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Found 468 results
  1. Content Article
    Urinary tract infections (UTIs) exert a significant health and economic cost globally. Approximately one in four people with a previous history of UTI continue to develop recurrent or chronic infections. This review aims to present a novel perspective on chronic UTI by linking microbiology with immunology, which are commonly divergent in this field of research. It also describes the challenges in understanding chronic UTI pathogenesis and the human bladder immune response, largely conjectured from murine studies. Lastly, it outlines the shortcomings of current diagnostic methods in identifying individuals with chronic UTI and consequently treating them, potentially aggravating their disease due to mismanagement of prior episodes. This discourse highlights the need to consider these knowledge gaps and encourages more relevant studies of UTI in humans.
  2. Content Article
    Ahead of World Cancer Day 2023, Cancer Research UK have published a new report that shows that the impact of cancer for people in the UK will only grow, and sets out the challenges that cancer services are already facing today. New modelling published in the report, Cancer in the UK: Overview 2023 shows that if current trends continue, cancer cases will rise from the 384,000 diagnosed each year now, to over half a million by 2040. To put that into context, that means around a third more people will be diagnosed with the condition every year in comparison to current levels. And we could see around a quarter more annual cancer deaths – 208,000 by 2040, With services barely treading water now, Governments across the UK must act if they are to effectively meet the increase in demand that this analysis anticipates, but efforts have been piecemeal so far.
  3. Content Article
    Cardiovascular disease (CVD) causes 1 in 4 deaths in England, and is a leading cause of morbidity, disability and health inequalities. The Covid-19 pandemic has added to the urgency of tackling CVD because CVD significantly increases the risk of severe disease and death from Covid-19. This report by The King's Fund looks at published data, literature, policy and evidence on CVD. The writers also carried out interviews and a workshop with key stakeholders working in health and care to inform their research.
  4. Content Article
    Many people see their GP with symptoms that could either get better without treatment, or be a sign of serious illness; their diagnosis is uncertain. Research has explored how GPs and patients can work together to develop follow-up plans (a process known as safety-netting). New recommendations could help GPs manage uncertain diagnoses. To avoid unnecessary referrals, GPs may adopt a ‘watch and wait’ strategy when someone has an uncertain diagnosis. This strategy should come with a clear follow-up plan so that people understand the possible causes of their symptoms, how to look after themselves and what to do if symptoms persist. This is good safety-netting. Without good safety-netting, watch and wait carries risks. For example, late cancer diagnoses have been linked to poor safety-netting. However, professional guidance on safety-netting is lacking. This is a knowledge and practice gap. A study from Friedemann Smith explored the best ways to deliver safety-netting advice. It suggests that people are more likely to follow advice if they are involved in developing the follow-up plan. They need to understand: why they are receiving this advice what actions are required, and by whom. The lack of time within primary care consultations is well known. This may need to be addressed for clinicians to have long enough to develop a safety-netting plan. Professionals may also need training to develop the appropriate communication skills.
  5. Content Article
    This video published by the Irish Health Service Executive (HSE) tells the story of Pat, whose bowel cancer diagnosis was missed, resulting in his premature death. His daughter Patricia talks about the two investigations that took place into her father's death and how the hospital's internal investigation failed to acknowledge that a staff member had raised concerns about Pat's initial colonoscopy on five occasions, but this had not been followed up. She describes the impact of these events on her father and the rest of the family and calls on medical professionals to "trust us (families) more and fear solicitors less."
  6. Content Article
    In this article for iNews, journalist Sarah Graham talks to Dee Montague-Coast, who has asthma and endometriosis, and who has had very different experiences of care between the two conditions. Dee describes how she has always received excellent care for her asthma, but how she has had to endure disbelief and many investigations, tests for sexually transmitted infections and even surgeries over twenty years, before finally being diagnosed with endometriosis by a private consultant. Sarah highlights the difficulties women face in receiving diagnosis and treatment for endometriosis, in spite of it being the second most common gynaecological condition. She also highlights geographical and race-based disparities in care and treatment and outlines how attitudes towards women's pain means their symptoms are not always listened to and taken seriously.
  7. Content Article
    This report from the National Asthma and COPD Audit Programme (NACAP) offers a view of the care of people with asthma and COPD in England and Wales, and is informed by 103,194 case records submitted to the audit programme. It is the first report to combine data on asthma, COPD and pulmonary rehabilitation across primary and secondary care services to underpin key messages, optimising respiratory care across the pathway.
