Hospital Bed-blocking

Delays in discharging patients out of hospital after treatment could be costing NHS in England £900m a year an independent review has said.

It said it was a major problem causing operations to be cancelled and resulting in the NHS paying private hospitals to see patients. Lord Carter (Labour peer) identified the issue in a wider look at how £5bn could be saved by 2020. His proposals called for better procurement and staff management, and savings to the drug bill.

But delayed discharges are likely to be a more intractable problem as it is largely not down to the actions of hospitals. Vulnerable and frail patients cannot be released if there is not the support in the community from home care workers or distinct nursing staff or a place in a care home. The report said information provided by trusts estimated as many as 8,500 beds in acute trusts were being blocked. It said if you take into account how much staffing and running a bed costs this works out at £900m a year. But the true costs are even higher. The report highlighted the growing trend to pay private hospitals to do NHS work as a consequence of this.

Last year the NHS spent £11bn in the private sector- 11% on the previous year.

Delayed discharges have also been blamed as one of the causes of growing waiting times in A&E as doctors struggle to find beds for patients who need to be admitted.

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INFORMATION FROM BBC HEALTH

Zika Outbreak- what you need to know

Zika Outbreak- what you need to know. 

 

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The world Health Organization has declared the Zika virus as a global health emergency. The infection is suspected of babies being born with underdeveloped brains. Some areas have declared a state of emergency, doctors have described it as “a pandemic in progress” some are even advising women in affected countries to delay getting pregnant

What are the symptoms?

Death are rare and only 1/5 people infected are thought to develop symptoms which include:

-Mild fever

-Conjunctivitis

-Heachaches

-Joint Pain

-A Rash

A rare nervous system disorder, Guillain-Barre syndrome has been linked to the infection. There is no vaccine or drug treatment so patients are advised to rest and drink plenty of fluids. The biggest concern is the impact it could have on babies developing in the womb.

 

Is it still safe to try for a baby?

The link to microcephaly is not certain but some governments have advised women to delay getting pregnant until more is known. Women visiting the region have been advised not to go, the US Centres of Disease Control says Zika lingers in the blood for about a week.

 

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Proton beam cancer therapy

 

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A cancer treatment at the centre of an NHS debate in 2014 causes fewer side effects in children than regular radiotherapy- according to new research, proton beam therapy is suggested to be as effective as other treatments.

In 2014, the parents of Ashya King took him out of hospital in Hampshire where he was receiving cancer treatment- to get the treatment abroad. Their actions lead to a police operation to find them. Ashya, who was just 5 at the time is now cancer free.

All of the patients who agreed to take part in the study had the most common type of brain tumour in children- known as medulloblastoma. After 5 years, their survival rate was similar to that of patients treated with conventional X-ray radiotherapy but the side effect to the heart and lungs was much fewer. Proton radiotherapy resulted in acceptable toxicity and had similar survival rate to those noted with conventional radiotherapy, suggesting that the use of the treatment may be an alternative to photon-based treatments.

Proton beam therapy is currently only available in the UK to treat eye cancers, but patients with other forms of cancer can apply for NHS funding for the therapy abroad. The first proton beam facility in the UK is due to be made available in Newport by the end of 2016.

The department of health has said that from April 2018 the treatment will be offered to up to 1,500 cancer patients at hospitals in London and Manchester, following investment worth £250million.

How proton beam technology works-

It uses charged particles instead of X-rays to deliver radiotherapy for cancer patients. The treatment allows high-energy protons to be targeted directly at a tumour, reducing the dose to surrounding tissues and organs. In general, it gives fewer side effects compared with high-energy X-ray treatments. It can be used to treat spinal cord tumours, sarcomas near the spine or brain, prostate cancer, lung cancer, liver cancer and some children’s cancer.

 

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Alcohol limits cut to reduce health risks

Harsh new guidelines issued upon alcoholic drinks have cut drinking limits as ‘there is no such thing as a safe level of drinking’.

The UK’s chief medical officers say new research shows that any amount of alcohol can increase risks of cancer. New advice says that men and women who drink regularly should consume no more than 14 units of alcohol per week; which is equivalent to 6 pints of beer or 7 glasses of wine. Pregnant women should not drink at all.

It also says that if people do drink, it should be moderately over three or more days, some days should be completely alcohol free. People shouldn’t “save up” their units and drink them over one evening, heavy drinking sessions increase the risk of accidents and injuries.

Low-level drinking-

The guidance marks the first full review of alcohol guidelines since 1995, but updated advice on drinking in pregnancy and for young people was published respectively in 2007 and 2009. In relation to pregnant women; the new guidelines bring the rest of the UK in line with Scotland as it is recommended that pregnant women should not drink at all. This marks a subtle shift from previous guidance for people in England, Wales and Northern Ireland which, whilst suggesting they shouldn’t drink- if they did it should be no more than one or two units of alcohol, once or twice a week.

