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Trust’s A&E ‘effectively running primary care service’, says chair

An acute trust chair has said its emergency department is effectively operating as a primary care service. 

Hattie Llewelyn-Davies, who has chaired The Princess Alexandra Hospital Trust since late 2021, told HSJ: “We’ve done an awful lot of changes in the way we run out A&E and same day emergency care service to try and get the flow through working better…

“We have particular problems with the Princess Alexandra because we are right in the middle of Harlow. And we have a GP service and primary care service which is under massive pressure. We have very high levels of deprivation in Harlow.

“When somebody is sick in Harlow and can’t get a doctor’s appointment on the spot, they walk into us. We have a very high level of people coming in, so a very high level of footfall but a very low level of admissions.

“We are therefore running effectively a primary care service through our A&E.”

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Source: HSJ, 15 May 2023

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Hepatitis C home test kits available to most-at-risk in England

Home test kits for a virus which attacks the liver are now available to order online in England, as the NHS tries to reach those needing treatment.

Hepatitis C tends to affect current or past drug users and people who have had contact with infected blood through a tattoo or medical procedure abroad.

It can lead to liver disease and cancer, but symptoms often go unnoticed for many years.

The NHS website says it can usually be cured by taking a course of tablets.

More than 70,000 people are thought to be living with the virus in England. Some may not know they have it, so would be unlikely to go to their GP for a test.

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Source: BBC News, 13 May 2023

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Nurses ‘fear being taken to court’ over degrading treatment of patients in corridors

Nurses fear they could be taken to court or struck off over the level of care they are able to give to patients, a union has warned, as the NHS stands on the brink of six more months of strikes.

The Royal College of Nursing, one of the two unions to turn down the recent government pay offer to NHS staff, revealed that over nine in 10 A&E nurses had raised concerns that patients may be receiving unsafe care and that patient dignity, privacy and confidentiality is compromised.

Six in 10 fear they will be struck off the nursing register or have a court case brought against them as a result of patient harm due to their working conditions, the RCN said.

Ms Cullen insisted that patient safety is “at the centre of everything that we do” but warned that it “cannot be guaranteed on any day of the week”, given it is missing 47,000 nurses “every single day and night”.

Speaking before its annual congress in Brighton, which begins on Monday, some nurses described themselves as “broken” and feeling “suicidal”, with corridor treatment being deemed “degrading for patients” and as “destroying staff morale”.

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Source: The Independent, 15 May 2023

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Quarter of people with dementia symptoms delay seeing doctor

Almost a quarter of people with dementia symptoms waited more than six months before seeing a doctor, new research shows.

A new survey for the Alzheimer’s Society to mark Dementia Action Week also found one in three people who notice they or a loved one has symptoms keep their fears to themselves or dismiss them as old age.

Just 15% of the 1,137 people surveyed raised the issue straight away and 11% said they hadn’t raised concerns after first spotting symptoms.

Kate Lee, chief executive of the Alzheimer’s Society, said: “We can’t continue to avoid the ‘d’ word – we need to face dementia head-on.

“As soon as you realise something is not right, come to Alzheimer’s Society – you can use our symptoms checklist to help have that all-important first chat with your GP.”

An early diagnosis is crucial to help manage symptoms, according to the charity, which has launched a new campaign called – It’s not called getting old, it’s called getting ill – to encourage people to seek support in getting a diagnosis.

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Source: The Independent, 15 May 2023

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Baby heart death parents left waiting 14 months for answers

Grieving parents have been left waiting more than 14 months for answers about why their 12-day-old son died.

Elijah was born at Merthyr Tydfil's Prince Charles Hospital on 25 February 2022 and died after being diagnosed with enterovirus and myocarditis.

Joann and Christian Edwards said they were told they would have a report by the end of 2022, but are still waiting.

Joann and Christian, from Mountain Ash, Rhondda Cynon Taf, said they were told Elijah's myocarditis was a "one off" but subsequently read about 10 babies, including one who died, getting severe enterovirus with myocarditis across south Wales.

Public Health Wales (PHW) said Elijah's death was not being looked into as part of an investigation into this cluster of cases, as the dates were set at June 2022 to April 2023 to coincide with the enterovirus season.

But it said it would look to include Elijah's death as part of a "wider clinical investigation" of the cases.

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Source: BBC News, 15 May 2023

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Warnings over NHS data privacy after ‘stalker’ doctor shares woman’s records

The confidentiality of NHS medical records has been thrown into doubt after a “stalker” hospital doctor accessed and shared highly sensitive information about a woman who had started dating her ex-boyfriend, despite not being involved in her care.

