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Testing artificial hip and knee joints 'will save the NHS £200 million a year'... and reduce unnecessary pain for patients in future

Artificial hip and knee joints that have to be removed after failing early are to be examined routinely to save the NHS £200million a year – and reduce unnecessary pain for patients in future.

Less than 1 in 100 removed implants are examined to see why they failed, so surgeons don’t learn what went wrong or pick up on potential scandals.

Consultant orthopaedic surgeon Raghavendra Sidaginamale, of North Tees and Hartlepool NHS Trust, said: "Most removed implants are put in the bin. A wealth of information goes down the drain."

Now the NHS is setting up an Implants Analysis Service, enabling hospitals to send them off to be analysed for signs of unusual wear or chemical degradation.

Each year, 15,000 hip and knee replacements are replaced. If this happens within ten years, they are deemed to have failed early. Jason Wilson, of the IAS, said they are ‘like a black box flight recorder in a plane’, adding: "They hold a wealth of information we can learn from."

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Source: Daily Mail, 29 January 2023

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Testing and contact tracing: a role for local leaders

Local authorities must be at the heart of contact tracing because COVID-19 is best understood as a pattern of local outbreaks rather than a national pandemic, says Sir Chris Ham and Robin Tuddenham in an HSJ article.

Community testing and contact tracing represent our greatest hope for managing the risks to health of COVID-19 until a vaccine and effective treatments become available. Experts in infectious disease base their understanding of this on previous pandemics, and the experience of countries like South Korea and Germany.

Work is underway at pace to resume contact tracking and tracing in England. It is understood that this programme will begin in earnest from 18 May following a pilot on the Isle of Wight. This work is a core part of Matt Hancock’s five-point plan for combating COVID-19, in support of some relaxation of lockdown anticipated soon.

Whilst the pace is understandable, the methods and approach taken are top down, lack an effective role for key regional co-ordination through the Integrated Care Systems/Sustainability and Transformation Partnerships and Local Resilience Forums, and risk marginalising the essential skills of local authorities, GPs and the voluntary and community sector in place, according to Ham amd Tuddenham.

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Source: HSJ, 5 May 2020

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Test and trace system kicks off in England and Scotland

A team of 25,000 contact tracers are making their first phone calls to track down people who will be told to self-isolate under a new scheme in England.

Tracers will text, email or call people who test positive with coronavirus and ask who they have had contact with. Any of those contacts deemed at risk of infection will be told to isolate for 14 days, even if they are not sick.

A test and trace system is also launching in Scotland, where an easing of the lockdown is expected later.

The aim of England's NHS Test and Trace system is to lift national lockdown restrictions and move towards more localised, targeted measures.

The team will start by contacting the 2,013 people who tested positive for the virus on Wednesday.

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Source: BBC News, 28 May 2020

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Test and trace chief warned lack of transparency on performance could ‘destroy confidence’

The head of NHS test and trace has refused to give MPs any data on the first six days of the new service, leading health committee chair Jeremy Hunt to warn that a lack of transparency could “destroy confidence” in its work.

Baroness Dido Harding, who is leading the new effort, said she was working to validate performance data, which relies on people with COVID-19 symptoms isolating and being called by a team of tracers to identify others they have been in contact with.

MPs had wanted to know how many patients had been contacted within 24 hours as well as how many were willing to share their contacts, and the compliance with self-isolation advice.

But Baroness Harding said she would not share the information until the UK Statistics Authority was happy with the data and could ensure it can be trusted. The UKSA criticised the government earlier this week over its public use of test results data.

Chair of the committee and former health secretary Jeremy Hunt said he was “disappointed” with her refusal and said it was hard for the committee to scrutinise services if it did not have the data, which she had been pre-warned it would ask for.

Leaked information on Tuesday suggested only two-fifths of coronavirus patients and one-third of their contacts were identified and contacted by the tracing service.

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Source: The Independent, 3 June 2020

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Terminal cancer: A&E 'wrong place for dying patients'

Palliative and end-of-life care must become a priority in healthcare, a cancer charity has said. Macmillan Cancer Support said emergency departments were not the right places to care for terminally ill people. Their comments come after new research conducted by Macmillan and the NI Cancer Registry at Queen's University.

