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NHS England launches independent review of teen death

A leading expert on learning disability services will work with the NHS to review the circumstances and lessons of the death of Oliver McGowan, a young teenager with learning disabilities. NHS England has announced that Dr Celia Ingham Clark, England’s Medical Director for Professional Leadership and Clinical Effectiveness, will oversee the completion of the learning disability mortality review (LeDeR) of Oliver’s death. 

Fiona Ritchie, an independent consultant, will chair the review which aims to ensure there is the necessary learning from deaths of people with a learning disability, working with the McGowan family. Ms Ritchie, the independent chair, will now take forward – with the family and Dr. Ingham Clark – finalising the terms of reference for review and overseeing the completion. Following agreement with Oliver’s family, further experts will join an oversight group, which will provide specialist clinical input and advice as needed to Ms Ritchie ensuring that the review process is thorough and the final findings are robust.

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Source: NHS England, 7 August 2019

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Three quarters of NHS computers still running Windows 7 less than six months before support cut-off

The Department of Health and Social Care (DHSC) indicates that more than a million machines are still on the decade-old operating system with less than six months until Microsoft ceases support for Windows 7.

In answer to a written parliamentary question from shadow Cabinet Office Minister Jo Platt, former Department of Health and Social Care Minister Jackie Doyle-Price said that the NHS operates about 1.37 million PCs. As of the end of last month, some 1.05 million of these, equating to 76% of the overall total, still run on Windows 7, she added.

Platt – whose parliamentary question recently revealed that there are still 2,300 computers across the NHS running Windows XP, for which support ended five years ago – claimed that the widespread use of Windows 7 is “deeply concerning”. She added: “The WannaCry cyberattack two years ago starkly proved the dangers of operating outdated software. Unless the government swiftly acts and learns from their past mistakes, they are risking a repeat of WannaCry. Protecting public data and computer systems should be a highest priority of government...".

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Source: Public Technology.net, 30 July 2019

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NHS to set up national AI lab

The NHS in England is setting up a national artificial intelligence (AI) laboratory to enhance care of patients and research. The Health Secretary, Matt Hancock, said AI had "enormous power" to improve care, save lives and ensure doctors had more time to spend with patients. He has announced £250m will be spent on boosting the role of AI within the health service. 

Clinical trials have proven AIs are as good as leading doctors at spotting lung cancer, skin cancer, and more than 50 eye conditions from scans. This has the potential to let doctors focus on the most urgent cases and rule out those that do not need treatment. Other tools have been developed that can predict ovarian cancer survival rates and help choose which treatment should be given. However, AI will pose new challenges, including protecting patient data.

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Source: BBC News, 8 August 2019

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Two-thirds of women with physical disabilities unable to attend cervical screenings

New research released by Jo's Cervical Cancer Trust has revealed the extent to which women who have physical disabilities are discriminated against when attempting to undergo cervical screenings. The charity surveyed 335 women for the investigation who have health conditions including spinal muscular atrophy, Ehlers-Danlos syndrome, paraplegia and cerebral palsy. According to the study's findings, 88% of the participants felt that it is more difficult for a women with a physical disability to attend a cervical screening and just under half of the participants said that they had purposely chosen not to attend a smear test because of a negative, past experience they'd had due to their disability.

Robert Music, Chief Executive of Jo's Cervical Cancer Trust, said: ""It is not acceptable that women with a physical disability are often faced with additional hurdles or even being denied access to this potentially lifesaving test."

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Source: Independent, 8 August 2019

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Life-saving selfie app tested by 8,500 people at Portsmouth hospital 'will benefit millions'

Researchers at Queen Alexandra Hospital in Cosham carried out a study on 8,585 patients and staff using the Lifelight app. Using a selfie taken on a smartphone, and the ambient light that bounces off the skin, the app carries out calculations and tells the user the resulting rates. Among the hundreds of people who took part in the Vision-D project, 1,295 were diagnosed with previously unidentified high blood pressure during what was the largest digital physiological study in history.

Developer Xim has brought the technology’s accuracy in line with current NHS equipment. It also measures a person’s respiratory rate. Hopes are high it will win approval from the National Institute for Health and Care Excellence (NICE) - paving the way for it to be used by health care providers and patients.

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Source: Portsmouth News, 30 July 2019

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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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Why women are more likely to have dodgy hip implants or other medical devices

The past year has seen wide concern about the safety of medical implants. Some of the worst scandals have involved devices for women, such as textured breast implants with links to cancer, and transvaginal mesh implants, which were the subject of the asenate inquiry. But women are harmed not only by 'women's devices' such as breast implants and vaginal mesh. Women are also more likely to be harmed by apparently gender-neutral devices, like joint replacements and heart implants according to Katrina Hutchison in a recent MENAFN article.

