Obstacles to riding safely through pregnancy revealed: Study

In the UK, the National Institute for Clinical Excellence (NICE) and the National Health Service (NHS) both recommend pregnant women engage in daily exercise, but when it comes to cycling, the advice dries up: there are no clear recommendations women can use to decide whether to continue cycling.

Riding During Pregnancy
During pregnancy, depending on women’s proportions and the type of bike, the growing belly can feel physically restrictive.

Pregnant women could get on their bikes and stay healthy with better support, but according to a new study, they are encountering obstacles to riding.

Medical advice from risk-averse health professionals may contribute to some women’s decisions to stop cycling to work during pregnancy, meaning they miss out on the potential benefits of the active commute. The recent research revealed the reasons why women decide to stop or continue cycling to work when they are pregnant, including often ambiguously worded or overly-cautious advice from medical guidelines, midwives and obstetricians.

More people than ever are commuting to work by bicycle in London. According to data from the 2011 census, the city saw a 144% increase in cycle-commuting over the previous decade. This has big health benefits, for the health of the individual cyclist as well as for public health more broadly, as it helps people move more as part of their everyday activities.

In the UK, the National Institute for Clinical Excellence (NICE) and the National Health Service (NHS) both recommend pregnant women engage in daily exercise to help manage common discomforts, reduce pregnancy complications like preeclampsia, reduce discomfort and improve mood. But when it comes to cycling, the advice dries up: there are no clear recommendations women can use to decide whether to continue cycling.

“Despite the clear health benefits of cycling and the push to get more people commuting by bike, especially in cities like London, the medical advice on cycling during pregnancy remains murky,” commented author Davara Lee Bennett. “My research aimed to explore why women do – and don’t – cycle to work when they’re pregnant, with a view to supporting informed decision-making – including, if women so wish, rocking the rust off their chains, and bringing their bikes out from under the stairs and into the light.”

Bennett conducted three individual interviews and held three focus group discussions: with a group of women who had stopped cycling early, a group that had carried on into later pregnancy and a mixed group. She recorded and transcribed all of them, and analyzed the transcripts line-by-line to develop themes.


The resulting factors that affected women’s decisions fell into a few main areas: physical obstacles and enablers, perceptions of risk and of pregnancy itself and advice. The idea of risk was a key factor in decisions about continued cycling: women adjusted their cycling practices to minimize risk, taking partners’ support or concern into account. Although some women had positive encounters with health professionals, the medical advice they received was often noncommittal or risk-averse.

During pregnancy, depending on women’s proportions and the type of bike, the growing belly can feel physically restrictive. Some women stopped cycling because of this, while others found comfort from their daily aches and pains when they commuted by bike. Either way, more comfortable bikes helped: women preferred Dutch-style, upright designs with a low crossbar and a wide, supportive seat.

Perceptions of pregnancy also had an impact on women’s decisions: some preferred to abandon their active commute, opting for a more peaceful state, while others continued to cycle in a bid to remain connected to their authentic selves.

“Understanding the obstacles to women’s cycling during pregnancy can support the development of safer cycling infrastructure and informed medical guidelines, ultimately offering more women the opportunity to benefit from an active commute,” said Bennett. “By addressing some of the more socially prohibitive public discourses on the topic, I hope that my research will not just enable informed decision-making by women, but also encourage more constructive support and advice for women from health professionals.” The study appears in the Journal of Transport & Health.

Dear Pregnant women, beware! Paracetamol might affect sex drive in male progeny

The use of pain reliever paracetamol when pregnant is linked to reduced sex drive and aggressive behaviour in males, finds study.

Taking paracetamol during pregnancy might damage the development of male behaviour.

Although paracetamol is usually considered safe during pregnancy, a new research from the University of Copenhagen in Denmark suggests that if you are pregnant, you should think twice before popping these pills as their use is linked to reduced sex drive and aggressive behaviour in males. In an animal model, the use of the popular pain reliever paracetamol was found to damage the development of male behaviour, according to a paper published in the journal Reproduction.