The report highlights the need for planning and communication around end-of-life care. It also found late diagnosis of cancer to be a problem. Among the research's findings is that three quarters of cancer patients who died in Northern Ireland in 2015 were admitted to A&E at least once in the last year of their lives.

"Emergency departments cannot provide the very specialist care needed by cancer patients", said Heather Monteverde, Macmillan's Head of Service.

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Source: BBC News, 8 August 2019

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Tens of thousands waiting too long for 999 calls to be answered in England

Tens of thousands of emergency calls are taking more than two minutes to be answered in England amid a crisis in the ambulance service, The Independent has learned.

More than 37,000 emergency calls took more than two minutes to answer in April 2022 – 24 times the 1,500 that took that long in April 2021, according to a leaked staff message.

April’s figures were slightly down compared to March, The Independent understands, when 44,000 calls took more than two minutes to answer.

The deterioration in 999 calls being answered within the 60-second goal comes as ambulance services across the UK have been placed under huge pressures.

The latest NHS data showed long delays in response times for ambulance services with stroke or suspected heart attack patients waiting more than 50 minutes on average. Response times are being driven by ambulances being held up outside of A&Es because emergency departments are unable to take patients.

In March, there were likely to have been more than 4,000 instances of severe harm caused to patients as a result of ambulances being delayed by more than 60 minutes.

Martin Flaherty, managing director of AACE said: “It is no secret that UK ambulance services and their staff are under intense pressure, which is further evidence of the need to secure more funding for ambulance services as soon as possible, continue to find more ways to protect and care for our staff, prevent the depletion of our workforce and above all, eradicate hospital handover delays.

“AACE believes that whilst reasons such as overall demand and increasing acuity of patients are certainly contributory factors, the most significant problem causing these pressures remains hospital handover delays. These have increased exponentially and the numbers of hours lost to ambulance services is now unprecedented. For example, in some regions in March, ambulance trusts were losing up to one third of all the ambulance hours they were capable of producing due to hospital handover delays.”

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Source: The Independent, 15 May 2022

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Tens of thousands of operations cancelled because of staff shortages and faulty equipment, NHS figures show

Tens of thousands of people have have had their operations cancelled because of staff shortages and faulty medical equipment, according to newly revealed NHS figures. 

The number of procedures called off by hospitals for non-clinical reasons has increased by 32 per cent in the last two years, the statistics obtained via a freedom of information (FOI) request. Almost 4,000 more were scrapped in 2018 than in 2016.    

 They also show that of the 79,000 operations to be cancelled last year, 20 per cent were scrapped because of staffing issues and equipment failures.

It comes as the staff vacancies continue to put the health service under strain, with the NHS reporting last year it was short of 100,000 staff including, 10,000 doctors and 35,000 nurses.

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Source: The Independent, 5 November 2019

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Tens of thousands of NHS staff off sick because of COVID-19, data reveals

Almost half of all staff absence linked to coronavirus in parts of northern England

Tens of thousands of NHS staff are off sick or self-isolating because of coronavirus, according to data shared with The Independent as the second wave grows.

In some parts of northern England, more than 40% – in some cases almost 50% – of all staff absences are linked to COVID-19, heaping pressure on already stretched hospitals trying to cope with a surge in virus patients. The problem has sparked more calls for wider testing of NHS staff from hospital leaders and nursing unions who warned safety was being put at risk because of short staffing on wards.

Across England, more than 76,200 NHS staff were absent from work on Friday – equivalent to more than 6% of the total workforce. This included 25,293 nursing staff and 3,575 doctors.

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Source: The Independent, 1 November 2020

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Tens of thousands of children to be treated in ‘virtual wards’ at home

Tens of thousands of children will be treated in “virtual wards” to free hospital beds for more critically ill patients under new NHS plans.

The Hospital at Home service will be expanded to include paediatric care in every region of England this month, the health service announced.

As part of the service, clinical teams review patients daily and can provide treatments including blood tests, prescribe medicines or administer fluids through a drip. Ward rounds can include home visits or a video call, and many services use technology such as apps and wearable devices to monitor recovery.

Professor Simon Kenny, the NHS’s national clinical director for children and young people, said: “The introduction of paediatric virtual wards means children can receive clinical care from home, surrounded by family and an environment they and their parents would rather they be — with nurses and doctors just a call away.” 