Bias starts with design and then lab testing: biological and social factors can affect how women present when injured or ill, and how well treatments work. Often, device designers do not take these differences into account. The lab tests used to make sure implants are safe often ignore the possibility women could have different reactions to materials, or their activities could place different loads on implants.

Bias continues with clinical trials. And then there's the doctor-patient relationship; the gender of the doctor and patient can make a difference to what women learn about their implant. 

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Source: MENAFN, 11 August 2019

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AI standards need to be created to protect patient safety, experts warn

Appropriate methods and standards around artificial intelligence (AI) need to be created to protect patient safety, experts have said. Responding to the Government’s pledge of £250 million for a National Artificial Intelligence (AI) Lab, Matthew Honeyman, researcher at The Kings Fund, said the NHS workforce needs to be equipped with digital skills for the benefits of new technologies to be realised.

“AI applications are in development for many different use cases – from screening, to treatment, to admin work – there needs to be appropriate methods and standards developed for safe deployment and evaluation of these solutions as they enter the health system,” he told Digital Health.

Adam Steventon, Director of Data Analytics at the Health Foundation, said the commitment was a “positive step” but that technology needs to be driven by patient need and “not just for technology’s sake”. “Robust evaluation therefore needs to be at the heart of any drive towards greater use of technology in the NHS, so that technologies that are shown to be effective can be spread further, and patients protected from any potential harm,” he said.

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Source: Digital Health, 9 August 2019

 

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What the US government should be doing – but isn’t – to guard against unsafe prescription drugs

Documents released in an Ohio court case last month, in a landmark, multi-district opioid lawsuit, gave new insight into an unparalleled opioid epidemic in the United States. It revealed that between 2006 and 2012, some 76 billion opioid pills were distributed in the United States — more than 200 pills for every man, woman and child.

It paints a damning picture of the tension between drug company profits and patient safety during the time opioid sales were climbing dramatically. In one 2009 exchange, a pharmaceutical company representative emailed a colleague at another company to alert him to a pill shipment. “Keep ’em comin’!” was the response. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are.”

According to Charles L. Bennett et al. in an editorial published in the Los Angeles Times, the failings are at every point in the system, starting with drug approvals. But the authors believe there is a particularly serious problem with the mechanisms for identifying, monitoring and disseminating information about issues with a drug after its release.

They suggest a good starting point for reforming the system would be increased transparency about drugs already recognised as particularly dangerous. These drugs, currently numbering about 70 (including opioids), carry the FDA’s so-called 'black box warning,' intended to alert patients and their doctors to the high risks associated with the drugs. But that is not enough. The authors propose a 'black box' database or 'registry,' publicly available and simple to use, that would contain extensive information about where, by whom and for what purpose black box drugs are prescribed, as well as where and in what quantities such drugs are being distributed and sold. Information about adverse side effects, culled from the myriad of government databases that now collect them, would also be consolidated in an open form and format.

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Source: Los Angeles Times, 8 August 2019

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Gosport War Memorial Hospital patient deaths inquiry ‘buried evidence’

Whitehall investigators have launched an inquiry into allegations of serious misconduct during the official review of the Gosport hospital scandal. They are examining claims that civil servants working on the £13m inquiry bullied staff, buried evidence and went on taxpayer-funded “working retreats” to Spain.

An independent panel last year linked Dr Jane Barton to the premature deaths of up to 656 elderly people given opiate overdoses at Gosport War Memorial Hospital between 1989 and 2000.

Whistleblowers have alleged that the panel ignored concerns about the hospital’s culture and use of faulty medical equipment to deliver a “clean hit” and “draw a line under it all”.

The Department of Health said last night: “We take all and any allegations of wrongdoing very seriously. An investigation is being undertaken and it would be inappropriate to comment further until it is concluded.”

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Source: The Sunday Times, 11 August 2019

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Digital GP service provider secures biggest ever deal with NHS

Nearly 2 million NHS patients are to be given access to video consultations with doctors employed by a digital healthcare supplier as a result of a series of deals signed with NHS commissioners.Nearly 2 million NHS patients are to be given access to video consultations with doctors employed by a digital healthcare supplier as a result of a series of deals signed with NHS commissioners.

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Source: HSJ, 12 August 2019

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NHSE declares emergency over IV shortage

NHS England has declared a national emergency over shortage of feed for babies and disabled patients, with some patients being told to go to Accident & Emergency (A&E) departments.  Hundreds of NHS patients, including children, who depend on intravenous (IV) nutrition, have been experiencing delays in deliveries.

