening waiting times. But it singled out years of inaction by the Department of Health and Social Care (DHSC) for particular blame.

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Source: The Guardian, 16 March 2022

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Javid ‘unconcerned’ as Covid admissions rise 46% in a fortnight

Admissions of covid positive patients to English hospitals are once again rising steadily across England.

The seven day total of new confirmed covid cases in hospitals on 12 March (the latest data available) stood at 9,642. This is 46% higher than the seven day total of 6,612 recorded on 25 February, the day before the current rise began.

Asked on Radio 4’s Today programme yesterday about the rise in Covid infections, health and social care secretary Sajid Javid said there was “nothing in the [covid] data that gives us any cause for concern”.

The Covid admissions figures used include patients who are already covid-positive when admitted, are diagnosed on admission, or are diagnosed while in hospital, so in some cases have caught Covid while in hospital.

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Source: HSJ, 15 May 2022

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Government overseen years of decline in NHS

The government has overseen years of decline in cancer care and non-urgent hospital services in England, MPs say.

The House of Commons Public Accounts Committee said services had started deteriorating long before the pandemic. It pointed out key targets had not been met since 2016 and the pandemic had just exacerbated the problems.

But ministers said they were investing extra money and creating more capacity to treat patients, to address the backlog that had now developed.

More than six million people are currently on a hospital waiting list - one in nine of the population - the highest figure on record. This includes people waiting for operations such as knee and hip replacements.

Meanwhile, just two-thirds of urgent cancer patients start treatment within the target time of 62 days. And the number of referrals for cancer care has dropped by between 240,000 and 740,000 since the pandemic started.

The MPs said people would face serious health consequences because of delays in cancer treatment, with some dying earlier.

The government is also accused of failing to recognise staffing the health service remains its biggest problem.

The MPs said the workforce was crippled by shortages and exhausted by two years of the pandemic.

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Source: BBC News, 15 March 2022

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Pregnant women should be asked how much they drink

Pregnant women should be asked how much alcohol they are drinking and the answer recorded in their medical notes, new "priority advice" for the NHS says.

The advice, from the National Institute for Health and Care Excellence (NICE), is designed to help spot problem drinking that can harm babies.

Infants with foetal alcohol spectrum disorder (FASD) can be left with lifelong problems. The safest approach during pregnancy is to abstain from alcohol completely.

The more someone drinks while pregnant, the higher the chance of FASD - and there is no proven "safe" level of alcohol.

But the risk of harming the baby is "likely to be low if you have drunk only small amounts of alcohol before you knew you were pregnant or during pregnancy", the Department of Health says.

An earlier draft of the recommendations for NHS staff in England and Wales suggested transferring data on a woman's alcohol intake to her child's medical notes - but this has now been dropped, following concern women who needed help might hide their drinking.

The Royal College of Midwives spokeswoman Lia Brigante said: "As there is no known safe level of alcohol consumption during pregnancy, the RCM believes it is appropriate and important to advise women that the safest approach is to avoid drinking alcohol during pregnancy and advocates for this.

"We are pleased to see that the recommendation to record alcohol consumption and to then transfer this to a child's record has been reconsidered.

"This had the potential to disrupt or prevent the development of a trusting relationship between a woman and her midwife."

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Source: BBC News, 16 March 2022

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Scientists link ‘severe’ Covid-19 to long-term mental health problems

People who suffer from severe Covid-19 symptoms are more likely to have long-term mental health problems, a new study suggests.

Higher rates of depression and anxiety have been found in people who were “bedridden” with Covid-19 for more than seven days last year, according to a study published in the Lancet.

Scientists, drawing on data from 247,249 people across the UK, Denmark, Estonia, Iceland, Norway and Sweden, found that people with coronavirus who were not admitted to hospital were more likely to experience symptoms of depression up to 16 months after diagnosis, compared to those never infected.

However, over 16 months, patients who were bedridden for seven days or more were between 50 and 60% more likely to experience higher levels of depression and anxiety compared to people never infected during the study period, the researchers found.

