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Found 54 results
  1. News Article
    New guidelines for assessing people with coronavirus who go to hospital were amended after an outcry from parents of children with special needs. The emergency guidelines published by the National Institute for Health and Care Excellence (NICE) are designed to help determine how much treatment a patient will receive. Those deemed "completely dependent for personal care for whatever reason" will be offered end-of-life care rather than restorative treatment. This now excludes people with learning difficulties or cerebral palsy. In a statement NICE said the system was "not perfect" but was designed to support hospital medics "during this very difficult period of intense pressure". "We welcome the recent clarification that the Clinical Frailty Score should not be used in certain groups," it said. The updated guidelines now state that it "may not perform as well in people with stable long-term disability" and suggests that it is not used in those cases. Read full story Source: BBC News, 26 March 2020
  2. News Article
    A woman with brain cancer has been told her chemotherapy has stopped because of the coronavirus outbreak. Nancy Carter-Bradley, 44, from Hampshire, said the health secretary should ring-fence cancer treatment. She said her treatment at a London hospital had paused as it was at full capacity and oncologists were helping with the response to coronavirus. Imperial College Healthcare NHS Trust said it was "exploring use of private healthcare facilities". Mrs Carter-Bradley, from Penwood, said she had been dealing with "unbelievable stress" since she was informed her chemotherapy at Charing Cross Hospital for stage three brain cancer would be paused. Read full story Source: BBC News, 26 March 2020
  3. Community Post
    Do you usually access services, receive treatment or take medication for mental health difficulties? How is this being impacted by the coronavirus outbreak? We’re asking for patients, carers, family members and friends to share their stories, highlight weaknesses or safety issues that need to be addressed and share solutions that are working. We will be identifying themes and reporting to healthcare leaders with your insights. We want to help close the gaps that might emerge as everyone focuses on the pandemic. Please share your stories in the comments below. You’ll need to sign up (for free) to join the conversation. Register here - it's quick and easy.
  4. Content Article
    This guidance recommends the following: Suspend initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilisation (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation. Strongly consider cancellation of all embryo transfers whether fresh or frozen. Continue to care for patients who are currently “in-cycle” or who require urgent stimulation and cryopreservation. Suspend elective surgeries and non-urgent diagnostic procedures. Minimise in-person interactions and increase utilisation of telehealth. Note: This guidance will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible.
  5. News Article
    Delays have begun to cancer treatments, as patients are reprioritised ahead of capacity becoming overwhelmed by the coronavirus crisis. In three separate developments: A London trust announced it was cancelling chemotherapy and routine cancer operations for a fortnight due to coronavirus pressure; An NHS England covid-19 guidance document indicated palliative care cancer patients will be less likely to receive appropriate treatment; and Cancer waiting times guidance has been changed to provide for some urgent referrals for suspected cancer to be sent back to GPs without diagnosis. Read full story (paywalled) Source: HSJ, 23 March 2020
  6. News Article
    Southampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk. The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part. Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days. The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic. Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and to help patients recover quickly as the pressure on health systems mounts." Read full story Source: University of Southampton, 18 March 2020
  7. News Article
    Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition. The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.” NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen. “I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.” Read full story Source: The Guardian, 16 March 2020
  8. News Article
    Although community-based treatment can improve outcomes for people with eating disorders, it must not be at the expense of vital inpatient services, says Lorna Collins in an article today in the Guardian supporting Eating Disorders Awareness Week. No single treatment or approach works for every patient experiencing an eating disorder and it is extremely hard to get help; there is too little money in the system to provide enough care. "Speaking to patients, carers and clinicians, I am struck by the sheer desperation of so many people saying the system has failed them. Too many find that nothing is done until they are at death’s door. Others say no one talks about binge-eating disorder, which is still too often seen as a weakness or a problem that dieting can fix, rather than a real eating disorder," says Lorna. Clinicians, too, paint a gloomy picture of the state of services. Oxford-based