Religion may influence doctors' end-of-life care

Guidelines stress doctors should discuss treatment with their patients

Doctors with religious beliefs are less likely to take decisions which could hasten the death of those who are terminally ill, a study suggests.

The survey of nearly 4,000 doctors found those with a strong faith were also less likely to discuss end-of-life treatment options with their patient.
The London University research urges greater acknowledgement of how beliefs influence care.
Doctors and campaigners described the findings as "concerning".
Dr Clive Seale of Barts and the London School of Medicine analysed 3,733 responses from doctors practising in a wide variety of fields, with a particular focus on those who worked in palliative care and with the elderly.
The General Medical Council, which regulates the profession, says that while doctors should start from the assumption that life should be prolonged, this should not be at any cost.
While it is illegal to give drugs with the deliberate intention of ending someone's life, doctors may administer morphine or other medication to relieve pain or distress which may have the effect of shortening life - so-called deep sedation.
The GMC also advises that discussions surrounding end-of-life care, including issues such as tube-feeding, hydration and resuscitation, which can all cause avoidable distress, be started with those who are terminally ill well in advance of their dying days.
Patient communication
Those who described themselves as very or extremely non-religious were about 40% more likely to sedate than religious doctors, the study in the Journal of Medical Ethics reported.

Whilst entitled to their beliefs, doctors should not let them come in the way of providing patient-centred care at the end of life”

End Quote Dr Ann McPherson Dignity in Dying

Being very or extremely religious was also associated with significantly fewer discussions of decisions with patients around treatment at the end of life.

More than 12% of the doctors surveyed described themselves as very or extremely religious, compared with just over 6% of the UK general population - as documented in the last national survey of attitudes.
However one in five described themselves as very or extremely non-religious, slightly higher than the general population.
The UK medical population differs in ethnic profile from the population as a whole, with a higher proportion of doctors from South Asian backgrounds.
The survey showed that specialists in the care of the elderly were more likely to be Hindu or Muslim than other doctors, while palliative care doctors were slightly more likely to be white and Christian.
The British Medical Association said: "Decisions about end-of-life care need to be taken on the basis of an assessment of the individual patient's circumstances - incorporating discussions with the patient and close family members where possible and appropriate.
"The religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making. End-of-life decisions must always be made in the best interests of patients."
Deeply troubling
Professor Mayur Lakhani, chair of the National Council for Palliative Care, said he was concerned by the findings of the paper.
"Core training in palliative care should be mandatory for all doctors to ensure consistency of decision-making, based on best practice and current evidence.
"Decisions must be taken in partnership with people approaching the end of life and those close to them.
Dr Ann McPherson of the charity Dignity in Dying added that while there was growing awareness of the need to put patients' wishes first, the research indicated there was "still some way to go".
"The fact that some doctors are not discussing possible options at the end of life with their patients on account of their religious beliefs is deeply troubling.
"Whilst entitled to their beliefs, doctors should not let them come in the way of providing patient-centred care at the end of life."
David Praill, chief executive of Help the Hospices said the findings highlighted "the maze of complex moral and legal dilemmas that doctors can face when caring for patients at the end of life".
"Doctors need support to ensure that they have the information, skills and confidence necessary to make the best end of life care decisions with their patients."

Venezuelan village key in search for Huntington's cure

The village of Barranquitas in Venezuela has the highest concentration of Huntington's disease, a devastating brain condition, in the world. The BBC's Will Grant accompanies a US scientist there as she continues her life's work to find a cure.

Dr Nancy Wexler has been coming to Barranquitas for many years

Angela staggers across Barranquitas under the blistering sun to reach the children's lunch hall, her matchstick-thin legs struggling to support her frail frame.

Although it is a small village, it is hard work crossing it when your limbs won't do what you tell them to.

But Angela is determined to make the effort because an old friend has just arrived.

Continue reading the main story

HUNTINGTON'S DISEASE

• Hereditary neurological disorder
• Causes progressive degeneration of cells in brain
• Slowly impairs ability to walk, talk, think, or reason
• Symptoms usually appear between age 30 and 50
• Person has 50% change of inheriting the gene if a parent has HD
• No cure to date

• BBC: Huntington's disease

That friend, American scientist Nancy Wexler, has been travelling to Barranquitas for more than 30 years.

She is sure it holds the key to an answer she has been looking for her entire adult life: a cure for Huntington's disease (HD).

For Dr Wexler this is more than an academic pursuit or a career goal, it's a family obsession.

"My mother died of Huntington's and she was a scientist. My father was a scientist too, and so we said 'let's find a cure','" said Dr Wexler.

"And we still say that. You can't get up in the morning without having hope and confidence that the cure is just around the corner."

As the daughter of an HD sufferer, she has a one-in-two chance of carrying the fatal genetic flaw herself.

Huntington's is an incurable and fatal hereditary disease which causes the sufferer to lose control of their muscles.

Click to play

Click to play

Nancy Wexler explains what motivated her to seek a cure

It develops into serious problems with swallowing and many patients die from choking or malnutrition. Beyond the physical symptoms, deep depression can often take hold.

It affects 1 in 10,000 people, but in Barranquitas, a remote location where over the years there has been much inter-marrying between few families, the rate is more like 1 in 10.

Some 1,000 villagers already have fully-blown Huntington's; many more carry the gene.

Such a high concentration of Huntington's patients made it the backbone of Dr Wexler's research.

Her research in Venezuela was crucial for the breakthrough in 1993 when the abnormality that causes HD was identified: a single defective gene on chromosome 4.

Ciro Soto is one of the villagers whose DNA and family history helped that discovery.

Dr Wexler met Mr Soto when he was just eight years old. Now almost 40, his body twitches uncontrollably from the disease.

"Ciro was a wonderful drummer, very athletic, a beautiful fisherman," said Dr Wexler.

