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News Article
'Frail' people like me should not be denied lifesaving Covid care
Patient Safety Learning posted a news article in News
A frailty index is rationing treatment for older and disabled people who catch coronavirus, says Patience Owen. Patience has has a debilitating connective tissue disorder and, like thousands of others with rare conditions, is already in a minority within a minority, marginalised by our NHS, battling increasing disability day by day. Back in March, without consultation and days before the first lockdown, the Clinical Frailty Scale (CFS), a worldwide tool used to swiftly identify frailty in older patients to improve acute care, was adapted by the National Institute for Health and Care Excellence (NICE). It asked NHS staff in England to score the frailty of Covid patients. Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. Nice’s new guidelines advised NHS trusts to “sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”. "Checking the scale, I found I would score five, the 'mildly frail' category, and therefore should I get Covid I could be steered towards end-of-life care. Bluntly, if I catch the virus, the NHS may help me to die, not live," says Patience. By early April, there was a proliferation of illegal “do not resuscitate” (DNR) notices in care homes for people with learning disabilities, and for older people in care homes and in hospitals. Many acutely ill patients stayed at home with Covid symptoms in the belief that they risked being denied care in hospital. Following warnings by the healthcare regulator, the Care Quality Commission, and other medical bodies, that the blanket application of the notices must stop, and legal challenges by charities, exclusions were made to the NICE guidelines. These included “younger people, people with stable long-term disabilities, learning disabilities or autism”. Yet the guidelines remain in place, in spite of the fact that they appear to contravene the Human Rights Act (including the right to life, article 2, and the right to non-discrimination, article 14). A spokeswoman for NICE says it is “very aware of the concerns of some patient groups about access to critical care, and we understand how difficult this feels. Our COVID-19 rapid guideline on critical care was developed to support critical care teams in their management of patients during a very difficult period of intense pressure." “'Difficult' is a hollow word for the feeling of being selected to die," says Patience. "It’s difficult not to conclude that those with long-term conditions and disabilities, like myself, have become viewed as a sacrificial herd." Read full story Source: The Guardian, 29 September 2020 -
News Article
Leaked data gives first view of growing cancer waiting list post covid peak
Patient Safety Learning posted a news article in News
Official data from mid-September shows that nearly 6,400 people had waited more than 100 days following a referral to cancer services. The leaked data reveals for the first time the length of the cancer waiting list in the wake of the first pandemic peak, during which much diagnostic and elective cancer care was paused. The list consists of those waiting for a test, the outcome of a test, or for treatment. NHS England and Improvement only publish waiting times for patients who have been treated – not the number still waiting – so this information has been secret. The data, obtained from official emails seen by HSJ, showed the total number of people on the cancer waiting list grew substantially, from 50,000 to around 58,000, between the start of August and the middle of September. Of the 6,400 people recorded to be waiting more than 104 days on 13 September, 472 had a “decision to treat classification”, meaning they have cancer and are awaiting treatment. NHS England has said reducing the cancer waiting list would be overseen by a national “taskforce”, which is being chaired by national director for cancer Peter Johnson. Experts have warned the delays already stored up in the system could cost tens of thousands of lives as patients go undiagnosed or have their diagnosis and treatment later than they otherwise would. HSJ asked NHS England if harm reviews had been carried out for those on the waiting list and whether it had discovered if those waiting longer than104 days had been harmed, but did not receive an answer. Read full story (paywalled) Source: HSJ, 29 September 2020 -