eating disorder consultant Agnes Ayton, who chairs the faculty of eating disorders at the Royal College of Psychiatrists, is frank about the problems. She believes NHS eating disorder services are on their knees and desperately need more money after years of austerity. However, there are some encouraging signs. In West Yorkshire and Harrogate, consultant psychiatrist William Rhys Jones, who works for the Connect community and inpatient eating disorders service, says he is seeing real change. Connect’s community outreach teams deliver home-based treatment for people with severe and enduring eating disorders. This is one of the NHSE new care models and Jones says results so far have been very positive. Clinical community services and early intervention result in a good prognosis, he says – and it is cost effective. While inpatient treatment costs about £434 a day, community treatment costs about £20 to £35 a day, with similar or even improved clinical outcomes. While there are concerns about limiting inpatient treatment and prioritising community treatment simply because it may be cheaper, positive examples like this can help hold the NHS to its promise to make treatment truly open to all who need it. Read full story Source: The Guardian, 2 March 2020
  9. News Article
    More than 70 children and young people have been put at risk by long delays in treatment by mental health services in Kent and Medway, HSJ has learned. According to a response to a Freedom of Information request submitted by HSJ, 205 harm reviews have been carried out for patients waiting for treatment following a referral to the North East London Foundation Trust, which runs the child and adolescent mental health services in Kent and Medway. Of those, 76 patients, who had all waited longer than the 18 week target time for treatment, were found to be at risk of harm. One patient had to be seen immediately as they were judged to be at “severe” risk. Seven were found to be at “moderate” risk and 68 at “low” risk. The trust said “risk” meant a risk of harm to themselves or others. But it said none of the 76 patients had come to actual harm. Read full story (paywalled) Source: HSJ, 25 February 2020
  10. News Article
    The Streatham terrorist attack has again highlighted one of the most difficult decisions the emergency services face – deciding when it is safe to treat wounded people. In the aftermath of the stabbings by Sudesh Amman, a passer-by who helped a man lying on the pavement bleeding claimed ambulance crews took 30 minutes to arrive. The London Ambulance Service (LAS) said the first medics arrived in four minutes, but waited at the assigned rendezvous point until the Metropolitan police confirmed it was safe to move in. Last summer, the inquest into the London Bridge attack heard it took three hours for paramedics to reach some of the wounded. Prompt treatment might have saved the life of French chef Sebastian Belanger, who received CPR from members of the public and police officers for half an hour. A LAS debriefing revealed paramedics’ frustration at not being deployed sooner. A group of UK and international experts in delivering medical care during terrorist attacks have highlighted alternative approaches in the BMJ. In Paris in 2015, the integration of doctors with specialist police teams enabled about 100 wounded people in the Bataclan concert hall to be triaged and evacuated 30 minutes before the terrorists were killed. The experts writing in the BMJ believe the UK approach would have delayed any medical care reaching these victims for three hours. These are perilously hard judgment calls. Policymakers and commanders on the scene have to balance the likelihood that long delays in intervening will lead to more victims dying from their injuries against the increased risk to the lives of medical staff who are potentially putting themselves in the line of fire by entering the so-called 'hot zone'. First responders themselves need to be at the forefront of this debate. As the people who have the experience, face the risks and want more than anyone to save as many lives as possible, their leadership and insights are vital. In the wake of the Streatham attack the government is looking at everything from sentencing policy to deradicalisation. Deciding how best to save the wounded needs equal priority in the response to terrorism. Read full story Source: The Guardian, 7 February 2020
  11. Content Article
    The Primary Care Cancer Toolkit has been developed by the Royal College of General Practitioners (RCGP) in collaboration with Cancer Research UK as part of our partnership to raise awareness and knowledge of the role of primary care in cancer control. It is designed for use by primary healthcare professionals in the UK. If you are accessing these resources from outside the UK, bear in mind that guidelines and systems may be different. Resources are split into professional and patient sections. Professional resources consist of guidelines, information and tools aimed at those working in primary healthcare. Those within the patient section are websites, information leaflets and other resources aimed at a public audience which a healthcare professional can signpost patients to during or post consultation.
  12. Content Article
    This infographic sets out standardised, safe care of children and young people who are receiving or for consideration of receiving Heated humidified high flow therapy (HHHFT).