"Both of Ciro's parents had Huntington's," she explained. "There were 14 siblings and 10... have Huntington's. Some of them have unfortunately already died of the disease."

Tough life

Despite the breakthrough, the team had not been back to Venezuela since 2002 given the strained ties between the Bush administration and President Hugo Chavez.

There is still no formal protocol with the Venezuelan government for removing the DNA samples Dr Wexler needs.

But in a positive development, the Venezuelan Health Ministry sent a representative to Barranquitas to meet her.

"I think Dr Wexler's persistence has been admirable," said Dr Federico Savinon.

Casa Hogar is a care home looking after some 50 people

While acknowledging there been some "difficulties in working together", Dr Savinon said that "the ministry and the health minister herself, Col Eugenia Sader, are completely disposed to reopening a space for joint work with Dr Wexler".

However, Dr Wexler and the people of Barranquitas have heard such promises before.

Successive health ministers have voiced support for the research, but the New York-based team are yet to see any serious progress on the signing of the protocol for the research.

Life in Barranquitas is tough. The government has provided new housing for some families, including Ciro's.

But most Huntington's sufferers still live in deep poverty while simultaneously trying to deal with the fatal illness.

In 1999, Dr Wexler co-founded a care home for HD patients outside the state capital, Maracaibo.

Built on the site of the "roughest bar in town", the Casa Hogar is a haven for more than 50 people whose families can no longer cope.

Everyone who works there has relatives with Huntington's sufferers. Many of them don't know if one day they may develop the disease too.

Dr Wexler's long association with Barranquitas gives her hope

The Casa Hogar is facing a chronic lack of funding, possibly even closure. Still, Dr Wexler remains confident that one day it won't be needed.

"We never know when some miraculous discovery is going to be made," she said.

"There are science breakthroughs on the horizon and happening now so I am very hopeful about the cure in the near future."

When Angela made it to the lunch-hall, she was greeted with a huge hug by Dr Wexler.

Despite the setbacks, Dr Wexler is optimistic that Angela's grandson, who is also at risk of the disease, will have more of a chance at a cure than she did

NHS spends more than £300m on consultancy services

21 August 2010 Last updated at 00:04

• Email

By Clare Murphy Health reporter, BBC News

IT, project management and human resources were included in the consultancy bill

NHS trusts in England spent more than £300m on external consultancy services last year, figures show.

The money was used to pay for advice on a range of issues, from legal contracts to human resources and media work.

The NHS Confederation, which represents trusts, says taxpayers' money should not be wasted but that outside help was often needed to deliver reform.

The figure represents less than half of 1% of the NHS budget but the health secretary described it as "staggering".

Overall, primary care trusts (PCTs) and strategic health authorities (SHAs) spent £313.9m on consultancy services in the financial year 2009/2010.

Pounds and pence

London areas spent nearly three times more per head on consultancy services than any other part of the country.

Camden PCT spent more than £12m, in excess of £50 per head of the local population, although they stressed much of this was down to a large spend on a body providing support to help achieve value for money and efficiency in commissioning services.

In contrast, Bournemouth and Poole PCT spent just 20p per head.

The government's health White Paper, released last month, includes measures to abolish SHAs and PCTs and replace them with GP-led consortiums.

Continue reading the main story

“Start Quote

There are currently more managers within the NHS than at any point in its history, so why are SHAs and PCTs buying in additional expertise?”

End Quote Royal College of Nursing

Health Secretary Andrew Lansley said he was "staggered by the scale of the expenditure", adding that he had asked PCTs and SHAs to reduce their management costs by 46% over the next four years.

"This will root out unnecessary bureaucracy and any expensive duplication of functions," he said. "Every penny saved will be re-invested in improving patient care, meeting demand and driving up quality."

Nigel Edwards, acting chief executive of the NHS Confederation, said: "Any spending of taxpayers' money has to be justified, and the NHS has been asked by successive governments to perform tasks for which internal expertise was not present or needed to be developed. Dismissing all this spending as wasteful is unfounded."

He added that the proposed overhaul would likely increase the need for consultants' services.

"External advice will be necessary if NHS organisations are to deliver change and, with the financial challenges and size of the current reform programme, it is probable NHS organisations, especially new GP consortia, will require external help to deliver what the government wants," he said.

But the Royal College of Nursing described the figures as "shocking and nothing short of a scandal".

"It is extremely difficult to see how spending more than £313m on consultancy services in one year can be justified. There are currently more managers within the NHS than at any point in its history, so why are SHAs and PCTs buying in additional expertise?" said its chief executive Dr Peter Carter.

"At a time when nurses and other staff are seeing front line services cut and being asked to accept a pay freeze, these organisations need to clearly demonstrate they are getting good value for money from the taxpayer's health pounds."

Shadow health secretary Andy Burnham said: "We were already acting to bring consultancy spend down by one-third but Mr Lansley's reforms will give consultancy firms a field day.

"What he seems not to understand is the NHS needs good managers. By wiping away the expertise currently in primary care trusts, he is opening the door to consultancy firms who know that hundreds of new, untested GP groups won't have the experience to go it alone."

This is the first time the figures have been collected in this way. Estimates published by the Conservatives in 2006 suggested trusts had spent £172m on external advice that year

20 August 2010 Last updated at 00:46

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Green leafy veg 'may cut diabetes risk'

By Emma Wilkinson Health reporter, BBC News

Green leafy veg, rather than a healthy diet in general, were linked to benefits

A diet rich in green leafy vegetables may reduce the risk of developing diabetes, UK research says.

In an analysis of six studies into fruit and vegetable intake, only food including spinach and cabbage was found to have a significant positive effect.

A portion and a half a day was found to cut type 2 diabetes risk by 14%, the British Medical Journal (BMJ) reports.

