Vending machines 'undermine' hospitals' good work'

Comments (87)

By Dr Rachel Thompson World Cancer Research Fund

Vending machines tend to dispense high-calorie food like chocolate

Continue reading the main story

Scrubbing Up

• 'Move child care'
• Millions of malnourished 'go unnoticed'
• Fat, pregnant or both?
• UK 'doing too few tonsil operations'

Hospitals are, by definition, buildings that are dedicated to health.

But in this week's Scrubbing Up, Dr Rachel Thompson, deputy head of science at World Cancer Research Fund, says that good work is being undermined by the contents of hospital vending machines.

Whenever I visit hospitals, I am always struck by how the efforts of the dedicated healthcare professionals who work in them are being undermined by what is happening in the waiting areas.

All too often, these waiting areas have vending machines that are filled with high-calorie foods and drinks such as chocolate bars, crisps and sugary drinks.

But because these foods are a cause of obesity, they are part of the reason many of the people will have ended up in hospital in the first place.

There is strong scientific evidence that excess body fat is a risk factor for cancer, as well as other non-communicable diseases such as heart disease and diabetes.

And yet hospital vending machines are selling products that are a cause of obesity at the same time as the health professionals working there are trying to cope with its consequences.

That is why hospitals should put an end to vending machines that sell high calorie foods and drinks.

Little focus

It is true that on its own this would be unlikely to have a serious impact on obesity levels.

You would have to spend a lot of time in hospital waiting rooms for the contents of the vending machines to make much of a difference to your weight.

Continue reading the main story

“Start Quote

There is no great mystery about what needs to happen”

End Quote

But rather, the fact that hospital vending machines are filled with these kinds of foods and drinks is a symptom of how little meaningful focus there is on the obesity crisis.

Across society, big changes are needed if we are to address obesity and the preventable cases of cancer and other diseases that result from it.

The changes that we need are supported by common sense.

If you prioritise the needs of motorised transport when you plan a town, it is to be expected that people won't walk or cycle enough.

If you allow the food and drinks industry to market unhealthy products to children, then don't be surprised when children pester their parents to buy those products.

But the fact that hospital vending machines are still stocked with high-calorie foods and drinks illustrates that we are not recognising the problem.

There is no great mystery about what needs to happen.

There is already a large evidence base for what works and doesn't work when it comes to policy changes. What we need to see is political will and a change to the mindset where we tolerate the things that promote obesity.

This would not only mean the end of the kind of culture where the sale of unhealthy foods and drinks in hospital waiting rooms is seen as acceptable.

It could also mean fewer people end up in those waiting rooms in the first place.

Your comments (87)

More on This Story

Scrubbing Up

• 'Move child care'

• Millions of malnourished 'go unnoticed'

• Fat, pregnant or both?

• UK 'doing too few tonsil operations'

• Britain needs 'obesity GPs'

• Why a nudge is not enough

• School sun care policy

• Car smoking ban call

• Why we need a 'nudge'

• 'Lipo with your facial?'

• Ageing assets

• Weighty issue

mengele: abo's malaise

mengele: abo's malaise

cjd deaths up year on year !

CJD Statistics

---

CJD Figures

These figures show the number of suspect cases referred to the NCJDRSU in Edinburgh, and the number of deaths of definite and probable cases in the UK, from 1 January 1990 up to 5th September 2011

REFERRALS OF SUSPECT CJD		DEATHS OF DEFINITE AND PROBABLE CJD
Year	Referrals	Year	Sporadic	Iatrogenic	Familial	GSS	vCJD	Total Deaths
1990	[53]	1990	28	5	0	0	-	33
1991	75	1991	32	1	3	0	-	36
1992	96	1992	45	2	5	1	-	53
1993	79	1993	36	4	5	2	-	47
1994	119	1994	54	1	5	3	-	63
1995	87	1995	35	4	2	3	3	47
1996	133	1996	40	4	2	4	10	60
1997	163	1997	60	6	4	2	10	82
1998	155	1998	64	3	3	2	18	90
1999	170	1999	62	6	2	0	15	85
2000	178	2000	50	1	2	1	28	82
2001	179	2001	58	4	4	2	20	88
2002	163	2002	72	0	4	1	17	94
2003	162	2003	79	5	4	2	18	108
2004	114	2004	50	2	4	2	9	67
2005	124	2005	67	4	8	5	5	89
2006	112	2006	69	1	6	3	5	84
2007	119	2007	64	2	9	1	5	81
2008	150	2008	88	5	2	3	1	99
2009	153	2009	78	2	3	5	3	91
2010	149	2010	84	3	6	1	3	97
2011*	108	2011	49	2	6	1	2	60
Total Referrals	2841	Total Deaths	1264	67	89	44	172	1636