The researchers said that the dosage administered to the mice was very close to the recommended dosage for pregnant women. But they cautioned that because the trials are restricted to mice, the results cannot be transferred directly to humans. However, the researchers’ certainty about the harmful effects of paracetamol means it would be improper to undertake the same trials on humans, explained David Mobjerg Kristensen, who was associated with the University of Copenhagen during the study.

Paracetamol can inhibit the development of the male sex hormone testosterone in male foetuses.

“In a trial, mice exposed to paracetamol at the foetal stage were simply unable to copulate in the same way as our control animals. Male programming had not been properly established during their foetal development and this could be seen long afterwards in their adult life. It is very worrying,” Mobjerg Kristensen, now associated with the Institut de Recherche en Sante, Environnement et Travail (IRSET) in France, said.

Previous studies have shown paracetamol can inhibit the development of the male sex hormone testosterone in male foetuses, thus increasing the risk of malformation of the testicles in infants. But a reduced level of testosterone at the foetal stage is also significant for the behaviour of adult males, Mobjerg Kristensen added. Testosterone is the primary male sex hormone that helps develop the male body and male programming of the brain. The masculine behaviour in mice observed by the researchers involved aggressiveness towards other male mice, ability to copulate and the need for territorial marking.

“We have demonstrated that a reduced level of testosterone means that male characteristics do not develop as they should. This also affects sex drive,” Mobjerg Kristensen said. But even if paracetamol is harmful, that does not mean it should never be taken, even when pregnant, the researchers said. “I personally think that people should think carefully before taking medicine. These days it has become so common to take paracetamol that we forget it is a medicine and all medicine has side effects. If you are ill, you should naturally take the medicine you need. After all, having a sick mother is more harmful for the foetus,” Mobjerg Kristensen noted.

According to Britain’s National Health Service (NHS), “paracetamol is usually safe to take” during pregnancy. Kristensen emphasised that pregnant women should continue to follow the guidelines given by their country’s health authorities and recommends people to contact their GP if in doubt about the use of paracetamol

Masturbation Myths Debunked: Why Do We Masturbate And What Are The Pros And Cons?


Besides making us feel good, what are other benefits associated with masturbation?

Masturbation is about as taboo as a topic can get. Men may discuss the topic in a joking manner and ladies may whisper about it among each other after a few glasses of wine, but in actuality serious conversations on the subject are few and far in between. Taking the shame out of masturbation is the first step to fully understand this equally unique and healthy human activity.

The Science Bit

What makes us human? A lot of things could be used to answer this question, but for the sake of this topic, the fact that we masturbate quite a lot is another distinctively human trait. Although other animals have been observed practicing self-pleasure, none do it to quite the same extent as man.

Masturbation is here for a reason. In males, the younger and more fresh the sperm sample is, the more likely it is to be accepted by the female reproductive tract and result in a fertilized embryo, Scientific Americanreported. Evolutionary biologists Robin Baker and Mark Bellis took samples of female “flowbacks,” the post-coital sperm that is rejected by the woman’s body, exiting around 5-120 minutes following sexual intercourse. It was found that the longer a man went without masturbating, the higher the number of sperm in their partner’s “flowback.” Based on this finding, they labeled male masturbation as a natural way to shed old sperm and make room for new, fitter sperm.

In females, orgasms, which are often obtained through masturbation, are also attributed to higher sperm retention. It is also believed that orgasms give women an incentive to have more sex, and therefore increase their chances of procreating.

The Benefits of Masturbation

Although there may be an evolutionary reason for why the habit of masturbation has stuck around for so long, the lists of benefits from the act of self-pleasing do not end with fertility. The orgasm so often achieved as a result of masturbation releases endorphins into the body. These hormones can help to relieve stress, relieve sexual tension, help offset insomnia, and boost metabolism, Everyday Health reported.

