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Found 2,349 results
  1. Content Article
    Jerome, a patient safety manager, discusses the impact the pandemic is having on patient referrals and waiting lists, and the subsequent increases in serious incidents and never events that will arise. With an already overstretched and exhausted workforce, how will these be investigated, how will this be managed? Jerome urges NHS England to give guidance.
  2. Content Article
    The NIHR-supported RECOVERY trial has shown that tocilizumab – an anti-inflammatory rheumatoid arthritis treatment – reduces the risk of death for hospitalised patients with severe COVID-19. Researchers also found that the drug reduces the length of hospital admission, and the risk of patients requiring mechanical ventilation. Last year, the RECOVERY study was the world’s first to show that dexamethasone – a cheap and available steroid – reduces the risk of dying from COVID-19. The latest results from the study also suggests that for COVID-19 patients who have significant inflammation and require oxygen, a combination of a systemic corticosteroid – such a dexamethasone – alongside tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation. RECOVERY is now the second NIHR-supported study to demonstrate the effectiveness of tocilizumab as a treatment for COVID-19 patients, after results from the REMAP-CAP study last month showed that tocilizumab and a second similar drug called sarilumab have a significant impact on survival and can reduce the relative risk of death for critically ill patients in intensive care. The latest results from RECOVERY show that a much wider cohort of COVID-19 patients can potentially benefit from tocilizumab - beyond those critically ill on mechanical ventilation. For this preliminary report, information on the primary outcome was available for 92% of patients. Report has not been peer-reviewed yet.
  3. News Article
    A campaign has started to prevent children and young people receiving cancer treatment alone in the pandemic. Charities behind the #Hand2Hold campaign want to enable all young people aged 16 to 25 to be allowed a chaperone, instead of only some. Mikaela Forrester, 18, from Somerset had some of her cancer treatments alone and said she did not want other young people to have that experience. She said without her mother she found it "scary" and "lonely". Miss Forrester lives in Frome and was diagnosed in July 2019 with Stage 2 Hodgkin Lymphoma, an uncommon cancer that develops in the lymphatic system. In March 2020 she was told she had relapsed and would need to undergo a further round of chemotherapy, radiotherapy, and a stem cell transplant. Because of the coronavirus pandemic, she was told she had to have those treatments on her own, without immediate support from her family or friends. She said: "When I had my transplant and my cells harvested with three weeks in hospital, with no visitors, it was just so scary. It was quite lonely." "Even if I could hug my parents, or if they could stand two metres away with a mask on, just knowing they were there during the most difficult times would have made me feel comfortable because it was so overwhelming." Read full story Source: BBC News, 16 February 2021
  4. News Article
    Availability of inpatient child and adolescent mental health services beds — particularly for eating disorders — has reached ‘crisis point’, with young people left waiting on a standard paediatric ward or at home as demand surged during the covid pandemic. A report to Surrey Heartlands Clinical Commissioning Group (CCG) in January read: “Availability of tier four beds [inpatient mental health beds for children and adolescents, commissioned centrally by NHS England] in the South East and across the country is at crisis point and providers have to compete for the small pool of beds." “Waits for beds or being placed far from home is a distressing and unacceptable experience for children and young people and families and places an additional burden on other parts of the system such as paediatric wards.” The report noted a “demand upsurge to the highest levels in the last three years” since the pandemic. It stated, in mid-January, the CCG had two patients awaiting eating disorder beds being managed on paediatric wards as they had become “physically too unwell to be managed at home”. Four others also waiting for a CAMHS bed were being managed at home. Read full story Source: 16 February 2021
  5. News Article
    The World Health Organization (WHO) has urged countries to prioritise rehabilitation for the medium and long term consequences of covid-19 and to gather information on “long covid” more systematically. WHO has produced a standardised form to report clinical data from individual patients after hospital discharge or after their acute illness to examine the medium and long term consequences of COVID-19.1 It has also set up technical working groups to build a consensus on the clinical description of what WHO now calls “the post-covid-19 condition” and to define research priorities. Speaking at the first of a series of seminars, WHO’s director general, Tedros Ghebreyesus, highlighted the “three Rs”—recognition, research, and rehabilitation. Recognition of the post-covid-19 condition was now increasing, he said, but still not enough research was carried out. He added that countries needed to show commitment to including rehabilitation as part of their healthcare service. “Long covid has an impact on the individual, on society, and on the economy,” he warned. Read full story Source: BMJ, 10 February 2021
  6. News Article