But experts urged people to continue to aim for five portions of fruit and vegetables a day.

Continue reading the main story

“Start Quote

This study suggests that green leafy vegetables seem to be particularly important in terms of preventing diabetes”

End Quote Professor Melanie Davies University of Leicester

The researchers from Leicester University reviewed data from the studies of 220,000 adults in total.

They found that eating more fruit and vegetables in general was not strongly linked with a smaller chance of developing type 2 diabetes but "there was a general trend in that direction".

Yet when it came to green leafy vegetables, which the researchers said also includes broccoli and cauliflower, the risk reduction was significant.

The team calculated that a daily dose of 106g reduced the risk of diabetes by 14% - a UK "portion" is classed as 80g.

It is not clear why green leafy vegetables may have a protective effect but one reason may be they are high in antioxidants, such as vitamin C and another theory is that they contain high levels of magnesium.

Study leader Professor Melanie Davies, professor of diabetic medicine at the University of Leicester, said the message to eat five portions of fruit and vegetables a day remains an important one.

But she added: "People like very specific health messages.

"We know that intake of fruit and vegetables is important, but this study suggests that green leafy vegetables seem to be particularly important in terms of preventing diabetes."

The team are now planning a study in people at high risk of developing the condition to see if increasing their intake of vegetables like spinach and kale can help to reduce their chances of being diagnosed with diabetes.

Fruit and veg

In 2008/09, the National Diet Nutrition Survey showed that, although fruit and vegetable intake has risen over the past decade, only a third of men and women eat the recommended five-a-day.

In an accompanying editorial in the BMJ, Professor Jim Mann from the University of Otago in New Zealand, stressed that the message of increasing overall fruit and vegetable intake must not be lost "in a plethora of magic bullets," even though green leafy vegetables clearly can be included as one of the daily portions.

Dr Iain Frame, director of research at Diabetes UK said: "We already know that the health benefits of eating vegetables are far-reaching but this is the first time that there has been a suggested link specifically between green leafy vegetables and a reduced risk of developing type 2 diabetes."

But he warned the evidence was limited and it was too early to isolate green leafy vegetables and present them alone as a method to cut the chances of developing the condition.

"We would be concerned if focusing on certain foods detracted from the advice to eat five portions of fruits and vegetables a day, which has benefits in terms of reducing heart disease, stroke, some cancers and obesity as well as type 2 diabetes."

Diabetes UK is currently funding research into whether fermentable carbohydrates found in foods such as asparagus, garlic, chicory and Jerusalem artichokes could help weight loss and prevent Type 2 diabetes.

Dark chocolate can be good for the heart,

16 August 2010 Last updated at 21:08

Dark chocolate can be good for the heart, study says

Higher cocoa content in the chocolate is associated with greater heart benefits

Older women who eat dark chocolate once or twice a week could be lowering their risk of heart failure, says a US study.

It found those eating chocolate once or twice a week cut the risk of developing heart failure by a third, but those eating it every day did not benefit.

The Boston study, in a journal of the American Heart Association, looked at nearly 32,000 Swedish women aged between 48 and 83 over nine years.

Dieticians say eating chocolate too often can be damaging and unhealthy.

The study notes that one or two 19 to 30 gram servings of dark chocolate a week led to a 32% reduction in heart failure risk.

This fell to 26% when one to three servings a month were eaten.

But those who ate chocolate every day did not appear to reduce their risk of heart failure at all.

Continue reading the main story

“Start Quote

Whilst antioxidants in chocolate may be helpful to your heart, they can also be found in fruit and veg - foods which don't come with the saturated fat and high calories”

End Quote Victoria Taylor British Heart Foundation

The researchers conclude the protective effect of eating chocolate reduces as more or less is eaten than the optimum one to two servings a week.

'Flavanoids'

Too much chocolate is unhealthy because it contains high levels of sugar and fat which can make people put on weight, the researchers say.

But chocolate also contains high concentration of compounds called flavonoids which can lower blood pressure and protect against heart disease, previous studies have found.

The researchers behind this study say this is the first time long-term effects related specifically to heart failure have been shown.

Dr Murray Mittleman is study leader and director of the Cardiovascular Epidemiology Research Unit at the Beth Israel Deaconess Medical Centre in Boston.

He said: "You can't ignore that chocolate is a relatively calorie-dense food and large amounts of habitual consumption is going to raise your risks for weight gain.

"But if you're going to have a treat, dark chocolate is probably a good choice, as long as it's in moderation," Dr Mittleman said.

Cocoa content

Differences in chocolate quality will affect the study's implications, the authors say. Higher cocoa content is associated with greater heart benefits.

Although the chocolate consumed by the Swedish women in the study was milk chocolate, it contained a high concentration of cocoa solids - about 30%.

This is equivalent to dark chocolate by UK standards.

Dark chocolate can contain as much as 75% cocoa while standard milk chocolate may have 25% or less cocoa.

Victoria Taylor, senior dietitian at the British Heart Foundation, said the study showed the importance of finding the right balance in our diets.

"Before you rip open those sweet treats, remember that whilst antioxidants in chocolate may be helpful to your heart, they can also be found in fruit and veg - foods which don't come with the saturated fat and high calories that chocolate does," she said.

Dr David Kelly inquest

Michael Howard urges Dr David Kelly inquest

Lord Hutton's inquiry found that Dr Kelly had committed suicide

Ex-Conservative leader Michael Howard has urged a full inquest into the death of government scientist Dr David Kelly.

He told the Mail on Sunday "serious questions" had been raised by experts who said the official cause of death was "extremely unlikely".
Dr Kelly died in 2003 after he was exposed as the source of a BBC story on the grounds for going to war in Iraq.
An inquiry found the 59-year-old had died from blood loss after slashing his wrist with a blunt gardening knife.
Severed artery
Michael Howard, who is now a Tory peer, led his party at the time the scientist's body was found in woods near his Oxfordshire home.
He told the newspaper: "In view of the growing number of relevant questions that have arisen and cast doubt on the conclusions reached by Lord Hutton, I believe it would now be appropriate for a full inquest to be held.

