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Content ArticleThe CVDPREVENT Audit has published its third annual audit report covering the audit period up to March 2022. The report provides insight into the impact of the Covid-19 pandemic on primary care services, when diagnosis and management of hypertension were significantly disrupted. It also compares the national position against key ambitions identified as milestones for the prevention of cardiovascular disease (CVD) and the detection and management of atrial fibrillation, blood pressure and cholesterol. It also includes findings relating to diagnoses of chronic kidney disease and diabetes, lifestyle and health inequalities, as well as a number of recommendations to support the prevention of cardiovascular disease.
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Content Article
I guess that a common feature linking most visitors to Patient Safety Learning is that they have a profound interest in two things. First, recognising and applauding innovations and ‘best practice’ in healthcare. Second, recognising, exposing and denouncing bad practice. The thing they have in common is the desire to learn from the mistakes in the past to do better in the future. When it comes to ‘bad practice’ in healthcare it is usually in connection with some adverse and damaging impact on patients. Our thoughts turn perhaps to certain medical failures, such as the ‘Mid‑Staffs scandal’. Seldom do we find the need to consider the adverse and damaging impacts on the doctors, nurses and all the other staff who work in the health and social care sector. However, those of you who watched the recent BBC Panorama programme, 'Forgotten heroes of the Covid frontline' will have been appalled at the scandal that now confronts so many frontline staff for whom we stood outside our front doors and clapped for so enthusiastically back in those dark days at the height of the pandemic. This blog is dedicated to those 'forgotten heroes'. I hope that it demonstrates that they are not, in fact, forgotten I hope that the resources linked to this blog may be of help to them. -
Content ArticleDawn Stott has worked in healthcare for many years. Her passion is customer care and service improvement. She has designed courses to support healthcare providers improve practice through capturing enthusiasm and sharing best practice. For the last thirteen plus years she has worked as CEO of the Association for Perioperative Practice (AfPP), a healthcare charity that supports theatre personnel who work in hospitals. When faced with lock down, Dawn shared her thoughts and feelings, via regular emails with her work team. The result is a culmination of her musing, along with some impressions, observations and learning that formed the basis for her book.
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Content ArticleNHS Wales has published a new report detailing the good progress being made to investigate and learn from hospital-acquired COVID-19 in Wales. Established in April 2022, the National Nosocomial COVID-19 Programme is supporting NHS Wales organisations to carry out a review of nosocomial (hospital acquired) COVID-19 patient safety incidents that occurred between March 2020 and April 2022. The programme has prioritised the investigation of the most complex cases, with an aim to provide as many answers as possible for service users, families, carers and staff impacted by nosocomial COVID-19. The programme also aims to maximise learning opportunities across NHS Wales, to drive quality and safety improvements.
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Content ArticleA shortage of nurses across the world, including in countries that provide nurses for international recruitment, has created a global health emergency, according to the latest report from the International Council of Nurses. The report, Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, lays out the devastating impact that the Covid-19 pandemic has had on nurses around the world. It urges that investment in a well-supported global nursing workforce is needed if health systems around the world are to recover and be rebuilt effectively. It also warned against reliance on the “quick fix” of international recruitment instead of investing in nursing education, as this was contributing to staff shortages even in countries with a long tradition of educating nurses to work in higher income countries. The report, co-authored by the organisation's chief executive, Howard Catton, and nursing workforce policy expert Professor James Buchan, includes the findings of workforce surveys from more than 25 countries, including the UK, as well as other research.
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Content ArticleThis long read by the Nuffield Trust looks at priority areas where further development and action could help improve the effectiveness of virtual wards. It outlines different models for virtual wards and looks at how to ensure effective system oversight. It also highlights the need to ensure the workforce is equipped to run virtual wards effectively and safely.
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Content ArticleThe Nuffield Trust held its fifteenth Summit in March 2023. In these video interviews captured at the summit, health and care leaders talk about the challenges and issues currently facing the NHS and social care: Prof Kevin Fong on the immense cost of the pandemic to NHS staff Prof Martin Marshall on the range of challenges facing health and care Nigel Edwards on how the NHS gets on the road to recovery Jill Rutter on squeezed budgets and hospitals dominating health finances Dr Arif Rajpura on practical policies for reducing inequality Chris Hopson on promises to decentralise the NHS to better meet patient need
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Content ArticleThis study in Brain, Behaviour & Immunity - Health aimed to examine associations between symptomatic Covid-19 history, neurocognitive function and psychiatric symptoms. The authors used cognitive task performance, functional brain imaging and a prospective population survey to conduct the study. Converging findings from laboratory and population survey data support the conclusion that symptomatic Covid-19 infection is associated with task-related, functional imaging and self-reported indices of cognitive dysfunction as well as psychiatric symptoms. In some cases, these findings appear to be more amplified among women than men, and among older women than younger.