    NHS guidance which often forces pregnant women who test positive with coronavirus to give birth alone is legally wrong, lawyers warned. Official guidance drawn up by NHS England states that if a woman tests positive for Covid, their husband or partner must self-isolate at home and is not allowed to support them during childbirth. But campaigners and lawyers told The Independent their guidance for visitor restrictions in maternity services during the pandemic is legally inaccurate as people have the “right to private and family life” under Article Eight of the Human Rights Act. Maria Booker, of Birthrights, a leading maternity care charity, said: “The NHS oversimplifies the government’s self-isolating Covid regulations and tells partners they have to stay at home. But this hasn’t taken into account the legal nuance that government rules state people can leave home if they have a reasonable excuse." “A woman being anxious about giving birth alone, which most people will be, is likely to legally constitute as a reasonable excuse." “It is completely inhumane for a woman to give birth without a partner or supporter. It is even scarier giving birth alone you are Covid positive. It is terrifying. Nobody should give birth alone and that includes Covid positive women.” Read full story Source: The Independent, 13 February 2021
  7. News Article
    The backlog of patients who have been waiting for cancer treatment for more than 104 days has more than doubled since last year, according to internal NHS England papers seen by HSJ. At the start of February, the backlog of cases already at more than 15 weeks had hit 6,109, compared to 3,000 at the same point in 2020. National targets state cancer patients should be treated with 62 days of being referred. In the North West region, the backlog has nearly tripled over the same time period, from 289 to 831 (see regional breakdown below). Senior sources told HSJ the increase had been largely driven by acute providers in Greater Manchester and Merseyside. Cases in which patients have to wait more than 104 days for treatment are generally considered serious breaches, and typically trigger a process to identify if the delay has caused harm to the patient. Some local systems have declared a “zero tolerance” for such instances. The data in the papers is provisional. Michelle Mitchell, Cancer Research UK’s chief executive, said the impact of covid-19 on cancer patients has been “devastating”. She added: “The government must urgently make sure the NHS gets the funding it needs to increase cancer service capacity, and give every person with cancer the timely diagnosis and treatment they deserve.” Read full story (paywalled) Source: HSJ, 13 February 2021
  8. News Article
    People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog. Mencap said it had received reports in January from people with learning disabilities that they had been told they would not be resuscitated if they were taken ill with COVID-19. The Care Quality Commission (CQC) said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year. DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks. The disclosure comes as campaigners put growing pressure on ministers to reconsider a decision not to give people with learning disabilities priority for vaccinations. There is growing evidence that even those with a mild disability are more likely to die if they contract the coronavirus. Read full story Source: The Guardian, 13 February 2021
  9. News Article
    A new trial is to test how well the Oxford-AstraZeneca coronavirus vaccine works in children. Some 300 volunteers will take part, with the first vaccinations in the trial taking place later in February. Researchers will assess whether the jab produces a strong immune response in children aged between six and 17. The vaccine is one of two being used to protect against serious illness and death from Covid in the UK, along with the Pfizer-BioNTech jab. As many as 240 children will receive the vaccine - and the others a control meningitis jab - when the trial gets under way. Andrew Pollard, professor of paediatric infection and immunity, and chief investigator on the Oxford vaccine trial, noted that most children were relatively unaffected by Covid and were unlikely to become unwell with the virus. But he said it was important to establish the safety and immune response to the vaccine in children and young people as some children might benefit from vaccination. Read full story Source: BBC News, 14 February 2021
  10. Content Article
    The coronavirus has a high incidence of patients with severe acute respiratory syndrome (SARS). Many patients infected with COVID-19 need to be admitted to the ICU for invasive ventilation. They are also at a high risk of developing secondary, ventilator-associated pneumonia (VAP).
  11. Content Article
    In a BMJ interview, former health secretary Jeremy Hunt tells Gareth Iacobucci his regrets from his time in charge, how they made the pandemic worse, and why this has fuelled him to be so outspoken since.
  12. Content Article
    More than 1·8 million lives have been lost due to COVID-19. Two frontrunner vaccines from Moderna and Pfizer-BioNTech promise some relief, with data suggesting 95% efficacy,1 and have been granted emergency use authorisations in several countries. In an open letter responding to these developments, participants in COVID-19 vaccine trials argued that those who received placebos should be unmasked and given priority access to authorised vaccines. The letter cited the American Medical Association's Code of Medical Ethics, which highlights the importance of minimising the time research participants spend in a placebo group. Fulfilling these requests could help to foster trust in medicine and research, reward those who take risks for the many, and prevent future harm from COVID-19 for these participants. However, granting these requests also comes with tradeoffs and highlights competing interests inherent in vaccine development. Importantly, these requests also reveal shortcomings in bioethical resources, particularly clinical equipoise conceptualisations. Friesen et al. discuss this further in this Lancet correspondence.
