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Sam

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  1. Sam
    A London hospital hit by a COVID-19 outbreak that required 70 staff to self-isolate has been ordered to take stringent measures to control infection.
    Hillingdon Hospital NHS Foundation Trust declared a COVID-19 outbreak in July and revealed that 70 staff members, some of whom had tested positive, were self-isolating. Ambulances were forced to divert patients to other emergency departments.
    An investigation later found that a nurse who had COVID-19 unwittingly infected 16 others during a training session on 30 June, described by one doctor as a “super spreading event.”
    The Care Quality Commission (CQC), which carried out an unannounced inspection on 4-5 August, has used its urgent enforcement powers to place conditions on the trust’s registration to protect patients and staff.
    Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said, “We found a number of concerns relating to infection control and this is why we have taken action to ensure the safety of patients, staff and visitors."
    “We have imposed urgent conditions upon the trust’s registration and expect the trust to focus on making the required improvements as a matter of priority. We will return to inspect and ensure that action has been taken and that improvements have been made and are being sustained.”
    The trust has been told it must ensure that staff and patients observe social distancing, must place personal protective equipment (PPE) in easily accessible places, and must make sure that staff wear PPE before going into high risk areas.
    Read full story
    Source: BMJ, 9 September 2020
  2. Sam
    A risk calculator that takes seconds to produce a score indicating a COVD-19 patient’s risk of death could help clinicians make care decisions soon after patients arrive in hospital, according to a large study conducted by a consortium of researchers across the UK.
    As UK COVID-19 cases rise, schools reopen and the weather gets colder, doctors at UK hospitals are expected to see an influx of coronavirus patients.
    Patients with COVID-19 behave very differently to patients with other conditions such as flu and bacterial pneumonia, said Dr Antonia Ho of the University of Glasgow, one of the study’s authors, and it is very challenging for doctors managing this unfamiliar disease to accurately identify those who are at high risk of deterioration or who can ride out their illness at home.
    “So having a tool that … can help clinicians at the front door to accurately group patients who are coming in with COVID-19 into four distinct risk categories – low, intermediate, high and very high risk – is hugely valuable,” she added. “Having an accompanying low-risk score will provide that doctor with increased confidence that the vast majority of people, patients with that low-risk score, will come to no real harm.”
    Read full story
    Source: The Guardian, 9 September 2020
  3. Sam
    Serious patient safety and wellbeing concerns about the latest hospital discharge guidance have been raised to HSJ by senior clinicians and charities.
    Senior geriatricians warned that the guidance could prompt an increase in “urgent readmissions”, “permanent disability” and “excess mortality”, while charities said families could be left with “unsustainable caring responsibilities” because of the new rules.
    The government guidance, Hospital Discharge Service: policy and operating model, published in August, said clinicians should consider discharging patients when they were “medically optimised” rather than “medically fit”. It said 95% of these patients would return straight home with additional social care and rehabilitation support if needed.
    Many of the concerns raised surround the retention of the “criteria to reside”. This was originally agreed in March when there was a push from NHS England to free up acute beds over fears hospitals would become overwhelmed with covid admissions as the pandemic hit the UK. The criteria has, however, been maintained in the new guidance, despite a significant fall in infections and deaths from the virus.
    Rachel Power, chief executive of The Patients Association charity, warned: “This guidance makes it clear that the NHS is still having to take drastic emergency action in the face of covid-19, that will continue to take a heavy toll on patients. It is clear that many patients will be rushed home who would normally have had a longer period of hospital care.”
    Read full story (paywalled)
    Source: HSJ, 8 September 2020
  4. Sam
    Hundreds of women with breast cancer in London were not picked up by routine screening as services closed during the lockdown, officials have estimated.
    Data from NHS England and Improvement’s London office said it expected 450 people to have breast cancer and have gone undiagnosed because of the heavily reduced amount of screening at the height of the outbreak. It was included in a letter from officials to local health system leaders, seen by HSJ.