  8. Content Article
    In November 2021, 15-year old Alice Tapper nearly died due to a missed diagnoses of a perforated appendix. In this opinion piece, Alice shares her experience of being admitted to hospital with intense abdominal pain and other serious symptoms. In spite of her parents' requests for imaging to rule out appendicitis, doctors diagnosed that Alice had a viral infection and refused to prescribe antibiotics. Alice's condition severely deteriorated, leading her father to call the hospital and beg a gastroenterologist for further investigation. Fortunately, the hospital granted his request and after an x-ray and ultrasound, Alice was found to have a perforated appendix. She was going into hypovolemic shock, when severe blood or other fluid loss makes the heart unable to pump enough blood to the body. Thankfully, emergency surgery and antibiotics saved Alice's life, but she reflects on the fact that without her father's intervention, she would probably have died. She describes how her doctors failed to take the concerns she and her parents repeatedly expressed seriously, and that this lack of responsiveness could have been fatal. She highlights research that shows that appendicitis is missed in up to 15% of paediatric patients, and that missed diagnosis is most common in children under five, and is more common in girls than boys.
  9. Content Article
    Roughly 16 million Americans are living with Long Covid, but many are not getting the right medical care. In this article in Popular Science, Miles Griffis argues that one way to improve the system is by letting patients lead. He describes his own disabling case of Long Covid, the issues he has faced in gaining access to Long Covid clinics and the lack of treatment options available to him. He argues that at some point, the demand from patients for treatment will force progress in Long Covid research.
  10. Content Article
    In the UK, the focus of osteoporosis care in the NHS has been on people who have sustained a fragility fracture as a result of their underlying condition. Not much has been done to try and prevent the first fracture by promoting good bone health and proactively identifying people at higher risk. This report by the APPG on Osteoporosis and Bone Health presents the results of its inquiry into primary care provision for people with osteoporosis and those at high risk of fracture, launched in March 2022. The inquiry aimed to establish the current quality of care being offered to patients.
  11. Content Article
    Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). The authors from the John Hopkins University conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measured error and harm frequency, as well as assessing causal factors.
  12. Content Article
    Jenny Edwards died in February 2022 from pulmonary embolism, following misdiagnosis. In this blog, her son Tim introduces us to Jenny, illustrating the deep loss felt following her premature passing. He talks about the care she received and argues that there were multiple points at which pulmonary embolism should have been suspected. Tim found the investigation that followed Jenny’s death to be lacking in objectivity and assurance that any learning could be taken forward. He has since produced an independent report, drawing on existing data, freedom of information requests and his mother’s case, to highlight broader safety issues.
  13. Content Article
    The BMJ, in partnership with the Choosing Wisely international collaboration, led by the Choosing Wisely Canada campaign, has introduced a “Change” series in the Education section. Articles in the series highlight evidence based strategies and tools to help change practice and reduce unnecessary tests, treatments, and procedures. The articles indicate why and how practice needs to change, usually focusing on one aspect of care, and are aligned with recommendations made by national Choosing Wisely campaigns.
  14. Content Article
    The waiting list in England stood at more than seven million in September 2022, up by 1.2 million since September 2021 and 2.6 million since 2019. This analysis by the King's Fund outlines what different patients on the waiting list are waiting for, breaking this figure down into: different medical and surgical specialties whether patients are waiting for admission, diagnostics or decisions It highlights that many on the waiting list are awaiting further diagnostics or decisions before treatment can commence, and others are waiting for treatment that does not require admission to hospital.
  15. Content Article
    This investigation by the Healthcare Safety Investigation Branch (HSIB) explores the issues associated with the assessment of risk factors for venous thrombosis in pregnancy and the first six weeks after birth. Venous thrombosis occurs when a blood clot forms and causes a blockage in a person’s vein. This can lead to venous thromboembolism (VTE), when part of the clot breaks off and travels through the bloodstream, blocking a blood vessel elsewhere in the body. Pregnant women and pregnant people are at greater risk of developing a venous thrombosis than those who are of the same age and not pregnant. Because of the increased risk, healthcare staff assess a pregnant woman’s risk factors for VTE at key stages before and after the birth, so that they can be given preventative treatment if necessary. While rare, in the UK venous thrombosis and VTE is the leading direct cause of death of pregnant women during pregnancy or up to six weeks after the end of pregnancy. Reference event The reference event for this investigation was the case of Alice, who was 26 years old and was pregnant with her second child. A VTE risk assessment was completed for Alice at her first antenatal appointment, when she was admitted to hospital for the birth of her child, and 24 hours after admission. Her score was zero each time, meaning no risk factors were identified for VTE. During her pregnancy Alice reported experiencing some pain in her calf; she was examined by a doctor who referred her for a scan. This ruled out a deep vein thrombosis (DVT). After giving birth by caesarean section, Alice's risk assessment was repeated, and as it indicated that medication was required, a preventative dose of low-molecular-weight heparin was prescribed and Alice was discharged. Eleven days after the birth of her baby, Alice was taken by ambulance to the emergency department with chest pain, shortness of breath and leg cramps. She was diagnosed with a pulmonary embolism (PE) and was started on a treatment dose of blood-thinning injections. Following investigation, it was found that Alice may not have received an appropriate preventative dose of low-molecular-weight heparin to help prevent the VTE.