  13. Content Article
    The scale of the emergency response to the COVID-19 pandemic has been extraordinary, but what comes next? The King's Fund spoke with people involved in response efforts for disasters from around the world, from the Christchurch earthquakes in New Zealand to the Grenfell Tower fire in London, to understand what the health and care system can learn from the experience of recovery from other disasters as it responds to the pandemic.
  14. News Article
    The NHS must have a realistic and steady approach to resuming services disrupted by the pandemic that explicitly recognises the need for staff to recover, NHS leaders have said. In a letter to the prime minister leaders from the NHS Confederation, which represents healthcare providers, warned, “The NHS cannot recover its services at the same rate of increase when staff are so exhausted.” The letter noted that there were over 5000 more patients with COVID-19 in UK hospitals right now that at the peak of the first wave and that this was taking its toll on staff. The leaders called for sustained local mental health support for the NHS workforce beyond the end of March and for a long term, fully funded plan to increase staffing numbers. The government must also set out clear expectations for the public on when routine procedures and other treatments would be fully back on line, they added. “With a workforce on its knees and many of the pre-pandemic challenges still very much at play they need your government both to acknowledge the consequences of the immense pressure their workers have been under so far, and to be realistic and honest with the public about what the NHS can safely deliver moving forward,” the letter said. Layla McCay, director of policy at the NHS Confederation, said that while health leaders would continue to prioritise urgent care and patients with the greatest clinical need, the prime minister must “be upfront with the public about what the NHS can safely deliver in this next phase.” Read full story Source: The BMJ, 11 February 2021
  15. News Article
    The number of patients in critical care grew at one in four English hospital trusts in the past week, despite overall covid-19 occupancy falling, HSJ can reveal. It comes with adult critical care occupancy still very high in many areas — 10 trusts still have at least double the number of patients that they normally have space for. It highlights the ongoing pressure still on hospitals, with the prime minister due to decide in coming days on a timetable for loosening lockdown. HSJ analysis of NHS sitrep data shows that 31 trusts (of a total 125 general acute trusts) saw the number of critically ill adults climb between 2 and 9 February. Twenty-five of these trusts were either at or above their total capacity available last winter. The critical care units still seeing increasing pressure when compared to last year are spread nationally, but are predominantly in Yorkshire, Midlands and the North West, where the covid third wave peaked later. Read full story (paywalled) Source: HSJ, 11 February 2021
  16. News Article
    Nearly 6 out of every 10 people who died with coronavirus in England last year were disabled, figures suggest. Some 30,296 of the 50,888 deaths between January and November were people with a disability, Office for National Statistics (ONS) data shows. It also suggests the risk of death is three times greater for more severely disabled people. Charities have called for urgent government action, describing the data as "horrifying and tragic". The ONS figures suggest disabled people were disproportionately affected by the pandemic - accounting for 17.2% of the study population but nearly 60% of coronavirus deaths. Among women, the risk of death involving coronavirus was 3.5 times greater for more-disabled women - defined as having their day-to-day activities "limited a lot" by their health - compared with non-disabled women. For less-disabled women, defined as having their day-to-day activities "limited a little", the risk was two times greater. Compared to non-disabled men, the data showed that the risk was 3.1 times greater for more-disabled men, and 1.9 times greater for less-disabled men. Looking at people with a medically diagnosed learning disability, the risk of death involving Covid was 3.7 times greater for both men and women compared with people who did not have a learning disability. Read full story Source: BBC News, 11 February 2021
  17. News Article
    A drug used to treat rheumatoid arthritis could cut the number of Covid deaths and speed up recovery, a new scientific trial has found. The drug, tocilizumab, could save the lives of one in 25 coronavirus patients in hospital and reduce the need for ventilators in intensive care. Researchers say around half of the people admitted to hospital with coronavirus could benefit from the treatment. Scientists from the nationwide Recovery trial said when tocilizumab was given alongside the steroid dexamethasone, it reduced the absolute risk of mortality by four percentage points. The medicine was already being used by the NHS to treat some coronavirus patients after early results last month showed it reduced the risk of death as well as time spent in hospital by up to 10 days. As a result of the latest findings, the health secretary said the drug would be made more widely available on the NHS to help treat Covid patients. Read full story Source: The Independent, 11 February 2021
  18. Content Article
    The COVID-19 pandemic has caused unprecedented morbidity, mortality and global disruption. Following the initial surge of infections, focus shifted to managing the longer-term sequelae of illness in survivors. ‘Post-acute COVID’ (also known as ‘Long COVID’) is emerging as a prevalent syndrome. It encompasses a plethora of debilitating symptoms (including breathlessness, chest pain, palpitations and orthostatic intolerance) which can last for weeks or more following mild illness. Dani et al. describe a series of individuals with symptoms of ‘Long COVID’, and posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. They suggest that all physicians should be equipped to recognise such cases, appreciate the symptom burden and provide supportive management. They present our rationale for an underlying impaired autonomic physiology post-COVID-19 and suggest means of management.
