Tuesday 16 December 2014

With correct foot care and education, limb loss can be avoided

  • With correct foot care and education, limb loss can be avoided

Diabetes amputations are 'too high' say health bosses

Diabetes amputations are 'too high' say health bosses

Insulin and blood-checking equipment for diabeticsDiabetics have to monitor their blood sugar levels

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The number of diabetics in Cornwall, Devon, Dorset and Somerset who have had amputations due to their condition is too high, health bosses have admitted.
About 1,500 procedures to remove limbs were carried out in the four counties over three years.
Charity Diabetes UK said 80% of amputations were avoidable if more care was available to prevent complications.
Health bosses said they were "acutely aware" of the situation and were improving education about diabetes.
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Diabetes and amputation
  • The risk of amputation comes from damage done to nerves and blood vessels
  • Extremities of the body such as feet are worst affected
  • With correct foot care and education, limb loss can be avoided
Source: Diabetes.co.uk
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Diabetics must know their blood sugar level to stop it going dangerously high or low.
Poorly-managed blood glucose levels can lead to serious complications such as blindness, amputations and stroke.
Of the 1,562 amputations among diabetics carried out across the counties between 2010-2013, 528 were classed as major - above the ankle - statistics from Public Health England said.
The national rate for major amputations at that time was 0.9 per 1,000 people with diabetes. Areas across South West England saw rates of between 0.8 to 1.5.
Phaedra Perry, from Diabetes UK, said evidence showed amputation levels were reduced in areas where teams with the right expertise were in place.
However, diabetic Jacqueline Heather, from St Austell, Cornwall, said patients, not just health staff, had to be "aware of what to look for",
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Number of major amputations 2013-13
  • National rate is 0.9 per 1,000 people with diabetes
  • NHS NEW (Northern, Eastern and Western Devon) Devon Clinical Commissioning Group CCG area - 1.5
  • Somerset - 1.4
  • Cornwall - 1.2
  • Dorset - 1
  • Torbay and South Devon - 0.8
Source: Public Health England
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Dr Gary Lenden, from the NEW (Northern, Eastern and Western Devon) Devon Clinical Commissioning Group - which had the highest rate in the counties - said: "It's something we're clearly concerned about and acutely aware of."
He said managers saw the need "to improve the education for primary care teams" and staff were also working on improving education for patients so they had an "understanding of their own condition".
He added that staff were also working on "getting diabetes teams into the community".

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grains

Why do Americans love ancient grains?


