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Found 222 results
  1. Content Article
    Chronic pain is the most common complication affecting adults with sickle cell disease (SCD).Pain profoundly affects people’s quality of life, functional ability, and health care utilization. Clinicians are often unsuccessful at addressing chronic pain in SCD, especially among the large number of patients for whom nonopioid analgesics aren’t sufficient and those who have developed opioid tolerance. Why aren’t we doing better? In this perspective article in the New England Journal of Medicine, Childerhose et al. discuss how a biopsychosocial model can help capture people’s experience of chronic pain by affirming that biologic, neuropsychological, and socioenvironmental elements play a role in pain-related processes. 
  2. Content Article
    Outpatient and daycase hysteroscopy and polypectomy (OPHP) are widely recognised methods for the treatment of endometrial polyps. There have been concerns regarding pain affecting satisfaction and tolerability of the outpatient procedure. Dr Bhawana Purwar and colleagues from the Royal Wolverhampton Hospitals NHS Trust conducted a service evaluation of their outpatient hysteroscopy and polypectomy (OPHP) and compared it with their daycase procedures. They concluded that the OPHP is cost-effective and efficient method with reasonable acceptability. It is well tolerated with remarkable success rates and excellent patient satisfaction. As compared to daycase group, it requires less time for recovery and sooner returns to work.
  3. Content Article
    In this special edition episode of 'I forgot to ask the doctor', host Dr Gail Busby interviews Professor Justin Clark and Dr Helgi Johnannsson about the options for pain relief for the important procedure of hysteroscopy. 
  4. Content Article
    In this article for Chamber UK magazine, Lyn Brown MP warns that hysteroscopy could be the next big women's health scandal and calls for dramatic improvements in care. She describes the accounts of women being encouraged to undergo hysteroscopy without anaesthesia and appropriate pain relief, and how lack of informed consent is leaving women feeling violated and scared to undergo future gynaecological procedures. She also describes how she raised the issue in the House of Commons and outlines the failure of the Royal College of Obstetrics and Gynaecology's new 'Good Practice Paper' to properly address the decision making process and acknowledge the severity of the pain experienced by many women who undergo hysteroscopy. The article can be found on page 64 of the e-magazine.
  5. Content Article
    Today (8 March 2023) is International Women’s Day and this year’s theme is #embraceequity. Sex and gender-based inequities in health are widely recognised, with much work needed to improve care, treatment and outcomes for women. In this blog, we’ve selected seven resources to highlight and evidence some of the key patient safety issues and the need for greater investment in this area.
  6. Content Article
    Hysteroscopy is a procedure used as a diagnostic tool to identify the cause of common issues such as abnormal bleeding, unexplained pain or unusually heavy periods. It involves a long, thin tube being passed through the vagina and cervix, into the womb, often with little or no anaesthesia.  Studies indicate that some women do not find hysteroscopy procedures painful. However, it is now widely recognised that many women experience severely painful and traumatic hysteroscopies.[1-5]  At Patient Safety Learning, we have worked with patients, campaigners, clinicians and researchers to understand the barriers to safe care and call for improvements.[6] We believe that no woman should have to endure extreme pain or trauma when accessing essential healthcare.  In this blog we will:  outline the key safety concerns around hysteroscopy procedures summarise recent national discussions highlighting these concerns reflect on the new national guidance outline six calls for action. 
  7. Content Article
    Pain and trauma experienced as a preterm baby in the NICU have been linked to lasting psychological injury, altered brain development and individuals' ability to regulate emotions later in life. In this blog, Vox's Science and Health Editor Brian Resnick looks at how scientists are investigating how to treat pain in babies who can’t tell you when it hurts.