Overall, people diagnosed with Covid-19 had a higher prevalence of depression and poorer sleep quality compared with individuals who were never diagnosed – 20% of those in the former group experienced symptoms of depression, versus 11% in the latter group.

Researchers suggested patients who spent longer in bed or had higher depression or anxiety rates could be suffering from ill health due to a combination of worrying about long-term health effects and Covid symptoms persisting.

Patients with severe Covid often experience inflammation, which has previously been linked to chronic mental illness, particularly depression.

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Source: The Independent, 15 March 2022

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Lateral flow tests could cost care home visitors £73 a month

Lateral flow tests could cost care home visitors £73 a month, a leading UK charity has said, as it renewed calls to keep the devices free in such settings.

The government has previously announced that free testing for the general public will end from 1 April, and that this will include care home visitors.

However, charities have warned the shift away from free tests could place a heavy financial burden on those visiting care homes, where testing is still advised.

James White, the head of public affairs and campaigns at the Alzheimer’s Society, said the proposed charge on lateral flow tests for visitors to care homes was a cruel tax on care.

“Over the past two years, we’ve consistently heard many tragic stories from families struggling to visit their loved ones in care homes. For many people with dementia, this isolation has led to a significant deterioration in their condition and mental health,” he said.

“With infection rates rising once again, the government must provide free lateral flow tests for all visitors to care homes so that families are not put in an agonising position where they are forced to ration visits, leaving people with dementia once again isolated and alone.”

Caroline Abrahams, Age UK’s charity director, said: “No one should have to pay out of their own pocket for tests in circumstances where the expert advice is clear that testing remains an important safeguard against Covid,” she said.

“If care home visitors are going to continue to be asked to keep testing to protect their loved ones, it would be completely unacceptable to expect them to pay.”

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Source: The Guardian, 15 March 2022

Further reading

Visiting restrictions and the impact on patients and their families: a relative's perspective

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Covid-19: Countries in the Americas are warned not to lower their guard

Covid-19 is on the retreat across the American continents but it is too early for the region to let its guard down, warned the Pan American Health Organisation, the World Health Organization’s regional office for the Americas, on 9 March.

Reported cases of Covid-19 fell by 26% in the past week and deaths by nearly 19%, as the omicron wave of infections tailed off. But ongoing transmission and future variants could expose the region’s public health priorities once more, said PAHO’s director, Carissa Etienne.

A total of 2.6 million people have died from Covid-19 in the Americas, the highest number of any region of the world and almost half of the global total, despite being home to only 13% of its population. “This is a tragedy of enormous proportions, and its effects will be felt for years to come,” said Etienne on the second anniversary of the pandemic.

Patchy vaccination coverage has left countries vulnerable to current and future variants of SARS-CoV-2. Around 248 million people in Latin America and the Caribbean are yet to receive a single dose of a covid vaccine, with vaccination rates particularly low in hard-to-reach rural areas.

In the first two months of 2022 the Americas accounted for 63% of the world’s new cases. Despite a general fall in incidence across the region, new cases rose by 2.2% in the Caribbean, while Bolivia and Puerto Rico reported an increase in deaths in the past week.

Michael Touchton, head of the University of Miami’s Covid-19 policy observatory for Latin America, said, “Latin America is perhaps the most vulnerable region in the world to the emergence of a new variant. Vaccine delays have a greater impact in Latin America due to concentrated urban populations, chronic disease burden, and low capacity health systems. Taken together, Latin America is likelier to fare worse than other similarly low and middle income regions.”

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Source: BMJ, 14 March 2022

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Archie Batten: Inquest hears baby's mother was turned away from maternity unit

The parents of a baby boy who lived for just 27 minutes have told an inquest they were "completely dismissed" throughout labour.

Archie Batten died on 1 September 2019 at the Queen Elizabeth the Queen Mother Hospital (QEQM) in Margate, Kent.

His inquest began on Monday at Maidstone Coroner's Court. The East Kent Hospitals University NHS Foundation Trust has already admitted liability and apologised for Archie's death.

