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GP shortages cause 'unacceptable' patient waits

Family doctors are under intense pressure and general practice is running on empty, warns the Royal College of GPs (RCGP). It says severe staff shortages are causing "unacceptable" delays for patients in England.

In a letter to Health Secretary Matt Hancock, its chairman says ministers must take urgent action to deal with the lack of GPs.

The government said it had recruited a "record number" of GP trainees. Ministers are committed to recruiting 6,000 more GPs in England by 2025.

Prof Martin Marshall, who took over as RCGP chairman in November, says GPs are struggling with an escalating workload, which is causing many to burn out and leave the profession.

Dr Andrew Dharman, who works at the The Avenue surgery in Ealing, said the stress has got worse because of the enormous workload placed on GPs. He said: "Sometimes it feels like you're drowning. You know you're trying to stay afloat and on top of all the workload. And you're trying to make sure you're providing the kind of care that you envisage when you go to medical school."

"You feel frustrated sometimes that you can't necessarily do that because of the amount of work and patients."

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Source: BBC News, 9 January 2020

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Latest HSIB report highlights ‘devastating’ impact of delays and pressure on national glaucoma services

Delays to follow-up appointments for glaucoma patients leaves them at risk of sight loss, the Healthcare Investigation Safety Branch (HSIB) warns in their new report.

The report highlights the case of a 34-year old woman who lost her sight as a result of 13 months of delays to follow-up appointments.

Lack of timely follow-up for glaucoma patients is a recognised national issue across the NHS. Research suggests that around 22 patients a month will suffer severe or permanent sight loss as a result of the delays. In HSIB’s reference case, the patient saw seven different ophthalmologists and the time between her initial referral to hospital eye services (HES) and laser eye surgery was 11 months. By this time her sight had deteriorated so badly, she was registered as severely sight impaired.

The investigation identified that there is inadequate HES capacity to meet demand for glaucoma services, and that better, smarter ways of working should be implemented to maximise the current capacity. The report makes several safety recommendations focused on the management and prioritisation of appointments. 

Helen Lee, RNIB Policy and Campaigns Manager, said: “This report has brought vital attention to a serious and dangerous lack of specialist staff and space in NHS ophthalmology services across the country. We know that thousands of patients in England are experiencing delays in time-critical eye care appointments, which is leading to irreversible sight loss for some."

“Without immediate action, the situation will only continue to deteriorate as the demand for appointments increases. RNIB urges full and immediate implementation of the recommendations set out in this report to improve the capacity, efficiency and effectiveness of ophthalmology services.”

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Source: HSIB, 9 January 2020

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NHS use of puberty blockers legal challenge begins

Legal action is being launched against the NHS over the prescribing of drugs to delay puberty. 

Papers have been lodged at the High Court by a mother and a nurse against the Tavistock and Portman NHS Trust, which runs the UK's only gender-identity development service (Gids). Lawyers will argue it is illegal to prescribe the drugs, as children cannot give informed consent to the treatment.

The Tavistock said it had a "cautious and considered" approach to treatment.

The nurse, Sue Evans, left the Gids more than a decade ago after becoming increasingly concerned teenagers who wanted to transition to a different gender were being given the puberty blockers without adequate assessments and psychological work.

Ms Evans said: "I used to feel concerned it was being given to 16-year-olds. But now, the age limit has been lowered and children as young as perhaps 9 or 10 are being asked to give informed consent to a completely experimental treatment for which the long-term consequences are not known."

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Source: BBC News, 8 January 2020

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Death review backlog still growing despite NHSE commitment

A backlog of thousands of deaths of people with learning disabilities awaiting official review has grown further, despite NHS England committing in spring last year to “address” the buildup. 

Information obtained by HSJ shows the number of incomplete reviews increased slightly between May and November last year – from 3,699 to 3,802.

The “national learning disabilities mortality review” programme – known as LeDeR – was launched in 2016 and is meant to review all deaths of people aged four and over.