News ArticleDelays at the Great Ormond Street Hospital led to a boy dying an agonising death, a health watchdog has found. Arvind Jain, 13, who had Duchenne Muscular Dystrophy, died in August 2009 after waiting months for an operation. The ombudsman's report found he had "suffered considerable distress" and criticised referral procedures as "chaotic and substandard". The Great Ormond Street Hospital said there were "failings in clinical care". Arvind's sister Shushma said: "To read that he was suffering all the time, that was disgusting. He had been asking us repeatedly if he would get the operation and we would be constantly reassuring him that he would not die." The degenerative disease Arvind, who lived in Cricklewood, north London, suffered from was not immediately life threatening but in January 2009 his condition had become acute enough for him to struggle with swallowing and feeding. He had a temporary medical solution where a tube was inserted through his nose to help him get the required nutrition. He also experienced a number of other medical complications although none of these was considered life-threatening. The permanent solution recommended by his consultant paediatric neurologist was a gastrostomy insertion which would allow Arvind to feed through his stomach. The Great Ormond Street Hospital Trust (GOSH) excels in such procedures, however, a series of communication errors meant despite repeated and urgent requests from his neurological consultant, proper investigations were not carried out into Arvind's suitability for the operation. After five months of delays he and his family were reassured that as soon as he got the operation he would be much more comfortable. Another hospital also offered to carry out the operation in the event that the delays continued. But the surgical team that was due to carry out the operation never managed to assess Arvind. His condition deteriorated to the point where he was not well enough to be operated on and Arvind died on 9 August 2009. The Parliamentary and Health Service Ombudsman's report said he "suffered considerable distress and discomfort". It also describes a series of basic shortcomings in Arvind's care. The report said: "The standard of care provided for Arvind fell so far below the applicable standards as to amount to service failure." Read full story Source: BBC News, 23 September 2020
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Content ArticleThe webinar took place on Wednesday 16 September but if you missed it, you can watch the recording below. To receive information about future webinars please register with the hub for free or you can follow us on Twitter @ptsafetylearn. To find out more about this issue, please read Patient Safety Learning's blog: Patient safety on the frontline: Responding to the treatment backlog safely
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News ArticleA survey of members of the Royal College of Physicians (RCP) has found that almost two thirds (60%) of doctors worry that patients in their care have suffered harm or complications following diagnosis or treatment delays during the pandemic, while almost all doctors (94%) are concerned about the general indirect impact of COVID-19 on their patients. This is also compounded by the difficulty doctors are finding in accessing diagnostic testing for their patients. Only 29% of doctors report experiencing no delays in accessing endoscopy testing (one of the main diagnostic tests used by doctors) for inpatients, decreasing to just 8% for outpatients. Only 5% of doctors feel that their organisations are fully prepared for a potential second wave of COVID-19 infection, and almost two thirds (64%) say they haven’t been involved in any discussions about preparations for a second wave of the virus. While the government’s promise to roll out flu vaccines to millions more people is welcome, the RCP recently set several more priorities to help prepare the health service for future waves of COVID-19, including the need to ensure the NHS estate is fully able to cope. Only 5% say they wanted an antibody test for COVID-19 but were unable to access one. Of those tested, a quarter (25%) were positive, with little or no difference when it came to gender, between white and BAME doctors, trainees and consultants or between London and the rest of England. Professor Andrew Goddard, president of the Royal College of Physicians, said: “Delays to treatment are so often a major issue for the NHS but as a result of the COVID-19 pandemic, it’s fair to say we’ve reached crisis point. Doctors are, understandably, gravely concerned that their patients’ health will have deteriorated to the point where they will need much more extensive treatment than previously, at a time when NHS resources are already incredibly depleted." “We also cannot underestimate the need to prepare for a second wave of COVID-19 infection, which threatens to compound the situation. Without careful and rigorous preparation, a second wave coupled with the winter flu season, could overwhelm the NHS.” Source: Royal College of Physicians, 5 August 2020