  16. Content Article
    Pulmonary embolism is the third most common cause of cardiovascular death worldwide after stroke and heart attack. Although life-threatening, when diagnosed promptly survival rates are good.  This report, authored by risk expert Tim Edwards and published by Patient Safety Learning, highlights serious and widespread patient safety concerns relating to the misdiagnosis of pulmonary embolisms.  Drawing on existing data, freedom of information requests and his mother’s case, he outlines nine calls for action to improve pulmonary embolism care. 
  17. Content Article
    This briefing paper, from the Royal College of Radiologists, was produced to help inform an adjournment debate in the house of commons focusing on pulmonary embolism misdiagnosis. The briefing highlights concerns around staffing gaps, workforce planning and equipment shortages within this area, and the threat this poses to patient safety.
  18. Content Article
    This is an Adjournment Debate from the House of Commons on Wednesday 30 November 2022 on patient safety concerns relating to the diagnosis of pulmonary embolisms.
  19. Content Article
    An expert review of the clinical records of 44 deceased patients who had been under the care of neurologist Dr Michael Watt has found there were “significant failures” in their treatment and care. Dr Watt, a former Belfast Health and Social Care Trust consultant neurologist, was at the centre of Northern Ireland’s largest ever recall of patients, which began in 2018, after concerns were raised about his clinical work. More than 4,000 of his former patients attended recall appointments. At the direction of the Department of Health, in August 2021, the Regulation and Quality Improvement Authority (RQIA) commissioned the Royal College of Physicians to undertake an expert review of the clinical records of certain deceased patients who had been under the care of Dr Watt, with the intention to understand his clinical practice, to ensure learning for others and to help make care better and safer in the future.
  20. Content Article
    In July 2022, HSIB launched a national investigation into the safety risk of clinical investigation booking systems failures. Specifically, the investigation explores the use of paper or hybrid booking systems and the production of appointment letters. This interim bulletin highlights a safety risk identified by the investigation and presents a safety observation for the attention of NHS care providers. Some vital NHS services still use paper-based or hybrid systems, which may have been developed over time and could leave unintended gaps where patients can be lost in the system. The reference case for this investigation is the experience of a patient whose magnetic resonance imaging (MRI) scan was not rescheduled following a cancellation, leading to a delay in the diagnosis of cancer. Hybrid systems were in use, which did not assist staff to keep track of patients. Additionally, the hybrid systems in use did not allow appointment letters in non-English languages to be produced.
