Sunday, 30 December 2012

Prince Charles calls for more compassion in NHS


Prince Charles calls for more compassion in NHS

prince charlesThe prince called for society to adopt a more holistic approach to health

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The Prince of Wales has called for a national health service with more compassion.
Writing in the Journal of the Royal Society of Medicine, Prince Charles called for a service that accounts for "the core human elements of mind, body and spirit" as well as disease.
He urged medical professionals to develop a "healing empathy" to help patients find their own path to health.
The Patients Association said "compassion" was "lacking" in the NHS.
'Holistic approach'
In his article, Prince Charles set out his vision of a health service with a wider perspective - one that acknowledges "physical and social environment, education, agriculture and architecture".

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This is an important article and the prince's vision for health is engaging”
Dr Kamran AbbasiJournal of the Royal Society of Medicine
He said those in the industry must "listen and honour what is being said and not said by patients," adding that symptoms "may often be a metaphor for underlying disease and unhappiness".
A scientific and therapeutic approach that "understands, values and uses patient perspective and belief rather than seeking to exclude them" would allow patients to discover better health.
However, he emphasised he did not wish to confront accepted medical wisdom.
The prince's article - which draws on the work of several of his charities based in the Lancashire town of Burnley - said inequalities in the area had led to a reduction in life expectancy to one of the worst levels in Britain.
He insisted that a focus on improving the built and natural environment - including work on education, business and the arts - would lead to improvements "not only in health, but also in the overall cost-efficiency and effectiveness of local services".
By encouraging clinicians to emphasise "the value of caring, continuing relationships and for society to adopt a more holistic approach to health and disease that maximises the potential of the physical and social environment so that healing and better health can thrive," he wrote.
Speaking to BBC News, Dr Mike Smith, vice chairman of the Patients Association, said he thought the prince was right.
"The chief nursing officer of the Department of Health only recently has set out her six Cs, one of which is compassion care," he said.
"So the pair of them are singing from the same hymn sheet. And that's what we've seen lacking over the last half dozen years, when increasingly the care element of the NHS has been not up to its previous standard."
'Vision for health'
The journal's editor, Dr Kamran Abbasi, welcomed the article, describing Prince Charles as "a prominent and influential voice".
"When he sets out his vision for health, something he clearly thinks deeply about, speaking directly to medical professionals is the best way of allowing a constructive debate to flourish," he said.
"This is an important article and the prince's vision for health is engaging."
A Department of Health spokeswoman agreed that "wider determinants of health - such as housing and environment - are very important to our wellbeing", underlining government plans to start "putting local councils in charge of improving the public's health".
"They will have the power and the budget to tackle the causes of poor health in their areas. This should help to reduce health inequalities and mean that everyone has the same opportunity to lead a healthy life."
She added: "Ensuring that patients get the best possible care is a priority... Nursing leaders recently launched a new drive to ensure values such as compassion and courage are at the heart of the NHS and the public health and care sectors."

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prince charlesThe prince called for society to adopt a more holistic approach to health

Related Stories

The Prince of Wales has called for a national health service with more compassion.
Writing in the Journal of the Royal Society of Medicine, Prince Charles called for a service that accounts for "the core human elements of mind, body and spirit" as well as disease.
He urged medical professionals to develop a "healing empathy" to help patients find their own path to health.
The Patients Association said "compassion" was "lacking" in the NHS.
'Holistic approach'
In his article, Prince Charles set out his vision of a health service with a wider perspective - one that acknowledges "physical and social environment, education, agriculture and architecture".