The victim was left in “fear, shock and horror” when she learned that the doctor had used her hospital’s medical records system to look at the woman’s GP records and read – and share – intimate details, known only to a few people, about her and her children.

“I felt violated when I learned that this woman, who I didn’t know, had managed to access on a number of occasions details of my life that I had shared with my GP and only my family and very closest friends. It was about something sensitive involving myself and my children, about a family tragedy,” the woman said.

The case has prompted warnings that any doctor in England could abuse their privileged access to private medical records for personal rather than clinical reasons.

Sam Smith, of the health data privacy group MedConfidential, said: “This is an utterly appalling case. It’s an individual problem that the doctor did this. But it’s a systemic problem that they could do it, and that flaws in the way the NHS’s data management systems work meant that any doctor can do something like this to any patient.

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Source: The Guardian, 14 May 2023

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Patient safety at risk in crumbling hospital Boris Johnson promised to replace

Patients, doctors and nurses are enduring constant ward closures and flooding in “dilapidated and unpleasant” buildings because a new hospital promised by the government has still not been delivered, one of its most senior medics has warned.

Patient safety could soon be at risk unless the replacement for St Helier Hospital, in south London, is finally confirmed by ministers, according to the outgoing chief medical officer of its NHS trust. Some of the buildings pre-date the NHS, while wards have been shut due to sinking foundations.

Writing in the Observer, Dr Ruth Charlton, the chief medical officer of Epsom and St Helier University Hospitals NHS Trust, warns:

“Right now, we are delivering safe care – but it’s not easy in such a dilapidated and unpleasant environment, and I fear we won’t be able to provide the level of care we’d like to – or should be – for much longer,” she writes. “Our patients and our staff deserve so much better than this current state – where wards are being shut down because the foundations are sinking, and floods and leaks are a certainty every winter.

“Every day we wait costs money, and each year we have to spend more and more on updating our old, rundown buildings – diverting scarce resources from the front line … there’s no other option. We must progress our plans to build our new hospital and make improvements to our existing sites.”

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Source: The Guardian, 13 May 2023

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ADHD: Private clinics exposed by BBC undercover investigation

Patients are being offered powerful drugs and told they have attention deficit hyperactivity disorder (ADHD) after unreliable online assessments, a BBC investigation has discovered.

Three private clinics diagnosed an undercover reporter via video calls. But a more detailed, in-person NHS assessment showed he didn't have the condition.

Panorama spoke to dozens of patients and whistleblowers after receiving tip-offs about rushed and poor-quality assessments at some private clinics, including Harley Psychiatrists, ADHD Direct and ADHD 360.

The investigation found that:

  • Clinics carried out only limited mental health assessments of patients.
  • Powerful drugs were prescribed for long-term use, without advice on possible serious side effects or proper consideration of patients' medical history.
  • Patients posting negative reviews were threatened with legal action.
  • The NHS is paying for thousands of patients to go to private clinics for assessments.

Commenting on Panorama's findings, Dr Mike Smith - an NHS consultant psychiatrist - said he was seriously concerned about the number of people who might "potentially have received an incorrect diagnosis and been started on medications inappropriately".

"The scale is massive."

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Source: BBC News, 

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Medicines courier Sciensus was warned it was failing patients three years ago

The boss of a private healthcare company exposed by the Guardian for putting seriously ill children and adults at risk was warned it was failing patients three years ago.

Darryn Gibson, the chief executive of Sciensus, Britain’s biggest medicines courier, was told in November 2020 that patients with bleeding disorders were being left dangerously exposed to internal bleeding with little or no treatment at home as a result of botched, delayed or missed deliveries.

Gibson received the written warning from Kate Burt, the chief executive of the Haemophilia Society, a leading health charity, after she had become outraged at how vulnerable patients were being let down.

Sciensus blamed IT issues and promised action. However, three years later, patients remain at “very serious” risk of harm because of “recurring” problems with the company, Burt said.

“We continue to receive complaints about missing, incomplete or inaccurate deliveries and are very concerned to see the same issues recurring, indicating that far more needs to be done to improve Sciensus’s ordering and delivery systems,” she said.

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Source: The Guardian, 12 May 2023

 

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Children’s surgery waiting lists hits record high as NHS fails to tackle spiralling backlog

Hospitals are failing to tackle spiralling children's surgery waiting lists as the backlog hits more than 400,000 for the first time.

Leaked documents show children’s waiting lists for both inpatient and outpatient care are “increasing at double the rate of adults” and, despite efforts, services have failed to catch up after they were paused during the pandemic.