 

Previous government guidance set out daily drinking limits of 3/4 units for men and 2/3 for women. The new guidance moves to weekly limits to get away form the idea that every day drinking is fine.

The new 14 unit limit represents a cut in drinking levels for both sexes, the lower end of the daily range has been advised by the government. Regarding drinking during pregnancy, the new advice is unambiguous- women should not drink. Previously women in the UK had been told not to drink but if they did, to a limit.

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INFORMATION FROM BBC HEALTH

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Calorie Counts To Be Put On Alcoholic Drinks

Different shaped wine glasses

The Local Government Association (LGA) have said that it believes that companies should be forced to warn people that drinking alcohol can contribute to wait gain.

It is contributing to an obesity crisis, the association claims.The UK currently has one of the highest obesity rates in Western Europe, possibly because of this alcohol issue. The LGA says calories from alcohol are classed as “empty calories”, with no nutritional value. By drinking alcohol, the amount of fat the body burns for energy is reduced. A pint of cider at 4.5% has 216 calories, the equivalent to 3/4 of a burger, while a single spirit at 40% is 61 calories, or an eighth of a burger.

Over 24 hours, drinking 5 pints of beer at 4% strength, is the equivalent to eating more than 3 burgers. A bottle of wine- about 4 small glasses- has the same calorie count as more than two burgers, the association says.

The Royal Society for Public Health has previously called for calorie labels to be put in place, by giving its own warning that a large glass of wine can contain around 200 calories- the same as a doughnut.

In 2015, MEPs backed calls for calorie labels to be put on all alcoholic drinks in a vote at the European Parliament, although that vote is not binding. It has recently emerged that new advice on how much people in the UK should limit their drinking is to be issues following the first review of official alcohol guidance in 20 years. Reports suggest the chief medical officer for England, Dame Sally Davies will recommend abstaining from alcohol for at least two days a week.

 

INFORMATION FROM THE BBC HEALTH WEBSITE.

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Which Painkiller?

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Which painkiller?

  • Paracetamol: Used to treat headaches and most non-nerve pains, side effects are not common and this dose can be taken regularly for long periods, but overdosing can cause serious side effects; if the pain lasts for more than three days, see your GP
  • Ibuprofen: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, seem to work better for arthritis or an injury. They should not be used for a long period unless you have inflammation. If you take them for long periods, there’s an increased risk of stomach upset, bleeding, and kidney and heart problems
  • Aspirin: Produces the same type of side effects as other NSAIDs, but is not as effective as a painkiller, which means it’s not usually prescribed for pain – dangerous for children under 16.

Source: NHS Choices

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The Placebo Effect

The manufacturer of a leading brand of painkiller has been accused of misleading customers in Australia. But how do people choose over-the-counter pain relief?

There’s a whole range of Nurofen products. There are Nurofen capsules, caplets and “meltlets”. Some are marketed to treat specific problems – Nurofen Migraine Pain or Nurofen Tension Headache.But Nurofen maker Reckitt Benckiser has been ordered to take some of these “specific pain” products off the shelves in Australia. A court decided they were misleading consumers because the packaging made it seem as though they had been formulated to treat different types of pain. In fact, these products contained the same active ingredient – 342 mg of ibuprofen lysine. Reckitt Benckiser says that they are just meeting demand. They argue that 88% of people look for relief for a specific type of pain. Packaging tablets with clear labels saying “back pain” or “period pain” makes it easier for people to decide which one to get to meet their needs, they add.

But take this scenario. A customer has a packet of Nurofen Migraine Pain in their handbag. They suffer a tension headache. They buy Nurofen Tension Headache. By the Australian court’s view they are completely wasting their money – it’s fundamentally the same medicine in different packaging. All of these specific pain versions cost about double the price of Nurofen’s standard version in Australia. The formulations used in Nurofen’s specific pain range in Australia contain lysine and sodium. The manufacturer says that this allows them to be absorbed faster than the standard version. In the UK, similar medication is sold. Nurofen Migraine Pain and Nurofen Tension headache caplets have identical active ingredients. They contain the same 342mg of ibuprofen lysine that is in the Australian versions. But no legal action has been taken against Nurofen in the UK.

When someone swallows a general painkiller such as ibuprofen it’s distributed around the whole body through the bloodstream. Painkillers targeting specific areas will treat the areas in pain but they cannot be sent directly to a particular part of the body. The discrepancy in price between different versions of branded painkiller is arguably no stranger than the variation in price between brands like Nurofen, and the generic equivalents that sit near by them on supermarket shelves. Somebody could walk into a Tesco in the UK and spend £2 on a packet of 16 Nurofen when a packet of 16 generic ibuprofen tablets – an identical drug – is just 30p.