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Source: The Times. 5 July 2023

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Tens of thousands of children suffering long Covid as experts demand vaccine rollout for all over-12s

A new report has found tens of thousands of children are suffering from Long Covid, with experts worried children will be left vulnerable if the vaccine roll-out does not expand to include the 12-15 year old age group. Experts have also warned herd immunity cannot be achieved without the young people taking the jab. 

"There is no time to waste in getting on with this. We could have had all of this age group [16- and 17-year-olds] vaccinated before September." Said Dr Deepti Gurdasani, an epidemiologist at Queen Mary University London. 

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Source: The Independent, 6 August 2021

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Tennessee hospital faces civil rights investigation over release of transgender health records

Vanderbilt University Medical Center is facing a federal civil rights investigation after turning the medical records of transgender patients over to Tennessee’s attorney general, hospital officials have confirmed. The U.S. Department of Health and Human Services’ investigation comes just weeks after two patients sued VUMC for releasing their records to Attorney General Jonathan Skrmetti late last year.

“We have been contacted by and are working with the Office of Civil Rights,” spokesperson John Howser said in a statement late Thursday. “We have no further comment since this is an ongoing investigation.”

VUMC has come under fire for waiting months before telling patients in June that their medical information was shared late last year, acting only after the existence of the requests emerged as evidence in another court case. The news sparked alarm for many families living in the ruby red state where GOP lawmakers have sought to ban gender-affirming care for transgender youth and limit LGBTQ rights.

The patients suing over the release of their information say VUMC should have removed personally identifying information before turning over the records because the hospital was aware of Tennessee authorities’ hostile attitude toward the rights of transgender people. Many of the patients who had their private medical information shared with Skrmetti’s office are state workers, or their adult children or spouses; others are on TennCare, the state’s Medicaid plan. Some were not even patients at VUMC’s clinic that provides transgender care.

“The more we learn about the breadth of the deeply personal information that VUMC disclosed, the more horrified we are,” said attorney Tricia Herzfeld, who is representing the patients. “Our clients are encouraged that the federal government is looking into what happened here.”

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Source: NBC News, 10 August 2023

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Tennessee Board of Nursing’s unjust decision to revoke nurse’s license

The US Institute for Safe Medication Practices (ISMP) has expressed its shock that the Tennessee (TN) Board of Nursing has recently revoked RaDonda Vaught’s professional nursing license indefinitely, fining her $3,000, and stipulating that she pay up to $60,000 in prosecution costs.

RaDonda was involved in a fatal medication error after entering “ve” in an automated dispensing cabinet (ADC) search field, accidentally removing a vial of vecuronium instead of VERSED (midazolam) from the cabinet via override, and unknowingly administering the neuromuscular blocking agent to the patient.

While the Board accepted the state prosecutor’s recommendation to revoke RaDonda’s nursing license, ISMP doubts that the Board’s action was just, and believe that it has set patient safety back by 25 years.

On September 27, 2019, in a stark reversal of a 2018 decision to take no licensing action against the nurse, the TN Board of Nursing filed disciplinary action against RaDonda that focused on three violations:

  • Unprofessional conduct related to nursing practice and the five rights of medication administration
  • Abandoning or neglecting a patient requiring nursing care
  • Failure to maintain a record of interventions.

During the hearing, RaDonda was given an opportunity to testify and defend herself; however, she never shrank from admitting her mistake. According to her defense attorney, her acceptance of responsibility for the error was immediate, extraordinary, and continuing. However, RaDonda also testified that the error was made because of flawed procedures at the hospital, particularly the lack of timely communication between the pharmacy computer system and the ADC, which led to significant delays in accessing medications and the hospital’s permission to temporarily override the ADC to obtain prescribed medications that were not yet linked to the patient’s profile in the ADC.

Although many questions regarding RaDonda’s alleged failures and the event remain unanswered, the Board still voted unanimously to strip RaDonda of her nursing license and levy the full monetary penalties allowed, noting that there were just too many red flags that RaDonda “ignored” when administering the medication.

The ISMP has asked whether the Board’s action was fair and just in this situation? 