Mencap head of policy and public affairs, Dan Scorer, said: “It is unacceptable that thousands of deaths have still not been reviewed despite NHS England announcing further funding to make sure all reviews were carried out quickly and thoroughly. These latest figures show that little progress has been made; the programme is still failing to address outstanding reviews as well as keep pace with incoming referrals."

“Behind these figures are families whose loved ones’ deaths may have been potentially avoidable and they have a right to know that health and care services are learning and acting on LeDeR reviews’ recommendations.”

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Source: HSJ, 8 January 2020

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Hospital wrong to ban woman visiting partner on his deathbed

The partner of a dying man was denied the chance to be at his bedside during his final moments after a hospital wrongly banned her from daily visits, an ombudsman report has found.

Brian Boulton, 70, was admitted to Royal Gwent Hospital in Newport, South Wales, after suffering from a chest infection, which was later diagnosed as aspiration pneumonia caused by oesophageal cancer.

Celia Jones, his “long term life partner” of twenty years, was accused by hospital staff of giving the retired tailor a larger dose of the prescribed furosemide medication than was allowed. Ms Jones, 65, was restricted to one-hour visits twice a week, meaning she was unable to be with him when he died a day after her last authorised visit on Wednesday 27 September 2017.

The Public Services Ombudsman for Wales has upheld her complaints about her “appalling” treatment, ruling that the visiting restrictions were imposed “without warning” and resulted in a “significant injustice”.

It found no record of Ms Jones, a retired nurse, admitting to a senior ward manager that she gave the large dose of medicine to her partner.

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Source: The Telegraph, 6 January 2020

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Anger over UK's failure to ban breast implants linked to 61 cancer cases

At least 61 women in the UK have been diagnosed with a potentially fatal cancer linked to breast implants, but the type they received continues to be used, with no plans by the regulator to follow France and Australia in banning them.

Lawyers for more than 40 of the women, who are bringing legal action against the manufacturers as well as the clinics and doctors who carried out the surgery, say the textured implants linked to anaplastic large cell lymphoma (ALCL) should be withdrawn from the market. Smooth implants are available instead, which have no proven connection to the cancer of the white blood cells.

The Medicines and Healthcare Products Regulatory Agency (MHRA) says the disease is very rare, but Sarah Moore, a solicitor at Leigh Day law firm, believes there are more cases than the regulator is aware of. “I think there has been misdiagnosis and under-diagnosis, and I think we have to bear in mind that in the last 18 months there have been 17 more reported cases of ALCL,” she said.

The leading manufacturer of textured implants, Allergan, has withdrawn them from worldwide sale. In December 2018 its European kitemark for the implants expired – the French agency that had granted certification had asked for extra safety data that the company said it could not provide in time. They have not been on sale in Europe since then. The US authorities asked the company to recall its textured implants in July 2019 and Allergan took them off the market.

France and Australia have since banned the sales of all textured implants, although neither has suggested that women should actively seek to have them removed.

In the UK, other brands of textured implants are still in use. Neither NHS England, the NHS Business Services Authority nor the MHRA could say how many had been given to women in the NHS after a mastectomy for breast cancer.

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Source: The Guardian, 7 January 2020

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Health strike: RCN nurses in second day's strike

About 9,000 nurses across Northern Ireland have begun a 12-hour strike today in a second wave of protests over pay and staffing levels.

More than 2,000 appointments and procedures have been cancelled, including a number of elective caesarean operations.

The Health and Social Care Board said it expects "significant disruption"

Royal College of Nursing (RCN) Director Pat Cullen told BBC Radio Ulster's Good Morning Ulster programme that nurses felt "bullied" by health officials. Her comments followed a warning by the heads of Northern Ireland's health trusts on Tuesday that this week's strikes could push the system "beyond tipping point".

Valerie Thompson, a deputy ward sister at Londonderry's Altnagelvin Hospital, said concerns over safe staffing levels and pay parity had brought her to the picket line.

"We need to have the proper amount of staff to care for our patients, give them the respects, dignity, care they deserve," she said. "We are a loyal workforce; we get on with it, and rally around. But it is difficult. We miss breaks, go home late, staff are just exhausted."