Orgasms, achieved by oneself or with the help of a partner, were also found to suppress the pain of a migraine and at times even halt the actual migraine processs altogether, LiveScience reported. “There’s a [portion] of patients with migraines, about one-third, who experience relief from a migraine attack by sexual activity,” said study researcher Stefan Evers, a neurologist and headache specialist at the University of Münster in Germany. Alexander Masukop, a neurologist and director of the New York Headache Center added to LiveScience that “having an orgasm in any way shape or form” will help with migraine relief.

What About Hairy Palms and Acne?

The good news is that masturbating will not give one hairy palms, make one go blind, or ruin future experiences of sexual intercourse. In fact, most experts will agree that moderate masturbation will lead to more satisfaction in one’s sex life with a partner. The old wives’ tale that masturbating gives you acne may be based a tiny bit on truth, for men at least. Male arousal results in the surge of male hormones, the same hormones that are also known to be responsible for the formation of acne. Theoretically, the long-term abusive masturbation can result in acne because of an imbalance of androgen hormones, which cause an increase in acne. However, most dermatologists regard this link as being very strained.

Too Much of a Good Thing?

Excessive masturbation — that is masturbating every day several times a day for several years — can stimulate acetylcholine/parasympathetic nervous functions. The result of this is an overproduction of sex hormones and neurotransmitters. Possible bodily side effects can be fatigue, hair loss, memory loss, blurred vision, and groin pain. It can also lead to sexual exhaustion, which is exhibited in the form or impotence or erectile dysfunction.  Askmen also reported seminal leakage as another common problem associated with extreme masturbation.

Just like any other obsessive compulsive behavior, such as alcohol abuse or gambling, extreme masturbating can interfere with an individual’s personal relationship and professional life. At this point, the National Health Service suggests taking a break from the act may serve as a good thing. For those who seriously experience problems with controling their masturbation habits, there are programs such as Sex Addicts Anonymous that may prove helpful.


21st-century healthcare: how technology is revolutionising the National Health Service

Nurse showing a tablet to a patient
Tech innovation: the NHS aims to provide a more personalised experience

A number of tech innovations within the NHS can help provide a more personalised and improved experience for patients.

The NHS is a cherished and vital institution across the UK – the average life expectancy has increased by 10 years since its introduction – yet it is under intense and increasing pressure.

Occasionally, referrals take longer than necessary, letters don’t arrive, or waiting times are greater than expected.

But this could all be about to change with the introduction of a number of tech innovations that should lead to a more personalised, improved experience for patients, thanks to a new partnership with leading communications company BT.

Scott Adams, director of integrated health and social care at BT says: “We have a great relationship with the NHS on a national, regional and individual level, from top-level solutions to those affecting individual GP surgeries. Not many organisations work with the NHS on this kind of scale.”

Personal access to health records

In a partnership between the NHS Islington Clinical Commissioning Group and Islington Council , more than 200,000 people will be given direct access to their health records via a digital database early next year.

“This will allow patients to participate in the management of their healthcare, leading to a more personalised outcome. Some other health economies have trialled similar initiatives, but never on this scale,” says Mr Adams.

<img src=”/content/dam/telegraph-connect/small-business/woman-doing-blood-sugar-test-at-home-small.jpg” alt=”Woman doing a blood sugar test at home” width=”320″ height=”200″ class=”responsive-image–fallback”/> Woman doing a blood sugar test at home
Home treatments: patients are able to monitor their own healthcare

“The partnership team see the provision of a Person Held Record as a pivotal part of the overall transformation, changing the entire way patients interact.”

The initiative is also likely to have a major impact on the way referrals are managed. The current referral process works on a national basis by the local GP writing a letter to a Specialist at an Acute Hospital, who would in turn write a further letter to the patient offering them an appointment. The new system will digitise this process, making it more efficient and streamlined.

Improving the bed blocking challenge

Another big problem for the NHS is what’s known as “bed blocking”. This happens when people are admitted to hospital for a particular issue, which is treated and resolved.

But because they still require some care or monitoring, they’re not discharged, so they stay in the hospital longer than necessary. Assisted Living technology is helping to solve this problem.