"Recent evidence by the first police officer on the scene, together with new statements by doctors, raise serious questions which should be considered.

"This has been on my mind for quite a while and recent events have crystallised my view."
Last week, a group of prominent experts cast doubt on the official cause of death.
They wrote a letter to The Times arguing that a severed ulnar artery, the wound found to Dr Kelly's wrist, was unlikely to be life-threatening unless an individual had a blood clotting deficiency.
The letter's signatories included a former coroner, Michael Powers, a former deputy coroner, Margaret Bloom, and Julian Bion, a professor of intensive care medicine.
When former prime minister Tony Blair appointed Lord Hutton to head the public inquiry into the scientists's death, the then lord chancellor, Lord Falconer, unusually ruled it should also act as an inquest.

'No Sun link' to climate change By Richard Black Environment correspondent, BBC News website

'No Sun link' to climate change

By Richard Black Environment correspondent, BBC News website

Cloud cover affects temperature - but what determines cloud cover?

Scientists have produced further compelling evidence showing that modern-day climate change is not caused by changes in the Sun's activity.

The research contradicts a favoured theory of climate "sceptics", that changes in cosmic rays coming to Earth determine cloudiness and temperature.

The idea is that variations in solar activity affect cosmic ray intensity.

But UK scientists found there has been no significant link between cosmic rays and cloudiness in the last 20 years.

Presenting their findings in the Institute of Physics journal, Environmental Research Letters, the University of Lancaster team explain that they used three different ways to search for a correlation, and found virtually none.

The IPCC has got it right, so we had better carry on trying to cut carbon emissions Terry Sloan

This is the latest piece of evidence which at the very least puts the cosmic ray theory, developed by Danish scientist Henrik Svensmark at the Danish National Space Center (DNSC), under very heavy pressure.

Dr Svensmark's idea formed a centrepiece of the controversial documentary The Great Global Warming Swindle.

Wrong path

"We started on this game because of Svensmark's work," said Terry Sloan from Lancaster University.

Terry Sloan has simply failed to understand how cosmic rays work on clouds Henrik Svensmark

"If he is right, then we are going down the wrong path of taking all these expensive measures to cut carbon emissions; if he is right, we could carry on with carbon emissions as normal."

Cosmic rays are deflected away from Earth by our planet's magnetic field, and by the solar wind - streams of electrically charged particles coming from the Sun.

The Svensmark hypothesis is that when the solar wind is weak, more cosmic rays penetrate to Earth.

That creates more charged particles in the atmosphere, which in turn induces more clouds to form, cooling the climate.

The planet warms up when the Sun's output is strong.

Professor Sloan's team investigated the link by looking for periods in time and for places on the Earth which had documented weak or strong cosmic ray arrivals, and seeing if that affected the cloudiness observed in those locations or at those times.

FEELING THE HEAT Three theories on how the Sun could be causing climate change In graphics

"For example; sometimes the Sun 'burps' - it throws out a huge burst of charged particles," he explained to BBC News.

"So we looked to see whether cloud cover increased after one of these bursts of rays from the Sun; we saw nothing."

Over the course of one of the Sun's natural 11-year cycles, there was a weak correlation between cosmic ray intensity and cloud cover - but cosmic ray variability could at the very most explain only a quarter of the changes in cloudiness.

And for the following cycle, no correlation was found.

Limited effect

Dr Svensmark himself was unimpressed by the findings.

"Terry Sloan has simply failed to understand how cosmic rays work on clouds," he told BBC News.

"He predicts much bigger effects than we would do, as between the equator and the poles, and after solar eruptions; then, because he doesn't see those big effects, he says our story is wrong, when in fact we have plenty of evidence to support it."

But another researcher who has worked on the issue, Giles Harrison from Reading University, said the work was important "as it provides an upper limit on the cosmic ray-cloud effect in global satellite cloud data".

Climate change: No Sun link A cosmic climate connection?

Dr Harrison's own research, looking at the UK only, has also suggested that cosmic rays make only a very weak contribution to cloud formation.

The Svensmark hypothesis has also been attacked in recent months by Mike Lockwood from the UK's Rutherford-Appleton Laboratory.

He showed that over the last 20 years, solar activity has been slowly declining, which should have led to a drop in global temperatures if the theory was correct.

The Intergovernmental Panel on Climate Change (IPCC), in its vast assessment of climate science last year, concluded that since temperatures began rising rapidly in the 1970s, the contribution of humankind's greenhouse gas emissions has outweighed that of solar variability by a factor of about 13 to one.

According to Terry Sloan, the message coming from his research is simple.

"We tried to corroborate Svensmark's hypothesis, but we could not; as far as we can see, he has no reason to challenge the IPCC - the IPCC has got it right.

"So we had better carry on trying to cut carbon emissions."

mixed-sex hospital wards

16 August 2010 Last updated at 07:24

Pledge to end mixed-sex hospital wards by end of 2010

Patients' groups have questioned how the goal can be achieved during a period of cut backs

The coalition government is preparing to announce an end to most mixed-sex hospital wards in England by the end of the year, it has been reported.

Despite Labour committing to the policy when it won power in 1997, it failed to completely abolish them.

Health Secretary Andrew Lansley said bringing about the change was a priority, but patients' groups have questioned how it could be achieved.

The move would apply to all wards except for intensive care and A&E.

It would mean patients sharing sleeping, bathroom and toilet facilities only with people of the same sex. This could be through single rooms or whole wards occupied by men or women only, or mixed wards in which men and women are separated in bays or rooms.