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Content ArticleNHS waiting lists have risen to record numbers since the pandemic and attempts to bring down the numbers of people waiting for treatment have been ramping up. The NHS Elective Recovery Plan (ERP), launched in February 2022, is intended to make a major contribution to reducing waiting lists. This paper by consultancy firm Lane Clark & Peacock sets out: how the national waiting list has changed over the year and the impact of the ERP. inequalities in the waiting list by speciality and geography and how the ERP has so far impacted regions differently. how LCP's previous projections compare to 2022’s waiting list and what their projections are for 2027 in light of over a year's worth of new data being available.
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Content ArticleConcerns about Covid-19 related mental health are substantial, but the sheer volume of low quality evidence has posed a barrier to evidence synthesis and decision making. In this systematic review, Thombs et al. synthesised results of mental health outcomes in cohorts before and during the Covid-19 pandemic. The authors compared general mental health, anxiety symptoms, and depression symptoms in the general population and other groups during covid-19 with outcomes from the same cohorts before Covid-19. The study found high risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues.
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Content ArticleThe NHS was struggling before Covid-19 and was further severely disrupted by the pandemic. As a result, it is now dealing with a massive backlog in elective care. This blog by Saoirse Mallorie, Senior Analyst at The King's Fund, looks at the causes and state of the backlog and identifies ways to tackle the issue, including increasing workforce and investment, innovation and focusing on prevention.
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Content ArticleIn this report, the Public Accounts Committee, which examines the value for money of UK Government projects, programmes and service delivery, looks in detail at the implementation of NHS England’s three-year recovery programme for tackling the Covid-19 backlog of elective care.
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Content ArticlePatients with Long Covid—defined by the National Institute for Health and Care Excellence (NICE) as signs and symptoms that persist for more than four weeks following acute Covid-19—may present in primary care with symptoms of palpitations (tachycardia) triggered by standing or minimal exertion. These may be accompanied by dizziness, breathlessness, chest pain, sweating, bloating, fatigue and other symptoms which may be caused by a dysfunction of the autonomic nervous system (dysautonomia). This practice pointer in the BMJ outlines: how tachycardia present in patients with Long Covid. what clinical assessment should involve. how to test for postural orthostatic tachycardia syndrome in primary care. drug and non-drug treatments that are available. what patients can do for themselves. when patients should be referred to a specialist.
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Content ArticleThe UK Covid-19 Inquiry is the independent public inquiry set up to examine the UK’s response to the Covid-19 pandemic, assess the impact of the pandemic and learn lessons for the future. The Inquiry is Chaired by Baroness Heather Hallett, a former Court of Appeal judge. This is a recording of the UK Covid-19 Inquiry's preliminary hearing for its third investigation looking at the impact of the pandemic on healthcare. The agenda includes: introductory remarks from the Chair update from Counsel to the Inquiry including designation submissions from core participants. Read the transcript of the hearing.
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Content ArticleStephanie Longe first arrived in the UK from Switzerland in 2019 to work at the High Consequence Emerging Viruses Group at what is now the UK Health Security Agency. At the time, her project was focused on Ebola virus disease survivors. But Covid quickly changed plans. Stephanie and her colleagues had to use their skills to develop Covid treatments and new antivirals. Stephanie was involved in early research to study the Sars-CoV-2 infection, and test vaccine candidates. Then in June 2022, Stephanie had Covid and she is now one of the 2 million people who experience self-reported Long Covid symptoms in the UK. She shares her experience of Long Covid and the research she is doing in this Guardian article.
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Content ArticleThis study in the journal Acta Neuropathologica Communications examined neuropathological findings of patients who died following hospitalisation in an intensive care unit with Covid-19. The researchers conducted brain autopsy on 20 people who had died, followed by ex-vivo imaging and dissection. They found that acute tissue injuries and microglial activation were the most common abnormalities discovered in Covid-19 brains. They also found evidence of encephalitis-like changes despite the lack of detectable virus. The majority of older subjects showed age-related brain conditions even in the absence of known neurologic disease. The findings of this study suggest that acute brain injury alongside common pre-existing brain disease may put older subjects at higher risk of post-Covid neurological issues.
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Content Article
The haunting brain science of Long Covid (Stat,16 February 2023)
Patient-Safety-Learning posted an article in Blogs
In this article for Stat, E. Wesley Ely, Professor of Medicine and Critical Care at Vanderbilt University Medical Center, looks at the impact Covid-19 and Long Covid can have on people's brains. He speaks to people with Long Covid who have experienced a sharp decline in brain function, leading to them losing their jobs, struggling to hold a conversation and in some cases developing early-onset dementia. He also highlights biomedical research that has shown changes to the brain in people with confirmed Covid-19 infections, including a reduction in grey matter, problems in the cells lining the blood vessels and impaired cellular metabolism in the frontal lobe six months following acute Covid. -
Content ArticleWaiting for procedures delayed by COVID-19 may cause anxiety and related adverse consequences. This study from Gagliardi et al. looked at the research on the mental health impact of waiting and patient-centred mitigation strategies that could be applied in the COVID-19 context. Findings revealed patient-centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID-19 context.