  13. News Article
    European clinical guidelines on how to treat a major form of heart disease are under review following a BBC Newsnight investigation. Europe's professional body for heart surgeons has withdrawn support for the guidelines, saying it was "a matter of serious concern" that some patients may have had the wrong advice. Guidelines recommended both stents and heart surgery for low-risk patients, but trial data leaked to Newsnight raises doubts about this conclusion. Thousands of people in the UK and hundreds of thousands worldwide will be treated for left main coronary artery disease each year. This is a narrowing of one of the main arteries in the heart. The guidelines on how to treat it were largely based on a three-year trial to compare whether heart surgery or stents – a tiny tube inserted into a blocked blood vessel to keep it open – was more effective. The trial called Excel started in 2010 and was sponsored by big US stent maker, Abbott. Led by US doctor Gregg Stone, the study and aimed to recruit 2,000 patients. Half were given stents and the other half open heart surgery. Success of the treatments was measured by adding together the number of patients that had heart attacks, strokes, or had died. The research team used an unusual definition of a heart attack, but had said that they would also publish data for the more common "Universal" definition of a heart attack alongside it. There is debate around which is a better measure and the investigators stand by their choice. In 2016, the results of the trial for patients three years after their treatments were published in the New England Journal of Medicine. The article concluded stents and heart surgery were equally effective for people with left main coronary artery disease. But researchers had failed to publish data for the common, "Universal" definition of a heart attack. Newsnight has seen that unpublished data and it shows that under the universal definition, patients in the trial that had received stents had 80% more heart attacks than those who had open heart surgery. The lead researchers on the trial have told Newsnight that this is "fake information". But Newsnight has spoken to experts who say they believe the data is credible. Read full story Source: BBC News, 9 December 2019
  14. Content Article
    This study from Schultz et al., published in the The Canadian Journal of Hospital Pharmacy, clearly shows hat abbreviations currently used by manufacturers to differentiate short- and long-acting medications are problematic. Furthermore, it has highlighted the potential consequences of using non-intuitive abbreviations to differentiate medications with different release rates. The study demonstrates how evidence-based research at the local level, along with feedback and input from front-line staff, can be used to address longstanding problems. Although no strategy can eliminate all errors involving medications with different release rates, this study generated evidence-based solutions that were subsequently implemented to minimise potential errors through more intuitive labelling of medications. The findings from this evaluation are applicable to other organisations seeking to reduce the risk of errors related to medication abbreviations and should also be considered by pharmaceutical companies.
  15. Content Article
    The focus of this CwPAMS project is antimicrobial stewardship, which aims to improve the use of antimicrobials using the expertise of pharmacists and so tackling antimicrobial resistance (AMR); a threat that the World Health Organization (WHO) states currently causes 700,000 deaths per year, which will increase to 10 million worldwide by 2050,[1] and could disrupt the cornerstones of current medicines, such as cancer management and joint replacements.[2] Zambia is lower-middle income country but has a very high burden of infectious diseases, including high morbidity and mortality rates from HIV, lower respiratory tract infections, malaria, diarrhoeal diseases and tuberculosis.[3],[4]University Teaching Hospital (UTH) has reported very high AMR rates to a variety of key antimicrobials and while they were aware of antimicrobial stewardship they didn’t proactively engage with it. WHO has developed an AMS framework with four key components: AMR awareness, appropriate use of antimicrobials, infection prevention and control, and surveillance. Using this framework, our small team from Brighton & Sussex University Trust, UTH and UNZA organised a stakeholders meeting and ‘train the trainers’ event to develop key interventions to improve antimicrobial stewardship at UTH. The three-day event was held in June 2019 in Lusaka and had excellent engagement from doctors, pharmacists and environmental health professionals from UTH plus representatives from Zambian Ministry of Health, THET, Hospital Pharmacist Association of Zambia, University of Zambia and Zambian Medicines Regulatory Authority. The three-day event was a hive of energy, highlighting the Zambian interest and commitment to AMS and improving outcomes for their people, from grass roots to ministerial level. The main outcomes from the event were: To conduct global point prevalence survey (GPPS) for antimicrobial surveillance. To develop and implement an antimicrobial specific drug chart which can improve prescribing practices. To implement a bare below the elbows (BBE) dress code change to improve infection prevention and control. To implement an infection prevention and control and antimicrobial stewardship training programme. To employ an antimicrobial specialist pharmacist to be the guardian of above outcomes. Data collection was a daunting task for our UTH colleagues, so while in Zambia we volunteered to help with data collection for the GPPS pilot. This was a huge success, highlighting how quick and simple the process could be plus the useful data outputs it enabled. From this, we were able to get first-hand experience in UTH, which was invaluable for future programme development; the hospital is huge and sprawling, with little or no access to computers. Six-bedded bays held 11-beds and outpatient pharmacy requests were often above 700 per day. BBE and infection prevention and control were not present, with staff having to wear long-sleeved white lab coats and hand sanitising stations being woefully lacking. Despite these conditions all staff were committed to patient care and safety, and their enthusiasm for