Mr Lansley said: "I have made clear repeatedly my deep frustration at the fact that mixed-sex accommodation has not been eliminated from the NHS.

Continue reading the main story

Related stories

• Call for improved hospital stays
• Mixed-sex wards to be penalised

"Eliminating mixed-sex accommodation is in patients' best interests, and I made clear the priority I attach to it in the revised Operating Framework published in June. I will have more to say on this shortly."

The Daily Telegraph said Mr Lansley had asked Chief Nursing Officer Dame Christine Beasley to visit all hospital trusts that still have mixed-sex wards to see what they were doing to ensure that male and female patients did not have to share facilities.

Cost of conversion

Catherine Murphy, of the Patients Association, told the newspaper: "Given that each incoming secretary of state, and there have been a lot, and every new prime minister has made this same pledge since 1997, we will wait to see if this time it really is more than just rhetoric.

Continue reading the main story

Analysis

Norman Smith Chief political correspondent, BBC Radio 4

---

Although mixed sex wards are still distressing for many patients - they are no longer the great political issue they once were - when Tony Blair first promised to get rid of them in 1997.

Its estimated now that only around one in ten hospital wards are still mixed sex.

Labour eventually concluded it would be impossible to abolish all of them - because of the disproportionate costs involved in converting some of the older Victorian hospitals.

And like Mr Lansley, Labour too threatened to fine NHS trusts which failed to get rid of them.

If anything it may be even harder for Mr Lansley to achieve because of the costs pressures now on the NHS. For although the NHS budget is set to increase in real terms, hospital managers are still having to make sweeping savings to meet rising health care costs.

Many NHS managers may well conclude they simply don't have the money to carry out expensive building work.

"At a time when we know that there are huge savings that have to be made in the health service, it is hard to see how hospitals are going to find the money for this."

The BBC's political correspondent Norman Smith said only about one in 10 wards in England were still mixed-sex, and the majority of those were in old, redbrick, Victorian hospitals which would be very expensive to convert.

He said the previous government decided that the money needed to do so would be better spent elsewhere in the NHS.

Now, however, the suggestion appeared to be that any hospitals which failed to remove mixed-sex wards by a certain deadline could be fined, our correspondent added.

Two years ago, Lord Darzi, who was made a health minister by Gordon Brown, said providing single-sex wards across the NHS was an "aspiration that cannot be met".

12 August 2010 Last updated at 22:27

Warning of missed patient safety alerts in NHS

Jane Hughes

Drug dosage is one area where alerts are issued

NHS trusts are putting people at risk by failing to implement a critical system of safety alerts, campaigners say.

Patient Safety Alerts are issued when potentially harmful situations are identified in healthcare organisations.

Charity Action against Medical Accidents said 63% of trusts in England have at least one overdue alert.

But the Department of Health said in the vast majority of cases trusts responded to alerts in good time.

“Start Quote

There can be no excuse for trusts continuing to put lives at unnecessary risk”

End Quote Peter Walsh AVMA

AVMA asked all NHS trusts in England how many outstanding alerts they had.

The charity said there were 1,242 cases where trusts had failed to act on alerts, even after deadlines for the implementation of safer measures had passed.

These include warnings about procedures in surgery, the risk of overdoses, and using medical equipment properly.

Twenty-nine trusts said they had 10 or more overdue alerts. Some were years past the deadline for completion.

Challenge

AVMA said this was despite a warning earlier in the year about overdue alerts.

"There can be no excuse for trusts continuing to put lives at unnecessary risk," said chief executive Peter Walsh

"There needs to be a much more robust system for regulation."

Continue reading the main story

Related stories

• Grim toll of missed safety alerts
• Surgery targets 'endanger safety'
• Hospitals face readmission fines

AVMA said that more than two years after the deadline, 67 trusts had not taken action on an alert advising healthcare workers about avoiding overdoses with injectable medicines.

Lisa Richards-Everton said the situation made her "despair". Her husband Paul died in March 2007 while he was being treated for cancer, after being given a massive overdose. Another patient died for the same reason, and a patient safety alert was issued as a result.

"Three years on, and yet there are still trusts that haven't complied," she said. "I don't think they quite understand the importance of this."

But the report's conclusions have been challenged by the National Patient Safety Agency which issues alerts.

It said it took some trusts longer than others to put them into action because of staffing levels, the size of some organisations, and the different ways they were run.

'Significant improvement'

Earlier this year, the Department of Health wrote to NHS trusts reminding them of the importance of acting on Patient Safety Alerts. It said the vast majority had been carried out.

Health minister Anne Milton said: "Across the NHS there must be a culture of patient safety above all else. We expect all NHS trusts to comply, in order to minimise any risks in the future."

The Care Quality Commission is responsible for making sure trusts act on safety warnings. It said there were often good reasons behind delays.

"There has been a significant improvement in trusts reporting compliance," said regional director Ian Biggs. "If we find that patient safety has been put at risk we will take action."

The National Patient Safety Agency is one of the quangos being cut by the government. The new NHS commissioning board will take over responsibility for the alerts.

Patient Safety Alerts are also sent to healthcare organisations in Scotland, Wales and Northern Ireland, but information was not available on their levels of compliance.

Climate change impact on mental health

Climate change impact on mental health

03 Dec 2009, PR 263/09

Leading mental health researchers are warning that some of the most important health consequences of climate change will be on mental health, yet this issue is unlikely to be given much attention at the UN climate change conference in Copenhagen next week.

Dr Lisa Page and Dr Louise Howard from the Institute of Psychiatry (IoP) at King’s College London reviewed a range of recent research by scientists into the potential mental health impacts of climate change.

In an article published in Psychological Medicine online, the two mental health experts conclude that climate change has the potential to have significant negative effects on global mental health. These effects will be felt most by those with pre-existing serious mental illness, but that there is also likely to be an increase in the overall burden of mental disorder worldwide.