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Source: ISMP, 12 August 2021

 

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Tenfold rise in A&E patients waiting more than 24 hours for a bed

More than 150,000 patients had to wait a day in A&E before getting a hospital bed last year, according to new data.

Freedom of information data compiled by the Liberal Democrats from 73 hospital trusts – about half the total – found that the number of patients forced to wait more than 24 hours in A&E before a bed could be found for them has increased by tenfold since 2019. The majority of those forced to wait were elderly or frail, with two-thirds of the patients over the age of 65.

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Source: Guardian 8 April 2024

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Ten-fold increase in children waiting too long for specialist care

The number of children and young people waiting longer than recommended for admission to a mental health bed has increased nearly ten-fold since last summer, according to figures from one NHS region seen by HSJ.

There has been major concern about worsening mental health of children and young people through the pandemic, but these are thought to be the first official figures to emerge indicating the extent of the growth in waiting times.

Board papers show that, across the NHS’ South East region, from mid-March to mid-April this year, about 50 young people each week were waiting more than the recommended time for admission or transfer into a child and adolescent inpatient mental health unit. Last June, the weekly average was less than six.

The papers show much of the rise was due to eating disorders referrals, which rose from five in June to nearly 30 in early March. However, other specialist services also saw rises.

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Source: HSJ, 25 May 2021

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Telemedicine saves chronic pain patients time and money

Patients who saw a pain medicine specialist via telemedicine saved time and money and were highly satisfied with their experience, even before the COVID-19 pandemic, according to a study presented at the ANESTHESIOLOGY® 2020 annual meeting.

Results of the study confirm many chronic pain patients are confident they will receive good care via telemedicine, while avoiding lengthy commutes and time spent in traffic.

"This era of contactless interactions and social distancing has really accelerated the adoption of telemedicine, but even before the pandemic, patient satisfaction was consistently high," said Laleh Jalilian, M.D., lead author of the study and clinical assistant professor at the University of California, Los Angeles (UCLA).

"Patients who are being evaluated for new conditions may be better off having office visits initially. But once patients establish a relationship with providers, follow-up visits can occur efficiently with telemedicine, while maintaining patient rapport and quality outcomes. We believe 50% of our visits could be conducted via telemedicine."

"Now that telemedicine is more widespread, it may become a valued part of care delivery in chronic pain practices," said Dr. Jalilian. "Clearly many patients benefitted from remote consultations and follow-up appointments using telemedicine. We hope it will encourage policymakers and insurance providers to continue to support these platforms and inspire more innovation in this developing field of research and patient care."

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Source: EurekAlert, 5 October 2020

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Teeth-whitening: Reports of illegal procedures up 26%

Reports of illegal teeth-whitening that could leave patients at risk of health problems including burns or lost teeth have increased, the BBC has found.

General Dental Council (GDC) figures showed a 26% rise in reports last year.

Teeth-whitening can only be performed legally in the UK by professionals registered with the GDC. One beauty school claimed to have provided "thousands" of candidates with illegitimate qualifications, an undercover investigation found. Failure to comply with the requirement to be registered can result in a criminal record and an unlimited fine.

Untrained beauticians using teeth-whitening kits have been known to cause tooth loss, burns and blisters.

Dr Ben Atkins, president of the Oral Health Foundation, said: "When things go wrong in dentistry, they can really go wrong. I've been that dentist with the full back up service when the patient's had that heart attack. It would be catastrophic for the patient and the person who's been trained and told it's legal to do it."

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Source: BBC News, 10 February 2020

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Tees, Esk and Wear Valley NHS Trust prosecuted after three patients died

A mental health trust is to be prosecuted after three patients died in its care.

The Care Quality Commission (CQC) is bringing charges against the Tees, Esk and Wear Valleys (TEWV) NHS Trust.

It is thought they relate to the deaths of Christie Harnett, 17, Emily Moore, 18, and a third person.

The trust is said to have failed "to provide safe care and treatment" which exposed patients to "significant risk of avoidable harm".

Both Christie Harnett and Emily Moore had complex mental health issues and took their own lives.

The CQC said the trust "breached" the Health and Social Care Act, which relates to healthcare providers' responsibility to "ensure people receive safe care and treatment".

In response, a spokesperson for the trust said: "We have fully cooperated with the Care Quality Commission's investigation and continue to work closely with them.