Start Quote

This is an important article and the prince's vision for health is engaging”
Dr Kamran AbbasiJournal of the Royal Society of Medicine
He said those in the industry must "listen and honour what is being said and not said by patients," adding that symptoms "may often be a metaphor for underlying disease and unhappiness".
A scientific and therapeutic approach that "understands, values and uses patient perspective and belief rather than seeking to exclude them" would allow patients to discover better health.
However, he emphasised he did not wish to confront accepted medical wisdom.
The prince's article - which draws on the work of several of his charities based in the Lancashire town of Burnley - said inequalities in the area had led to a reduction in life expectancy to one of the worst levels in Britain.
He insisted that a focus on improving the built and natural environment - including work on education, business and the arts - would lead to improvements "not only in health, but also in the overall cost-efficiency and effectiveness of local services".
By encouraging clinicians to emphasise "the value of caring, continuing relationships and for society to adopt a more holistic approach to health and disease that maximises the potential of the physical and social environment so that healing and better health can thrive," he wrote.
Speaking to BBC News, Dr Mike Smith, vice chairman of the Patients Association, said he thought the prince was right.
"The chief nursing officer of the Department of Health only recently has set out her six Cs, one of which is compassion care," he said.
"So the pair of them are singing from the same hymn sheet. And that's what we've seen lacking over the last half dozen years, when increasingly the care element of the NHS has been not up to its previous standard."
'Vision for health'
The journal's editor, Dr Kamran Abbasi, welcomed the article, describing Prince Charles as "a prominent and influential voice".
"When he sets out his vision for health, something he clearly thinks deeply about, speaking directly to medical professionals is the best way of allowing a constructive debate to flourish," he said.
"This is an important article and the prince's vision for health is engaging."
A Department of Health spokeswoman agreed that "wider determinants of health - such as housing and environment - are very important to our wellbeing", underlining government plans to start "putting local councils in charge of improving the public's health".
"They will have the power and the budget to tackle the causes of poor health in their areas. This should help to reduce health inequalities and mean that everyone has the same opportunity to lead a healthy life."
She added: "Ensuring that patients get the best possible care is a priority... Nursing leaders recently launched a new drive to ensure values such as compassion and courage are at the heart of the NHS and the public health and care sectors."

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dementia by type'


Brain scan 'can sort dementia by type'

Frontotemporal dementia on MRI scanTell-tale shrinkage of the frontal and temporal lobes on an MRI scan

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Scientists say they have found a way to distinguish between different types of dementia without the need for invasive tests, like a lumbar puncture.
US experts could accurately identify Alzheimer's disease and another type of dementia from structural brain patterns on medical scans, Neurology reports.
Currently, doctors can struggle to diagnose dementia, meaning the most appropriate treatment may be delayed.
More invasive tests can help, but are unpleasant for the patient.

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This could be used as a screening method and any borderline cases could follow up with the lumbar puncture or PET scan”
Lead researcher Dr Corey McMillan
Distinguishing features
Despite being two distinct diseases, Alzheimer's and frontotemporal dementia, share similar clinical features and symptoms and can be hard to tell apart without medical tests.
Both cause the person to be confused and forgetful and can affect their personality, emotions and behaviour.
Alzheimer's tends to attack the cerebral cortex - the layer of grey matter covering the brain - where as frontotemporal dementia, as the name suggests, tends to affect the temporal and frontal lobes of the brain, which can show up on brain scans, but these are not always diagnostic.
A lumbar puncture - a needle in the spine - may also be used to check protein levels in the brain, which tend to be higher in Alzheimer's than with frontotemporal dementia.
A team at the University of Pennsylvania set out to see if they could ultimately dispense of the lumbar puncture test altogether and instead predict brain protein levels using MRI brain scans alone.
They recruited 185 patients who had already been diagnosed with either Alzheimer's disease or frontotemporal dementia and had undergone a lumbar puncture test and MRI scanning.