The scientists urge for the lack of research into the mechanisms that cause the effects of climate change on mental disorder to be addressed, so that mental health policy makers can plan for the significant impacts of climate change on mental health that are to be expected.

Dr Page, lead author of the article and Clinical Lecturer in Liaison Psychiatry at the IoP, comments: ‘Climate change is assuming centre stage with the upcoming UN conference in Copenhagen. While delegates will discuss the effects of climate change and possible responses by the international governments, we fear that the effects of climate change on mental health will be largely ignored, posing a tremendous risk to the mental health of millions of people in the not-too-distant future.’

Impacting factors

Dr Page and Dr Howard identified the following ways in which climate change is likely to impact mental health:

• Natural disasters, such as floods, cyclones and droughts, are predicted to increase as a consequence of climate change. Adverse psychiatric outcomes are well documented in the aftermaths of natural disasters and include post-traumatic stress disorder, major depression and somatoform disorders.


• The needs of people will chronic mental illness have often been overlooked following disaster in favour of trauma-focused psychological interventions and yet the mentally ill occupy multiply vulnerabilities for increased mortality and morbidity at such times.
  
  
• As global temperatures increase, people with mental illness are particularly vulnerable to heat-related death. Contributing risk factors such as psychotropic medication, pre-existing respiratory and cardiovascular disease and substance misuse, are all highly prevalent in people with serious mental illness. In addition, maladaptive coping mechanisms and poor quality housing are likely to further increase vulnerability, and death by suicide may also increase above a certain temperature threshold.
  
  
• Adverse impacts such as psychological distress, anxiety and traumatic stress resulting from emerging infectious disease outbreaks are also likely to increase if the predicted outbreaks of serious infectious diseases become reality.
  
  
• Coastal change and increased flooding is expected to lead to forced mass migration and displacement, which will undoubtedly lead to more mental illness in affected population.
  
  
• Urbanisation, a phenomenon which will be partially beneficial, for example by increasing opportunities for work and better access to health services, is associated with an increased incidence of schizophrenia in developed countries. In many low- and middle-income countries, mental health provision is already hugely inadequate and is unlikely to be prioritised should further economic collapse occur secondary to climate change.
  
  
• The knowledge of man-made climate change could in itself have adverse effects on individual psychological well-being.

Notes to editors

L. Page and L. Howard, ‘The impact of climate change on mental health (but will mental health be discussed at Copenhagen)?’, 30 November 2009. Psychological Medicine online.

King's College London
King's College London is one of the top 25 universities in the world (Times Higher Education 2009) and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 21,000 students from nearly 140 countries, and more than 5,700 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit:

New brain scan to diagnose autism

The computer scan shows up a distinctive pattern associated with autism

A brain scan that detects autism in adults could mean much more straightforward diagnosis of the condition, scientists say.

Experts at King's College London said the scan - tested on 40 people - identified tiny but crucial signs of autism, only detectable by computer.
Current methods of diagnosis can be lengthy and expensive.
But some experts say further research will be needed before the new technique can be widely used.

Autism Spectrum Disorder affects an estimated 1 in every 100 adults in the UK, most of them men. It varies from mild to very severe, and people with the condition can find the world appears chaotic and hard to understand.

Conventional diagnosis involves a team of experts who analyse behaviour and make a complex series of assessments.
The Medical Research Council study looked at 20 non-autistic adults and 20 adults with Autism Spectrum Disorder (ASD).
They were initially diagnosed using traditional methods, and then given a 15 minute brain MRI scan. The images were reconstructed into 3D and were fed into a computer, which looked for tiny but significant differences.

“Start Quote

It could help to alleviate the need for the emotional, time consuming and expensive diagnostic process which ASD patients and families currently have to endure”

End Quote Dr Christine Ecker Lead researcher

The researchers detected autism with over 90% accuracy, the Journal of Neuroscience reports.

"What the computer can do very quickly is to see that a patient has autism," said Professor Declan Murphy from the Institute of Psychiatry, who supervised the research, "even though their brain, to the naked eye, looks very normal."
Dr Christine Ecker, who led the study, said she hoped the findings might result in a widely available scan to test for autism.
"It could help to alleviate the need for the emotional, time consuming and expensive diagnostic process which ASD patients and families currently have to endure," she said.
Once a patient has a diagnosis, he or she is able to access help and support with managing the condition.
Visible confirmation
Joe Powell was diagnosed with Asperger's syndrome, a form of autism, 14 years ago. Before his diagnosis, he didn't speak at all.
Since then, he says he's made big progress in managing his condition.
His brain scan confirms his ASD. He says seeing his diagnosis charted in black and white made a big difference to him.
"You need to physically see it," he says.
"I know the autism is still there. The progress I've made in managing my condition is real, but it's still there."
The research team is now looking at whether the test would be effective on children.

Nicholas Joy describes what an Asperger's diagnosis meant for his health and treatment

The findings have been welcomed by the National Autistic Society, who say they add to the understanding of the condition. They say adults can find it very difficult to get a diagnosis of autism, and this may help.
However, they say without more awareness among doctors, it may be of limited use.
"There's still a woeful lack of awareness in GPs' knowledge of autism," said NAS centre director, Carol Povey.
"People with autism are often dismissed when they go to their GPs for help, so we have to make sure front-line professionals have awareness of autism so they can make appropriate referrals."
Professor Uta Frith from UCL Institute of Cognitive Neuroscience, said much more work would be needed before the scans could be used for diagnosis. "This study shows that the subtle brain abnormalities associated with autism show a distinctive pattern," she said. "It is crucial that we learn more about what the brain abnormalities mean."