  21. News Article
    Eighteen people died at two Teesside hospital trusts following patient safety lapses over a 12-month period. Sixteen such deaths were recorded at the South Tees Hospitals NHS Foundation Trust, with two at the North Tees and Hartlepool NHS Foundation Trust. Examples of patient safety lapses include a failure to provide or monitor care, a breakdown in communication, an out-of-control infection in a hospital, insufficient staffing or a missed diagnosis. NHS England figures show that, between April 2021 and March this year, there were 16,557 incidents at the South Tees Trust, which operates James Cook University Hospital in Middlesbrough, and Northallerton's Friarage Hospital. Thirty-four resulted in "severe" harm. Middlesbrough MP Andy McDonald told the Local Democracy Reporting Service the figures were a concern and that he planned to take them up with the South Tees Trust's chief executive. He said NHS staff worked under "the most demanding of conditions" but added: "Every person going into hospital rightly expects to receive the best treatment. Patient safety is paramount and no family wants to see a loved one suffer." Dr Mike Stewart, the trust's chief medical officer, said: "We encourage an open and transparent culture and promote the reporting of all patient safety incidents, even when there is uncertainty over a direct link between any problems in care and incidents of severe harm or death. "In the last year there were no deaths graded as definitely preventable due to a problem in the care delivered by the trust. "While our reporting has increased consistently over the last three years, the number of serious incidents has not risen, which is strong evidence of a positive safety culture." Read full story Source: BBC News, 30 October 2022
  22. News Article
    Cancer patients in this country should have the best survival chances in the world. With its universal healthcare system and world-leading researchers, the UK should be able to offer every patient the knowledge and reassurance that their disease will be picked up quickly and treated rapidly, with the best that science can throw at it. Yet Britain languishes towards the bottom of developed nations’ league tables of cancer performance. On nearly every metric this is one of the worst places in the western world to get cancer — and some experts fear that survival rates are about to go backwards for the first time in a generation. Britain is now operating a “late diagnosis service” for the disease, a former UK cancer tsar has said, while waiting times are creeping up and up and nearly half of patients are diagnosed when their tumours have already spread, slashing their survival chances. Read full story (paywalled) Source: The Times, 22 October 2022
  23. News Article
    More than a quarter of women with ovarian cancer saw their GP three or more times before getting a referral for tests, according to a new study. Researchers also found that almost a third had waited for longer than three months after first going to see their GP before being given the right diagnosis. If doctors are able to diagnose ovarian cancer at the earliest stage, nine out of 10 women will go on to live for five years or longer, but only around one in 10 survive if it is not caught until it has progressed to stage 4, the most advanced stage. The report, by Target Ovarian Cancer, also revealed that 14 per cent of women polled said they were not given their diagnosis in private, meaning others could listen in on the exchange. “I was told of my stage 4 diagnosis behind the curtain on a busy respiratory ward. The rest of the ward heard the conversation,” one woman said. Meanwhile, GPs and ovarian cancer patients told researchers that the support available for the disease is insufficient – with almost half of the women polled not having been asked by a doctor, nurse or other individual providing treatment about how the cancer diagnosis was affecting their mental health. This is despite the fact that 60% of the women diagnosed with ovarian cancer said their mental health had been harmed by the disease. Read full story Source: The Independent. 18 October 2022
  24. News Article
    A woman says she was forced to pay around £25,000 for private healthcare to treat endometriosis after her symptoms were “overlooked” for eight years. Aneka Hindocha, 34, started voicing her concerns about painful periods when she was aged 25 but says she was initially told by doctors this was normal. Ms Hindocha, who described the pain of endometriosis as “someone ripping your insides out”, says the condition should have been diagnosed sooner but argued women’s pain often gets overlooked and ignored. Endometriosis is a very common chronic inflammatory condition, impacting an estimated 1.5 million women in the UK. An inquiry by the All-Party Political Group found that like Ms Hindocha, it takes an average of eight years to get a diagnosis. The condition sees tissue comparable to womb-lining grow in other places in the body - with symptoms often debilitating and spanning from infertility to painful periods, tiredness, pain while having sex, as well as depression and anxiety. “I was told painful periods were normal, which they are not, but I believed that at the time,” Ms Hindocha told The Independent. “I thought the issue was me. I thought I was being a hypochondriac.” Her health massively deteriorated in the summer of 2020 and she became bedbound for three days. “I needed someone to find out what was wrong with me,“ Ms Hindocha added. “I was crying I was in so much pain.” She says that two years later she still had not received her laparoscopy despite the fact her pain was getting more severe and so she ended up paying for a private scan. She finally got diagnosed with stage 4 endometriosis a week later. “By the time of having my surgery at the end of February 2022, it had been nearly two years on the NHS waiting list and I was still being told to wait.” Read full story Source: The Independent, 18 October 2022
  25. News Article
    New patient data shows significant regional differences in the effectiveness of primary care in getting cancer sufferers diagnosed – with an even more alarming picture when the data is broken down by ethnicity. A survey of cancer patients asked how many times they had “spoken to a healthcare professional at [their] GP practice about health problems caused by cancer” before they were diagnosed, with a range between one and more than five times. The overall figure for five times or more in England was 7% – but all four cancer alliances in London scored significantly above this. Cancer Research UK said this could reflect the greater concentration of ethnic minority patients in the capital, and the data bore this out. Nationally, 6.6% of white cancer patients had seen five or more primary care staff before getting a diagnosis. This compared to 11.7% for Asian cancer patients and 12.9% for Black cancer patients. Read full story (paywalled) Source: HSJ, 18 October 2022
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