*As at 5th September 2011

Summary of vCJD cases

Deaths Deaths from definite vCJD (confirmed): Deaths from probable vCJD (without neuropathological confirmation): Number of deaths from definite or probable vCJD:	119 53 172
Alive Number of definite/probable vCJD cases still alive:	3
Total number of definite or probable vCJD cases (dead and alive):	175

(Table updated 9th September 2011)

The National Creutzfeldt-Jakob Disease Research & Surveillance Unit (NCJDRSU)

---

The incidence of Creutzfeldt-Jakob disease (CJD) is monitored in the UK by the National CJD Research & Surveillance Unit (NCJDRSU) based at the Western General Hospital in Edinburgh, Scotland. The Unit brings together a team of clinical neurologists, neuropathologists and scientists specialising in the investigation of this disease. This document is intended to summarise the research in progress at the NCJDRSU and also provide some background information about CJD and other human spongiform encephalopathies. We have also provided some links to other resources and contrary points of view available on the Web.

---

Creutzfeldt-Jakob Disease Surveillance.

• Figures for the number of CJD cases and referrals of suspected cases of CJD to the NCJDRSU since 1990.
• NCJDRSU protocol for CJD surveillance across the UK.
• National Referral System. From July 2004, a new national reporting system was announced by the Chief Medical Officer. This is centred on the National CJD Reporting Form to be faxed, by the notifying clinician, to the National Creutzfeldt-Jakob Disease Research & Surveillance Unit (NCJDRSU), the National Prion Clinic (NPC) and the local CCDC.
• Interim guidance on incidents involving inherited prion disease - this document sets out how inherited prion disease incidents should be reported to the CJD Incidents Panel and complements the guidance on local reporting by clinicians of CJD cases to public health departments (above).
• Text and figures of the latest annual report of the NCJDRSU covering the period 1990-2009 (published 11th March 2011).
• Archive of previous NCJDRSU annual reports (1992-2008).
• National CJD Research & Surveillance Unit Scientific Report 2007/08 (published 13th November 2008).
• Reporting CJD cases to public health departments - Guidance Document. - (updated November 2006)
• Potential treatments for Creutzfeldt-Jakob disease (updated July 2006).

---

Information on variant CJD.

• Reproduction of the complete Lancet article published by the NCJDRSU in April 1996.
• Text of a letter written by Dr Robert Will to every Neurologist in the UK. This letter describes in some detail the clinical and pathological variants observed between sporadic CJD and the new variant of the disease which has been identified here at the NCJDRSU.
• The original statement issued by SEAC, the government's advisory committee on spongiform encephalopathies, about these ten cases of the new variant of CJD.
• Protocol for the investigation of geographically associated cases of variant CJD
• Incidence of variant Creutzfeldt-Jakob disease diagnoses and deaths in the UK compiled by N J Andrews at the Statistics Unit, Centre for Infections, Health Protection Agency.(updated 18th May 2011)
• Figures for the number of vCJD cases worldwide [data courtesy of the European and Allied Countries Study Group of CJD (EUROCJD/NEUROCJD)]

---

Care and Support.

• Reproduction of report entitled Patients with new variant Creutzfeldt-Jakob disease and their families: care and information needs by Dr Margaret Douglas, Dr Harry Campbell and Professor Robert Will.
• About the National Care-Cordinators (updated December 2004).
• CJD Support Network. The CJD Support Network was set up in Autumn 1995 by relatives of people who have died of CJD with backing from the Alzheimer's Disease Society. Since 2003 the CJD Support Network became an independent charity and offers practical and emotional support to families and professionals affected by all strains of CJD.

---

Practical information about CJD.

• The different types of CJD are described.
• The clinical aspects of this disorder are described. (updated July 2003)
• Possible investigations undertaken in cases of CJD are described here. (Updated 15/10/02)
• The neuropathology of CJD as observed in the CJD surveillance unit laboratory.
• The National CJD Surveillance Unit Brain Bank
• A Glossary of medical and scientific terms relevant to CJD.

---

Creutzfeldt-Jakob Disease research.

.....SECTION UNDER DEVELOPMENT .........

• Complete reference list of scientific research articles produced by the NCJDRSU since 1990.