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News Article
Covid causing liver damage lasting months after infection, study finds
Patient-Safety-Learning posted a news article in News
Covid is causing liver damage lasting months after infection, according to new research. Researchers at Massachusetts General Hospital, Boston, discovered Covid-positive patients had a “statistically significant” higher liver stiffness than the rest of the population. Liver stiffness could indicate long-term liver injury such as inflammation or fibrosis, the buildup of scar tissue in the liver. Dr Firouzeh Heidari a Research Fellow at Massachusetts General Hospital, said their findings show damage caused by Covid persists for a long time. She said, “Our study is part of emerging evidence that Covid-19 infection may lead to liver injury that lasts well after the acute illness. We don’t yet know if elevated liver stiffness observed after Covid-19 infection will lead to adverse patient outcomes.” Read more Source: The Independent, 4 December 2022 -
News Article
Officials slow to act on Covid contact-tracing warnings, leaked evidence says
Patient Safety Learning posted a news article in News
Public health leaders were slow to act on repeated warnings over Christmas 2020 that contact tracing and isolation should be triggered immediately after a positive lateral flow test result, leaked evidence to the Covid inquiry shows. A scathing “lessons learned” document written by Dr Achim Wolf, a senior test and trace official, and submitted to the inquiry, gives his account of a trail of missed opportunities to improve the NHS test-and-trace regime in the first winter and spring of the pandemic – before vaccines were available. It suggests that people will have unnecessarily spread the virus to friends and relatives in the first Christmas of the pandemic and subsequent January lockdown period because they were not legally required to isolate and have their contacts traced as soon as they got a positive lateral flow test. Instead, for around two months, those eligible for rapid testing were told to get a confirmatory PCR test after a positive lateral flow. About a third of those who subsequently got a negative PCR result were likely to have had Covid anyway. In the “lessons learned” document seen by the Guardian, Wolf says: “Over the winter months, the prevalence in individuals who had 1) a positive lateral flow; followed by 2) a negative PCR; may have been upwards of 30%. These individuals were then allowed to return to their high-risk workplaces.” The former head of policy at NHS test and trace highlights how it took too long to get clear advice from Public Health England about policy on contact tracing and isolation rules in the face of changing scientific evidence on the accuracy of lateral flows. Read full story Source: The Guardian, 30 November 2022 -
News Article
Former vaccines chief sounds warning about UK pandemic readiness
Patient Safety Learning posted a news article in News
The UK is not in a significantly better place to deal with a new pandemic, the former vaccine taskforce chief has said, as a leading public health expert suggested Covid infections may be on the rise again. Dame Kate Bingham, the managing partner at the life sciences venture capital firm SV Health Investors, headed the UK’s vaccine taskforce between May and December 2020. Speaking to a joint session of the Commons health and social care committee and the science and technology committee, about lessons learned during the pandemic, Bingham said many of the initiatives set up by the taskforce had been dismantled, while key recommendations it had provided had not been acted upon. “To begin with, I thought it was lack of experience of officials since we don’t have a lot of people within Whitehall who understand vaccines, relationships with industry, all of that, but actually, I’m beginning to think this is deliberate government policy, just not to invest or not to support the sector,” she said. Among her concerns, Bingham cited the failure to create bulk antibody-manufacturing capabilities in the UK and the proposed termination of the NHS Covid vaccine research registry through which the public could indicate their willingness to participate in clinical trials for Covid vaccines. The decision by the National Institute for Health and Care Research to close the registry was eventually reversed after Robert Jenrick, then a health minister, stepped in. “I am baffled as to the decisions that are being made,” she said. Bingham also raised concerns about the length of time it is taking to agree a contract with Moderna – a US-based company that produces mRNA Covid vaccines – to create a research and development, and manufacturing, facility in the UK. Read full story Source: The Guardian, 30 November 2022 -
News Article
Covid test errors may have led to 23 extra deaths
Patient Safety Learning posted a news article in News
Staff mistakes in a private laboratory may have caused 23 extra deaths from Covid-19. The UK Health Security Agency (UKHSA) made the claim in a report into errors at the Immensa lab in Wolverhampton. It said as many as 39,000 positive results were wrongly reported as negative in September and October 2021. The mistakes led to "increased numbers of [hospital] admissions and deaths", the report, published on Tuesday, concluded. Thousands of people, many in the South West, were wrongly told to stop testing after their results were processed by Immensa. The Wolverhampton laboratory was used for additional testing capacity for NHS Test and Trace from early September 2021, but testing was suspended on 12 October following reports of inaccurate results. Experts said high case rates in some areas were down to people unwittingly infecting others when they should have been isolating. UKHSA experts said the mistakes could have led to as many as 55,000 additional infections in areas where the false negatives were reported. "Each incorrect negative test likely led to just over two additional infections," the report said. "In those same geographical areas, our results also suggest an increased number of admissions and deaths." Read full story Source: BBC News, 29 November 2022 -