  19. Content Article
    In The Lancet correspondence, Norton and colleagues on behalf of the ISARIC and GloPID-R Long COVID Forum Working Group, write following an international, multistakeholder forum, in which peoples’ voices were central, to expand the call to action and to identify how we can prevent long COVID from becoming the long-lasting legacy of COVID-19.
  20. Content Article
    The outbreak of COVID-19 changed everything, for everyone, across the globe. New ways of working and every day challenges were a reality for us all, none more so than for key workers.  But the pandemic also highlighted the role whistleblowing plays in all of our lives and the perils of not listening to whistleblowers and their concerns. From the late Wuhan doctor, Dr Li Wenliang, who selflessly tried to warn of the dangers of the coronavirus outbreak (and was later reprimanded for his “false comments”), to our own NHS staff and care home workers speaking out about PPE safety concerns and working conditions, and the furlough fraud crisis, whistleblowing has been centre-stage during COVID-19. This report from Protect considers the concerns whistleblowers raised with our Advice Line in the first six months of lockdown in the UK (March - September 2020). 
  21. News Article
    People previously admitted to hospital or needing "continuous or repeated" steroid use because of asthma are to be prioritised for the Covid vaccine. The most severe cases will fall into priority-group four, the "clinically extremely vulnerable", who should have received a letter advising they shield. And the government has now confirmed the rest who meet the above category will be included in group six, the clinically "at risk", including some but not all those usually eligible for a free flu jab. It follows patients' calls for clarity. The government said it was following independent experts' advice. Read full story Source: BBC News, 11 February 2021
  22. News Article
    More than 100,000 people were waiting for ‘urgent’ priority two operations in late January, as planned care rates plummeted amid the covid third wave, according to NHS data seen by HSJ. However, the rate of elective procedures carried out last month appears to have been a lot higher than in the spring wave of coronavirus, despite there being more covid patients in hospital this time. In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 planned overnight admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 planned overnight admissions per week. This equates to a reduction of 23% and 44%, respectively. Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed. In London and the South East, day case activity reduced by around 40% between the same periods, while elective overnight admissions fell by around 57%. Read full story (paywalled) Source: HSJ, 10 February 2021
  23. News Article
    The MP leading an investigation into coronavirus fears long Covid could cost the UK around £2.5 billion a year. Layla Moran believes the emerging crisis is comparable to the impact rheumatoid arthritis has on the health service, with hundreds of thousands of people expected to be dealing with the condition for months. The ONS says around one in ten people who test positive will go on to develop long Covid, a catch all term to describe a host of ongoing symptoms in coronavirus patients. More than 1.7 million COVID-19 infections have been reported since Christmas Day in the UK. Speaking exclusively to Metro.co.uk, Ms Moran – who chairs the All Party Parliamentary Group (APPG) on coronavirus, said: "The amount of money that we are expecting to spend long term on long Covid could be similar to rheumatoid arthritis. How many people know someone with rheumatoid arthritis? It is going to be higher for long Covid." Read full story Source: The Metro, 10 February 2021
  24. Content Article
    During the first wave of the COVID-19 pandemic in England, several population characteristics were associated with an increased risk of death from the virus, including age, ethnicity, income, deprivation, care home residence and housing conditions. Public health agencies wanted to understand how these vulnerability factors were distributed across their communities.  Daras et al. from the NIHR Applied Research Collaboration North West Coast (NIHR ARC NWC) analysed 6,789 small areas in England and assessed the association between COVID-19 mortality in each area and five vulnerability measures relating to ethnicity, poverty, and prevalence of long-term health conditions, living in care homes and living in overcrowded housing. They developed a Small Area Vulnerability Index (SAVI) modelling tool, which forecasts the vulnerability of the local population to the virus.  The data identified noticeably higher levels of vulnerability to COVID-19 clustered within specific communities in the North West, West Midlands and North East regions.
  25. News Article
    Elective activity levels were significantly lower in January than were achieved before Christmas, according to provisional NHS data seen by HSJ. In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 ordinary admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 ordinary admissions per week. This equates to a reduction of 23% and 44%, respectively. Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed. In London and the South East, day case activity reduced by around 40 per cent between the same periods, while ordinary admissions fell by around 57%. Data for the Christmas fortnight was discounted, as activity always falls dramatically in this period. However, the activity levels in January appear to be significantly higher than those reported in the first wave of coronavirus in the spring. Read full story (paywalled) Source: HSJ, 10 February 2021
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