News highlights

Adult autism diagnosis by brain scan

11 Aug 2010, PR 172/10


Scientists from the Institute of Psychiatry (IoP) at King’s College London have developed a pioneering new method of diagnosing autism in adults. For the first time, a quick brain scan that takes just 15 minutes can identify adults with autism with over 90 per cent accuracy. The method could lead to the screening for autism spectrum disorders in children in the future.


The team used an MRI scanner to take pictures of the brain’s grey matter. A separate imaging technique was then used to reconstruct these scans into 3D images that could be assessed for structure, shape and thickness – all intricate measurements that reveal Autism Spectrum Disorder (ASD) at its root. By studying the complex and subtle make-up of grey matter in the brain, the scientists can use biological markers, rather than personality traits, to assess whether or not a person has ASD.


ASD is a lifelong and disabling condition caused by abnormalities in brain development. It affects about one per cent of the UK population (half a million people), the majority of these being men (4:1 male to female). Until now, diagnosis has mainly relied on personal accounts from friends or relatives close to the patient – a long and drawn-out process hinged on the reliability of this account and requiring a team of experts to interpret the information.


Dr Christine Ecker, a Lecturer in the Department of Forensic and Neurodevelopmental Sciences from the IoP, who led the study, said: ‘The value of this rapid and accurate tool to diagnose ASD is immense. It could help to alleviate the need for the emotional, time consuming and expensive diagnosis process which ASD patients and families currently have to endure. We now look forward to testing if our methods can also help children.’


Improved quality of life


Professor Declan Murphy, Professor of Psychiatry and Brain Maturation at the IoP, who supervised the research, said: ‘Simply being diagnosed means patients can take the next steps to get help and improve their quality of life. People with autism are affected in different ways; some can lead relatively independent lives while others need specialist support or are so severely affected they cannot communicate their feelings and frustrations at all. Clearly the ethical implications of scanning people who may not suspect they have autism needs to be handled carefully and sensitively as this technique becomes part of clinical practice.’


Professor Christopher Kennard, Chair of the Medical Research Council’s (MRC) Neuroscience and Mental Health funding board, said: ‘Bringing together the knowledge gained from neuroscience in the laboratory and careful clinical and neuropsychological evaluation in the clinic has been key to the success of this new diagnostic tool. In fact, this approach to research is a crucial theme throughout the MRC’s strategy. We know that an investment like this can dramatically affect the quality of life for patients and their families. The more we understand about the biological basis of autism, the better equipped we will be to find new ways of treating those affected in the future.’


The research studied 20 healthy adults, 20 adults with ASD, and 19 adults with ADHD. All participants were males aged between 20 and 68 years. After first being diagnosed by traditional methods (an IQ test, psychiatric interview, physical examination and blood test), scientists used the newly-developed brain scanning technique as a comparison. The brain scan was highly effective in identifying individuals with autism and may therefore provide a rapid diagnostic instrument, using biological signposts, to detect autism in the future.


The research was undertaken using the A.I.M.S. (Autism Imaging Multicentre Study) Consortium, which is funded by the MRC. Support funding was also provided by the Wellcome Trust and National Institute for Health Research (NIHR).


The paper, ‘Describing the brain in autism in five dimensions - MRI-assisted diagnosis using a multi-parameter classification approach’ is published in the Journal of Neuroscience today.


Notes to editors


At present, the Bethlam/ Maudsley Hospital clinic does not offer private assessments or scans. We recommend that people ask their GP or health professional for a referral letter to the Behavioural Genetics Clinic at the Bethlam/Maudsley Hospital, where the patient can then be seen and scanned. More information about the hospital can be found at: www.slam.nhs.uk


King's College London
King's College London is one of the top 25 universities in the world (Times Higher Education 2009) and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,000 students (of whom more than 8,600 are graduate students) from nearly 140 countries, and some 5,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.


King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.


King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.


King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org.

Rice yields falling under global warming

Dark clouds hang over future farming under climate change, the study suggests

Global warming is cutting rice yields in many parts of Asia, according to research, with more declines to come.

Yields have fallen by 10-20% over the last 25 years in some locations.
The group of mainly US-based scientists studied records from 227 farms in six important rice-producing countries such as Thailand, Vietnam, India and China.
This is the latest in a line of studies to suggest that climate change will make it harder to feed the world's growing population by cutting yields.

“Start Quote

We haven't seen a scenario where daytime temperatures cross over a threshold where they'd stop benefiting yields and start reducing them”

End Quote Jarrod Welch UCSD

In 2004, other researchers found that rice yields in the Philippines were dropping by 10% for every 1C increase in night-time temperature.

That finding, like others, came from experiments on a research station.
The latest data, by contrast, comes from working, fully-irrigated farms that grow "green revolution" crops, and span the rice-growing lands of Asia from the Indian state of Tamil Nadu to the outskirts of Shanghai.
Describing the findings, which are published in Proceedings of the National Academy of Sciences (PNAS), lead researcher Jarrod Welch said:
"We found that as the daily minimum temperature increases, or as nights get hotter, rice yields drop."
The mechanism involved is not clear but may involve rice plants having to respire more during warm nights, so expending more energy, without being able to photosynthesise.
By contrast, higher temperatures during the day were related to higher yields; but the effect was less than the yield-reducing impact of warmer nights.
However, if temperatures continue to rise as computer models of climate project, Mr Welch says hotter days will eventually begin to bring yields down.

Warmer climates will bring changes to rainfall, potentially causing drought

"We see a benefit of [higher] daytime temperatures principally because we haven't seen a scenario where daytime temperatures cross over a threshold where they'd stop benefiting yields and start reducing them," he told BBC News.
"There have been some recent studies on US crops, in particular corn, that showed the drop-off after that threshold is substantial," said the University of California at San Diego researcher.
The 2007 assessment of climate impacts from the Intergovernmental Panel on Climate Change (IPCC) concluded that although a modest temperature rise could increase crop yields in some regions, for "temperature increases more than 3C, average impacts are stressful to all crops assessed and to all regions".
A study published at the begining of last year concluded that half of the world's population could face a climate-induced food crisis by 2100, with the most extreme summers of the last century becoming routine towards the end of this century

Is it safe to consume milk and meat from cloned cattle?