  8. News Article
    Mothers are being offered water injections by the NHS to relieve pain during childbirth, while in some hospitals midwives are burning herbs to encourage breech babies to turn in the womb. Safety campaigners have dubbed the practices dangerous and say that they amount to “pseudoscience” being offered by the health service. They have called on the chief executive of NHS England, Amanda Pritchard, to ban their use in a letter published over the weekend. At least three trusts in England offer water injections for pain relief, including Newcastle upon Tyne Hospitals Trust, United Lincolnshire Hospitals Trust and North Tees and Hartlepool Trust. Information on the Newcastle trust’s website describes the injections as an “alternative form of pain relief” while in Lincolnshire patients are told the body’s response to the injections “prevents pain signals from reaching the brain.” The National Institute for Health and Care Excellence (NICE), which is responsible for setting out which treatments patients should receive, has said the NHS should not use injected water for pain relief. Read full story (paywalled) Source: The Times, 27 November 2022
  9. News Article
    Responding to a backlash from pain patients in the USA, the Centers for Disease Control and Prevention (CDC) have released updated guidelines that offer clinicians more flexibility in the way they prescribe opioids for short- and long-term pain. The new recommendations eliminate numerical dose limits and caps on length of treatment for chronic pain patients that had been suggested in the landmark 2016 version of the agency’s advice, which was aimed at curbing the liberal use of the medication and controlling a rampaging opioid epidemic. Those guidelines cautioned doctors that commencing opioid therapy was a momentous decision for patients. Parts of that nonbinding document were widely misinterpreted, resulting in unintended harm to patients who were benefiting from use of opioids without much risk of addiction. Patients reported they were rapidly tapered off medication by doctors or saw their medication abruptly discontinued, the CDC acknowledged in the new document. The new 100 pages of guidance — which remain only recommendations for doctors, nurse practitioners and others authorised to prescribe opioids — emphasize returning the focus to the caregiver and patient deciding on the best course of treatment. Read full story (paywalled) Source: The Washington Post, 3 November 2022
  10. News Article
    Almost 90% of those living with Long Covid in Ireland have not returned to their pre-Covid level of health, according to a new report. The study of 988 participants was carried out by APC Microbiome Ireland, a research centre based at University College Cork (UCC), in conjunction with Cork University Hospital and Long Covid Advocacy Ireland. It found that more than two-thirds of participants in the study continued to experience fatigue, memory problems, chest pain, stomach upset, and muscle pain. Those surveyed also reported that they were suffering from new symptoms that had not been present before catching Covid. These included tinnitus (38%), mouth ulcers (28%), new allergies (16%) and sexual dysfunction (13%). They said these prolonged symptoms can significantly impact their quality of life, affect their ability to work and cause significant disability. Read full story Source: BBC News, 7 November 2022 Further reading and resources can be found in our dedicated area of the hub on Long Covid.
  11. News Article
    Hysteroscopy Action says thousands of women are in extreme pain during and following the invasive procedures to treat problems in the womb, with many suffering for days. It says some are left with symptoms of post-traumatic stress and subsequently feel unable to have intimate relationships with partners. Others avoid important examinations such as smear tests. The group has written to Women’s Minister, Maria Caulfield, to raise its concerns. In its letter, it claims women are not always given the choice of intravenous sedation or general anaesthetic to reduce pain because of an NHS drive to cut costs. Some are given local anaesthetic which is often painful and doesn’t work. Others are given no drugs at all and expected to cope with distraction techniques - known as “vocal locals.” Hysteroscopy Action has urged Ms Caulfield to open more theatre space for women to have procedures under general anaesthetic as well as offering women the choice of intravenous sedation. Yet Hysteroscopy Action, which has been in touch with thousands of patients who have undergone such examinations, says women are not made aware of this. Last week RCOG President Dr Edward Morris, said it was “working to improve clinical practice around outpatient hysteroscopy”. He added: “No patient should experience excruciating pain and no doctor should be going ahead with outpatient hysteroscopy without informed consent.” "Hysteroscopy Action has collated more than 3,000 accounts of “brutal pain, fainting and trauma during outpatient hysteroscopy.” Hysteroscopy Action's spokeswoman, Katharine Tylko said: “We are counselling hundreds of patients with PTSD, who for various medical reasons find the procedure extremely painful, some even find it torturous." “This does not happen for other invasive procedures such as colonoscopy. We urge the Women’s Minister to act and are demanding an end to this gender pain-gap.” The letter, which has over 20 signatories, including Helen Hughes, Chief Executive of the Patient Safety Learning charity, Baroness Shaista Gohir, civil rights campaigner, and women’s rights activist, Charlotte Kneer MBE, calls for women to be given informed consent and choice about whether and what type of sedation they want. Read full story Source: Express, 6 November 2022 Read hub members experiences of having a hysteroscopy in the Community thread and Patient Safety Learning's blog on improving hysteroscopy safety.
  12. News Article
    More than two-fifths of people in Britain suffer from some form of chronic pain by the time they are in their mid-40s, research suggests. Scientists have found that persistent bodily pain at this age is also associated with poor health outcomes in later life – such as being more vulnerable to Covid-19 infection and experiencing depression. The findings, published in the journal Plos One, suggest chronic pain at age 44 is linked to very severe pain at age 51 and joblessness in later life. Study co-author Professor Alex Bryson, of University College London’s Social Research Institute, said: “Chronic pain is a very serious problem affecting a large number of people. “Tracking a birth cohort across their life course, we find chronic pain is highly persistent and is associated with poor mental health outcomes later in life including depression, as well as leading to poorer general health and joblessness. “We hope that our research sheds light on this issue and its wide-ranging impacts, and that it is taken more seriously by policymakers.” Read full story Source: The Independent, 2 November 2022
  13. Content Article
    This Healthcare Safety Investigation Branch (HSIB) investigation aims to improve patient safety in relation to the use of oral morphine sulfate solution (a strong pain-relieving medication taken by mouth). As its ‘reference case’, the investigation used the case of Len, an 89 year-old man who took an accidental overdose of morphine sulfate oral liquid. Patient Safety Learning has published a blog reflecting on the key patient safety issues highlighted in this report.