News Article
‘Patient safety progress stopped in its tracks by covid’ says Hunt report
Patient Safety Learning posted a news article in News
A report commissioned by Jeremy Hunt before he became Chancellor has highlighted how the pandemic ’stopped progress on patient safety in its tracks’ and called for more accurate data to be published on a range of measures. The National State of Patient Safety was funded by Mr Hunt’s Patient Safety Watch charity and produced by Imperial College London’s Institute of Global Health Innovation. It highlights a rise in rates of MRSA and C. difficile since the onset of the pandemic in 2020, as well as an increase in deaths due to venous thromboembolism and hip fractures. The report said the pandemic had also exacerbated issues associated with staff wellbeing, claiming there had been “notable rises” in staff burnout and ill-health. The researchers described problems with the breadth and accuracy of available patient safety data and highlighted that only 44% of trusts currently fulfilled the obligation to report their own estimated number of avoidable deaths. Although the report added that “data on rates of avoidable deaths are not a panacea”, it described them as a “snapshot of safety and harm and are most usefully used to initiate further work to understand the causes of unwarranted variation”. Read full story (paywalled) Source: HSJ, 27 November 2022 -
News ArticleAt a time when it feels like the world’s perpetually on fire, we all need a therapist – but trying to find one in the USA is difficult. A study from the American Psychological Association (APA) found that 6 in 10 psychologists “no longer have openings for new patients” in America. The shortage comes as demand for therapy soars: since the beginning of the pandemic, about three-quarters of practitioners have seen their waiting lists expand. In the same period, almost 80% of practitioners report an increase in patients with anxiety disorders and 66% have seen an increase in those needing treatment for depression. “I started my private practice just before Covid hit, and it was certainly filling up then,” says Dr Jennifer Reid, a psychiatrist, writer and podcast host in Philadelphia. “But the numbers have exponentially risen since that time.” Reid focuses on anxiety and insomnia, which have been “major players” in the pandemic. Early on, people with anxiety, phobias or obsessive-compulsive disorder related to germs had particular trouble, she says. Then there was the isolation and the doomscrolling. And now, she says, people are struggling to re-enter the world. “People are finding they’re having anxiety trying to re-engage in social settings in situations that were previously not as safe” at Covid’s peak, she says. Often, she says, people may need to return to their primary care doctor for a period of time, “or they just end up going without and waiting on waitlists, unfortunately”. The APA study found that the average psychologist reported being contacted by 15 potential patients every month; Reid, who combines therapy and medical approaches, says she generally has space for about one new patient every few weeks. Read full story Source: The Guardian, 21 November 2022
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News Article
Long Covid: What's changed, and what we know now
Patient Safety Learning posted a news article in News
More than two million people in the UK say they have symptoms of Long Covid, according to the latest Office for National Statistics (ONS) survey. Many long Covid patients now report Omicron was their first infection. But almost three years into the pandemic there is still a struggle to be seen by specialist clinics, which are hampered by a lack of resources and research. So has the condition changed at all, and have treatments started to progress? NICE defines Llong Covid, or post-Covid syndrome, as symptoms during or after infection that continue for more than 12 weeks and are not explained by an alternative diagnosis. An estimated 1.2m of those who answered the ONS survey reported at least one such symptom continuing for more than 12 weeks - health issues that they didn't think could be explained by anything else. It's easy to assume that new cases of long Covid have significantly decreased, given recent research suggesting the risk of developing long Covid from the Omicron variant is lower. However, the sheer scale of cases over the past year has resulted in more than a third of people with long Covid acquiring it during the Omicron wave, according to the ONS. Patients are usually referred to post-Covid assessment clinics after experiencing symptoms for 12 weeks - however, waiting times have not improved much within the past year. The latest NHS England figures show 33% of Londoners given an initial assessment had to wait 15 weeks or more from the time of their referral, compared to 39% from a similar period in 2021. The British Medical Association (BMA) has called on the government to increase funding for Long Covid clinics to deal with ever-increasing patient numbers. The BMA says that NHS England's 2022 strategy set out in July failed to announce any new funding. Read full story Source: BBC News, 18 November 2022