<img src=”/content/dam/telegraph-connect/small-business/nurse-with-female-patient-small.jpg” alt=”Nurse with female patient” width=”320″ height=”200″ class=”responsive-image–fallback”/> Nurse with female patient
Looking to the future: patients should get an improved experience

“Through the use of wearable technology, such as a push button, or fall sensors and alarm pendants worn around the neck, patients can safely go back to their own homes, rather than staying in hospital longer than necessary,” says Mr Adams. This can also be applied to individuals with long-term health conditions, such as diabetes or heart disease.

“An individual may have specific health-monitoring equipment at home, which links up to a device that can send the information to a contact centre or a local care authority,” Mr Adams adds.

“For example, a diabetes patient could test their blood sugar at home and the information could be sent to their doctor. This means that if their blood sugar levels are getting to a position where they’re going to become problematic, they could receive a visit or a call to ensure the necessary precautions are taken to prevent further complications.”

Less repetition for patients

Currently individuals are having to tell their story over and over again every time they come into contact with a new department, which can be frustrating and upsetting.

BT and their partner Total Mobile have created a service allowing healthcare professionals to work remotely – taking notes and accessing patient information on-the-go.

While these are important steps in the evolution of the NHS, Mr Adams sees the availability of personal health records as key to future improvements in the service – and believes this is a model that can be transferred to other industries.

“In the banking sector, for example, companies have found ways for individuals to manage their own finances and self serve.

“Over the next five years, I think it’s going to be equally ubiquitous for us to come to expect having direct access to our own personal health records. Where we have started offering these services, the uptake is voracious. I’m confident this is the future of healthcare technology.”

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.”

Care of brain injury victims ‘poor’

Patients with serious brain injuries are being let down by poor care, the BBC’s Newsnight programme has learned.

Secretly-filmed footage passed to Newsnight shows examples of patient neglect and ignored safety procedures.

Incidents include one healthcare worker cleaning a feeding and medicine tube with a pen nib and one patient marked as nil-by-mouth being given drinks.

NHS England told the BBC it is working to improve specialist rehabilitation for patients with such complex needs.

However, one leading expert told Newsnight that some patients were not recovering as fully as they might because of these problems with their care.

Professor Michael Barnes, a specialist in neurological rehabilitation medicine who chairs the UK Acquired Brain Injury Forum, said: “There are some very good rehabilitation centres in this country, but equally I’m afraid there are units in this country that really don’t provide proper co-ordinated rehabilitation at all.

“And yet that’s what they are called. And that, I think, is a sad reflection and something needs to be done about that.”

Every 90 seconds someone in the UK suffers a brain injury. There can be many causes, such as a bleed to the brain, a fall, an assault – often it is the result of a road accident.

“Start Quote

Every time I went to see him he was wet to his armpits [with urine]”

Binny Partner of Grant Clarke

Following an injury of this sort, the brain has to rebuild pathways to allow the person who has suffered the injury to re-learn the things they once took for granted, and that is why specialist rehabilitation and good care are so vital.

Grant Clarke had a massive brain haemorrhage last year, at the age of 43. He was left severely disabled, but during 12 weeks in hospital he made steady progress.

His family believed with the right help he would be home within four months.

But they say his recovery was undermined by poor care and a lack of appropriate rehabilitation when he was transferred to the West Kent Neuro-rehabilitation Unit in Sevenoaks.

“He didn’t have his teeth brushed,” Mr Clarke’s partner Binny told us.

“He didn’t have his armpits washed. He was left in urine, all the time. Every time I went to see him he was wet to his armpits, and cold.”

After raising her concerns on a number of occasions she decided to take the extreme action of installing a secret camera in his room. She was shocked by the footage it recorded.


Mr Clarke’s injuries had left him unable to swallow, and so a tube was inserted to bring food, liquids and medication straight to his stomach.

Grant Clarke receiving treatment
Grant Clarke is now receiving appropriate, specialist treatment

The tube had to be cleaned with care to avoid infection, but the secret filming shows a healthcare worker cleaning the top of it with the nib of a pen.