---

Other links

• The European and Allied Countries Collaborative Study Group of CJD (EUROCJD/NEUROCJD). Information and results.
• Transfusion Medicine Epidemiology Review (TMER). Collaborative project between the UK NCJDRSU and the NHS Blood and Transplant. Information and results from this project whose main purpose is to investigate whether there is any evidence that CJD or vCJD may have been transmitted via the blood supply. (updated May 2009)

• NEUROPRION is a network of excellence funded by the European Union via the 6th Framework programme in the priority 5 "Food Quality and Safety".

• Scottish TSE Network The aim of the STN is to provide a forum for the exchange of ideas, results, reagents and expertise in research, diagnosis and clinical studies of TSE diseases in Scotland.
• Transfusion Guidelines Joint UKBTS/NIBSC Professional Advisory Committee Position Statement (Creutzfeldt-Jakob disease) prepared by the vCJD Working Party of the Standing Advisory Committee on Transfusion Transmitted Infections.
• Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection. Guidance from the Advisory Committe on Dangerous Pathogens and the Spongiform Encephalopathy Advisory Committee. (updated June 2003 - updates and revisions since June 2003 are clearly indicated in the document index)
• Department of Health CJD Policy Unit
• CJD Incidents Panel containing information about the Panel and relevant documents and links, including the new framework document and the surgical incident reporting form.
• vCJD Trust - website set up by Charles Russell Solicitors containing information on the Compensation Scheme and how to claim
• The Association of British Neurologists
• The National Prion Clinic at the National Hospital for Neurology and Neurosurgery, Queen Square, London.
• PRION-1 trial this website provides details of a randomised trial of quinacrine in human prion disease. Further details can be found here.
• MRC New Therapies Scrutiny Group for Prion Disease (NTSG) provides an independent source of advice on research into the development of potential therapeutics or preventative agents for prion disease.
• Food Standards Agency is a new government department set up in April 2000 to protect people's health and the interests of consumers in relation to food.
• The European Food Safety Authority (EFSA) has been delivering risk assessments and scientific opinions on BSE/TSE since 2003. Information on BSE/TSE can chiefly be found in the subsections under the headings BIOHAZ Panel and TSE Assessments.
• TSE Resource Centre. The TSE Resource Centre, directly supported by the BBSRC and MRC, was established in 1999 to collect, store, characterise, produce and distribute a range of reagents, from monoclonal antibodies to teaching aids.
• CJD Resource Centre provides standard reagents to researchers working on CJD.
• CJD Alliance is an independently run organisation involved in TSE's such as CJD - its key interests are in early diagnosis and treatment issues.
• USA - American CJD Foundation The Foundation seeks to promote the research, education and awareness of CJD, as well as to reach out to people who have lost loved ones to this illness.
• Information on CJD and BSE in the USA - Centers for Disease Control and Prevention, Atlanta, Georgia
• USA - National Prion Disease Pathology Surveillance Center (from the Division of Neuropathology, Case Western Reserve University. CJD surveillance system in collaboration with CDC).
• USA - CDC's website on infection control and TSEs
• USA - FDA website describing the ruminant feed ban introduced in the US as a result of the BSE outbreak in Europe.
• Information on BSE and CJD provided by the British Medical Journal.
• The World Health Organisation have provided information on BSE and the possible risks to humans.
• Research Report on Transmissible Spongiform Encephalopathies from the Biotechnology and Biological Sciences Research Council.
• Position statement on BSE from the Institute of Food Science & Technology.
• The Yahoo Index for CJD information on the WWW.

---

About ourselves

• The people involved in the research being undertaken at the CJD unit.
• The setup, details of the funding of the CJD and the collaborative projects we are involved in.
• Our address should you wish further contact.

For enquiries contact:

Call for more training to improve blood tests in A&E

By Adam Brimelow Health Correspondent, BBC News

Can doctors take a blood sample?

Continue reading the main story

Related Stories

• Baby sex blood tests 'accurate'
• UK scientists 'develop vCJD test'
• Tiny blood card offers easy tests

Scientists say doctors need better training to avoid mistakes in blood samples taken in hospital A&E departments.

The warning from the Association for Clinical Biochemistry follows an audit at Birmingham City Hospital.

The trust has put in place extra training, but the ACB says this is a problem across the UK.

The College of Emergency Medicine says it is essential that staff use the right technique to collect blood.

Blood test results are often key to assessing patients when they arrive in A&E. But staff are frequently working under extreme pressure.

The ACB is worried that this contributes to errors when they take blood samples.

The concerns are highlighted by the Birmingham audit of samples collected by a range of junior doctors and nurses.

Urgent cases

In the study, published in the Annals of Clinical Biochemistry, the researchers followed the collection of 50 samples from some of the most urgent cases, over a two week period.

More than half were taken using the wrong equipment. They should normally by collected into vacuum tubes with special needles rather than using syringes which can damage fragile blood cells.