NHS leaders have repeatedly raised concerns about the backlog amid warnings that services for young people have been “deprioritised” to cut adult lists.

One NHS leader warned that the long waits would be likely to affect some children’s “ability to lead full and active lives” and worsen existing inequalities between adult and children’s care.

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Source: The Independent, 11 May 2023

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Artificial intelligence could ‘transform’ heart attack diagnosis, scientists say

Artificial intelligence (AI) could be “transformational” in improving heart attack diagnosis to reduce pressure on emergency departments, a new study suggests.

Doctors could soon use an algorithm developed using AI to diagnose heart attacks with better speed and accuracy than ever before, the research from the University of Edinburgh indicates.

It could also help tackle dangerous inequalities in diagnosing the condition, scientists suggest.

Researchers found that, compared to current testing methods, the algorithm called CoDE-ACS was able to rule out a heart attack in more than double the number of patients, with an accuracy of 99.6%.

Nicholas Mills, British Heart Foundation (BHF) professor of cardiology at the Centre for Cardiovascular Science, University of Edinburgh, who led the research, said: “For patients with acute chest pain due to a heart attack, early diagnosis and treatment saves lives.

“Unfortunately, many conditions cause these common symptoms, and the diagnosis is not always straight forward.

“Harnessing data and artificial intelligence to support clinical decisions has enormous potential to improve care for patients and efficiency in our busy emergency departments.”

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Source: The Independent, 11 May 2023

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World-renowned NHS centre downgraded by watchdog

A world-renowned cancer centre hit by whistleblowing concerns over alleged bullying has been downgraded by the health watchdog.

The Care Quality Commission (CQC) told The Christie NHS Foundation Trust in Manchester it "requires improvement" in safety and leadership.

A former trust nurse told the BBC leaders had intimidated staff to stop them voicing concerns to inspectors.

Rebecca Wight worked at The Christie - Europe's largest cancer centre - from 2014 but quit her role as an advanced nurse practitioner in December, claiming her whistleblowing attempts had been ignored.

She told BBC Newsnight the trust had attempted to manipulate the inspection by intimidating those who wished to paint an honest picture.

Roger Kline, an NHS workforce and culture expert from Middlesex University Business School, told BBC Newsnight there was a culture at The Christie which was "unwelcoming of people raising concerns".

He said: "The trust response is more likely... to see the person raising the concerns as the problem rather than the issues they have raised," adding this was "not good for patient care".

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Source: BBC News, 12 May 2023

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Monkeypox: WHO declares global emergency over

Monkeypox is no longer a global public health emergency, the World Health Organization (WHO) has said, almost a year after the threat was raised.

The virus is still around and further waves and outbreaks could continue, but the highest level of alert is over, the WHO added.

The global health body's chief Tedros Adhanom Ghebreyesus called on countries to "remain vigilant".

More than 87,000 cases and 140 deaths have been reported from 111 countries during the global outbreak, according to a WHO count.

But almost 90% fewer cases were recorded over the last three months compared with the previous three-month period, meaning the highest level of alert is no longer required, Tedros said.

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Source: BBC News, 11 May 2023

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WHO issues warning on weight loss drug Wegovy

New weight loss drugs such as Wegovy will not be a “silver bullet” in tackling obesity, the World Health Organization (WHO) has warned.

Francesco Branca, WHO director of food and nutrition safety, said weight loss drugs must be used alongside a healthy diet and exercise.

Ms Branca’s comments come as the health body conducts its first review of obesity management guidelines in two decades.

Semaglutide, marketed as Wegovy by drugmaker Novo Nordisk, is an appetite suppressant drug that has been approved by the UK medicines regulator and described by some as a “game changer” in helping people to shed weight.

People will only be given Wegovy on prescription as part of a specialist weight management service involving input from several professionals and for a maximum of two years.

Some experts described the decision as a “pivotal moment” for the treatment of people living with obesity but others warned that the drug is not a “quick fix”.

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Source: The Independent, 12 May 2023

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Legal action may be needed to lower ‘appalling’ death rates of black women in childbirth

 

The death rates for black women in childbirth were revealed in a recent report from MPs and were described as “appalling”, yet action, not words, are needed for what could be considered breaches of the Human Rights Act.

Ministers are not giving priority to reducing the gap in health inequalities, write Nicola Wainwright and Suleikha Ali in a commentary to the Times. 

"If the response to the review is foot-dragging from the government and senior health service officials, then legal action may be the only way to draw focus to this issue and to try to reduce the number of ethnic minority women and babies dying unnecessarily."