    It said the figure was an estimate based on the 115,000 routine breast screenings that would have taken place between late March and the end of June and which had to be re-scheduled.
    London represents around 15% of England’s population, so a nationwide estimate would run into thousands. 
    Responding to the figures, Breast Cancer Now chief executive Baroness Delyth Morgan said: ”While it’s encouraging that the breast screening programme in London is now back up and running, we are concerned to hear of the hundreds of potential delayed cancer diagnoses as a result of disruption due to the pandemic. The earlier breast cancer is diagnosed, the more likely treatment is to be successful."
    “With over a hundred thousand people missing out on vital breast screening during the pandemic in London alone, we urge the government to ensure there is sufficient capacity in the already-stretched workforce to meet the huge backlog and to avoid any cancers going undetected for longer.”
    Read full story (paywalled)
    Source: HSJ, 9 September 2020
  5. Sam
    Thursday 17 September is WHO’s World Patient Safety Day. There’s no better moment in history to call for new legislation that finally ensures health worker and patient safety. Today, the Patient Safety Movement Foundation released a detailed white paper urging the creation of a National Patient Safety Board.
    In a statement, the Patient Safety Movement said COVID-19 has exposed the safety gaps in our healthcare system that already cause 200,000 deaths a year and that we must put health workers, and thus patients, first by finally establishing a National Patient Safety Board (NPSB). This would solve the problem in three key ways:
    Data-driven insight and standards: An NPSB would create and maintain a National Patient Safety Database to receive non-identifiable patient safety work product. The Board would facilitate the reporting, collection, and analysis of patient safety data and the development and dissemination of training guidelines and other recommendations to reduce medical errors and improve patient safety and quality of care. Transparency and accountability: The NPSB would also require an on-going analysis of the patient safety data in the Database and other available data to determine performance and systems standards, tools, and best practices (including peer review) for doctors and other health care providers necessary to prevent medical errors, improve patient safety, and increase accountability within the health care system. Align incentives: An NPSB would save lives and taxpayer dollars by aligning incentives, especially Medicare reimbursements, with proven patient safety protocols. "COVID-19 shouldn’t be the breaking point for our health workers, but it should be the breaking point for our tolerance of the lack of patient safety. Congress must act today on this bipartisan issue.”
    Read full story
    Source: The Patient Safety Movement, 8 September 2020
  6. Sam
    The development of a promising COVID-19 vaccine has been put on hold due to an adverse reaction in a trial participant.
    A spokesman for AstraZeneca, the company working with a team from Oxford University, told the Guardian the trial has been stopped to review the “potentially unexplained illness” in one of the participants. The spokesman stressed that the adverse reaction was only recorded in a single participant and said pausing trials was common during vaccine development.
    “As part of the ongoing randomised, controlled global trials of the Oxford coronavirus vaccine, our standard review process was triggered and we voluntarily paused vaccination to allow review of safety data by an independent committee,” the spokesman said.
    “This is a routine action which has to happen whenever there is a potentially unexplained illness in one of the trials, while it is investigated, ensuring we maintain the integrity of the trials. In large trials illnesses will happen by chance but must be independently reviewed to check this carefully."
    “We are working to expedite the review of the single event to minimise any potential impact on the trial timeline. We are committed to the safety of our participants and the highest standards of conduct in our trials.”
    Read full story
    Source: The Guardian, 9 September 2020
  7. Sam
    In April, when the coronavirus outbreak was at its peak in the UK and tearing through hospitals, junior doctor Rebecca Thornton’s mental health took a turn for the worse and she ended up having to be sectioned.
    Even now, three months later, she cannot face going back to her job and thinks it will take her a year to recover from some of the horrors she saw while working on a Covid ward in a deprived area of London.
    “It was horrendous,” Thornton recalls. “It’s so harrowing to watch people die, day in, day out. Every time someone passed away, I’d say, ‘This is my fault’. Eventually I stopped eating and sleeping.”