Dementia

  • There are many causes of dementia, with Alzheimer's the most common
  • More than half a million people in the UK have Alzheimer's disease
  • Frontotemporal dementia tends to affects people who are younger - under 65 - and can affect a personality and behaviour
  • Other types of dementia include vascular dementia and dementia with Lewy bodies
The researchers scrutinised the brain scans to see if they could find any patterns that tallied with the protein level results from the lumbar puncture tests.
They found the density of gray matter on the MRI scans correlated with the protein results.
The MRI prediction method was 75% accurate at identifying the correct diagnosis.
Although this figure is some way off an ideal 100%, it could still be a useful screening tool, say the researchers.
Lead researcher Dr Corey McMillan said: "This could be used as a screening method and any borderline cases could follow up with the lumbar puncture or PET scan."
Dr Simon Ridley, Head of Research at Alzheimer's Research UK, said: "This small study suggests a potential new method for researchers to distinguish between two different types of dementia, and a next step will be to investigate its accuracy in much larger studies involving people without dementia.
"While this method is not currently intended for use in the doctor's surgery, it may prove to be a useful tool for scientists developing new treatments. The ability to accurately detect a disease is vital for recruiting the right people to clinical trials and for measuring how well a drug may be working.
"Ultimately, different causes of dementia will need different treatment approaches, so the ability to accurately distinguish these diseases from one another will be crucial."
The only drug currently licensed in England and Wales for treating frontotemporal dementia is rivastigmine.
There are four licensed treatments for Alzheimer's - donepezil, galantamine, rivastigmine and memantine.

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Norovirus


Q&A: Norovirus

NorovirusThe Health Protection Agency says there has been a 72% increase in cases on last year

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Wards in hospitals across the UK have been closed to visitors to try to prevent the spread of winter vomiting bug norovirus, which causes sudden vomiting and diarrhoea. What is it?
What is it?
Noroviruses are a group of viruses that are the most common cause of stomach bugs in the UK, affecting all ages.
It is estimated that between 600,000 and a million people in the UK become infected each year. Noroviruses are also sometimes known as "winter vomiting viruses" or "Norwalk-like viruses".
What are the symptoms?
Around 12 to 48 hours after becoming infected, the virus causes sudden onset of nausea followed by projectile vomiting and watery diarrhoea.
Some people may have a fever, headaches and aching limbs - often leading people to call the illness "stomach flu".
The illness is not generally dangerous and most people make a full recovery within one to two days.
However, the very old and very young risk becoming dehydrated which may require hospital treatment.
How does it spread?
The virus is easily transmitted from one person to another by contact with an infected person or through contaminated food or drink or touching contaminated surfaces or objects.
It is able to survive in the environment for many days and outbreaks tend to affect more than 50% of susceptible people.
Anyone is susceptible as immunity to the virus is not long-lasting.
Outbreaks commonly occur in hospitals, nursing homes, schools and on cruise ships.
It can be difficult to control because it is so easily spread but the best way is to disinfect contaminated areas, washing hands and to avoid handling food.
Also, those who have been infected should be isolated for 48 hours after their symptoms have gone away.
What is the treatment?
There is no treatment other than to let the illness run its course.
Those infected should drink plenty of fluids to prevent dehydration and practise good hygiene to reduce the risk of the illness spreading.

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Wednesday, 26 December 2012


Norovirus: The winter vomiting bug that is hard to conquer

Norovirus is the Ferrari of the virus world," says Professor Ian Goodfellow, a Wellcome Trust fellow


Vomiting bug still affects wards

'Vomiting Larry' is busy being sick over and over again in an experiment to test just how far the winter vomiting bug can travel when it makes you ill.
Lucky for Larry, he is not a constantly retching human - but a simulated vomiting system that shows the virus can travel an impressive 3m (9.8ft) in a projectile episode, according to his creators at the Health and Safety Laboratory.
The winter vomiting bug (norovirus) has been responsible for an estimated 880,000 cases of vomiting and diarrhoea in the UK since the summer.
It is a hardy virus that clearly spreads with ease - one of the few infections you really can catch from a toilet seat, or even from the air in the bathroom if an infected person has recently pulled the flush.
Luckily most people make a full recovery in a few days, but for anyone who is already vulnerable - people who are already unwell or in their later years for example - it can pose a serious threat.
It was first noticed when 150 children at the Norwalk-Bronson Elementary School in Ohio were all struck down with the bug in 1968.
This 40-year-old incident is now eternalised in medical history, making up the first part of the virus's name.
And unsuspecting groups of students continue to be knocked down by its tenacious grip on the small intestine.
A girls' football team from Canada was taken ill after a team-mate developed the illness - but she had had no contact with them.
The culprit was a grocery bag in the corner of the bathroom she had used.
Computer model of the virusOne in 20 people in the UK suffer from norovirus each year
Aerosolised particles of the virus landed on the grocery bag, and spread to members of the team who touched the bag or ate the packaged crisps and cookies inside it, according to research published in the Journal of Infectious Diseases.
And it can stick around for a long time.
It is widely accepted that it can last for two weeks on hard surfaces, says Professor Ian Goodfellow of the University of Cambridge.
It is not only its ability to travel so far or survive on everyday surfaces that makes it, in viral terms, "the ideal infectious agent", says Dr Aron Hall, from the Centers for Disease Control and Prevention in the US.
'Rapid reproduction'
As few as 18 viral particles can infect a new person, but there are often thousands of particles present in each drop of vomit.
And it is able to reproduce at a rapid speed - thousands of times more quickly than humans.
The fact it makes most of us only mildly or moderately ill is all part of its high-achieving strategy.
If it made people more seriously ill, or even killed them, it would not be able to spread so well.
"From an evolutionary stand point if you kill your host you are not going to have anywhere to live, so keeping your host alive has its advantages," says Dr Hall.
All these factors make it very difficult to stop in its tracks.
That is, apart from the good old fashioned method of washing your hands with soap and water.