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Content ArticleBacklog of care and treatment COVID-19 has placed the health and social care system under unprecedented pressure this year. To meet the demand created by the pandemic, a range of non COVID care and treatment was postponed at the peak of the crisis to free up capacity of the NHS. These decisions have created a long-term challenge, with a significant backlog in treatment and care.[1] Postponing all non-urgent elective operations for a period of three months is estimated as resulting in more than half a million cancelled procedures.[2] This, alongside other challenges to restoring services following the peak in the pandemic, could result in the waiting list reaching 10 million by the end of 2020.[3] Impact on patients The delays in treatment resulting from this backlog will have a significant impact of patients’ quality of life and, in some case, their survival. For those managing chronic diseases, such as arthritis, long delays in fairly common surgeries (for instance knee replacements) can reduce functional capacity gain and lead to increased pain and disability.[4] Meanwhile, a recent study looking at delayed diagnosis and cancelled treatment for cancer cases during the pandemic suggested that this could result in “anywhere between 7,000 and 35,000 additional deaths from the disease over the coming year”.[5] In addition to those waiting to be referred for treatment, there is also the issue of high numbers of patients waiting on follow-up appointment. Clinicians have expressed concerns about the clinical risk to those facing delays on their follow-up outpatient lists, particularly because the scale of this is hard to gauge due to there being “no official, verified data on follow up appointments”.[6] Addressing the backlog safely In its recent ‘Third Phase’ response guidance, the NHS identified one of its three key priorities as “accelerating the return to near-normal levels of non-COVID health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”.[7] As we do this, it is vital that patient safety considerations are placed at the heart of this process, as the NHS seeks to address the backlog of cases while also meeting regular demand for services. Key points to consider include: How are organisations tackling the treatment backlog? How is access to treatment and care being prioritised? What are the risks to patient safety, and are these being addressed? Who will ensure that patients’ needs are considered, and who will provide information to manage patients’ expectations? Should cases where surgery delays lead to significant health issues, or even death, be considered as serious incidents? Do we have adequate data about the backlog so we can quantify the problem and manage waiting lists, whether referral to treatment or follow-up appointments? Find out more - join the webinar Are you interested in hearing more about these issues? The webinar is scheduled for 11.00am (BST) on Wednesday 16 September and you can sign up here. References Patient Safety Learning, Response to the Health and Social Care Select Committee Inquiry: Delivering Core NHS and Care Services during the Pandemic and Beyond, 8 May 2020; Patient Safety Learning, The return of elective surgery and implications for patient safety, 15 June 2020. Estimates on this figure vary between around 516,000 at the lower end of the scale (University of Birmingham, COVID-19 disruption will lead to 28 million surgeries cancelled worldwide, 15 May 2020) to potentially as high as 749,248 (Alexander Fowler et al, Resource requirements for reintroducing elective surgery in England during the COVID-19 pandemic: a modelling study, medRxiv, 2020). NHS Confederation, Public reassurance needed on slow road to recovery for the NHS, 10 June 2020. Versus Arthritis, Written evidence submitted by Versus Arthritis (DEL0173), May 2020. Health Data Research UK, The Big C isn’t COVID-19 – it’s cancer, 25 August 2020. Health Service Journal, Recovery watch: the NHS' biggest restoration challenge, 2 September 2020. NHS England and NHS Improvement, Third phase of NHS response to Covid-19, 31 July 2020.
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News Article
Patients don’t feel safe in A&E, research finds
Patient Safety Learning posted a news article in News
Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50. Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off. Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77). Read full story (paywalled) Source: HSJ, 3 September 2020 -
Content ArticleImplementation of COVID-19 related safety measures such as social distancing, use of PPE and cleaning were strongly supported by most respondents. There was ambivalence around less certain measures such as regular staff antigen and antibody testing. Respondents were most likely to participate in research related to their own condition, COVID-19 research and vaccine research, but less likely to participate in healthy volunteer research, especially if suffering from a pre-existing comorbidity identified with increased risk or were female. There was general agreement that participants are comfortable with new ways of working, such as remote consultation, though women and BAME respondents were less comfortable. Findings raise concerns for health inequalities already impacting some groups in the pandemic. The role of clinical necessity and personal benefit support the reopening of services in line with clinical necessity. Moderate caution in respect of vaccine research relative to patient-participant research presents a challenge for pending recruitment demands, and would benefit from qualitative research to explore themes and concerns in more depth and support development and targeting of key messaging.