    Thornton’s case may sound extreme but her experiences of working through Covid are far from unique. More than 1,000 doctors plan to quit the NHS over the government’s handling of the pandemic, according to a recent survey, with some citing burnout as a cause.
    A psychologist offering services to NHS staff throughout the UK, who asked to remain anonymous, has witnessed the toll on staff. “I’ve seen signs of PTSD in some healthcare workers,” she says. “Staff really stood up to the plate and worked incredibly hard. It was a crisis situation that moved very quickly ... After it subsided a little bit, the tiredness became very clear.”
    Roisin Fitzsimons, who is head of the Nightingale Academy, which provides a platform to share best practice in nursing and midwifery, and consultant nurse at Guy’s and St Thomas’ NHS foundation trust, also worries about the looming threat of an uncertain future. “Are our staff prepared? Do they have the resilience to go through this again? That’s the worry and that’s the unknown. Burnout is hitting people now. People are processing and realising what they’ve gone through.”
    Read full story
    Source: The Guardian, 8 September 2020
  8. Sam
    A leading health expert has suggested ministers have “lost control of the virus”, after the UK recorded it’s largest 24-hour spike in COVID-19 cases since 23 May.
    Government figures showed there have been a further 2,988 lab-confirmed cases of coronavirus in the UK as of 9am on Sunday. This brings the total number of confirmed cases in the UK to 347,152.
    Sunday's figure is the highest since May 22 when 3,287 cases were recorded, and is also the first 24-hour period when cases passed 2,000 since the end of May. The tally was an increase on Saturday's figures of 1,813 new cases.
    Prof Gabriel Scally, a member of the Independent Sage group and a former NHS regional director of public health for the south-west, warned that government ministers had “lost control of the virus”.
    “It’s no longer small outbreaks they can stamp on,” he told The Guardian. “It’s become endemic in our poorest communities and this is the result.
    Shadow health secretary Jonathan Ashworth called upon the government to respond to the sharp spike.
    He added that it was “a stark reminder that there is no room for complacency in tackling the spread of the virus”.
    “This increase, combined with the ongoing testing fiasco where ill people are told to drive for miles for tests, and the poor performance of the contact tracing system, needs an explanation from ministers,” he said on Sunday.
    Read full story
    Source: The Independent, 7 September 2020
  9. Sam
    Greater NHS support is needed for people chronically ill for months with COVID-19 symptoms, experts have told BBC Radio 4's File on 4.
    The Royal College of GPs is calling for a national network of "post-Covid" clinics to help such people. But less than 12% of 86 NHS care commissioning groups asked by the BBC said they were running such services.
    NHS England said it was "rapidly expanding new and strengthened rehab centres".
    Tim Spector, professor of genetic epidemiology at King's College London and leader of the Covid Symptom Study app, said around 300,000 people in the UK have reported symptoms lasting for more than a month - so called "long Covid".
    He added that data from the app showed around 60,000 people have been ill for more than three months. However, many of these people may not have been tested for Covid.
    The government moved away from community testing on 12 March, instead only testing those admitted to hospital. That meant people who recovered from suspected coronavirus at home were unable to access tests.
    Elly MacDonald, 37, from Surbiton, was training for the London Marathon when she first developed what she believes were Covid symptoms on 21 March. More than five months on, she still suffers from breathlessness and extreme fatigue, but has not received a positive test result - because community testing was re-introduced too late for it to detect her illness.
    She changed her GP practice after initially feeling she was not being helped. Elly said: "Just knowing that I actually have people who are taking me seriously - that's been very important for my recovery. I just want my life back."
    Read full story
    Source: BBC News, 8 September 2020
  10. Sam
    Inquest finds Susan Warby, 57, received insulin she did not need after blood test mistakes. Hospital errors contributed to her death five weeks after bowel surgery, an inquest into her death has concluded.