Despite him being nil-by-mouth, another healthcare assistant was seen giving Mr Clarke drinks of water five times over two nights.

And though he can barely speak, his call bell was removed three times in 10 days.

Binny later discovered that only one of the nursing staff at the unit had training in brain injuries, even though it was described as a specialist unit.

Following a complaint made by the family the healthcare worker who gave Grant the drinks was interviewed by police, but they decided not to take action against him.

The worker gave a letter to the police in which he expressed his regret for his actions. He no longer works for the West Kent Neuro-rehabilitation Unit.

Mr Clarke’s family made 26 complaints to the Kent and Medway NHS and Social Care Partnership Trust. Most were upheld – including the removal of the call bell and the use of a pen to clean the top of Mr Clarke’s feeding tube.

In a statement to BBC Newsnight the Trust said: “We remain appalled by what happened.”

It continues: “We subsequently created a robust action plan to address all concerns,” and adds that compulsory, specialist training for all staff has now been introduced.

Failings in basic care

Mr Clarke, who is now in another rehabilitation unit that is providing him with the care and support he needs, is making progress and starting to spend time at home with his family.

“Start Quote
Professor Michael Barnes

There is good evidence that although rehabilitation costs more money, that money is recouped by that person requiring less support from the state”

Professor Michael Barnes Chairman, UK Acquired Brain Injury Forum

But concerns of a similar nature have been raised by the family of Mark Courtney.

He had a severe asthma attack in March 2007 that left him severely brain damaged. His family say they have experienced failings in basic care ever since.

“He has been in four different placements in the last six-and-a-half-years and I have found that not any of the placements are ideal,” his wife Chammelle told BBC Newsnight.

Mrs Courtney’s concerns about her husband’s care include unexplained cuts and bruises, medication errors and a failure to position him correctly.

She believes patients in all of the facilities where he has been treated are at serious risk of harm.

Professor Michael Barnes says that investment in brain injury rehabilitation could save the state money in the longer term.

“There is good evidence that although rehabilitation costs more money clearly than someone going home, or going to a nursing home, that money is recouped over two to three years by that person requiring less support from the state, getting back to work and earning money.”

Dr John Etherington is the National Clinical Director for Rehabilitation and Recovering in the Community at NHS England.

He told BBC Newsnight: “This role bolsters a number of initiatives already underway which will start to enhance provision. These include the establishment of a Clinical Reference Group to examine the commissioning of specialised rehabilitation services, the development of regional trauma networks to review services – which has already led to service improvements – and a review of funding for long term conditions which is underway through the ‘Year of Care’ initiative that will enable a more flexible and patient centred distribution of funding.

“We have also for the first time, put in place a national specification for specialised rehabilitation to combat variation in services and ensure more equitable access across the country. This work is vital to improving outcomes for patients.”

Patient information leaflets: “a stupid system”.

The NHS’s multifarious patient information leaflets are inaccurate, inconsistent, and confusing, finds Margaret McCartney, and effort is duplicated because each trust commissions its own, often from the private sector

The so called patient revolution is nothing without quality information. And so the NHS is awash with patient information, especially leaflets, in hospital wards, outpatient clinics, and general practitioners’ surgeries. Some trusts commission leaflets from external, profit making companies; others write their own. But how efficiently does the health service coordinate them, and are leaflets tested for effectiveness on patients?

In a recent study researchers asked 128 trusts for leaflets given to patients after an inguinal hernia repair, and 93 trusts responded.1 Almost one in five trusts sent a leaflet created by a private company, Eido Healthcare. Others had inconsistent guidance on when to return to office work (ranging 1-6 weeks) or manual work (2-12 weeks). Similarly, leaflets gave conflicting advice about when to resume driving, sex, and sport. This means that patients are being given very different information about the effects of the same surgery, depending on where they live and which leaflets are used.