NOROVIRUS

  • Symptoms include vomiting and/or diarrhoea
  • You may also have a fever, headache and stomach cramps
  • Over-the-counter medicines can be useful in treating headaches and other aches and pains
  • Do not visit your GP surgery or A&E unit if you have it
  • If symptoms persist for more than three or four days, or if you have a serious illness, seek medical attention through contact with your GP
  • Wash hands thoroughly, particularly after using the toilet and before eating
  • Clean hard surfaces with detergent followed by disinfection with a bleach solution, paying particular attention to the toilet and surrounding area
According to a study of seven outbreaks at an international scout jamboree, each boy scout who had the infection passed it on to 14 others until enhanced hygiene measures were imposed.
This included separate bathrooms for infected people and strict hand-washing regimes.
The number of infections passed on per person then went down to two - but still not enough to stop it from spreading completely.
The virus also manages to evade many commonly used alcohol gels and some domestic cleaning products.
You are safe with thoroughly cooked food, but it can escape freezing and mild heating.
Scientists have spent many years trying to find a way to stop it from closing hospital wards, leaving offices short-staffed in winter months and causing chaos on cruise ships.
Legend has it that the first of the now many attempts to study the virus involved volunteers who drank the filtered diarrhoea of people who had the infection.
Study designs may have moved on a lot since then, but we are still far from finding a cure.
One of the reasons is that no one has been able to persuade the virus to grow in a lab, says Prof Ian Goodfellow:
"In my lab we are trying to understand how these viruses work, with the overall aim of trying to identify a drug that will prevent infection and control outbreaks when they do occur," he says.
But no one has yet pinned down why it is so elusive. And until a vaccine or cure is found it is likely to continue to put some people off their turkey this Christmas.

Tuesday, 25 December 2012

patient neglect


Alexandra Hospital neglect: Jeremy Hunt 'disgusted'

Alexandra Hospital, RedditchVulnerable patients were left starving and thirsty, a solicitor for the families said in a statement

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Health Secretary Jeremy Hunt has said he is "disgusted and appalled" at accounts of patient neglect at a hospital in Worcestershire.
It was claimed in one case an 84-year-old man starved to death at Redditch's Alexandra Hospital in 2009.
Worcestershire Acute NHS Hospital Trust will apologise to the families of 38 people and many will receive a payment of, on average, about £10,000.
In a statement, the trust issued an apology over its "shortcomings".
'Appalling failings'
The incidents happened between 2002 and 2011, with 35 cases brought against the Alexandra Hospital and three against the Worcestershire Royal Hospital, Worcester.
Lawyers for the families started a class action against the trust 15 months ago, after failings in basic day-to-day care were highlighted in a report by health watchdog the Care and Quality Commission (CQC).
Inspectors concluded the trust was breaking the law in failing to meet "essential standards".
Health bosses at the trust agreed in November to write to each of the families apologising for lapses in care, but have not admitted legal liability.
The financial payments will total £410,000.