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News ArticleThe use of inexpensive steroids in treating patients hospitalised with COVID-19 has been found to reduce the risk of death by 20%, according to a new international study. The research encompassed seven clinical trials, which focused on three different types of anti-inflammatory corticosteroids, and was co-ordinated by the World Health Organization (WHO). Following the publication of the findings, the WHO issued new guidelines in which it recommended the use of corticosteroids as standard treatment for patients with “severe and critical” COVID-19. The study, analysed by the National Institute for Health Research (NIHR) at the University of Bristol, looked at patient mortality over a 28-day period after treatment. It found that corticosteroid treatment led to an estimated 20% reduction in the risk of death. Researchers said it was equivalent to about 68% of critically ill patients surviving after treatment with the steroids, compared to approximately 60% surviving without them. Jonathan Sterne, professor of medical statistics and epidemiology at the University of Bristol, said: “Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by COVID-19." Read full story Source: The Independent, 2 September 2020
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News Article
Major A&E shake-up plans to be rolled out in coming weeks
Patient Safety Learning posted a news article in News
Pilots for a new urgent care model requiring walk-in patients to book slots in emergency departments are expected to be rolled out in at least one site in every health system in the coming weeks, HSJ has learned. The move comes amid concerns from trust managers who warned some 111 providers’ systems were too “risk averse” and were sending too many patients who could have been treated in other care settings to hospitals. Local managers believe NHS 111 not directing enough people to alternative services was a cause of a major incident at Gloucestershire Hospitals Foundation Trust’s emergency services earlier this month, HSJ understands. And trust leaders in other parts of the country are understood to have similar concerns. Trials of 111 First have already been publicly confirmed at Portsmouth Hospitals Trust, Royal Cornwall Trust, Newcastle Hospitals FT and Blackpool Hospitals FT. HSJ also understands five London sites, one for each integrated care system in the capital, are also running trials. These “early adopter” trusts have been given autonomy to trial different models for “111 First”. Most EDs at these sites still treat “walk-in patients” as normal. But in Portsmouth, patients with minor injuries who turn up at ED without calling ahead have, on three different days, been instead told to call 111 following assessments. NHS England said further trials will take place in the Midlands and East of England, but the specific trusts undertaking these trials have not been decided yet. Read full story (paywalled) Source: HSJ, 2 September 2020 -
Content Article
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News ArticleThe US Food and Drug Administration (FDA) has approved convalescent plasma for emergency use in hospital patients with COVID-19. The announcement on 23 August said that the FDA had concluded that plasma from recovered patients “may be effective” in treating the virus and that the “potential benefits of the product outweigh the known and potential risks.” The move came despite the absence of results from randomised controlled trials, with only a preprint paper on the effects on hospitalised COVID-19 patients being published to date. Experts have warned that although these early findings show promise there is not enough evidence to show that it works. Plasma from recovered patients was approved on a case by case basis by the FDA for people critically ill with COVID-19 in March. Since then more than 70 000 patients have been treated with plasma. Emergency use approval allows clinicians to use unapproved medical products to diagnose, treat, or prevent serious or life threatening diseases or conditions when there are no adequate, approved, and available alternatives. The FDA’s commissioner, Stephen Hahn, said, “I am committed to releasing safe and potentially helpful treatments for covid-19 as quickly as possible in order to save lives. We’re encouraged by the early promising data that we’ve seen about convalescent plasma. The data from studies conducted this year shows that plasma from patients who’ve recovered from covid-19 has the potential to help treat those who are suffering from the effects of getting this terrible virus.” But Martin Landray, professor of medicine and epidemiology at the University of Oxford and lead researcher for the RECOVERY trial, which is comparing treatments for COVID-19, including convalescent plasma for hospital patients, urged caution. He said, “There is a huge gap between theory and proven benefit. That is why randomised clinical trials are so important. At present, we simply don’t know if it works." Read full story Source: BMJ, 25 August 2020
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Content Article
Could telemedicine solve the cancer backlog?
