One fifth of drips ‘are dangerous’

Nurse attending to drip

A fifth of patients on an intravenous drip develop complications because they are given the wrong levels of fluid, according to a review of guidance in England and Wales.

Too much fluid can cause heart failure and too little leads to kidney problems.

The National Institute for Health and Care Excellence (NICE) said doctors and nurses needed better drip training.

Patients’ groups said the scale of the problem was “staggering”.

Thousands of people each year need a drip in hospital. But NICE warns that staff are putting lives in danger due to a lack of education in managing intravenous drips.

It has developed new guidelines for the NHS in England and Wales.

Dr Mike Stroud, a gastroenterology consultant at Southampton University Hospitals NHS Trust, who developed the guidelines, said: “Doctors and other health professionals are not well educated in terms of what a patient needs and that is astonishing really.

“This needs to change.”

Drip chief

Hospitals will also be expected to appoint an “intravenous fluid champion” and patients’ drips will need to be managed and monitored more closely.

Katie Scales, a consultant nurse at Imperial College Healthcare NHS Trust, said: “The majority of patients who receive intravenous fluids do so without complications but this is not the case for every patient.

“This NICE guideline is an important lever for improvement and may ultimately help to save lives.”

Katherine Murphy, the chief executive of the Patients’ Association, said the guidelines were “very welcome” due to the “staggering” figure of one in five patients developing complications.

“It’s essential that all staff receive support and training in the administration of IV fluids and hospitals should ensure time is dedicated to this,” she added.

Dr Mike Durkin, director of patient safety at NHS England, said: “I welcome this new guidance.

“Hospitals across the country need to ensure that the recommendations are implemented as routine practice so that the clinical effectiveness of infusion fluids are maximised and any risks are minimised.”

Hip replacement death rate halved

Death rates following hip replacement surgery fell by half in England and Wales between 2003 and 2011, a study in The Lancet has found.

Although death within 90 days of surgery is rare, mortality decreased from 0.56% to 0.29% in an analysis of more than 400,000 patients.


The researchers said that fitter patients and better physiotherapy could be behind the decrease.

They added that simple treatment options would reduce the risk further.

Researchers from the universities of Bristol, Oxford, East Anglia and Exeter used data from the UK’s joint-replacement database, the National Joint Registry, to look at death rates following this type of surgery.

In their study they found that 1,743 patients died within 90 days of surgery during the eight years.

In 2004, 24,723 patients had hip replacement surgery and 139 of those died within 90 days.

While in 2011, there were 60,727 hip replacement operations carried out and 164 patient deaths.

Quick fix

The reason for the fall in death rates could be down to a number of factors.

The researchers identified the use of a spinal anaesthetic as likely to lead to fewer complications. Specific treatments to stop blood clots after surgery were also linked to a lower risk of death.

We need to concentrate efforts on reducing the risk of death in high risk groups such as those with severe liver disease.”

Prof Ashley BlomUniversity of Bristol

But people are also living longer and patients are recovering more quickly after surgery as a result of better post-operative care. For example, patients are encouraged to get up and start walking around the day after surgery.

The study said: “More recent generations of old people… are generally fitter and less frail than old people at the start of the study.

“Likewise, other aspects of surgery and anaesthesia have improved sufficiently to account for the change in mortality rates.”

The research team noticed that people with certain medical conditions were at a much higher risk of dying following surgery – particularly those with severe liver disease, those who had had a heart attack and those with diabetes and renal disease.

Those patients who died were most likely to be elderly men, they said.


But there were also some unexpected findings. Overweight people (with a body mass index of 25-30) appeared to have a lower risk of death after hip surgery than those patients with a “normal” BMI of 20-25.

Ashley Blom, professor of orthopaedic surgery at the University of Bristol, said: “The finding that overweight people have a lower risk of death is surprising, but has been confirmed by other recent studies, and challenges some of our preconceptions.

“We need to concentrate efforts on reducing the risk of death in high risk groups such as those with severe liver disease.”

But he said that the “dramatic” overall fall in death rates was “extremely good news”.

“It is also very exciting that we can further reduce the risk of post-operative death by adopting relatively simple measures,” Prof Blom said.

A spokesperson from Arthritis Research UK, welcomed the findings.

“This is great news for people in the UK who have osteoarthritis and require hip replacement surgery.