The report, published by the women and equalities committee last month, highlights the “glaring and persistent” disparities faced by ethnic minority women compared to their white counterparts with regards to pregnancy and birth. However, these same disparities have been known and reported on for 20 years, while progress on improving the situation has been shockingly slow.

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Source: The Times, 11 May 2023

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'Hidden' rise in blood clot deaths 'breaking families' warns charity

Thrombosis UK has warned that deaths involving blood clots are higher than expected as it called for more transparency over the work hospitals are doing to reduce the risk for patients.

Before the pandemic hit, hospitals were regularly publishing data on the number of patients who had been risk assessed for blood clots. In March 2020, the NHS in England took the decision to suspend the data collection on venous thromboembolism (also known as VTE) risk assessments to “release capacity in providers and commissioners to manage the Covid-19 pandemic”.

But the data collection and publication is yet to resume. The charity said the data shows how many VTE cases are missed in hospitals.

One bereaved man described how his mother died last year after the condition was missed. Tim Edwards, 42, said healthcare workers missed signs of the condition while Jennifer Edwards, 74, was in hospital on the south coast.

Despite having many symptoms of a pulmonary embolism she was discharged home and died three days later. Mr Edwards said: ““My mother’s symptoms were missed from her admission to hospital right up to her time in the cardiology department.

“She was discharged and passed away three days after phoning the NHS with shortness of breath. She should not have died. I took it upon myself to enquire about the circumstances surrounding her death and was overwhelmed by the lack of care taken.

“Sadly, I know this is not an isolated case.”

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Source: Wales Online, 12 May 2023

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Hospital boss claims unfair dismissal after chairman 'bullied' her

A former NHS chief executive is suing her employer, saying she was "bullied, harassed, intimidated and undermined" by the hospital trust's chairman.

In legal papers, seen by BBC News, Dr Susan Gilby alleges she was effectively unfairly dismissed by the Countess of Chester NHS Foundation Trust, after she made a formal complaint.

Dr Gilby claims the chairman was "highly aggressive and intimidatory" in meetings, that he banged his hand on a desk to emphasise his point, and oversaw a climate where "offensively sexist comments and ferocious and repetitive criticisms" were made by either him or his associates.

Dr Gilby's complaint accuses the chairman of putting finance above patient safety at the hospital trust

She made a formal whistle-blowing complaint against the chairman in July 2022, raising her concerns about his behaviour to both the trust and NHS England.

The trust responded to her concerns, Dr Gilby claims, by proposing that she be seconded to a senior advisory role within NHS England on the condition she withdrew her allegations.

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Source: BBC News, 12 May 2023

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

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

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

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

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

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Source: HSJ, 11 May 2023

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Autistic teenager was stuck on general hospital ward for months

An autistic girl aged 16 spent nearly seven months in a busy general hospital due to a lack of suitable children's mental health services in England.

The teenager, called Molly, spent about 200 days living in a side-room of a children's ward at the Queen Alexandra Hospital in Portsmouth. It is not a mental health unit.

Experts say a general hospital was not the right place for her, but she had nowhere else to go because of a lack of help in the community.

Agency mental health nurses were brought in because she needed constant, three-to-one observations to keep her safe. Her family says security guards were also often stationed outside her room.

Like many autistic people, Molly finds dealing with noise difficult. The clamour of the hospital overloaded her senses and her behaviour sometimes became challenging. She was restrained numerous times.

A spokesperson for Hampshire and Isle of Wight Integrated Care System (ICS) said it was sorry Molly "did not receive care in an environment better suited to her needs", adding: "Molly's safety has always been our priority."

Campaigners describe the shortage of appropriate support for people with autism as a human rights crisis.

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Source: BBC News, 10 May 2023

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ICBs should set up ‘escalation routes’ after 25 daily GP contacts, says new BMA guidance

ICBs should ensure there are ‘formal escalation routes’ in place for GPs after 25 daily clinical contacts, the BMA has said in new guidance.

From next week (15 May), GP practices are contractually required to offer an ‘appropriate response’ to patients the first time they get in contact, by offering them an appointment or redirection, rather than asking them to call back at a different time.

While GP leaders warned this would lead to increased pressure on NHS 111 and A&E, NHS England attempted to clarify in this week’s recovery plan that GPs should only redirect patients in ‘exceptional circumstances’. It also said practices should inform their ICB on each such occasion.

However, conflicting BMA guidance has now been published, warning that practices attempting to adhere to the new requirement ‘may do so at the expense of clinician wellbeing and patient safety’.

It reiterates the GP Committee for England’s safe working guidance recommending that clinicians have no more than 25 clinical contacts per day because anything beyond this "can lead to decision fatigue, clinical errors and patient harm, and clinician burn out".