A similar study examined leaflets provided to patients who had been offered extracorporeal shockwave lithotripsy. The researchers found that the leaflets did not consistently mention common recognised complications and some were not mentioned at all.2 Another study, which examined patient information leaflets given for transrectal ultrasound guided prostate biopsy, again found wide variation, with drugs, analgesia, and complications often inadequately explained.3

“It’s a stupid system, a waste of money, and, without rigorous standards of searching and appraisal, much of the information is biased and misleading—especially in terms of fair representations of risk,” Muir Gray told the BMJ, reflecting on the current situation in the NHS. Gray is co-chair of the executive council of the Information Standard, an independent certification scheme funded by the Department of Health for organisations producing evidence based healthcare information for the public.

Gray said that a lack of coordination and slow uptake of the certification scheme by the NHS has meant that much information provided to patients is of poor quality. “Patients have a right to clean, unbiased information, but they can’t get that off the internet,” he said. “It’s not possible to communicate to a patient in 10 or 20 minutes everything about a decision. Knowledge is essential, but you can’t rely on the consultation—you don’t have the time. Therefore we need to supplement and complement face to face. You need that to help people reflect on their values, to discuss their fears and anxieties.”

The Information Standard, which is run by the for profit company Capita, offers a kitemark if the information presented is evidence based, clear, and accurate. Patients should also be involved and have tested the information.

Some 400 UK hospitals use Eido, a private company, to produce information leaflets for them. Eido’s website says that the company produces “informed consent patient information leaflets,” which it says “improve the doctor-patient relationship, reduce the risk of litigation and increase patient satisfaction.” They advertise both their Information Standard accreditation and ability to customise information locally.

Simon Parsons, a consultant surgeon in Nottingham, set up the company when he was a surgical registrar out of concern that the informed consent process, which was subject to then new General Medical Council guidance, was using poor quality patient information leaflets. Eido’s information leaflets are indemnified, and Parsons said, “In the 10 years we have supplied in the UK, not a single claim has been brought against us in terms of inaccurate patient information.” The company supplied audit data in support of its claim of patient satisfaction. The leaflets are not publicly available except through a hospital or surgeon who has access to them. East Cheshire NHS Trust makes one payment a year to Eido, which was for £6511 in 2012, the trust said in response to a request under the Freedom of Information Act.

Meanwhile, Guy’s and St Thomas’ NHS Foundation Trust has an online, freely available library of about 850 patient information leaflets, regularly updated, but all are produced in house.4 These are written by clinicians and healthcare professionals, and tested by patients or lay readers to ensure they can be easily understood. Anita Knowles, director of communications, told the BMJ that the trust ensures leaflets are necessary and would not duplicate a good leaflet from elsewhere. The patient publications team is made up of two staff team who call on additional resources as needed. They made a decision not to use external agencies because “it was just as cheap to do it ourselves. We wanted the control, as well as the ability to change information rapidly,” Knowles told the BMJ.

The problem of varying quality of leaflets is not new; in 1998 the BMJ published an investigation into the quality of leaflets on asthma given out by general practitioners. It found inaccuracies and outdated information from the NHS, drug companies, and charities.5 In an accompanying editorial, Angela Coulter, now a researcher at the University of Oxford, called for a national strategy.6

She told the BMJ that “progress has been slow.” The problem is that “the NHS still fails to take this seriously.” For example, printable patient information leaflets are available as part of the Emis computer system used by general practitioners, which are Information Standard accredited but which come with advertisements attached.

“In the patient’s eye, that can devalue it,” Coulter said. “At the moment, in most NHS trusts, there is no one who has responsibility, or, if they are junior, often they have no budget. Often leaflets are written with the best of intentions in someone’s free time, but they can end up amateurish, with the evidence and uncertainties not expressed clearly. Yet there has been so much work internationally into setting standards,” such as the Delphi method, a structured communication technique.

A spokesman told the BMJ that NHS England is launching a “major project” in September to standardise all information going out to patients, which will then go to the Information Standards Board for Health and Social Care for approval.7 One of the aims of this board, which works throughout the NHS, is to reduce inefficiencies through reducing replication. A spokesman said that there needed to be “clinically endorsed, consistent information available across the country,” which would “lead on the standardisation of all information going out to patients.”