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Source: BBC new, 8 January 2020

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Implementation of safety improvements for the placement of nasogastric tubes

The Healthcare Safety Investigation Branch (HSIB) has launched an investigation looking at nasogastric tubes and how previously identified safety improvements for the placement of these tubes are put into practice.

Nasogastric (NG) tubes are used to deliver fluid, food and medication to patients via a tube that passes through the nose and down into the stomach. There is a risk of serious harm and risk to life if NG tubes are incorrectly placed into the lungs, rather than the stomach, and feed is passed through them.

HSIB has started this investigation after they were notified of a patient who inadvertently had a nasogastric tube inserted into his lung.

Further information

Source: HSIB, 7 January 2020

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Improve brand and batch number recording, urge drug safety professionals

New research from the UK’s Drug Safety Research Unit (DSRU) has found that hospital pharmacists, doctors and nurses only recorded batch numbers for biologic medicines between 38% and 58% of the time during routine hospital practice.

Further, an analysis of spontaneous adverse drug reaction (ADR) reports showed that brand names were only included 38% of the time, while batch number traceability was only 15%.

Because of the study results, the DSRU is encouraging health professionals to improve the recording in order to aid patient safety, suggesting that it has “some way to go to encourage health professionals to record this information.”

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Source: PharmaTimes Online, 7 January 2020

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Hundreds of sexual assaults each year on mixed-gender wards

Hundreds of sexual assaults are reported each year on mixed-sex mental health wards in England, HSJ can reveal, highlighting the urgent need for investment to improve facilities.

New figures obtained by HSJ show there have been at least 1,019 reports of sexual assaults between men and woman on mixed wards since April 2017 to October 2019. This compares to just 286 reports of incidents on single-sex mental health wards over the same period.

Of those reports made on mixed-sex wards, 491 were considered serious enough to refer to safeguarding, and 104 were reported to the police.

The level of incidents still being reported suggests patients are not being protected from sexual assault on mixed wards, despite the issue being highlighted by several national reports in recent years.

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Source: HSJ, 7 January 2020

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Artificial intelligence can accurately diagnose brain tumours within minutes

Artificial intelligence can diagnose brain tumours more accurately than a pathologist in a tenth of the time, a study has shown.

The machine-learning technology was marginally more accurate than a traditional diagnosis made by a pathologist, by just 1%, but the results were available in less than 2 minutes and 30 seconds, compared with 20 to 30 minutes by a pathologist.

The study, published in Nature Medicine, demonstrates the speed and accuracy of AI diagnosis for brain surgery, allowing surgeons to detect and remove otherwise undetectable tumour tissue.

Daniel Orringer, an Associate Professor of Neurosurgery at New York University's Grossman School of Medicine and a senior author, said: “As surgeons, we’re limited to acting on what we can see; this technology allows us to see what would otherwise be invisible to improve speed and accuracy in the [operating theatre] and reduce the risk of misdiagnosis."

“With this imaging technology, cancer operations are safer and more effective than ever before.”

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Source: The Independent, 6 January 2020

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Hywel Dda cancels operations after 'critical pressures'

A health board has cancelled planned operations at four of its hospitals "in the interest of patient safety".

Hywel Dda University Health Board made the decision after "an extraordinary weekend" of "critical pressures". On Monday, inpatient operations were cancelled at Bronglais, Glangwili, Prince Philip and Withybush hospitals in mid and west Wales.

The health board said it had contacted the patients affected and outpatient appointments continued as normal. No decisions have been taken yet to cancel more non-emergency operations on Tuesday, it added.

Dr Philip Kloer, the health board's medical director, said the weekend saw hospitals "at a level of escalation not seen before".

"It is in the interest of patient safety that we have postponed planned operations today," he added.

Plaid Cymru's shadow minister for health, Helen Mary Jones, said the decision to cancel operations was "deeply concerning". She said that patients in Wales "deserve so much better".