improvement has led to speedy employment of an antimicrobial pharmacist at UTH plus development of UTH antimicrobial guidelines, both of which will improve antimicrobial usage. One of our first priorities has been infection prevention and control implementation by utilising neighbouring Ndola Teaching Hospital's experience to conduct more ‘train the trainers’ sessions on handwashing technique, alcohol gel production and use, and BBE requirements. Uniquely we have organised this at hospital level (rather than external workshops) as we have found a larger and more diverse cadre of hospital staff are then able to attend (including nurses, porters and cleaning staff) and minimises patient care disruption and enables a whole hospital approach plus doesn’t require unobtainable technology. These trainers will now disseminate this information among their colleagues and an audit of implementation and practice is planned. Our second drive is implementation of the antimicrobial drug chart with GPPS to determine if the additional chart is effective in improving antimicrobial use. All these initiatives require training to ensure staff are aware of the importance of the initiative and its intended outcomes. We are also now exploring ways to make antimicrobial stewardship training mandated during staff induction. Once this baseline knowledge is established, we can continue to develop more complex training to develop skills and knowledge further and support clinical excellence. We have overcome many challenges to produce these outputs. The distance, lack of conference calling ability and rolling electricity shortages could make communication difficult, but we have employed weekly Zoom calls plus Trello online storage, which require smartphones only, to overcome these issues and this has been very successful and kept us to deadlines. Additionally, we have aimed for the Brighton & Sussex University Trust role to be supportive rather than directive to ensure that projects are owned and used by UTH colleagues and so more sustainable. We have tried to ensure that all tools are culturally appropriate and so more likely to be engaged with, such as newly developed infection prevention and control posters that have UTH staff promoting the initiative. During the workshop we noted Zambian staff enjoyed learning through games and case studies and so (in collaboration with Focus games) we have developed a Sepsis; Zambia board game and are now developing case studies using the new UTH antimicrobial guidelines. A reciprocal visit for UTH staff to experience life in the NHS was also arranged; this has included attendance on ward rounds, shadowing of staff, education observations (in Trust and at local university) and the UKCPA conference. Our feedback sessions have highlighted that there are more commonalities between our hospitals than differences; while the diseases and drugs may be different we are all working in resource tight settings trying to do the best for our patients. A repeating feedback theme though was that there was a more cohesive multi-disciplinary approach to antimicrobial stewardship at Brighton & Sussex University Trust and UTH would like to emulate this; we hope this has been started by involving doctors in the visit, mentoring of antimicrobial stewardship pharmacist and inclusive antimicrobial stewardship / infection prevention and control training and chart development. Future suggestions included undergraduate MDT training and pharmacy induction for medics. As expected, this project has allowed me to fulfil humanitarian aspects that I wanted to achieve. Unexpectedly, I have also seen a development in my problem-solving skills, teaching methods (especially when there is scant technology available), negotiation and leadership skills, which I can then apply to my daily job back in the NHS. Importantly this opportunity has enabled me to really feel like I am given back to the (global) community and provide immense job satisfaction in an area of important global challenge; I encourage anyone with an interest to become involved. References: World Health Organisation. 2016. https://www.who.int/bulletin/volumes/94/9/16-020916/en/ [Accessed 10/11/19]. World Health Organisation. Antimicrobial Resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance [Accessed 10/11/19]. Institute for Health Metrics and Evaluation. GBD Compare. Zambia. https://vizhub.healthdata.org/gbd-compare/ [Accessed 10/11/19]. World Health Organisation. Zambia: WHO Statistical Profile. https://www.who.int/gho/countries/zmb.pdf [Accessed 10/11/19].
  16. Content Article
    We have a new app within Homerton which is featured on the hub. The Homerton University Hospital (HUH) Action Card App is an initiative that aims to bridge the gap between information/processes with clinical members of staff without the need to log into a computer, access the intranet, and finding the long black and white document which is never ending. The Action Card App has easy to read, 1-page coloured documents relating to local and national/local incident trends and Never Events. We entered the Patient Safety Learning Awards on the back of seeing the hub and finding content on there that was incredibly useful on a day to day basis. We genuinely weren't expecting to hear anything back from the Patient Safety Learning team as we are a small trust that not a lot of people know about, and we thought the standard of patient safety initiatives would be high, with many trusts miles ahead of us. I have to say, the team at Patient Safety Learning were nothing but lovely, from the moment the conversation started about the prospect of entering the awards. They all took the time for correspondence and they treated you as a person, as oppose to an entry. When we got the information that we had won the overall prize, we were gobsmacked and elated. The app team were overjoyed with the sense that our hard work had paid off and someone had taken the time to appreciate the work we have been doing at Homerton. We were asked to prepare a presentation prior to the awards, which showcased our work and to share with the attendees of the conference. The day arrived, with so much great work, inspiring talks and a general atmosphere of wanting to do more to keep our patients safe. I would like to thank everyone who heard our presentation (some may say performance) and thank everyone in the Patient Safety Learning team for their help with this process.