“You’re paying for the marketing essentially and the shiny box,” argues Sheikh. She tends to recommend using cheaper generic painkillers, but says that many of her patients are still loyal to certain brands.

The placebo effect could help explain this. “Just knowing that you’ve taken something can make you feel better,” explains Sheikh. Believing in a particular brand can also have a big impact. In a recent study, researchers gave people with frequent headaches a dummy pill. Some of these placebos were packaged as branded painkillers and some weren’t. The branded ones were reported to be more effective at pain relief by those in the study and were associated with fewer side effects than the placebos packaged as generic medication._87199363_istock_000011206872_largeInformation from BBC Health

 

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Ovarian Cancer: Screening could cut deaths by a fifth.

_87247578_thinkstockphotos-470488119Doctors say there is now “encouraging” evidence that an annual blood test may cut ovarian cancer deaths by a fifth. Ovarian tumours are often deadly as they are caught too late. A 14-year study on 200,000 women, published in the Lancet, has been welcomed as a potentially landmark moment in cancer screening,but the researchers and independent experts say it is still too soon to call for mass screening because of concerns about the analysis.Ovarian cancer is difficult to pick up as symptoms, including abdominal pain, persistent bloating and difficulty eating, are common in other conditions.

Blood measure

The UK Collaborative Trial of Ovarian Cancer Screening is one of the biggest clinical trials ever conducted and is supposed to give the definitive verdict on screening, it monitored levels of a chemical called CA125 in women’s blood. Doctors tracked changes in the levels of CA125, which is produced by ovarian tissue, over time and if levels became elevated then the women were sent for further tests and ultimately surgery. The results are now in, but the interpretation is a bit messy and the researchers admit it is “controversial”. Their initial statistical analysis of the data showed no benefit to screening. But there was a benefit when they removed the data from any women who may have already started to develop ovarian tumors. The researchers then performed a more forgiving statistical analysis, which also showed a benefit.

Any benefit to screening seems to be delayed – kicking in towards the end of the trial.
The researchers are continuing to follow the patients for what is expected to be another three years to confirm whether there is a benefit. Kevin McConway, a professor of applied statistics at the Open University, said: “Doing these extra analyses can be seen as an appropriate response to how the data turned out to look, which in some respects weren’t as they originally expected. “But equally it is also the case that the more analyses done, the more likely it is that one of the results will come out as positive.

“The results are promising, but perhaps not all that promising.”

There is also the risk that screening can do harm and the test led to some women having unnecessary surgery to remove benign growths. Dr Adam Shaw, the clinical lead for cancer genetics at Guy’s & St Thomas’ NHS Foundation Trust, said the findings were “very encouraging” but there was still more work to do.

“Nonetheless, this study is a landmark step in devising effective screening for ovarian cancer, which is often portrayed as the silent killer.”

Dr Fiona Reddington, from Cancer Research UK, said: “It’s uncertain whether or not screening can reduce ovarian cancer deaths overall.

“While this is an important step in ovarian cancer research, we would not recommend a national screening program at this point.”

The UK’s National Screening Committee, which decides what diseases should be screened for, says it will have to make a “scientifically sound decision” and will review the findings.

Information from BBC Health website

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Failure to fortify flour.

downloadFolic acid to fortify flour would cut birth defects.

UK experts are backing the call for flour to be fortified with folic acid – a move which they say would have prevented about 2,000 cases of serious birth defects since 1998. The failure to fortify flour has caused serious disabilities, including spina bifida, and resulted in terminations and stillbirths, their study said. The Scottish government has urged UK ministers to take a quick decision on the issue in order to agree a uniform approach across the UK. This follows the Scientific Advisory Committee on Nutrition recently saying it was in favour of folic acid being added to flour for bread in the UK.

Folic acid is found naturally in some foods, such as green vegetables, nuts and granary bread. It is added to some breakfast cereals, but it is very difficult for pregnant women to get enough from diet alone. That is why in 1992, the Department of Health in England recommended that women take folic acid supplements before pregnancy to reduce their risk of having a baby with a neural tube defect (NTD) – which involve defects of the brain, spine or spinal cord. But recent research shows that only 28% of pregnant women take them at the correct time. However, the government has so far been reluctant to force manufacturers to add folic acid to all bread.

Dr Alison Tedstone, chief nutritionist at Public Health England, said too many women had folic acid levels below the new World Health Organization recommendation for women entering pregnancy. “This highlights the importance for pregnant women, and those trying or likely to get pregnant, of taking a daily folic acid supplement of 400 micro grams – before and up to the 12th week of pregnancy.”

Prof Alan Cameron, vice-president of clinical quality for the Royal College of Obstetricians and Gynecologists, said: “Food fortification will reach women most at risk due to poor dietary habits or socio-economic status as well as those women who may not have planned their pregnancy.”

 

Information from the BBC Healthcare website.

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