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Source: BBC News, 6 January 2020

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Myla’s mum left with ‘soul‑destroying sadness’

Mother Natalie Deviren was concerned when her two-year-old daughter Myla  awoke in the night crying with a restlessness and sickness familiar to all parents. Natalie was slightly alarmed, however, because at times her child seemed breathless.

She consulted an online NHS symptom checker. Myla had been vomiting. Her lips were not their normal colour. And her breathing was rapid. The symptom checker recommended a hospital visit, but suggested she check first with NHS 111, the helpline for urgent medical help. To her bitter regret, Natalie followed the advice.

She spoke for 40 minutes to two advisers, but they and their software failed to recognise a life-threatening situation with “red flag” symptoms, including rapid breathing and possible bile in the vomit.

Myla died from an intestinal blockage the next day and could have survived with treatment.

The two calls to NHS 111 before the referral to the out-of-hours service were audited. Both failed the required standards, but Natalie was told that the first adviser and the out-of-hours nurse had since been promoted. She discovered at Myla’s inquest that “action plans” to prevent future deaths had not been fully implemented. The coroner recommended that NHS 111 have a paediatric clinician available at all times.

In her witness statement at her daughter’s inquest in July, Natalie said: “You’re just left with soul-destroying sadness. It is existing with a never-ending ache in your heart. The pure joy she brought to our family is indescribable.”

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Source: The Times, 5 January 2020

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Toddlers died after NHS 111 helpline said they were not in danger

The NHS 111 helpline for urgent medical care is facing calls for an investigation after poor decision-making was linked to more than 20 deaths.

Experts say that inexperienced call handlers and the software used to highlight life-threatening emergencies may not always be safe for young children. At least five have died in potentially avoidable incidents.

Professor Carrie MacEwen, Chairwoman of the Academy of Medical Royal Colleges, said: “These distressing reports suggest that existing processes did not safeguard the needs of the children in these instances.”

Since 2014 coroners have written 15 reports involving NHS 111 to try to prevent further deaths. There have been five other cases where inquests heard of missed chances to save lives by NHS 111 staff; two other cases are continuing and one was subject to an NHS England investigation.

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Source: The Times, 5 January 2020

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Two-thirds of trusts failing to protect staff from violence

Around two-thirds of NHS providers were found to be breaking laws aimed at protecting staff from violence and aggression, when inspected by the Health and Safety Executive (HSE), information released to HSJ reveals.

The HSE has inspected 37 NHS organisations since April 2018, looking at how they manage risks to staff from violence and aggression, and found 25 of them (67%) were in breach of the law.

It comes amid concern about rising numbers of assaults on NHS and care staff. The HSE has identified that three staff members have been killed by patients or service users in the last five years.

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Source: HSJ, 6 January 2020

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Hospital in bullying claims did not monitor at-risk patients

A hospital accused of bullying its staff is facing new claims that it failed to act on a leading doctor’s warning about a potentially fatal failure to monitor vulnerable patients, the Guardian newspaper can reveal.

Dr Jonathan Boyle, the UK’s top vascular surgeon, had warned West Suffolk NHS trust that patients at risk of dying from burst aneurysms were not being safely monitored. An IT glitch meant that patients were not followed up to see how soon they would need potentially life-saving surgery.

A doctor at the trust, however, says it initially repeatedly refused to take any action, raising further questions about its management.

The trust initially suggested the problem was the result of senior doctors not keeping up with emails, but later accepted its IT systems were at fault. The hospital was forced to recognise that patients were potentially put at risk and took action only after a whistleblower alerted the NHS regulator.

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Source: The Guardian, 5 January 2020

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Surgery patients with deadly sepsis are not getting antibiotics fast enough, NHS audit finds

More than 80% of patients who have signs of a deadly sepsis infection before high-risk surgery are not getting antibiotics fast enough, a major NHS report has warned.

Sepsis kills an estimated 44,000 people in England every year and rapid access to antibiotics within the first hour after diagnosis is vital to halt the infection. However, a review of performance across 179 NHS hospitals has found a majority of patients undergoing emergency bowel surgery are not getting medication early enough. A leak of the bowel can cause sepsis and while antibiotics will help treat the infection, surgery is essential to repair any sepsis-causing leak.