"We remain focused on delivering safe and kind care to our patients and have made significant progress in the last couple of years."

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Source: BBC News, 25 February 2023

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Teen held in hospital for months due to lack of secure children’s home place

A young teenager with complex needs in local authority care has been deprived of their liberty and held in hospital for several months because no secure placement could be found anywhere in England, a family court has heard.

General hospitals are not registered to provide secure accommodation for children in this situation, and do not have the specialist staff required to provide the care and therapeutic input needed.

High court judges have repeatedly raised concerns that children in urgent need of secure accommodation are waiting months to find a place, to the detriment of their mental health.

England has an acute shortage of secure therapeutic placements for children with severe emotional and psychological needs. Government figures published in March show there are just 132 spaces in secure homes for children with urgent and complex needs.

On any given day, about 50 children – twice as many as in the previous 12 months – were seeking a placement. About 30 children – an increase of a third on the previous 12-month period – end up placed hundreds of miles from home in Scotland due to the lack of available secure units in England.

A Department for Education spokesperson said: “All children and young people deserve to grow up in stable, loving homes, and local authorities have a statutory duty to ensure that there are enough places for their looked-after children.

“We are supporting local authorities through providing £259m to maintain capacity and expand provision in secure and open children’s homes.

“This will provide high quality, safe homes for some of our most vulnerable children. It will mean children can live closer to their families, schools, and health services, in settings that meet their needs.”

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Source: The Guardian, 4 October 2022

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Technology can help the NHS, says AstraZeneca boss

The chairman of Covid vaccine giant AstraZeneca has said that investment in technology can help the NHS cut costs.

Leif Johansson said more spending on areas such as artificial intelligence and screening could prevent illness and stop people going to hospital.

The NHS is under severe pressure, with A&E waits at record levels and strike action exacerbating ambulance delays.

Mr Johansson said about 97% of healthcare costs come from "when people present at the hospital".

He said only the remaining 3% is made up of spending on vaccination, early detection or screening.

Mr Johansson told the BBC at the World Economic Forum in Davos: "If we can get into an investment mode in health for screening or prevention or early diagnostics on health and see that as an investment to reduce the cost of sickness then I think we have a much better model over time that would serve us well."

Commenting on the UK, he said: "All countries have different systems and the NHS is one which we have learned to live with and I think the Brits, in general, are quite appreciative about it."

He said he was not talking about "breaking any healthcare systems down". Rather, he said, "we should embrace technology and science".

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Source: BBC News, 23 January 2023

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Teaching trust’s staff ‘utterly rinsed and completely wiped out’ by elective targets

A major London trust’s critical care staff have urged leaders to review elective work targets amid serious concerns over workload, safe staffing and burnout, HSJ  has learned.

In a letter to Guy’s and St Thomas’ Foundation Trust’s board, staff represented by trade union Unite said they had “repeatedly” raised concerns about the provider’s approach to elective work, as well as winter pressures and second wave planning, and the implications this has had for “the health, safety and wellbeing of both staff and patients”. 

The letter — which was also addressed to the trust’s health and safety committee and has been seen by HSJ —  said: “Our primary concern is that the trust’s endeavours, and understandable need to square these circles, may be unrealistic given the current pressures on staffing and the high rates of sickness and burnout the trust is continuing to experience.

“This is especially in critical care, where we are concerned this may compromise patient safety and is already damaging staff wellbeing and morale.”

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Source: HSJ, 18 December 2020

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Teaching trust reviewing decisions made under Letby CEO

A trust which hired the former chief executive of the Countess of Chester Hospital as an interim CEO has launched a review of decisions about safety and whistleblowing taken under his leadership.

Jacqui Smith, chair-in-common at Barts Health and Barking, Havering and Redbridge University Hospitals trusts, made the announcement at a board meeting, following the nurse Lucy Letby’s conviction for murdering seven babies, and attempting to murder six more, during a year-long period between June 2015 and June 2016.

Tony Chambers was Countess of Chester Hospital Foundation Trust CEO for six years from December 2012 to September 2018, and resigned shortly after Letby’s initial arrest. His role – and that of fellow senior managers in Chester – in responding to concerns raised by doctors, has come under intense scrutiny since the verdicts.