    Susan Warby, 57, who died at West Suffolk hospital in Bury St Edmunds, was incorrectly given glucose instead of saline through an arterial line that remained in place for 36 hours and resulted in inaccurate blood test readings. She was subsequently given insulin she did not need, causing bouts of extremely low blood sugar (hypoglycemia) and the development of “a brain injury of uncertain severity”, recorded Suffolk’s senior coroner, Nigel Parsley.
    Speaking after the inquest was adjourned in January, Susan's husband, Jon Warby, said he was “knocked sideways completely” when he received an anonymous letter two months after her death highlighting blunders in her treatment.
    Doctors at the hospital were reportedly asked for fingerprints as part of the hospital’s investigation into the letter, a move described by a Unison trade union official as a “witch-hunt” designed to identify the whistleblower.
    Following January’s adjournment, Parsley instructed an independent expert to review the care that Warby received. Warby’s medical cause of death was recorded as multi-organ failure, with contributory causes including septicaemia, pneumonia and perforated diverticular disease, affecting the bowel.
    Recording a narrative conclusion, Parsley wrote: “Susan Warby died as the result of the progression of a naturally occurring illness, contributed to by unnecessary insulin treatment caused by erroneous blood test results. This, in combination with her other comorbidities, reduced her physiological reserves to fight her naturally occurring illness.”
    Jon Warby said in a statement: “The past two years have been incredibly difficult since losing Sue, and it is still a real struggle to come to terms with her no longer being here. The inquest has been a highly distressing time for our family, having to relive how Sue died, but we are grateful that it is over and we now have some answers as to what happened."
    “After learning of the errors in Sue’s care, I wanted to know how these occurred and what action was being taken to prevent any similar incidents in the future. The trust has now made a number of changes which I am pleased about.”
    Read full story
    Source: The Guardian, 7 September 2020
     
  11. Sam
    COVID-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists in Hong Kong showed.
    The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said.
    SARS-CoV-2 spreads mainly through respiratory droplets -- spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists in China have said infectious virus in the stool of patients may also play a role in transmission.
    The finding “highlights the importance of long-term coronavirus and health surveillance and the threat of potential fecal-oral viral transmissions,” Siew Chien Ng, associate director of the university’s Centre for Gut Microbiota Research, said in the statement.
    Read full story
    Source: Bloomberg, 7 September 2020
  12. Sam
    Over 1,000 doctors plan to quit the NHS because they are disillusioned with the government’s handling of the COVID-19 pandemic and frustrated about their pay, a new survey has found.
    The doctors either intend to move abroad, take a career break, switch to private hospitals or resign to work as locums instead, amid growing concern about mental health and stress levels in the profession.
    “NHS doctors have come out of this pandemic battered, bruised and burned out”, said Dr Samantha Batt-Rawden, president of the Doctors’ Association UK, which undertook the research.  The large number of medics who say they will leave the NHS within three years is “a shocking indictment of the government’s failure to value our nation’s doctors,” she added. “These are dedicated professionals who have put their lives on the line time and time again to keep patients in the NHS safe, and we could be about to lose them.
  13. Sam
    A leaked government report suggests a "reasonable worst case scenario" of 85,000 deaths across the UK this winter due to COVID-19.
    The document also says while more restrictions could be re-introduced, schools would likely remain open.
    But it says the report "is a scenario, not a prediction" and the data are subject to "significant uncertainty".
    However some are critical of the modelling and say some of it is already out of date.
    The document, which has been seen by BBC Newsnight, was prepared for the government by the Sage scientific advisory group, which aims to help the NHS and local authorities plan services, such as mortuaries and burial services, for the winter months ahead.
    Read full story
    Source: BBC News, 29 August 2020
  14. Sam
    There has been a sharp rise in the number of nurses considering quitting the profession compared to this time last year, suggest results from a new survey.
    The research also found that “existing tensions” among the workforce appeared to have been “exacerbated” by the COVID-19 crisis.