The Royal College of Anaesthetists, which carried out the study for the NHS, said although the number of patients getting surgery in time had improved over the last five years, the numbers receiving antibiotics within an hour had not.

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Source: The Independent, 4 January 2020

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'Outdated' IT leaves NHS staff with 15 different computer logins

IT systems in the NHS are so outdated that staff have to log in to up to 15 different systems to do their jobs. Doctors can find themselves using different logins for everything from ordering x-rays and getting lab results to accessing A&E records and rotas.

The government in England said it was looking to streamline the systems as part of an IT upgrade. Around £40 million is being set aside to help hospitals and clinics introduce single-system logins in the next year.

Alder Hey in Liverpool is one of a number of hospitals which have already done this, and found it reduced time spent logging in from one minute 45 seconds to just 10 seconds. With almost 5,000 logins per day, it saved over 130 hours of staff time a day, to focus on patient care.

Health Secretary Matt Hancock said it was time to "get the basics right". "It is frankly ridiculous how much time our doctors and nurses waste logging on to multiple systems. Too often outdated technology slows down and frustrates staff."

British Medical Association leader Dr Chaand Nagpaul said logging on to multiple systems did waste time. But he said on its own this move would not solve all the problems, pointing out that many of the IT systems themselves were "antiquated" and needed upgrading.

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Source: BBC News, 4 January 2020

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Somerset care home failed to notify health watchdog of deaths

A residential care home failed to notify the health watchdog about the deaths of people they were providing a service to, its report has found.

Kingdom House, in Norton Fitzwarren, run by Butterfields Home Services, was rated "requires improvement". The home cares for people with conditions such as autism. The Care Quality Commission (CQC) said the registered manager and provider lacked knowledge of regulations and how to meet them. Inspectors found the provider failed to notify the CQC about the deaths of people which occurred in the home, as required by Regulation 16 of the Health and Social Care Act 2008.

The report also found people were at "increased risk" because the provider had not ensured staff had the qualifications, competence, skills and experience to provide people with safe care and treatment.

Inspectors did, however, praise the "positive culture" at the home, that is "person-centred", and noted the provider was "passionate about their service and the people they cared for".

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Source: BBC News, 2 January 2020

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Refusing Scottish help a 'grave error' in blood scandal, letter says

Hundreds of people with haemophilia in England and Wales could have avoided infection from HIV and hepatitis if officials had accepted help from Scotland, newly released documents suggest.

A letter dated January 1990 said Scotland’s blood transfusion service could have supplied the NHS in England and Wales with the blood product factor VIII, but officials rejected the offer repeatedly.

Large volumes of factor VIII were imported from the US instead, but it was far more contaminated with the HIV and hepatitis C viruses because US supplies often came from infected prison inmates, sex workers and drug addicts who were paid to give blood but not screened.

The death of scores of people with haemophilia and blood transfusion patients and the infection of thousands of others across the UK in the contaminated blood scandal has been described as the worst health disaster to hit the NHS.

The latest document was released under the Freedom of Information Act to campaigner Jason Evans, whose father died in 1993 having contracted hepatitis and HIV. In it, Prof John Cash, a former director of the Scottish Blood Transfusion Service, said the decision not to use Scotland's spare capacity to produce Factor VIII for England was "a grave error of judgement".

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Source: The Guardian, 3 January 2020

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Nurse shortage forces NHS hospital to shut critical-care bed

An NHS hospital in Norwich has had to close four beds in its high dependency unit because it does not have enough nurses to staff them.

Norfolk and Norwich university hospital (NNUH) decided on Monday to temporarily shut the beds in the Gissing ward of its critical care complex.

The beds, which are used for seriously ill patients, have been shut despite flu and other viruses that circulate at this time of year leaving more patients than usual suffering from breathing problems.

Hospital managers told doctors in an email that: “A decision has been made to temporarily close our GHDU beds and reduce to 20 bed capacity on our CCC [critical care complex] from today as the nursing staffing is insufficient to keep Gissing open.”