The researchers also found that about half the samples were mishandled for testing, raising the risk of contamination.

Continue reading the main story

“Start Quote

It sounds a bread and butter procedure but it is very important that it is done correctly, safely and consistently. We need to ensure there is the right level of expertise. ”

End Quote Dr John Heyworth President, College of Emergency Medicine

The trust has arranged extra training and guidance for its A&E staff. The director of pathology at the hospital, Dr Jonathan Berg, who helped to carry out the study, says good technique is vital to ensure the tests reflect the true status of the patient.

"Junior doctors have surprisingly little training in taking blood and have a love of still using syringes which cause major problems and this is very easy to correct with a simple training programme. This is an issue right across the country".

The director of scientific affairs at the ACB, Dr Robert Hill, says there is a need for better training.

"The compromises to specimen quality made in A&E when attempting to rush through investigations clearly put some patients at risk, so fixing the problem requires more than just identifying a culprit.

"Solutions must include monitoring the competence of those taking blood during their training period and discouraging those whose lack of practice prevents them from doing it properly."

'Bread-and-butter' procedure

The study is being presented at the annual conference of the College of Emergency Medicine, which represents A&E doctors in the UK and the Republic of Ireland.

The college's president, Dr John Heyworth, says the paper is "universally relevant" to all A&E departments.

"It sounds a bread-and-butter procedure but it is very important that it is done correctly, safely and consistently. We need to ensure there is the right level of expertise.

"I think it is always seen as so routine, there is not enough focus on it as a technique for formal review and training."

The chairman of the BMA's Junior Doctor Committee, Dr Tom Dolphin, also welcomed the study.

"Emergency Departments are high pressure environments where junior doctors have to take blood in an efficient, timely manner.

"Bloods can be taken in a variety of ways and this study highlights some consequences of the choices faced by junior doctors when taking blood.

"Incorporating the findings of this research into training for junior doctors and medical students would be helpful if we are to reduce some of the issues that can arise from blood sampling."

More on This Story

Related Stories

• Baby sex blood tests 'accurate' 10 AUGUST 2011, HEALTH
• UK scientists 'develop vCJD test' 03 FEBRUARY 2011, HEALTH
• Tiny blood card offers easy tests 31 JULY 2011, HEALTH

Related Internet links

• The Association for Clinical Biochemistry
• Emergency Medicine UK
• Annals of Clinical Biochemistry

The BBC is not responsible for the content of external Internet sites

Share this page

London hospitals: Hundreds die 'due to weekend staffing'

"Stark" differences in consultant hours at weekends were identified

Hundreds of people die every year in London due to a lack of hospital consultants available at weekends, according to NHS London.

A report from the strategic health authority showed there were more than 500 avoidable deaths in emergency care in the capital every year.

It found: "Reduced service provision at weekends is associated with this higher mortality rate."

Under the review, NHS trusts were asked to rate themselves on key indicators.

The report, Acute medicine and emergency general surgery - case for change, was compiled for NHS London in the spring.

It focused on the care adult patients receive on a general ward after being admitted for emergency treatment.

'Inadequate access'

The review found: "If the weekend mortality rate in London was the same as the weekday rate, there would be around 520 fewer deaths."

It identified "stark" differences in consultant hours across the capital's hospitals at evenings and weekends.

Across London, consultant emergency general surgeons were on site for an average of four hours a day at the weekend, compared with 10 in the week.

The report said: "In London there is significant variation in the number of hours that a consultant is expected to be on site.

"There is inadequate access in almost a third of London's hospitals to an emergency theatre - this is detrimental to patient outcomes and can increase mortality and morbidity," it warned.

But John Appleby from The King's Fund, a charity which shapes NHS policy, said the reasons behind figures were much more complex than consultant cover alone.

However, he said: "Patients are entitled to expect high quality care whatever day of the week, or time that they are admitted and that includes safe levels of appropriate staffing."

More on This Story

Related Internet links

• NHS London
• The King's Fund

The BBC is not responsible for the content of external Internet sites

Share this page

Health Protection Agency fears student measles outbreak

The HPA says measles can be fatal and is urging students to get vaccinated

Continue reading the main story

Related Stories

• MMR vaccine uptake 'rises to 90%'
• Is measles making a comeback?

Students are being urged to make sure they have been vaccinated against measles, as health experts fear an outbreak of the disease.

Data from the Health Protection Agency (HPA) shows the number of confirmed cases so far this year is already more than double the total number for 2010.

By the end of July this year, there were 777 confirmed cases, compared with 374 cases for the whole of last year.