By Katia Moskvitch Science reporter, BBC News

The Food Standards Agency (FSA) will investigate reports that milk from a cloned cow's offspring has reached Britain's supermarket shelves.

BBC News looks deeper at the reports and at the issues surrounding produce from cloned animals.

Animal cloning has been around for years

What is being claimed?

The New York Times has reported that a British dairy farmer, who wished to remain anonymous, was selling milk from a cow bred from a clone.

He did not want to disclose his identity, the newspaper said, because "the British public regarded cloning as so distasteful that buyers would stop taking his milk…[and] he did not want to be required to get rid of a valuable cow." The paper also reports that the farmer was selling embryos from the same cow to breeders in Canada.

Continue reading the main story

“Start Quote

This technique raises serious issues about animal welfare, reduction of biodiversity, as well as ethical concerns ”

End Quote Corinne Lepage European Parliament

However, not everyone is convinced that the story is true. Professor Grahame Bulfield, former director of the Roslin Institute, where Dolly the Sheep was cloned, said: "Given that the farmer wishes to remain 'anonymous', it is very difficult to evaluate this story so it should be taken with a pinch of salt. I don't know of any cloned animals in the UK so I would be very suspicious."

What is a clone?

A clone is a genetic copy of an animal. Scientists say that clones are similar to identical twins, but born at different times.

Animal cloning has been around for more than two decades. The first mammal cloned from the cell of an adult animal was Dolly the sheep, born in 1996. She died in February 2003.

Most cloning nowadays is done using somatic cell nuclear transfer:

• Scientists remove the gene-containing nucleus from an egg taken from a female animal
• They then add to the egg the nucleus of a cell from an animal they wish to clone
• The egg cell begins to form into an embryo in the laboratory
• The embryo is then implanted in the uterus of a host animal which carries it to term and delivers it like her own offspring

According to the Genetic Science Learning Centre of the University of Utah, the success rate ranges from 0.1% to 3%. That means that only one to 30 clones are made for every 1,000 attempts.

Is it safe to consume milk and meat from cloned animals and their offspring?

According to a research paper done by scientists in the US and Japan in 2005, milk and meat from cloned cattle appear safe for consumption.

Hundreds of cloned animals exist today, but many clones die shortly after birth

The team, led by Jerry Yang from the University of Connecticut, compared the produce from two beef and four dairy clones with that from normal animals of similar age and breed.

The scientists found that the cloned cow meat was slightly higher in fat and fatty acids, but still within beef industry standards. Other than that, there were no significant differences, and produce from cloned cattle was said to be safe to eat and drink.

Dr Brendan Curran, a geneticist from the School of Biological and Chemical Sciences at Queen Mary, University of London, said cloning was "an extension of the process by which identical twins arise in nature".

"Therefore if you have a healthy cow that is producing milk, it will produce healthy milk. I would argue that once the animal has been certified by veterinary surgeons as a fit animal, I can't see how it would be in any way dangerous."

The US' Food and Drug Administration has a similar opinion.

It has concluded, based on the results of a number of studies, that "meat and milk from clones of cattle, swine (pigs), and goats, and the offspring of clones from any species traditionally consumed as food, are as safe to eat as food from conventionally bred animals".

What does the European Union think of the sale of foods from cloned cattle?

In July, the European Parliament called for a ban on the sale of dairy products and meat from cloned animals.

Continue reading the main story

“Start Quote

There is no genetic modification... they are just normal animals, and I do not understand the EU position on this”

End Quote Professor Robin Lovell-Badge National Institute for Medical Research

The governments of the 27 EU member states will finalise the rules of the bill with EU legislators in September.

"Although no safety concerns have been identified so far with meat produced from cloned animals, this technique raises serious issues about animal welfare, reduction of biodiversity, as well as ethical concerns," said Corinne Lepage, a French member of the European Parliament.

In the UK, milk and meat from cloned animals are considered "novel foods" and need to be authorised by the Food Standard Agency (FSA) before being sold.

"It is the responsibility of food business operators to ensure food that they place on the market is in compliance with the law. As the UK authority responsible for accepting Novel Food applications, the agency has not received any applications relating to cloning and no authorisations have been made," said the FSA in an e-mail to BBC News.

"The agency will, of course, investigate any reports of unauthorised novel foods entering the food chain."

Professor Robin Lovell-Badge, head of stem cell biology and developmental genetics at the National Institute for Medical Research (NIMR), said he did not understand the EU's concerns.

"There is no genetic modification. It was for this reason that the FDA has approved consumption of milk and beef from the offspring of cloned cattle - they are just normal animals, and I do not understand the EU position on this," he said.

"Obviously the FSA have their rules and need to look into what has happened, but it is more likely to be the milk of kindness than a horror story."

Are cloned animals generally normal and healthy?

It has been shown that animals conceived through an assisted reproductive technique have a higher risk of neo-natal death.

Those clones that do survive are often much bigger at birth than animals born in a natural way. They can have abnormally large organs, which can lead to a number of problems, including breathing and blood flow. This is known as "Large Offspring Syndrome" (LOS).

But Dr Curran from the school of biological and chemical sciences at Queen Mary, University of London, does not agree.

"I could see an argument for the animal welfare people being concerned, but since these procedures have to be done under very strict conditions and in a compassionate way for the animal, this also shouldn't be a problem," he said.

"After the animal has been born and grows to be an adult, it reproduces normally and does everything normally."