Quinoa farmer in Bolivia
Would you like to taste the health-giving grain found in the tomb of King Tutankhamun? Or feast on the unprocessed kernels said to have been stored on the ark by Noah? Or how about a vodka made from traditionally farmed Bolivian quinoa? If any of this whets your appetite, you are not alone.
In the past five years there has been an explosion in popularity of so-called "ancient grains" in the American food market.
There is no comprehensive list of "ancient" grains, but the category is generally agreed to include amaranth, barley, bulgur, buckwheat, kamut, millet, spelt, teff and quinoa.
Many of these grains - Bolivian quinoa and Ethiopian teff, for example - have been planted and harvested in the same way for thousands of years.
"It's been a positive perfect storm for these ancient grains," says Cynthia Harriman, director of food and nutritional strategies at the non-profit organisation, the Whole Grain Council.
"They fit with our desire to look for a super-food, a magic bullet we should be eating," she says.
Ancient grains are perceived as the opposite of modern wheat, which is the descendant of three ancient strains of wheat - spelt, einkorn and emmer - and often heavily refined.
They are seen as more healthy, more natural and better for us, providing more vitamins, minerals, fibre and protein than modern wheat - partly because they are rarely eaten in processed form.
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Ancient grains
Ancient grains
• Amaranth - a grain, used by the Aztecs, which is both gluten and wheat-free and is a source of vitamin C
• Barley - an excellent source of fibre, manganese, selenium, and thiamine
• Bulgur - a quick-cooking form of whole wheat which is high in manganese
• Kamut - has a nutty flavour and is high in fibre, protein and several minerals, including selenium and manganese.
• Millet - a small, whole grain is a staple in many Asian and African countries but thought of mostly as bird food in the United States
• Spelt - commonly eaten in medieval times, spelt is part of the wheat family and is high in protein and fibre
• Teff - common in Ethiopia, this grain has the highest calcium content
• Quinoa - perhaps the best known ancient grain, quinoa is a complete protein since it has all nine essential amino acids
Source: Today's Dietitian
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Many of the grains are also gluten-free, or at least low in gluten, tapping into a growing demand from consumers.
Part of the popularity of these grains are the stories that surround them, says Harriman.
"We're drawn to the idea that kamut comes from King Tutankhamun's tomb, the story draws our attention," she says.
"It's a revolt against processed food. It's the opposite of modern."
Cheerios with ancient grains box
Other nutritionists agree.
"Aztec, Indian, African," says Vandana Sheth, nutritionist and spokesperson for the Academy of Nutrition and Dietetics.
"People might be more interested in trying these grains because of their place of origin, history and the culture," she says.
One of the first references to ancient grains as a health food was in an article in the New York Daily News in 1996.
Since then they have seen a steady surge in popularity, with a huge increase in consumption over the past five years, particularly in the last year.
According to figures released by the US Whole Grains Council, sales of kamut rose 686% in the year from July 2013, while sales of spelt rose by 363% and amaranth by 123% - all, admittedly, from a low base.
Such growth figures have spurred the processed food industry to take notice, especially against a backdrop of falling sales of breakfast cereals.

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The gullible consumer is going to buy more if it sounds healthy”
Hemi WeingartenFooducate
"In the past year ancient grains saw a 50% growth across all categories, and a 44% growth in the cereal category," says Alan Cunningham, marketing manager for new products for the food giant General Mills.
The company has announced it will be launching a new line of its successful breakfast cereal, Cheerios, with ancient grains next year.
"It's a way to bring this product into the mainstream," Cunningham says.
"Consumers may feel that the barrier to eating ancient grains is that they're not convenient, so we figured a way to deliver them in a bowl of cereal."
But this will also mean including five times as much sugar as in the original Cheerios recipe - 5g of sugar per 28g serving, instead of just 1g - though, as Cunningham points out, about half as much as in the company's best seller, Honey Nut Cheerios.
"We feel great about the health profile of this Cheerios," he says.
But the addition of sugar and heavy processing has led some to accuse companies like General Mills of cynically making money from the "health halo" surrounding ancient grains.
"Like any grain they can be used in a healthy or unhealthy way," says Hemi Weingarten, founder and CEO of the food blog site Fooducate.
"The gullible consumer is going to buy more if it sounds healthy," he says.
Nutritionists argue that consumers should look at carefully at nutrition labels before buying processed food, to check for the amount of whole grains, and of added ingredients, such as sugar.
"I have heard industry analysts talking about taking advantage of the ancient grains trend," says nutritionist Cynthia Harriman.
"With ancient grains on the label, you could increase the price by 50-300%," she says.
The main barrier standing in the way of incorporating more ancient grains into the American diet is a shortage in supply.
There are also concerns that the exploding market for the grains could have an adverse effect on populations that have eaten them for centuries, the quinoa-growers of Bolivia, for example.
But experts do not see this as a passing fad.
"By incorporating ancient grains, we'll benefit by not only getting more whole grains but enjoying a wider array of flavours, textures and nutritional profiles," says Vandana Sheth.
"Although they are currently thought of as a hot trend, I believe that ancient grains are here to stay."