Mr Chambers served as BHRUT’s interim chief from January 2020 until August 2021, and Ms Smith told BHRUT’s board: “In the light of concerns, particularly around listening to staff and patients, and given the seriousness of the events, we will undertake a look at the periods of Tony Chambers’ tenure.

“To see whether there are, firstly, any significant decisions taken regarding quality and safety that we need to look at again, and [secondly], checking our log of whistleblowing cases and other concerns to make sure that they have been appropriately followed up."

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Source: HSJ, 8 September 2023

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Targeted screening of diabetic patients ‘could double heart condition diagnoses’

Targeted screening of patients with type 2 diabetes could more than double new diagnoses of heart conditions, a study suggests.

When applied at a larger scale, such an approach could translate into tens of thousands of new diagnoses, researchers believe.

Conditions such as coronary artery disease, atrial fibrillation and heart failure affect millions of people worldwide, causing a large number of deaths and increasing healthcare costs.

Treatments are available that can prevent stroke or acute heart failure, but systematic screening is not currently common practice.

Those living with conditions such as type 2 diabetes or chronic obstructive pulmonary disease (COPD) – a group of lung conditions that cause breathing difficulties – are at high risk of such conditions.

A team of researchers led by Dr Amy Groenewegen, from the University Medical Centre Utrecht in the Netherlands, has developed a three-step screening process to detect conditions in high-risk people at an early stage.

Study author Dr Groenewegen said: “An easy-to-implement strategy more than doubled the number of new diagnoses of heart failure, atrial fibrillation and coronary artery disease in high-risk patients.”

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Source: Independent, 29 August 2023

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Talking Medicines raises £1.1m to scale up AI patient tracking

Talking Medicines, a social intelligence company for the pharmaceutical industry, has secured £1.1 million funding deal to scale up its AI-based platform for measuring patient sentiment.

Tern, an investment company specialising in the Internet of Things (“IoT”), is the lead investor in a syndicated funding round alongside The Scottish Investment Bank, Scottish Enterprise’s investment arm.

Led by CEO Jo Halliday alongside co-founders Dr Elizabeth Fairley and Dr Scott Crae, Talking Medicines will use the funds to support the launch and roll-out of a new AI data platform, which will translate what patients are saying into intelligence by providing a global patient confidence score by medicine. As part of these plans, the business intends to immediately recruit 9 new employees to the NLP data tech team.

Formed in 2013 to create new ways of capturing the voice of the patient, the Glasgow-based firm uses a combination of AI, machine learning and Natural Language Processing (NLP) tech tools to capture and analyse the conversations and behaviours of patients at home, with the aim of transforming big pharma’s understanding of patient sentiment. Through mapping the patient voice from social media and connected devices to regulated medicine information, it is able to build data points to determine trends and patterns of patient sentiment across medicines.

The round brings the total raised by the firm to £2.5m, including three previous seed funding rounds with previous investors including impact investor SIS Ventures and the Scottish Investment Bank. Talking Medicines CEO Halliday, said: “This investment will scale our team and the development of our AI, ML, NLP tech tools to translate what patients are saying into actionable pharma grade intelligence through our global patient confidence score by medicine.”

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Talking about death better than ‘giving aggressive treatments to prolong life’

Death has become “over medicalised” and the public should be encouraged to discuss dying and grief, experts have said.

There's a call for shift in attitude towards palliative care, with more emphasis on compassion and less on giving medication that may prolong pain.

According to a new Lancet commission, an overemphasis on aggressive treatments to prolong life, global inequities in palliative care access, and high end-of-life medical costs have led to millions of people suffering unnecessarily at the end of their life.

The authors also note that the pandemic has made death and dying more prominent in daily life, while health systems have been “overwhelmed” when trying to care for those dying.

People often died alone, with families unable to say goodbye to loved ones or grieve together, the commission said – the effects of which will “resonate for years to come”.

The researchers argue that many people, mainly in low- and middle-income countries, have no access to end-of-life care, and particularly to opioids, while those in high-income countries may be overtreated.

Attitudes towards death and dying should be “rebalanced”, the authors conclude, away from a medicalised approach towards a “compassionate community model”, where families work with health and social care services to care for those dying.

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Source: The Telegraph, 31 January 2022

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