    The survey findings feature in a new report published by Royal College of Nursing and cover the views of almost 42,000 of its members across the UK and Channel Islands.
    Of those who responded to the survey, 36% of nurses were thinking of leaving the profession, an increase from 27% reported in a similar piece of research carried out at the end of last year.
    When considering the reasons for quitting, 61% of staff indicated that the level of pay was the “main driver”, while others said they were dissatisfied with the way nursing staff had been treated during the pandemic (44%).
    Meanwhile, 43% of nurses cited low staffing levels and 42% a lack of management support as key reasons for wanting to leave nursing.
    Read full story
    Source: Nursing Times, 17 July 2020
  15. Sam
    British scientists analysing data from a widely-used COVID-19 symptom-tracking app have found there are six distinct types of the disease, each distinguished by a cluster of symptoms.
    King’s College London team found that the six types also correlated with levels of severity of infection, and with the likelihood of a patient needing help with breathing - such as oxygen or ventilator treatment - if they are hospitalised.
    The findings could help doctors to predict which COVID-19 patients are most at risk and likely to need hospital care in future waves of the epidemic.
    Read full story
    Source: Reuters, 17 July 2020
     
  16. Sam
    A GP surgery that had been told it required improvement has been shut down after an inspection found patients could be at "risk of harm".
    Hampshire's Brockhurst Medical Centre had already been due to close on 31 December.
    However, the Care Quality Commission (CQC) suspended its registration with "immediate effect" following an unannounced inspection on Monday.
    Patients are expected to be transferred to other practices on Saturday.
    In September, a CQC assessment of the practice, on Brockhurst Road in Gosport, rated it overall as "requires improvement".
    The issues highlighted in the report included that the practice "did not have systems for the appropriate and safe use of medicines" and "there was a risk that some patients were not receiving the care and treatment they needed".
    Following Monday's inspection, Garry Higgins, of the CQC, said it had taken "urgent action" to suspend the registration of the GP surgery.
    "We took the action because we believe if we didn't people using the service may be exposed to the risk of harm," he added.
    Read full story
    Source: BBC News, 5 December 2020
  17. Sam
    Many people in Britain are likely to suffer from physical and mental problems for several years after the COVID-19 epidemic has subsided. That is the grim message from doctors and psychologists who last week warned that even after lockdown measures had been lifted thousands of individuals would still be suffering.
    Some of these problems will be due directly to the impact that the virus has had on those it has infected, especially those who went through life-saving interventions in intensive care units (ICUs) in hospital. In addition there will be a considerable impact on vulnerable people affected by the lockdown and isolation.
    Read full
    Source: The Observer, 2 May 2020
  18. Sam
    In recent weeks, there has been sustained public and media interest in the death from COVID-19 of health and social care workers. Both mainstream and social media outlets have been reporting on these deaths individually or collectively, but there has been no formal analysis of this data. 
    The deaths of 119 NHS staff have now been analysed by three leading clinicians and the results are been published by HSJ.
    HSJ highlights three key findings from the analysis:
    1. The disproportionately high rate of BAME individuals among those who have died;
    2. The absence of those members of staff considered at high risk of viral exposure and transmission; and
    3. The overall rate of fatalities compared to the population.
    Read full story
    Source: HSJ, 22 April 2020
  19. Sam
    Delays in diagnosing and treating people with cancer could lead to more years of lost life than with COVID-19, according to a leading cancer expert.
    A drop-off in screening and referrals means roughly 2,700 fewer people are being diagnosed every week, Cancer Research UK says.
    Cancer screening has paused in Wales, Scotland and Northern Ireland, with few invitations sent out in England.
    People are still advised to contact their GP with worrying symptoms.
    But Richard Sullivan, professor of cancer and global health at King's College London, said there was more fear of Covid-19 than of having cancer at the moment. With GPs more difficult to contact than normal, this was resulting in a "dramatic drop-off" in referrals to specialists, he said.
    "Most modellers in the UK estimate excess of deaths is going to be way greater than we are going to see with Covid-19," he said.