The coroner heard Archie's mother Rachel Higgs was frustrated at being turned away from the maternity unit in the morning, when she had gone to complain of vomiting and extreme pain.

She was told she was not far enough into labour to be admitted. 

She returned home to Broadstairs with her partner Andrew Batten, but continued to feel unwell so phoned the hospital. She was told the unit was now closed.

Instead, two community midwives were sent to their home, where they attempted to deliver the baby but could not find a heartbeat.

Andrew Batten told the inquest the midwives looked "terrified," and that there was "an air of panic", with the midwives whispering in the hallway instead of telling him and Ms Higgs what was happening.

Under examination from the family's barrister Richard Baker, Victoria Jackson, the midwife who had originally seen Ms Higgs, admitted the high number of patients she was having to deal with had affected her ability to spend time with her.

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Source: BBC News, 14 March 2022

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USA: Drop boxes are making it easier to get rid of old medication

What do you do with bottles of expired or no-longer-needed medications? That’s a problem, according to Elizabeth Skoy, an associate professor at North Dakota State University’s School of Pharmacy in the USA.

“In recent years, there’s been a spotlight on medication disposal, because of the opioid epidemic,” she said. “It’s important to get rid of any medication when you are done with it to prevent misuse or having it fall into the hands of others.” Plus, having old medications in the home increases the chances of accidental poisoning of children or pets.

But while many of us might be aware that we shouldn’t toss pill bottles in the trash or flush medication down the toilet, we’re less knowledgeable about safe alternatives. And there haven’t been many options beyond the USA's Drug Enforcement Administration’s semiannual National Prescription Drug Take Back Day.

In the past decade, however, pharmacies, hospitals and law enforcement agencies have been stepping up to help clean out medicine cabinets year-round. One of the most accessible solutions is medication collection bins, which are being added to convenient locations such as retail stores, health clinics, police stations and other easily accessed sites.

“We decided in 2016 we wanted to be part of the solution,” said Kurt Henke, ambulatory pharmacy manager for Colorado’s Denver Health hospital system, which has collection bins in each of its eight pharmacies. Drugstore chain CVS began putting units in police departments in 2014 and adding them to its more than 9,000 retail locations in 2017; so far it has deployed more than 4,000 of the bins. States are taking the initiative, as well. In North Dakota the state’s Board of Pharmacy provides MedSafe, a take-back box, to any pharmacy that wants one; at this point, about 120 are participating.

The DEA maintains a searchable database of controlled-substance collection sites. Simply type in your Zip code or city to find the nearest one.

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Source: The Washington Post, 15 March 2022

 

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Ukraine: GPs get updated guidance on treating refugees and returning citizens

GPs have received updated guidance on providing healthcare to people coming from Ukraine.

In a bulletin to general practices on 10 March notifying them of the update from the Office for Health Improvement and Disparities, NHS England said that the health service was starting to see refugees and citizens returning from Ukraine and reminded practices that proof of identity is not required for registration at a practice.

The guidance advises practices to explain to people coming from Ukraine how the NHS works and their entitlements to healthcare, to ensure that they are up to date with the UK immunisation schedule, and to ask about any travel plans they may have to visit friends and relatives in their country of origin.

GPs are also advised to:

  • Screen all new entrants, including children, for tuberculosis
  • Ascertain any risk factors for hepatitis B infection that may indicate the need for screening (owing to its low prevalence in the UK)
  • Consider screening for hepatitis C, because of a considerably higher prevalence in Ukraine than in the UK
  • Ensure that travellers are offered typhoid immunisation and advice on preventing enteric fever
  • Consider nutritional and metabolic concerns (anaemia, vitamin D, vitamin A, iodine)
  • Work with a professional interpreter where language barriers are present
  • Consider the effects of culture, religion, and gender on health
  • Assess for mental health conditions, and
  • Refer pregnant women to antenatal care.

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Source: BMJ, 14 March 2022

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Private hospital rated ‘inadequate’ again amid safety concerns

A privately run mental health hospital put in special measures last year has been rated “inadequate” again following a fresh Care Quality Commission inspection.