It follows an inspection by watchdogs which found manufacturers were failing to meet safety standards, and the presence of potentially fatal bacteria. The NHS National Patient Safety Director, Aiden Fowler, has written to all NHS hospital trusts, and affected patients, warning that the incident has been designated as an emergency incident, under the Civil Contingencies Act, at the highest level. 

British manufacturer Calea had already said the shortages could last up to four weeks. But the letter warns that the crisis could last far longer, outlining plans to ration the product to those most in need. 

Parents said the situation was “terrifying” with some told to go to A&E if vulnerable children were left too long without being fed. 

Hospitals have now been asked to review all patients receiving such IV feed to ensure only those deemed at high-risk are allocated the supplies, which are tailored to meet specific individual needs. Others will be allocated standard bags of nutrition, with extra supplements. 

In the letters from Dr Fowler, disclosed by the Health Service Journal, he warns that the NHS is facing a “difficult balance” between the risks caused by the shortages, and the dangers of allowing production to continue, without safety improvements. 

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Source: The Telegraph, 13 August 2019

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Australian junior doctors launch legal action against managers over working conditions

Registrars at an Australian hospital have launched legal action against its management amid claims that they are being worked beyond exhaustion while being denied their mandatory clinical training.

The alleged plight of the doctors at Melbourne’s Sunshine Hospital has become the latest instalment in a growing list of complaints among doctors in training over excessive workload pressures, exploitation, harassment, and bullying across the country’s public hospital system.

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Source: BMJ, 12 August 2019

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AI can say when neurosurgeons are ready to operate

Machine learning algorithms can accurately assess the capabilities of neurosurgeons during virtual surgery before they step into an actual operating room, a new study shows.

Researchers recruited 50 participants from four stages of neurosurgical training: neurosurgeons, fellows and senior residents, junior residents and medical students. The participants performed 250 complex tumour resections using NeuroVR, a virtual reality surgical simulator. Using the raw data, the machine learning algorithm developed performance measures that could predict the level of expertise of each participant with 90% accuracy. The top performing algorithm could classify participants using just six performance measures.

As reported in the Journal of the American Medical Association, the findings show that the fusion of artificial intelligence (AI) and virtual reality neurosurgical simulators can accurately and efficiently assess the performance of surgeon trainees. This means that scientists can develop AI-assisted mentoring systems that focus on improving patient safety by guiding trainees through complex surgical procedures. These systems can determine areas that need improvement and how the trainee can develop these important skills before they operate on real patients.

“Our study proves that we can design systems that deliver on-demand surgical assessments at the convenience of the learner and with less input from instructors. It may also lead to better patient safety by reducing the chance for human error both while assessing surgeons and in the operating room,” said leading author, Rolando Del Maestro of McGill University.

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Source: FUTURITY, 5 August 2019

 

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What was found in the FDA’s "hidden" device database?

After two decades of keeping the public in the dark about millions of medical device malfunctions and injuries, the US Food and Drug Administration (FDA) has published the once hidden database online, revealing 5.7 million incidents publicly for the first time.

The newfound transparency follows a Kaiser Health News investigation that revealed device manufacturers, for the past two decades, had been sending reports of injuries or malfunctions to the little-known database, bypassing the public FDA database that’s pored over by doctors, researchers and patients. Millions of reports, related to everything from breast implants to surgical staplers, were sent to the agency as “alternative summary” reports instead.

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Source: Kaiser Health News, June 27 2019

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Women take legal action over breast implant cancer link

Twenty UK women are taking legal action after developing a rare form of cancer linked to their breast implants. More than 50 women have been diagnosed with the same condition in the UK, and hundreds more worldwide. A top surgeon said there were gaps in implant information and people were almost being "used as guinea pigs".

One manufacturer has issued a worldwide recall of some textured implants, which have been linked to most cases of breast implant-associated lymphoma. The Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medical devices in the UK, is currently collecting data on women affected by breast implant associated-anaplastic large cell lymphoma (BIA-ALCL).

Tens of thousands of breast implant surgeries are thought to take place each year in the UK, mostly in private clinics.

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Source: BBC News, 16 August 2019

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Patients waiting for hip operations suffering 'pain worse than death'

Patients waiting for hip replacements are suffering pain "worse than death", a study by Edinburgh University suggests. The research recorded the health states of more than 2,000 people on waiting lists and found 19% were in extreme pain or discomfort.