“Although not everyone who has arthritis will need hip replacement surgery, for many people, it’s their only hope to reduce the pain, disability and stiffness associated with the disease.

“There are however always risks associated in having major surgery such as hip replacement surgery, so we advise people to discuss these risks with their surgeon before they decide to have a hip replacement.”

Source: BBC


‘Needle risk’ over beauty treatments.


A health watchdog is concerned that people having beauty treatments like Botox could be at risk of infection from dirty needles.

The National Institute for Health and Care Excellence says growing numbers of people are injecting tanning agents, dermal fillers and Botox at home and in salons, and some are lax about hygiene.

Sharing needles can spread blood-borne diseases like HIV and hepatitis C.

Nice is updating its advice for England and Wales accordingly.

The guidelines, which are out for public consultation, aim to encourage people to use sterile needle and syringe programmes to stem the spread of infections.

Sharps bins

Most blood-borne diseases occur among people who inject drugs like heroin and anabolic steroids.

But NICE says people seeking out cosmetic fixes are also at risk.

“Start Quote

The dangers of sharing needles in cosmetic injectables are so great that any practitioner who does this should be considered guilty of a criminal offence and nothing less”

President of BAAPS Rajiv Grover

A spokeswoman said: “We are seeing an increasing issue with drugs that are used for vanity purposes.”

This includes the anti-wrinkle treatment Botox, dermal fillers and tanning agents.

Prof Mike Kelly, Director of the NICE Centre for Public Health Excellence, said: “Since we last published our guidance on needle and syringe programmes in 2009, we’ve seen an increase in the use of performance-and-image-enhancing drugs such as anabolic steroids, Botox, tanning agents and the use of dermal fillers like collagen.

“We’ve also heard anecdotal evidence that more teenagers are injecting these performance-and-image-enhancing drugs too.

“We’re updating our guidance – and our public consultation on the draft update is an important part of this process – to make sure all of these groups of people are considered in the planning and delivery of needle and syringe programmes.”

One of the recommendations proposed in the new guidelines is that local councils consider providing sharps boxes for people to dispose of used needles and syringes.

Rajiv Grover, consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons (BAAPS), said: “Due to the lack of regulation in the cosmetic sector it is impossible to know how many patients could be at risk of blood borne diseases from needle sharing with either Botox or fillers.

“These should be considered medical procedures and BAAPS has campaigned for over a decade to have this field of non-surgical cosmetic treatments tightly regulated. The dangers of sharing needles in cosmetic injectables are so great that any practitioner who does this should be considered guilty of a criminal offence and nothing less.”

Allergan, a healthcare company that provides Botox, said that Botox is a prescription-only medicine which should only be administered by a trained and qualified medical healthcare professional.

“These treatments should be carried out by appropriately trained and qualified medical practitioners, who have high levels of expertise in full-face anatomy and can provide sufficient aftercare and redress for the patient in the event of an adverse event,” said a spokesman.

Rise in child obesity-related hospital admissions.

There has been a four-fold increase in the number of children and teenagers admitted to hospital for obesity-related conditions in the last decade, doctors in England and Wales warn.


In 2009, nearly 4,000 young people needed hospital treatment for problems complicated by being overweight compared with just 872 in 2000.

Rates of obesity surgery also went up, especially for teenage girls.

Doctors say the UK has the highest rate of child obesity in Western Europe.

Obesity has been linked with serious illnesses during childhood and an increased risk of developing conditions, such as type-2 diabetes, asthma and breathing difficulties during sleep.

National surveys in England suggest about three in 10 two-to-15-year-olds are overweight, while 14-20% are obese.

‘Ticking time-bomb’

A team led by Dr Sonia Saxena, of Imperial College London, analysed statistics on all NHS admissions for obesity – as a primary cause or alongside conditions that had been complicated by obesity – in hospitals in England and Wales over a 10-year period in patients aged five to 19.

 “Start Quote

These are very worrying findings that shed more light on a growing threat to the heart health of this nation”

Amy ThompsonBritish Heart Foundation

Admissions were more common in girls than boys, the team reported in the journal Public Library of Science ONE.

Meanwhile, the number of cases of surgery for obesity rose from just one in 2000 to 31 in 2009, with the majority in teenage girls.

Over the whole 10-year period, a total of 20,885 young people were treated in hospital for obesity-related conditions.

Nearly three-quarters of cases involved problems complicated by being overweight, such as asthma, sleep apnoea, and pregnancy complications.