The closure is another stark illustration of both the lack of staff in the NHS, which in England has around 100,000 vacancies, and the extra strain winter is putting on hospitals.

NHS bosses warned recently that staff shortages were now so widespread that patients’ safety and quality of care are under threat.

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Source: The Guardian, 31 December 2019

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Woman awarded £8m after doctors left sponge inside her during surgery

A woman has been awarded $10.5 million (£8m) in damages after medical staff left a sponge inside her body.

The sponge – which measured 18-by-18 inches and was left behind during surgery – was inside the woman's body for years before she realised.

It had been left in her body after she underwent heart surgery at a Kentucky hospital in 2011. The bypass surgery is said to have gone wrong, leaving a mess – and as nurses rushed to deal with the problems, the sponge was left inside her body. 

It was not discovered for four years, until she had a CT scan in 2015. In the meantime, the sponge had moved around the woman's body, shifting around her intestines and causing pain as it did so. She had her leg amputated and was left with gastrointestinal issues after the sponge eroded into her intestine.

The patient's lawyers said the case should be a reminder to hospitals to ensure that objects such as needles and other sharp objects, as well as sponges, are removed from patients after surgery.

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Source: The Independent, 1 January 2020

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Supply problems with life-saving IV feed could continue for months, warn NHS bosses

Hundreds of patients have been warned supply problems with the specially made IV feed they need to stay alive is likely to continue for months.

NHS England, which declared a national emergency incident in the summer because of the delays in production of intravenous nutrition, has written to patients warning the problems are far from resolved.

Dozens of patients have been admitted to hospital in the past six months because of the supply shortage, which was sparked in June when the main manufacturer, Calea, based in Runcorn, was hit by overnight restrictions by the Medicines and Healthcare products Regulatory Agency (MHRA).

Since the shortages started the NHS has been forced to fly in feed from other European countries, while some patients have had to switch from their bespoke feed to so-called off-the-shelf bags which don’t contain everything they need in the right quantities. Some hospitals have admitted patients to hospital to make sure they receive what they need because of fears for their health or lack of supplies in the community.

Initially it had been hoped the delays in production would be improved by the end of the year, but in a letter sent to some patients, seen by The Independent, NHS bosses warn patients could be facing many more months of delays.

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Source: The Independent, 1 January 2020

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AI 'outperforms' doctors diagnosing breast cancer

Artificial intelligence is more accurate than doctors in diagnosing breast cancer from mammograms, a study in the journal Nature suggests.

An international team, including researchers from Google Health and Imperial College London, designed and trained a computer model on X-ray images from nearly 29,000 women.

The algorithm outperformed six radiologists in reading mammograms. AI was still as good as two doctors working together.

Unlike humans, AI is tireless. Experts say it could improve detection.

Sara Hiom, director of cancer intelligence and early diagnosis at Cancer Research UK, told the BBC: "This is promising early research which suggests that in future it may be possible to make screening more accurate and efficient, which means less waiting and worrying for patients, and better outcomes."

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Source: BBC News, 2 January 2020

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Woman dies after being set on fire during surgery in Romania

A woman has died after being set on fire during surgery in Romania, the country’s health ministry has said, in a case that has cast a spotlight on the ailing Romanian health system.

The patient, who had pancreatic cancer, died on Sunday after suffering burns to 40% of her body when surgeons used an electric scalpel despite her being treated with an alcohol-based disinfectant.

Contact with the flammable disinfectant caused combustion and the patient “ignited like a torch”, Emanuel Ungureanu, a Romanian politician, said.

A nurse threw a bucket of water on the 66-year-old woman to prevent the fire from spreading. The health ministry said it would investigate the “unfortunate incident”, which took place on 22 December.

“The surgeons should have been aware that it is prohibited to use an alcohol-based disinfectant during surgical procedures performed with an electric scalpel,” the Deputy Minister, Horatiu Moldovan, said.

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Source: The Guardian, 30 December 2019

the hub has a number of posts on preventing surgical fires:

 

 

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