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Source: Pulse, 11 May 2023

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US recommends women start screening for breast cancer at 40

A leading health panel in the USA has recommended the age at which women are regularly screened for breast cancer should be cut from 50 to 40.

The US Preventive Services Task Force (USPSTF) said an extra 20 million women in their forties would benefit from a mammogram every two years.

The change would save 20% more lives, according to the USPSTF, which has drafted the proposal in response to rising rates among middle-aged women.

Currently, all women in the USA aged 50 to 74 are advised to get checked via a mammogram every two years.

The number of new breast cancer cases is rising roughly two percent every year, John Wong, an internist and professor of medicine at Tufts University School of Medicine, who is on the task force, told the Washington Post.

Dr Wong said: "It is now clear that screening every other year starting at age 40 has the potential to save about 20 percent more lives among all women, and there is even greater potential benefit for black women, who are much more likely to die from breast cancer."

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Source: Mail Online, 9 May 2023

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Simple intervention for severe blood loss after childbirth is found to save lives

A simple intervention to detect and treat postpartum haemorrhage could dramatically cut maternal mortality and morbidity worldwide, a large trial led by the University of Birmingham has shown.

Use of a special drape to measure blood loss during childbirth and rapid deployment of a “bundle” of existing treatments reduced severe bleeding, the need for laparotomy, or maternal death by 60% in a study done in 80 hospitals across Kenya, Nigeria, South Africa, and Tanzania.

Reporting the results in the New England Journal of Medicine, the researchers said that postpartum haemorrhage was detected in 93.1% of patients in the intervention and in 51.1% of those receiving usual care.

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Source: BMJ, 10 May 2023

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FDA panel backs first over-the-counter birth control pill in US

The first non-prescription birth control pill in the US is on the way to approval, after a thumbs-up from an advisory committee of drug regulators.

The Food and Drug Administration (FDA) panel's unanimous vote is not binding, but means the agency is likely to formally approve the drug this summer.

Opill has been available, but only by prescription, for the past 50 years.

The push for over-the-counter access in the US comes amid Republican-led efforts to restrict access to abortion and contraception at the national and state level.

Advisors on the panel said they were mostly confident women of all ages would use the drug as appropriate without first consulting a healthcare provider.

"In the balance between benefit and risk, we'd have a hard time justifying not taking this action," said chairwoman Maria Coyle, an Ohio State University pharmacist.

"The drug is incredibly effective, and I think it will be effective in the over-the-counter realm just as it is in the prescription realm."

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Source: BBC News, 10 May 2023

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Figures show maternal death rate race disparity

Figures showing the risk of maternal death being almost four times higher among women from black ethnic minority backgrounds compared with white women in the UK have been published.

The figures, which relate to 2019 - 2021, have been released by MBRRACE-UK, a collaboration involving the University of Leicester.

The MBRRACE-UK collaboration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries), led from Oxford Population Health's National Perinatal Epidemiology Unit, looked at data on women who died during, or up to six weeks after, pregnancy between 2019 and 2021 in the UK.

The report showed the risk of maternal death in 2019 - 2021 was almost four times higher among women from black ethnic minority backgrounds compared with white women.

Marian Knight, professor of Maternal and Child Population Health at Oxford Population Health and maternal reporting lead, said: "Persistent disparities in maternal health remain.

"It is critical that we are working towards more inclusive care where women are listened to, their voices are heard, and we are acting upon what they are telling us."

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Source: BBC News, 11 May 2023

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AI can predict pancreatic cancer three years before it occurs, major Harvard study finds

A breakthrough AI model can determine a person's risk of developing pancreatic cancer with staggering accuracy, research suggests.

Using medical records and information from previous scans, the AI was able to flag patients at a high risk of developing pancreatic cancer within the next three years with great accuracy.

There are currently no full-proof scans for pancreatic cancer, with doctors using a combination of CT scans, MRIs and other invasive procedures to diagnose it. This keeps many doctors away from recommending these screenings.

Over time, they also hope these AI models will help them develop a reliable way to screen for pancreatic cancer — which already exists for other types of the diseases.

"One of the most important decisions clinicians face day to day is who is at high risk for a disease, and who would benefit from further testing, which can also mean more invasive and more expensive procedures that carry their own risks," Dr Chris Sander, a biologist at Harvard who contributed to the study, said. 

"An AI tool that can zero in on those at highest risk for pancreatic cancer who stand to benefit most from further tests could go a long way toward improving clinical decision-making."

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Source: Mail Online, 9 May 2023

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