Wednesday 10 December 2014

Nearly 50% take prescription drugs

Nearly 50% take prescription drugs


Drugs

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Half of women and 43% of men in England are now regularly taking prescription drugs, according to the comprehensive Health Survey for England.
Cholesterol-lowering statins, pain relief and anti-depressants were among the most prescribed medicines.
The report, by the Health and Social Care Information Centre (HSCIC), showed an average of 18.7 prescriptions per person in England in 2013.
The cost to the NHS was in excess of £15bn-a-year.
More than a fifth of men and nearly a quarter of women were taking at least three prescriptions.
All the figures exclude contraceptives and smoking cessation products.
Nearly a third of prescriptions were for cardiovascular disease with more than 65 million prescriptions for tackling high blood pressure, heart failure or cholesterol levels.
Simvastatin - which lowers cholesterol - was the single most prescribed item with 40 million prescriptions.
Heart
Dr Jennifer Mindell, one of the report's authors at University College London, said: "This is the first nationally-representative study to report on the use of prescribed medicines taken by people in the community, not just those within the healthcare system.
"That half of men over 65 are taking cholesterol-lowering medicines reflects the high risk of cardiovascular disease in this group.
"Stopping smoking, being a healthy weight, eating more vegetables and fruit, and being physically active reduce people's risk of these diseases, for people who want to avoid taking medicines."
Pills and tape measureWeight was strongly linked with the number of pills being popped.
Antidepressants were taken by more than one in 10 women - double the figure for men.
The drugs were most commonly taken by middle-aged women and those from deprived areas - 17% of the poorest women took antidepressants compared with 7% of the richest.
Dr Sarah Jackson, at University College London, commented: "It's well known that rates of depression are much higher among women than men, so I am not surprised to see that antidepressant use follows the same pattern in this study.
"People with depression are less likely to be in regular employment, and people who are unemployed or in low paid jobs are more likely to have depression."
Obesity
The heavier people were, the more likely they were to need prescription drugs.
More than half of severely obese people in England reported taking at least one prescribed medicine and a third took at least three.
Sue Faulding, a pharmacist and programme manager of prescribing and primary care services at the HSCIC, said: "Obesity is often associated with high cholesterol, high blood pressure, joint pain and depression.
"Lifestyle changes are always recommended in the first instance, but medicines can help to address the symptoms and this study shows that medicine use increases steadily with body mass index."

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Saturday 6 December 2014

NHS Devon surgery restriction for smokers and obese plan revealed

NHS Devon surgery restriction for smokers and obese plan revealed

An overweight child can't do up his trousersMorbidly obese people and smokers in Devon will be refused routine surgery until they have lost weight

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Smokers and the morbidly obese in Devon will be denied routine surgery unless they quit smoking or lose weight.
Patients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.
The NHS in Devon has a £14.5m deficit and says the cuts are needed to help it meet waiting list targets.
The measures were announced the same day government announced an extra £2bn of annual NHS funding.
'Urgent and necessary'

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The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.
It announced a range of cost-cutting measures on Wednesday including only providing one hearing aid, instead of the normal two, to people with hearing loss.
Shoulder surgery will also be restricted.
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What is morbid obesity?
  • People with a body mass index (BMI) of 35 or more are considered morbidly obese by medical professionals
  • BMI is calculated by dividing weight in kilograms by height in metres, then dividing the answer by height again
  • Women of average height, 1.62 metres (5ft 3ins), are considered morbidly obese if they weigh more than 91.5kg (14st 6lb)
  • Men of average height, 1.75 metres (5ft 9ins), are considered morbidly obese if they weigh more than 108kg (17st)
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In November, the CCG said it would take "urgent and necessary" measures to prioritise major treatment.

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The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that”
Dr Tim BurkeNEW Devon CCG
That included delaying hip and knee operations for the morbidly obese, but Wednesday's announcement applies to all routine procedures.
NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.
A statement said all the decisions were "interim commissioning positions" and would require further consultation.
Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.
Dr Tim Burke, Chair of NEW Devon CCG, said: "All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.
"We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case."
NEW Devon CCG said it would announce another round of cost-cutting measures "in due course".
"We don't under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them," said Dr Burke.
"The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that."
In a statement the Royal College of Surgeons said it was "concerned" by the move and warned the region was merely storing up "greater pressures" for the future.
It said: "The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery - not determined by arbitrary criteria.
"Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.
"A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible."