Patient Safety Learning posted an article in Telemedicine
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News ArticleFollowing four deaths and more than 300 incidents with steroid replacement therapy involving patients with adrenal insufficiency in the past two years, patients at risk of adrenal crisis will be issued with a steroid emergency card. All adults with primary adrenal insufficiency (AI) will be issued an NHS steroid emergency card to support early recognition and treatment of adrenal crisis, a National Patient Safety Alert has said. The cards will be issued by prescribers — including community pharmacists — from 18 August 2020. AI is an endocrine disorder, such as Addison’s disease, which can lead to adrenal crisis and death if not identified and treated. Omission of steroids in patients with AI, particularly during physiological stress such as an additional illness or surgery, can also lead to an adrenal crisis. The alert has requested that “all organisations that initiate steroid prescriptions should review their processes/policies and their digital systems/software and prompts to ensure that prescribers issue a steroid emergency card to all eligible patients” by 13 May 2021. Read full story Source: The Pharmaceutical Journal, 17 August 2020
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News Article
Chemo doorstep drops help to keep cancer patients safe
Patient Safety Learning posted a news article in News
Thousands of patients with cancer have had chemotherapy delivered to their doors so that they can more safely receive treatment during the coronavirus pandemic. Up to 10,000 chemo home deliveries were made over three months at the peak of the outbreak, avoiding the need for patients to venture out and risk infection when their immune system was low. The drops are part of the COVID-friendly treatments introduced in response to the pandemic which have helped to ensure that 85,000 people could start treatment between March and June, with latest data showing referrals beginning to recover to pre-pandemic levels. NHS staff, including community nurses and pharmacists, and volunteers have been dropping off the life-saving medication – they step back two metres when they arrive at a patient’s house, identify them and make sure they have everything they need. Hospitals have also significantly increased the use of chemo at home, with local pharmacy teams and community nurses providing the service to reduce cancer patients’ risk of exposure to the virus. The action joins a series of measures, including the rollout of COVID protected cancer hubs for treatment and introducing ‘COVIDfriendly’ cancer drugs. NHS England is spending £160 million on drugs that mean patients do not have to go to hospitals for regular checks and treatment. Dame Cally Palmer, director of cancer for the NHS in England said: “NHS staff have treated more than 108,000 patients requiring specialist hospital care for COVID-19 while also keeping other vital services such as cancer, maternity and A&E running throughout the pandemic. “The NHS has also fast tracked modern, more convenient services that help to keep patients and staff safe – from video consultations to chemotherapy delivered to patients’ doors – that have allowed 85,000 people to start cancer treatment during the pandemic.” Read full story Source: NHS Improvement, 17 August 2020 -
Event
Online course. Hospital flow in the UK: During and beyond COVID-19
Patient Safety Learning posted a calendar event in Community Calendar
untilThe number one focus in the world right now is health care and the critical need to bring greater efficiency to treating patients. During the COVID-19 pandemic, vast amounts of information are rapidly cross-crossing the globe. Governments, health systems, and research communities in the European region are looking to learn as much as possible from each other, as quickly as possible, about the nature of COVID-19 and the most effective interventions for preventing and treating it. We cannot afford to ignore the clear signs pointing to a new future of increased care needs, labour shortages, and operational strain. From COVID-19 to general routine care, we must act now to ensure that no patient waits for the care they need. For health care professionals looking to structure their leadership plans around lessons learned in the field comes the 'Hospital Flow in the UK: During and Beyond COVID-19'. In this online course from the Institute for Healthcare Improvement (IHI), health care leaders address challenges and share successes, best practices, and strategies to effectively advance the long-term goal of improving community health in a post-COVID world. Experts will discuss noteworthy global challenges and responses to COVID-19, specifically focusing on efforts in the United Kingdom (UK) to monitor and quickly improve treatment for patients across the care continuum. Further information and registration -
News Article
NHS set to roll out £160m ‘Covid-friendly’ cancer initiative
Patient Safety Learning posted a news article in News