The internet has given us a great gift of instant information sharing. The challenge now, Coulter emphasised, is to adopt high standards, updating information regularly, and making it easily accessible. The size of the NHS makes this hard to do, but it is wasteful to franchise out the core role of information provision to the private sector because each trust is paying again for the same information over and over. This is one area of the NHS where efficiency savings look ripe for the picking.

Source: BMJ



History of Kidney Stones and the Risk of Coronary Heart Disease.

Importance  Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). Previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent.

Objective  To examine the association between a history of kidney stones and the risk of CHD in 3 large prospective cohorts.

Design, Setting, and Participants  A prospective study of 45 748 men and 196 357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-up Study (HPFS) (45 748 men aged 40-75 years; follow-up from 1986 to 2010), Nurses’ Health Study I (NHS I) (90 235 women aged 30-55 years; follow-up from 1992 to 2010), and Nurses’ Health Study II (NHS II) (106 122 women aged 25-42 years; follow-up from 1991 to 2009). The diagnoses of kidney stones and CHD were updated biennially during follow-up.

Main Outcomes and Measures  Coronary heart disease was defined as fatal or nonfatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records.

Results  Of a total of 242 105 participants, 19 678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16 838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones had an increased risk of CHD than those without a history of kidney stones in NHS I (incidence rate [IR], 754 vs 514 per 100 000 person-years; multivariable hazard ratio [HR], 1.18 [95% CI, 1.08-1.28]) and NHS II (IR, 144 vs 55 per 100 000 person-years; multivariable HR, 1.48 [95% CI, 1.23-1.78]). There was no significant association in men (IR, 1355 vs 1022 per 100 000 person-years; multivariable HR, 1.06 [95% CI, 0.99-1.13]). Similar results were found when analyzing the individual end points (fatal and nonfatal MI and revascularization).

Conclusions and Relevance  Among the 2 cohorts of women, a history of kidney stones was associated with a modest but statistically significantly increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific.

Souirce: JAMA

Reducing trauma deaths in the UK.

Traumatic haemorrhage is a leading cause of death in young adults in the UK.1 The CRASH-2 trial showed that the early administration of tranexamic acid safely reduces mortality in bleeding trauma patients.2 Further study demonstrated that the treatment is widely practicable and cost effective.3

RoadPeace—the UK national charity for road crash victims—represented trauma victims on the CRASH-2 trial steering committee, and we are now committed to ensuring that victims benefit from this life-saving treatment. To assess whether bleeding trauma patients in the UK are treated with tranexamic acid, we sent freedom of information requests to 291 UK hospitals in September, 2012, which asked the following questions: does your hospital’s trauma protocol include administration of tranexamic acid to bleeding trauma patients; and in 2011, how many acute trauma patients received a blood transfusion and, of those, how many were treated with tranexamic acid?

209 (72%) of the 291 hospitals responded. Of these 209 hospitals, 11 stated that they did not treat trauma patients and 19 failed to answer the question about trauma protocols. Of the 179 remaining hospitals, 159 (89%) include tranexamic acid in their trauma protocols. The second question aimed to assess whether bleeding trauma patients received tranexamic acid. Most hospitals did not answer this question (citing the pertinent Freedom of Information Act 2000 clause) on the basis that it would be too costly to obtain the data. 34 hospitals reported the number of trauma patients that received a blood transfusion and the number given tranexamic acid. Of 451 trauma patients transfused at these 34 hospitals, 34 (8%) received tranexamic acid. Four of these 34 hospitals were major trauma centres. Of 285 trauma patients transfused at these four major trauma centres, 13 (5%) received tranexamic acid.

Although tranexamic acid is included in most hospital trauma protocols, our data show that few bleeding trauma patients were given this treatment in 2011. Patients with trauma severe enough to require blood transfusion would be expected to benefit from tranexamic acid, and we are concerned that patients were denied this life-saving treatment. One explanation for the low use is that tranexamic acid might not have been incorporated into trauma protocols for the full duration of 2011. Since most hospitals now include tranexamic acid in their trauma protocols, more recent figures might be higher.