GP practices in university towns and cities have been alerted.

The HPA fears outbreaks are likely as students return to university campuses at the start of the new term, with the majority of cases so far being among children or young adults under the age of 25.

The organisation said these cases have been associated with small clusters in universities and schools, with many of the patients unvaccinated.

Dr Mary Ramsay, head of the immunisation department at the HPA, said: "Measles and meningitis are infections that can both be fatal, it is absolutely vital that all students ensure they are completely up to date with all their vaccinations, especially the MMR and Men C vaccine.

"University bars and campuses where lots of students are in close proximity is an ideal place for bacteria and viruses to spread which is why we may see more outbreaks of these infections in this environment.

"The MMR will protect against measles, mumps and rubella - all serious infections that can lead to many complications."

The HPA is an independent organisation, set up by the government in 2003, to protect the public from infectious diseases and environmental hazards.

More on This Story

Related Stories

• MMR vaccine uptake 'rises to 90%' 24 JUNE 2011, HEALTH
• Is measles making a comeback? 14 MAY 2011, HEALTH

Related Internet links

• Health Protection Agency

Around the BBC

• BBC - Health Measles

The BBC is not responsible for the content of external Internet sites

Share this page

Culture, medical standards and language are all issues

GMC says more support needed for overseas doctors in UK

Culture, medical standards and language are all issues

The General Medical Council says some overseas doctors come to the NHS with "little or no preparation" for working in the UK.

It says those trained under different cultural and professional standards need more support.
The GMC is planning a basic induction programme for all doctors to help them understand how healthcare is practised in the UK.
Doctors' representatives say the scheme will help to protect patients.
More than one in three doctors registered in the UK qualified abroad. The GMC says the NHS has relied heavily on their skills and dedication, and could not have kept going without them.
But it says they need better support in order to practise safely. The recommendation for an induction programme comes in its first State of Medical Education and Practice report.
This presents a profile of the medical profession and outlines challenges for the future.

Experiences of three foreign doctors

• "In my country, the doctor is a kind of king who can do everything that he wants to, so there were no actual dilemmas because I was brought up in a way that whatever was decided was the right thing."
• "The whole approach of explaining every aspect of treatment and giving the patient the option to actually make her own decisions, it was something totally new to me."
• "I have come to know that that the important things in the UK which I didn't really take seriously is confidentiality which is different… in our culture, confidentiality is important but in the UK it is very, very important."

It says last year there were 239,270 doctors on the medical register. Just over 150,000 qualified in the UK, a further 23,000 trained initially in the European Economic Area (EEA), and 66,000 completed their medical undergraduate education overseas.

Cultural attitudes
Drawing on a wide range of data including doctors' surveys and patients' complaints, the report concludes that many overseas doctors have problems adjusting to a different cultural, ethical and professional environment in the UK. The GMC says these differences become particularly important in handling the doctor-patient relationship.
The report also says doctors should have specific advice about what will be expected of them, how the health service works and how they will be regulated. It recommends training in communication skills to help them handle sensitive situations and avoid misunderstandings:

"While there are some good local schemes for supporting doctors who are new to this country, there are too many examples of new doctors undertaking clinical practice with little or no preparation for working in the UK. There have also been accounts of locum doctors being sent to undertake duties for which they have not been appropriately trained."
The GMC restates its worry that it is prevented under European law from providing language checks on doctors from the EEA. This became a central concern in the case of Dr Daniel Ubani, an out-of-hours doctor from Germany who killed a patient, David Gray, with an overdose of a painkiller.
The report confirms that the GMC is working with the UK government to change this restriction.
The GMC's chief executive, Niall Dickson, said the regulator was preparing an induction scheme with doctors' employers and professional bodies:
"Developing an induction programme for all doctors new to our register will give them the support they need to practise safely and to conform to UK standards. This will provide greater assurance to patients that the doctor treating them is ready to start work on day one."
Protection for patients
Dr Tom Dolphin from the British Medical Association's Junior Doctor Committee welcomed the move.
"Being a doctor in the UK requires much more that just clinical expertise. It is also important to have highly developed communications skills, knowledge of UK medical ethics and culture, and an understanding of how the NHS works.
"The development of an induction course which helps doctors coming from overseas would do much to help them as they make the difficult transition to practise medicine in another country."
The President of the Royal College of Surgeons, Prof Norman Williams, also gave his support: "Guiding doctors who are new to the UK on how to practise within our professional, language, ethical and legal boundaries is a positive role for the General Medical Council to take on and one the Royal College of Surgeons would strongly endorse.
"We want to see any potential problems headed off before situations develop that might harm patients."