The level is so poor it is defined by experts as "worse than death" - more painful than chronic health conditions such as diabetes, heart failure or lung diseases. Scientists who used the internationally approved EQ-5D measurement said the findings disprove perceptions that hip and knee arthritis only causes mild discomfort. Earlier this year research found that four in 10 clinical commissioning groups in England are rationing hip and knee operations.

The Royal College of Surgeons has described the restrictions are “alarming” and “arbitrary”.

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Source: The Telegraph, 15 August 2019

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Hospitals made money from scandal surgeon Ian Paterson

Private hospitals may have made more than £3 million from the actions of the disgraced breast surgeon Ian Paterson, a think tank has claimed.

Paterson was jailed in 2017 for carrying out unnecessary surgery on ten patients in private hospitals. However, it is believed he harmed about 750 patients, many of whom he wrongly led to believe they had cancer. He was paid each time he operated but the private hospitals would have received a separate payment for each operation, the Centre for Health and the Public Interest (CHPI) said. 

CHPI wants the inquiry set up by the government into Paterson’s actions to examine the financial incentives that could affect how private hospitals treat patients. David Rowland, director of CHPI, said: “The current financial incentives to over-treat patients weigh heavily against the weak measures which are in place to protect patients.”

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Source: The Times, 19 August 2019

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Changes to NHS health checks must be evidence based and beneficial, say GPs

A review of NHS health checks, which will look at tailoring checks based on risk and increasing the range of checks offered, must involve a “rigorous evaluation” to ensure they are safe, accurate and of benefit to patients, GPs have warned. The Department of Health and Social Care announced the review in the prevention green paper last month and has now fleshed out its scope.

It says it will consider including additional checks to prevent musculoskeletal problems and hearing loss, as well as how the checks can be digitised and tailored so people are offered “personalised interventions” based on risk, location, predisposition to diseases and their DNA.

While some experts welcomed the more targeted approach, others said the current scheme still needs to be evaluated for cost effectiveness and questioned how GPs will take on the extra work.

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Source: BMJ, 16 August 2019

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Hundreds of lives saved through new tech to spot sepsis

In a major nationwide push to tackle sepsis, including a one hour identification and treatment ambition, new ‘alert and action’ technology is being introduced which uses algorithms to read patients’ vital signs and alert medics to worsening conditions that are a warning sign of sepsis.

Three leading hospitals are using alerts to help identify sepsis and tell doctors when patients with the serious condition are getting worse, ahead of the measures being rolled out across England as part of the NHS Long Term Plan. 

In Liverpool, the hospital’s digital system brings together lab results and patient observations into one place to help staff diagnose and treat suspected sepsis, saving up to 200 lives a year. In Cambridge, deaths from sepsis have fallen consistently over the last three years, with at least 64 lives saved in the past year thanks to the innovative alert and action feature. In Berkshire since introducing a digital system, the Trust has increased screening rates by 70% with nine in 10 patients now consistently screened for sepsis during admission as opposed to two in ten beforehand, allowing doctors to spot more cases sooner.

The schemes are part of a national effort to push best practice and new technology across the NHS, to help hospitals learn from the success of others and spread use of the best technology further, faster.

Dr Ron Daniels BEM, CEO of the UK Sepsis Trust, and the hub's topic leader, said: “Any kind of technology which assists clinicians in making prompt decisions when the warning signs of sepsis are detected should be embraced; with every hour that passes before the right antibiotics are administered the risk of death increases".

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Source: NHS England, 18 August 2019

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The harm to hospitalised patients cost Ontarians more than $1 billion a year

A new study published in the Canadian Medical Association Journal has found that patients who suffered harm after being admitted in an Ontario hospital took longer to recover, spent more time in hospital, and required more healthcare to undo or mitigate the harm.

Tessier et al. studied the records of 610,979 patients admitted to Ontario hospitals over a one-year period ending in March 2016. Overall, 36,004 or six per cent of the patients were harmed during their hospital stay. As part of the study, the researchers categorised the kinds of harms experienced by patients. Just over half suffered harm due improper treatment. This included failing to make the correct diagnosis or making an incorrect diagnosis that led to incorrect treatment and harm caused by medications. 

The second biggest category (37%) was harm caused by an infection acquired during the hospital stay. The third leading cause (27.3%) was harm caused by a procedure, and the fourth (2.7%) was harm brought on by accidents such as falling off a hospital stretcher.

The current study is one of the first to use a new method that enables researchers to capture all of the care the patient received during their stay in hospital and following discharge from hospital, including home care.

In a commentary published alongside the study, Dr. Lauren Lapointe-Shaw and Dr. Chaim Bell wrote that reported rates of adverse events are widely considered to be the proverbial "tip of the iceberg."

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Source: CBC Radio Canada. 12 August 2019

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