Inspectors raised serious concerns about unsafe ward environments and staff not managing patient risks at the Priory Hospital Arnold, which has beds commissioned by Nottinghamshire Healthcare Foundation Trust.

Inspectors said that while the leadership team was experienced, the registered manager had been in post since April last year and the improvements they had made “had not been fully embedded”.

The registered manager had changed after the service was placed in special measures.

Ligature risks were found in patients’ bathrooms despite the provider making “some progress” and undertaking “substantial work” to remove them, the CQC said.

And in one instance, a patient had tried to harm themselves with a plastic bag which was a restricted item on the ward. 

CQC head of hospital inspection for mental health and community services Craig Howarth said staff “had not followed the patient’s risk assessment” and had not searched the patient on their return from a visit off the ward.

He added: “It was also concerning that despite rotas showing enough staff were available across the hospital, staff gave examples of when a lack of staffing had impacted on patient care and safety.

“Despite the measures in place, the risks to patients were not reduced and there was evidence of incidents of harm to patients.”

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Source: HSJ, 15 March 2022

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791 medical graduates could miss out on NHS junior doctor training

The highest ever number of medical students have been told there are no places for them this year, despite the health service’s crippling shortage of medics.

The risk that young would-be doctors may not be allocated to start their training at a hospital in the UK has sparked concern among the medical students affected, as well as medical organisations.

Pressure is growing for action to close the gap between the number of training places available across the NHS and the number of graduates seeking one, so medical talent is not wasted and hospitals hire as many fresh recruits as they can to help tackle the widespread lack of medics.

Doctors are worried that the mismatch between demand for and supply of training places will lead to the NHS missing out on medics it sorely needs and that some of those denied a place will either go to work abroad instead or give up medicine altogether. The most recent official figures showed that the NHS in England is short of almost 8,200 doctors.

Dr Dustyn Saint, a GP in Norfolk, tweeted the health secretary, Sajid Javid, about the situation, saying: “Sajid Javid sort this out! You know how much general practice needs these people in a few years, standing by and doing nothing is inexcusable.”

Another doctor said: “It’s bonkers that 800 would-be doctors could be denied training places at a time when the NHS in England is short of 8,200 doctors.”

The British Medical Association has voiced concern about the large number of unallocated medics. “Now we have a situation where a record number are left with unnecessary uncertainty about where they are headed this August,” said Khadija Meghrawi, the co-chair of its medical students committee. “In a time where student mental health is declining, this additional source of uncertainty and stress is particularly unfair.”

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Source: The Guardian, 15 March 2022

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Keeping electives on same site as A&E is ‘optimal’, says CEO

The chief executive of three NHS trusts says ringfencing elective care within an acute hospital site is potentially more ‘productive’ than sending it to a separate ‘cold’ site.

Glen Burley, who leads a “provider group” in the West Midlands, says his trusts have been grappling with the challenge of how to maximise elective activity without it being disrupted by emergency pressures.

The conventional view – as outlined in the NHS long-term plan – is that performing more elective care on a separate site from emergency can help ensure theatre lists are not disrupted.

But George Eliot Trust, which has been led by Mr Burley since 2018 and only has a single district general hospital, has created a “ringfenced” elective hub within the site.

In an interview with HSJ, Mr Burley said: “So I actually think the most productive model in the NHS is if you can pull that off.

“If you can actually protect your elective capacity and offer it on the same site [as] urgent care, so the clinicians are not having to move between sites, you’ve got optimal productivity.

“The challenge right across the NHS has been avoiding that spillage, of emergency care into your elective capacity.

“As you get busier and you escalate… the order in which you encroach into areas that you should not encroach into, is really key in that. We are saying we are going to protect our elective beds in a way that we haven’t done before."

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Source: HSJ, 14 March 2022

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England mental health referrals at 4.3 million high

The number of referrals for specialist NHS mental health care reached a record high in England by the end of 2021, an analysis suggests.

The Royal College of Psychiatrists says the pandemic has led to unprecedented demand and backlogs and services are struggling to keep up.