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The most shocking thing about these cases is the fact that they went on over so many years”
Solicitor Emma Jones
Lawyer Emma Jones, who brought the legal action, said the failings uncovered were "appalling".
Some patients treated by the trust were left thirsty with drinks left out of reach, while others were left to sit in their own excrement, she said.
A man was unable to feed himself and nurses would simply take his uneaten food away, according to his daughter.
There were further claims from the families of a man whose ribs were broken while hospital staff tried to lift him and a great-grandmother whose hip fracture went undetected by doctors.
Former nurse Patricia Brindle, 86, was left unwashed for 11 weeks despite her son Peter begging nurses for her to be bathed, he said.
Mrs Brindle, from Redditch, was admitted to the Alexandra Hospital in 2008 after a suspected mild stroke. She was transferred to another hospital but died a few days later.
Mr Hunt said: "I am disgusted and appalled to read these accounts of what patients and their relatives went through.
"These are examples of the sort of 'care' that should simply not happen in the NHS and there is no excuse for them.
"We will be keeping a careful eye on this situation, and will take further action if necessary."
'Significant changes'
Ms Jones said: "The most shocking thing about these cases is the fact that they went on over so many years, despite repeated assurances given from the management of the hospital.
"Families who complained were told that changes would be made so others would not have to endure these kinds of failings but, in fact, the problems were not tackled.
"Although the issues went on for almost a decade, we are pleased that the current management seems to be taking the matter seriously and making changes, and righting wrongs."
In March 2011, CQC inspectors arrived unannounced at the Alexandra Hospital and concluded the trust needed to improve care.
The trust said in a statement: "Whilst the trust has accepted that certain aspects of the care afforded to some patients fell below the standard that they were entitled to expect, all of the cases cited are several years old, in many incidences, more than a decade old.
"A number of very serious allegations made by the families of deceased patients are not borne out by the medical records.
"Nevertheless, the trust accepts that the care afforded to some patients some years ago - between 2002 and 2009 - fell below the requisite standard and has apologised for the shortcomings."
It said that following an inspection by the CQC in early 2011, "significant changes have been made to ensure patient care is excellent".

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Multiple sclerosis: World's highest rate in Orkney Islands

Brain scan of MS patientMS disrupts messages from the brain to the rest of the body

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Scotland's Orkney Islands have the highest rate of multiple sclerosis (MS) in the world, according to a major new study.
Researchers said that the rate for probable or definite MS was now 402 per 100,000 people, up from a previous 309 per 100,000 which was recorded in 1974.
Teams at the universities of Edinburgh and Aberdeen carried out the study.
They are now trying to work out why the figure in Orkney is so high, but believe genes could play a key role.
With MS, the protective layer around nerves, known as the myelin sheath, becomes damaged.
Messages from the brain to the rest of the body are disrupted, resulting in difficulty moving, muscle weakness and blurred vision.
There are many suspected risk factors, and the disease is known to be more common away from the equator.
MS affects about 100,000 people in the UK.
The new study found that one in 170 Orcadian women suffer from the condition.
The current figure for Orkney compares to 295 per 100,000 in Shetland and 229 per 100,000 in Aberdeen.
'So high'
Dr Jim Wilson, of the University of Edinburgh's Centre for Population Health Sciences, said: "Our study shows that Orkney has the highest prevalence rate of MS recorded worldwide.
"These findings may reflect improved diagnostic methods, improved survival or rising incidence.
"We are trying to work out why it is so high, but it is at least partly to do with genes."
It has previously been noted that areas of high MS prevalence around the world have been settled in by Scottish immigrants.
'Interesting study'
Previous studies have shown high rates of MS in Canada and Scandinavia.
The new study is published in the Journal of Neurology, Neurosurgery and Psychiatry.
An MS Society spokesperson said: "This in an interesting study which highlights the high prevalence of MS in Orkney, but it's still not clear why this might be the case.
"Further research is essential to build on our knowledge of the underlying causes of MS so that potential treatment and preventative strategies can be developed."

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