We will repeat this survey in 2013 to assess progress. We are optimistic that use will improve because of recent and rapid policy responses—notably, the aforementioned trauma protocol coverage, the Trauma Promise, and the NHS move to include tranexamic acid administration in its 2013—14 best practice tariff for major trauma centres.45 To support these efforts, we recommend that tranexamic acid be included in trauma audit at all UK accident and emergency hospitals and that hospitals regularly publish data on the proportion of trauma patients that are appropriately given the treatment. We urge all UK hospitals to reaffirm their commitment to providing effective trauma care by making the Trauma Promise.

Source: Lancet


Care of the dying ‘society’s litmus test’.

Every minute someone in the UK dies – and most deaths still occur in hospital.

But in this week’s Scrubbing Up Prof Mayur Lakhani, chair of the Dying Matters Coalition which aims to change public attitudes towards death, dying and bereavement, says most people would prefer to die at home – and that major changes are needed to allow people the death they want.

It has been estimated that in England alone around 92,000 people do not receive the palliative care that they need when they are dying.

Many complaints about hospitals are to do with end of life care.

Meanwhile, the number of people dying each year in England and Wales is set to rise over the next 20 years.

How prepared are we as a nation to deal with this demographic time bomb? And what does the NHS in particular need to do?

‘Home is best’

The NHS is not currently geared up to help people die at home.

As a practising GP, I know this only too well. Current services are inconsistent and fragmented and nowhere near strong enough in the community. Services are part time and not 24/7, which is what dying patients need.

The default is hospital admission.

But this is not what people want.

 “Start Quote

How we care for the dying is a litmus test for our society”

In a survey by British Social Attitudes, launched to mark Dying Matters Awareness Week, one of the strongest messages from the general public is that hospital is not the place where they want to die.

Only 7% of us say it’s the place we want to end our days, while two thirds say that home is the best place to die.

And here is the profound mismatch between our wishes and our reality.

Currently only one in five of us will die in our own home while over 50% of us will die in hospital.

A new deal is therefore needed for a 24/7 community service for patients at the end of life.

Wake-up call

What are the prospects for this happening?

Several things need to change.

We need much stronger leadership and planning.

The advent of GP led commissioning (clinical commissioning groups or CCGs) is an exciting, and unique opportunity to do something very special.

The reforms have been controversial, but for the sake of the patients everyone must rally round for better quality.

How we care for the dying is a litmus test for our society.

The attention paid to this area by this government should be applauded.

But it can go even further to deliver a stronger, caring and compassionate nation to deal with the predicted demographic change.

Earlier this spring, the House of Lords published a report which contained an urgent wake-up call to all of us by warning the UK is woefully unprepared for an ageing population.

The government should prioritise action by publishing draft proposals on how we should support older people in the last years of life.

As the number of people over the age of 85 is set to double over the next 20 years, the UK needs a new focus on health, wellbeing, housing, care and support for this emerging cohort.

Dignity and compassion

The case for change remains very strong and urgent, especially with the huge public concern in the light of the Francis report.

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Death is inevitable and not a failure”

Practically, NHS England and must accelerate improvement now and transfer resources from hospitals into communities and to develop stronger strategies for services working together.

The medical professions must play their part. They need to bring back dying into people’s homes by adopting a different approach to care.

They should recognise that death is inevitable and not a failure, and make sure dying people get the dignified and compassionate care they need, for example by encouraging the use of more advance care plans.

But we mustn’t just leave dying just to the professionals.

We all have a role to play with our families and friends to face up to death, to be better informed and more confidently plan for the end of life.

The Dying Matters Coalition is asking everyone to consider five things: write a will, record funeral wishes, plan for future care and support, register as an organ donor and tell loved ones their wishes.

We should be optimistic.

Things are improving and the number of people dying in their preferred place of care is increasing.

More and more people are talking about dying and death. But we need to go even further.

The way we care for dying people is a measure of our values, there are no dress rehearsals and only one chance to get it right.

Source: BBC