The researchers, from Imperial College and the Medical University of South Carolina, say that while part of the increase is probably due to better monitoring of obesity in children, the condition is imposing greater challenges for hospitals.

Dr Saxena said the UK was now seeing serious consequences of people being obese in their teenage years and early adulthood.

“We are seeing – through obesity – an increasing number of children with conditions that we previously diagnosed in adulthood… [and which] are now being diagnosed in childhood,” she told BBC News.

“What’s new about our paper is that we’re actually showing it’s not a ticking time-bomb – the time-bomb is exploding within the early life course, so in other words in the teenage years. That’s where it’s becoming manifest.”

‘Silver bullet’

The UK has the highest rate of child obesity in Western Europe, which is estimated to cost the NHS about £4.2bn a year.

The Royal College of Paediatrics and Child Health said there was a need for urgent action, but there was no “silver bullet” solution.

Officer for health promotion, Prof Mitch Blair, said: “We need to look seriously at how fast food is marketed at children and consider banning junk food prior to the 21:00 watershed, limiting the number of fast food outlets near schools, and making sure children are taught the importance of a healthy, balanced diet and how to cook nutritious meals from an early age at school.”

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: “These are very worrying findings that shed more light on a growing threat to the heart health of this nation.

“We know obese children are more likely to become obese adults who are then at greater risk of having a heart attack or stroke. We must encourage the next generation to make healthier lifestyle choices and help them eat a balanced diet and stay active.

“Ensuring children and teenagers are a healthy weight today means healthier hearts tomorrow.”

Source: BBC


Source: BBC


The inside story on prison health.

The rate of imprisonment in England, Wales, and Scotland—at around 154 per 100 000 people—is one of the highest in western Europe. While dwarfed by that of the United States, the so called “land of the free,” where roughly one in 100 people is behind bars, the number of prisoners in England and Wales has nearly doubled in the past 20 years, even though recorded crime has fallen. In the final article of his five part series on prison health (BMJ 2013;346:f2216, doi:10.1136/bmj.f2216), Stephen Ginn asks whether prison is the right place for many offenders and whether earlier assistance in the community might prevent a prison sentence.

As Ginn writes, many of those held in British prisons “come from the most economically deprived and socially disadvantaged groups within society.” He adds: “Many prisoners have chaotic lifestyles and complex health and social problems. They may also have limited health aspirations and low expectations of health services, which may not have the flexibility to respond effectively to their needs.”

Prisons, meanwhile, are vulnerable to infectious disease because of overcrowding, poor ventilation, shared facilities, and a high turnover of prisoners, staff, and visitors. They have higher rates of tuberculosis, hepatitis B, and HIV infection than in the outside population, and very high levels of illegal drug use. Ginn says: “Prisons are not principally in the business of promoting health and some people argue that there is an inherent contradiction between the aims of care and control.” While prison has a role in meeting the health needs of marginalised people—for example, in 2009-10, 60 067 prisoners received clinical treatment for drug addiction in English and Welsh prisons—it is “ultimately not the best place to tackle poor health,” writes Ginn.

Moreover, the average cost of a prison place in England and Wales is about £40 000 (€47 000; $60 000), and in 2012, UK total prison spend was £4.1bn. While some people clearly need to be in prison, and society understandably demands a custodial sentence for certain—particularly violent—crimes, in most cases couldn’t the money be better spent? Ginn says that community based drug treatment, for example, was found to be particularly effective at saving costs “as offenders receiving treatment were 43% less likely to reoffend after release.” If crime were a disease (and indeed some in the public health community have seen it that way), wouldn’t the smart money be more on crime prevention rather than the so called cure?

Ginn points out that around 80% of prisoners in England and Wales smoke, which is four times the proportion of the general public. While there are no plans for British prisons to become smoke free, the switch to e-cigarettes, the topic of Douglas Kamerow’s Observations column this week (BMJ 2013;346:f3418, doi:10.1136/bmj.f3418), might at least improve the environment for non-smoking prisoners. However, as Kamerow writes, e-cigarettes are worrying the public health community. They appear to help maintain the smoking habit and reduce incentives to quit, and now Big Tobacco is moving into the e-cigarette market. “Now that the vapour is fully out of the cartridge, we’re not going to be able to get it back in,” says Kamerow. “We need to make the best of a bad situation before it gets worse.”