  14. Content Article
    In 2016, the Centers for Disease Control and Prevention published prescribing guidelines for opioids. Though intended to encourage best practices in opioid prescribing, these guidelines fueled providers’ fears of opioids and led to many clinicians abandoning patients who relied on opioids for pain relief. In this article, Antje M. Barreveld reflects on the harms he may have caused by underprescribing these drugs, not overprescribing them.
  15. Content Article
    Keren Levy was fit and healthy when she first felt pain in a molar. After numerous dentists and doctors left it untreated, there were knock-on effects throughout her body. Today she is in constant pain and look almost unrecognisable She went to the dentist a number of times but X-rays showed nothing untoward. However, Karen started to develop a horribly rotting taste and knew the tooth was necrotic. She begged her dentist to give her root canal treatment or extract it, but without a visible sign this was needed she was refused. Instead she was referred to her GP, implying her distress was bereavement due to her mother recently dying. Many months later, Keren was referred to a different dentist who gave her a 3D scan that showed the original tooth to be necrotic, as she had said five months before. Evidence of the infection was clear in the surrounding bone. Her dentist records that the delay in treating the original dental infection appears to have triggered a systemic response in my body’s autonomic or endocrine system. Having had perfect health, eventually I had to have 12 root canals; all those teeth were necrotic.  Confronted by the facts, the first dentist Keren saw said that, had he been in his Athens surgery, he would have carried out a root canal on the original tooth. But here, in the UK, he had been concerned he could be held to account by General Dental Council (GDC) regulations, given the X-ray image had not been “definitive”.  An editorial in the British Dental Journal (BDJ) as long ago as 2014 described a climate of “fear and distrust” that had led to defensive dentistry because of the prospect of legal action or disciplinary procedures if anything goes wrong.  Karen's case is a horrific example of excessive diagnostic testing delay, instead of treatment. Months of referrals to neurologists, maxillo-facial specialists, psychologists, GPs, oral medicine departments and other dentists went against common sense and ensured responsibility could never be laid at a particular dentist’s door. Invariably, the first question was: “What did the last dentist say?”
  16. Content Article
    A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.
  17. Content Article
    In this blog Patient Safety Learning highlights the key issues included in its recent response to the Royal College of Obstetricians and Gynaecologists new draft guidance for healthcare professionals who are involved in providing outpatient hysteroscopy.
  18. Content Article
    The gender health gap is a long-standing, deeply entrenched problem that stretches back centuries - yet it is only finally starting to get the attention it deserves. In this discussion hosted by The Independent's Women's Correspondent Maya Oppenheim, Dr Jess Taylor, Le’Nise Brothers, Sandra Igwe and Dr Geeta Nargund explore the steps that must be taken to solve the gender health gap, including proper education of health professionals and engaging in open honest conversations.
  19. Content Article
    In this opinion piece, hub topic lead Saira Sundar looks at the culture of misogyny we have inherited in the medical profession, particularly in the obstetrics and gynaecology area of medicine. We hear time and time again women speaking up about being mistreated and/or disbelieved by medical professionals, resulting in delays in diagnosis and serious harm. However, there is a real change being forced by women themselves, with the public increasingly questioning and insisting on improvement and the right to be heard.
  20. Content Article
    This investigation by the Healthcare Safety Investigation Branch (HSIB) explores the prescription of oral paracetamol in adult inpatients who, on admission to hospital, have low bodyweight (less than 50kg). Paracetamol is a common painkiller often used as first-line management for mild to moderate pain. Although it is safe if taken at the right dose, paracetamol in large amounts is toxic to the liver and therefore the maximum dose must never be exceeded. As its 'reference case', the investigation used the case of Dora, an 83-year-old woman who weighed less than 50kg on admission and lost further weight in hospital. While in hospital, Dora was prescribed oral paracetamol 1g four times a day and towards the end of her admission, she developed multiorgan failure due to sepsis and was diagnosed with paracetamol-induced liver toxicity.
  21. Content Article
    NICE has published its updated guideline on the diagnosis and management of myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS). It is estimated that there are over 250,000 people in England and Wales with ME/CFS, with about 2.4 times as many women affected as men. The guideline covers every aspect of ME/CFS in children, young people and adults from its identification and assessment before and after diagnosis to its management, monitoring and review.
  22. Content Article
    Chronic pain patients are often dismissed and told the pain is in their head. For World Mental Health Day, Glasgow Live reporter Sophie Buchan shares her first-hand experience of gaslighting. Gaslighting refers to a form of emotional abuse which involves "manipulating someone by psychological means into doubting their own sanity". This can also happen in medical settings - referred to as medical gaslighting. This is used to describe medical practitioners who blame a patient's symptoms on psychological factors, or deny a patient's illness, for example, doubting their pain because they "don't look sick".
  23. Content Article
    This article lists some of the top chronic pain and illness blogs on the internet, with a short description of each one.
  24. Content Article
    This guidance from the British Dental Association provides information to help support dental practitioners and the wider dental team in the safe use of conscious sedation techniques.
  25. Content Article
    The report defines the standards for the provision of conscious sedation in the delivery of dental care.
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