GP 'disgust' at watchdog errors

GP 'disgust' at watchdog errors

Stethoscope

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GPs have told the BBC their reputations have been "tarnished by incompetence" from the health watchdog.
The Care Quality Commission has been forced to apologise to hundreds of GPs for giving incorrect patient safety risk assessments.
A BBC investigation found serious errors in the calculations used by the CQC.
The British Medical Association is calling for the whole banding system to be withdrawn.
Around 60 practices have been taken out of the highest risk categories and four low-risk surgeries need early inspection.
John Flather, a GP in Hadleigh, Suffolk, said his practice had been incorrectly banded as high risk.
He said he was "totally disgusted by the process" and that a formal complaint had been made.
He told the BBC: "Our reputation, which has been built over many years, has been tarnished by incompetence that they purport to eradicate.
"If they had only given us a chance to view their ratings we could have pointed out their errors and avoided this mess."
Dr Chris Cullen, from Ipswich, said: "My practice was rated for highest risk despite being one of the very high achieving practices in the country.
"The CQC claim we gave flu jabs to 24% of our patients, in fact it was over 96%.
"Our true rating should be for lowest risk, but the CQC aren't interested and have not returned our calls."
Bad data
Practices were judged on 38 indicators of performance, ranging from how easily patients managed to get appointments to how good doctors were at picking up conditions such as dementia.
Practices were graded in six bands, with Band 1 being the highest concern, and Band 6 the least risky.
The majority were of low concern, but 11% were rated in the highest risk band.
The BBC discovered that for one indicator, whether patients were able to get an appointment with a GP or nurse the last time they tried, the calculations were so flawed that the CQC has been forced to remove the indicator altogether.
A further four indicators had to be refined based on revisions to data provided to the CQC by NHS England.
Hundreds of practices will now be assigned a different band.
In its initial register, published two weeks ago, the health watchdog ranked 7,276 practices out of the total 7,661 in England, and placed 864 practices in the "highest concern" category.
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Original rankings
GP survey
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As a result of the recalculations, around 60 practices will be lifted out of the two "highest concern" categories, and four that were previously deemed low-risk have been found to be in need of early inspection.
The CQC says 519 practices will move bands, but most were between the lowest risk bands.
The CQC register was set up to help target inspections, and the watchdog said it did not necessarily indicate poor GP surgery performance.
Sir Mike Richards, chief inspector of hospitals for the CQC, told the BBC: "We will make them a big apology. This only became apparent when we ran the data on the thousands of practices rather than just the hundreds that we tested them on."
He defended the publication of the risk bands in the interest of transparency.
He said: "We are using the data to help us know where we might go first. Our judgement comes from a combination of data and inspection. The main thing that is going to matter is that we are going to be inspecting every practice."
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Poor data
Measures removed
  • Whether patients were able to get an appointment with a doctor or nurse last time they tried
Measures recalculated
  • Coronary heart disease incidence
  • Chronic obstructive pulmonary disease (COPD) incidence
  • Unnecessary A&E admissions
  • Dementia diagnosis rates
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The British Medical Association said mistakes by the CQC risked "doing serious harm" to the reputation of good surgeries.
Its GP committee chair, Dr Chaand Nagpaul, said: "The banding system as a whole needs to be withdrawn.
We warned at the time that simplistic targets would fail to take into account the enormous pressures GP practices are facing, and that skewed and limited information does not tell us about the quality of care.
"These failings have the potential to seriously undermine the trust in the system and patients' confidence in their GP and it is only right that all of those practices affected are now contacted and receive a full apology."

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