There were 4.3 million referrals, for conditions such as anxiety and depression, in 2021, NHS Digital says. Just under a quarter - 1.025 million - were for children or adolescents.

The college said the NHS had delivered 1.8 million mental health consultations in December 2021, but an estimated 1.4 million people were still waiting for treatment.

And hundreds of adults were being sent far from home for treatment because of a lack of beds in their area.

President Dr Adrian James said: "As the pressure on services continues to ratchet up, the silence from government continues to be of grave concern for the college, the wider mental health workforce and, most importantly, our patients.

"The warning of the long tail of mental ill health caused by the pandemic has not been heeded.

"Many thousands of people will be left waiting far too long for the treatment they need unless the government wakes up to the crisis that is engulfing the country.

"Staff are working flat out to give their patients the support they need but the lack of resources and lack of staff mean it's becoming an impossible situation to manage...

"...We need a fully funded plan for mental-health services, backed by a long-term workforce plan, as the country comes to terms with the biggest hit to its mental health in generations."

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Source: BBC News, 15 March 2022

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‘The real thing’: Delta-Omicron hybrid identified for first time

A newly-discovered Covid variant that combines mutations from both Omicron and Delta is “the real thing,” scientists have said.

Earlier in the year, concern was raised after a lab in Cyprus claimed to have found evidence of a Delta-Omicron recombination event – when the two variants co-infect a patient and exchange genetic material to produce a new viral offspring – but experts said the findings were false.

Now, however, virologists from L’Institut Pasteur in Paris have sequenced the genome of a genuine “Deltacron” variant, which has been detected in several regions of France and appears to have been circulating since early January.

“This one is legit,” said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford. “[It is] one to keep an eye on.”

“The French cluster appears to be a validated occurrence where a recombination event has given rise to a virus fit enough to circulate,” said Dr Stephen Griffin, a virologist at the University of Leeds.

In deriving its spike from Omicron, the Deltacron variant could similarly target the upper respiratory pathway, rather than the lungs, Dr Griffin said. “At the same time, there are some parts of Omicron thought to lessen severity that are missing from the recombinant,” he said.

Dr Griffin said: "This is another clear demonstration that we remain in a dynamic situation with respect to Sars-2, and that the maintenance of genetic surveillance and testing is both relevant and prudent."

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Source: The Independent, 11 March 2022

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Chronic UTI infections: NHS finally recognises debilitating condition exists in online advice for patients

The NHS has publicly recognised that chronic urinary tract infections (UTIs) exist and has updated its advice for patients following pressure from campaign groups.

For many patients who develop a UTI, their experience is extremely painful but short-lived. But for thousands of others, a one-off acute attack turns into a chronic infection that dominates their lives and lasts for months or even years.

NHS Digital updated its website to last week to provide information around chronic bladder infections where previously there was none.

Campaigners say this is a “huge step forward” but there is still a long way to go in improving testing and treatments for the condition. 

Chronic UTI sufferer Leah Herridge has been pushing for the change alongside Chronic Urinary Tract Infection Campaign (CUTIC) and Bladder Health UK.

The NHS website’s Cystitis page has been updated to include mentions of chronic UTI and to acknowledge that current tests may not pick up these infections. 

Previously, the NHS made no mention of chronic UTIs, meaning GPs and even consultants would often default to misdiagnosing patients with interstitial cystitis.

Specialists say the infections, which often begin as an acute bout of cystitis, can occur when bacteria become embedded within the bladder wall and become difficult to treat with short courses of antibiotics.

“People tend to think chronic means really bad. What it means is everlasting,” said Carolyn Andrew, from CUTIC.

In August 2021, Ms Herridge sent a letter to NHS Digital demanding the web page be updated. The campaign was backed by CUTIC and Bladder Health UK as well as 100 other chronic UTI sufferers who also wrote letters.

“NHS Digital has actually been really, really fantastic at working with us and I do feel like they have really co-produced, certainly the interstitial cystitis page with the leading professionals in the area, the charities and myself,” said Ms Herridge.

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Source: iNews, 14 March 2022

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