    Read full story
    Source: 22 April 2020, BBC News
  20. Sam
    The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalised with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives.
    Many will likely deal with lingering effects of the virus — and of the emergency treatments that allowed them to survive it.
    “The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine.
    Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices.
    Read full story
    Source: Science, 8 April 2020
  21. Sam
    NHS staff still do not have the protective equipment they need to treat coronavirus patients, medics have said.
    The British Medical Association (BMA) said doctors were putting their lives at risk by working without adequate protection.
    It comes as the health secretary said 19 NHS workers had died with coronavirus since the outbreak began.
    Read full story
    Source: BBC News, 11 April 2020
  22. Sam
    Doctors seeing patients with blood oxygen levels so low they are surprised they are conscious – yet they are sitting up and talking.
    British and American intensive care doctors at the front line of the coronavirus crisis are starting to question the aggressive use of ventilators for the treatment of patients. 
    In many cases, they say the machines – which are highly invasive and require the patient to be rendered unconscious – are being used too early and may cause more harm than good. Instead they are finding that less invasive forms of oxygen treatment through face masks or nasal cannulas work better for patients, even those with very low blood oxygen readings.
    Dr Ron Daniels, a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust, on Thursday confirmed reports from US medics that he and other NHS doctors were revising their view of when ventilators should be used. 
    Read full story
    Source: The Telegraph, 9 April 2020
     
  23. Sam
    Shortages are dogging the fight against the coronavirus. At Bradford Royal Infirmary (BRI) it's still only possible to test six staff for the virus per day, consultants have been making their own personal protective equipment, and there's an urgent need to save oxygen.
    Searching for ways round the problem, Dr Tom has been working with Leeds University on a 3D-printed valve that could be attached to the hospital's ventilators to reduce the amount of oxygen they use.
    But he also began looking at CPAP machines used to treat sleep apnoea at home. These maintain air at a continuous pressure, inside a mask, to keep the user's airways open - they have to be repurposed to provide oxygen for use in the hospital, but they use much less of it than standard hospital ventilators.
    They said, 'Yes we've got 2,000, how many do you want?''' he says. "And so our plan is to start with 100 and to see whether, if we use these early enough during a patient's stay, we can prevent people deteriorating and needing to go on to the more complex ventilators, and needing to come to the intensive care unit."
    We've been testing them over the weekend, and there's evidence from China and from the US that they seem effective. They just help inflate your lungs and that seems to be beneficial.
    They are also very simple, which means that there's no need for a huge amount of training.
    Read full story
    Source: BBC News, 7 April 2020
     
  24. Sam
    Hundreds of people are dying in care homes from confirmed or suspected coronavirus without yet being officially counted, the Guardian has learned.
    More than 120 residents of the UK’s largest charitable provider of care homes are thought to have died from the virus in the last three weeks, while another network of care homes is reported to have recorded 88 deaths.
    Care England, the industry body, estimated that the death toll is likely to be close to 1,000, despite the only available official figure for care home fatalities being dramatically lower.
    The gulf in the figures has prompted warnings that ministers are underestimating the impact of Covid-19 on society’s most frail, and are failing to sufficiently help besieged care homes and workers.
    Read full story
    Source: The Guardian, 7 April 2020
     
     
  25. Sam
    The health service has been promised “whatever it needs” to deal with the coronavirus pandemic, but government spending choices reveal possible long-term changes to funding and policy. 
    Having initially promised the health service “whatever it needs, whatever it costs” on 11th March, the government made this official when Matt Hancock issued a ministerial direction allowing the Department of Health to “spend in excess of formal Departmental Expenditure Limits”—effectively providing a blank cheque.
    But while the government’s actions are designed for the immediate crisis, they may be difficult to reverse once the peak of coronavirus has passed. Indeed, they could yet change how the health service operates on a permanent basis.
    Read full story
    Source: Prospect, 7 April 2020
     
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