As part of a £160m initiative, the NHS will look to roll out and expand ‘Covid-friendly’ cancer treatments which are safer for patients during the pandemic, the health service’s Chief Executive Sir Simon Stevens has announced. The funding will help pay for drugs which treat patients without having as significant of an impact on their immune system, or which could offer other benefits such as a reduced number of hospital visits. Almost 50 treatments have been approved for use as ‘swaps’ for existing drugs, with thousands of patients having already benefitted, and more are expected to be made available this week as part of deals struck between the NHS and pharmaceutical companies. Within these treatments include options which allow patients to take tablets at home or receive medicines with fewer side effects rather than undergoing hospital-based treatment which can leave them more susceptible to coronavirus and other infections. Sir Stevens said: “Since the first case of Covid in England six months ago, NHS staff have fast tracked new, innovative ways of working so that other services, including A&E, cancer and maternity could continue safely for patients and it is thanks to these incredible efforts that 65,000 people could start treatment for cancer during the pandemic. “We are now adopting new, kinder treatment options which are not only effective but safer for use during the Covid-19 pandemic and more convenient for thousands of patients, who can take medication at home or be given medicines with less harmful effects on their immune system.” Read full story Source: National Health Executive, 3 August 2020 -
News Article
Chronic pain sufferers should not be given opioids, says medicines watchdog
Patient Safety Learning posted a news article in News
People with chronic pain that can’t be explained by other conditions should not be prescribed opioids because they do more harm than good, the medicines watchdog has warned. The National Institute for Health and Care Excellence (NICE) has said people should instead be offered group exercise, acupuncture and psychological therapy. In new draft guidance, NICE said most of the common medications used for chronic primary pain has little or no evidence to support their use in patients aged over 16. Its latest guidance comes amid concerns over the level of opioid use. In September last year a review by Public Health England found 1 in 4 adults have been prescribed addictive medications with half of them taking the drugs for longer than 12 months. NICE’s new draft guidance said some antidepressants should be considered for people with chronic primary pain but it said paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, as well as benzodiazepines or opioids should not be given because of concerns they might do more harm than good. Read full story Source: The Independent, 4 August 2020 -
Content ArticleThese inspections have identified some good individual practice. But they have also found some common areas of concerns. These include: staff without the appropriate training, qualifications and competencies to carry out their role unsafe practice in the use of sedation and anaesthetics poor monitoring and management of patients whose condition might deteriorate a lack of attention to fundamental safety processes variable standards of governance and risk management failure to ensure consent is obtained in a two-stage process, with an appropriate cooling off period between initial consultation and surgery infection prevention and control standards not always being followed concerns about equipment maintenance.
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News ArticleA sponge-on-a-string pill test could transform the way oesophageal cancer is diagnosed, researchers say. The method can identify 10 times more people with Barrett’s oesophagus than the usual GP route, scientists say. The test, which can be carried out by a nurse in the GP surgery, is also better at picking up abnormal cells and potentially early-stage cancer. Barrett’s oesophagus is a condition that can lead to oesophageal cancer, cancer of the food pipe, in a small number of people. Normally it is diagnosed in hospital by endoscopy, which involves passing a camera down into the stomach, following a GP referral for long-standing heartburn symptoms. The cytosponge test, developed by researchers at the University of Cambridge, is a small pill with a thread attached that the patient swallows. It expands into a small sponge when it reaches the stomach, and is then quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis. The pill is a quick, simple and well tolerated test that can be performed in a GP surgery and helps tell doctors who needs an endoscopy. In turn, this could prevent many people from having potentially unnecessary endoscopies. Scientists say that as well as better detection, the test means cancer patients can benefit from kinder treatment options if their cancer is caught early enough. Read full story Source: The Independent, 1 August 2020
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Content Article
Foundation Doctor Handbook App
Claire Cox posted an article in Apps for health and care
There are 4 types of documents in the Foundation Doctor Handbook; Assessment Management Reference Calculator. -
Content ArticleThe outcome is that the RCP released a statement on its website relating to revised guidance on the use of early warning scores for COVID-19 inpatients. The RCP suggest that all staff should be aware that any increase in oxygen requirements should be an indicator of clinical deterioration as the early warning score might not significantly increase.
