Friday, 14 December 2012

Is miscarriage care insensitive?


Imagine being in hospital with the knowledge you've just miscarried and lost your baby. But at the same time you're being kept on a ward where you can hear women going through labour and life entering the world.
It happened during Julie Orford's first miscarriage and was just one instance of what she describes as "insensitive care" during a "really, really frightening" time.
"I found it quite distressing that I was in the process of losing my baby, when I could hear others actually having their baby downstairs," she told the BBC.
Julie, 40, from Suffolk, miscarried - as happens in one in five pregnancies in the UK - in 2008, when 11 weeks pregnant.
After she was told her baby had no heartbeat, she said she felt like she was left on a hospital "conveyor belt" and her treatment was "very insensitive".
One of the issues was language. She said she felt like she was losing a baby, but doctors would only refer to "pregnancy tissue".
"It's very common for a miscarriage to happen - you very much just become part of the process.
"Perhaps you're not treated sensitively and spoken to in a way that would help you through that difficult time.
"I felt it was more like a medical procedure, there was never any talk of a baby or losing babies."
New rules
Experiences like Julie's are why the National Institute of Health and Clinical Excellence (NICE) has published new guidelines for England and Wales, on dealing with women who miscarry or have an ectopic pregnancy (when a fertilised egg implants outside the womb).
The NICE panel highlighted huge differences in pregnancy services across the country, with some available seven days a week, while others operated only for three mornings.
One of the recommendations was to set up dedicated early pregnancy assessment services. These would include a 24-hour contact number for women who have problems during their pregnancy.
Prof Mark Baker, director of the centre for clinical practice at NICE, said: "It's vital that women and their families receive good, consistent, timely and effective care and support that addresses their needs and enables them to make informed decisions.
"We know that not every woman is receiving this level of treatment at the moment, but this guideline will address that inconsistence and ensure all women receive excellent care, no matter where they live."
He added: "It's not rocket science to separate people who are losing a baby from people who are having a baby."
Mary Ann Lumsden, a professor of gynaecology and medical education at Glasgow University who led the panel, said it was about creating "a pivotal central point in the care of these women.
"It's an excellent opportunity for all the care to be in one place."
She also stressed that it was important that women were treated sensitively: "It doesn't cost a great deal to be sympathetic.
"For each woman it is a unique event and we must recognise people's distress.
"Most healthcare professionals do a pretty good job and try to be compassionate, but there are examples of bad practice."
Jacqui Clinton, of the baby charity Tommy's, said women who lost a child due to an ectopic pregnancy often struggled to cope without seeking help.
"No matter how early on your experience, the loss of a baby can feel like a bereavement. We therefore welcome these guidelines, and any initiatives, to provide the best possible care and support for women and their babies."
Jane Munro, of the Royal College of Midwives, said the guidelines should help ensure standardised and consistent care for women.
"The focus on emotional support and information giving is important, so that women can be clear about their choices and make informed decisions," she said.

Winter vomiting bug

Birmingham's City Hospital, Maidstone Hospital in Kent, and George Eliot Hospital in Nuneaton, Warwickshire, all have patients with the infection.
At Southampton more than 400 virus-infected passengers disembarked from a cruise ship.
The Health Protection Agency has said a 72% rise in cases was unexplained.
In its latest weekly report, it said there had been 2,630 confirmed laboratory reports of norovirus - up from 1,533 cases reported in the same period last season.
"There are no indications as to why activity is higher this year," it said.
Norovirus is highly contagious, and involves a sudden onset of vomiting and diarrhoea, with possible temperature, headache and stomach cramps. The illness usually lasts one or two days and there are no long-term effects.
The HPA said that lab reports represent only a small proportion of the actual amount of norovirus activity, as most infected people do not go to a doctor for treatment.
"It has been estimated that for every confirmed case there are around 288 unreported cases," the HPA said.
The figures for the number of hospital outbreaks showed that there were 45 hospital outbreaks during the last two weeks up to 9 December, which was similar to the previous fortnight to 2 December.
The HPA advices infected people not to visit friends or relatives in hospitals or residential care homes while ill, to avoid spreading the virus.
Cruise ship illness
Southampton's port health authority confirmed that 417 infected passengers disembarked on Friday after a 10-day Baltic cruise with P&O Cruises.
The cruise company apologised to passengers on Oriana who suffered diarrhoea and vomiting.
At City Hospital in Birmingham four wards were closed to visitors as a precautionary measure to stop the spread ahead of Christmas. Officials hoped to re-open within a week.
In Kent, three wards at Maidstone Hospital were closed to new admissions and family and friends of patients have been told to stay away.
Maidstone and Tunbridge Wells NHS Trust said 27 patients had norovirus.
Four wards have also been closed at The Queen Elizabeth the Queen Mother Hospital (QEQM) in Margate because of the bug.
NHS Tayside reopened two wards on Friday that were closed to new admissions following an outbreak of norovirus.
The wards were at Crieff Community Hospital and Dundee's Royal Victoria Hospital.
In Wales, visitors have been urged to stay away from five hospitals - Ysbyty Gwynedd, Dolgellau, Colwyn Bay, Glan Clwyd and Wrexham Maelor - to prevent the spread of the infection.

Monday, 10 December 2012

'Fat' drug could treat epilepsy


A substance made by the body when it uses fat as fuel could provide a new way of treating epilepsy, experts hope.
Researchers in London who have been carrying out preliminary tests of the fatty acid treatment, report their findings in Neuropharmacology journal.
They came up with the idea because of a special diet used by some children with severe, drug resistant epilepsy to help manage their condition.
The ketogenic diet is high in fat and low in carbohydrate.
The high fat, low carbohydrate diet is thought to mimic aspects of starvation by forcing the body to burn fats rather than carbohydrates.

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Although often effective, the diet has attracted criticism, as side-effects can be significant and potentially lead to constipation, hypoglycaemia, retarded growth and bone fractures.
By pinpointing fatty acids in the ketogenic diet that are effective in controlling epilepsy, researchers hope they can develop a pill for children and adults that could provide similar epilepsy control without the side-effects.
In early trials, the scientists, from Royal Holloway and University College London, say they have identified fatty acids that look like good candidates for the job.
They found that not only did some of the fatty acids outperform a regular epilepsy medication called valproate in controlling seizures in animals, they also had fewer side-effects.

But many more tests are needed to determine if the treatment would be safe and effective in humans.
Prof Matthew Walker, from the Institute of Neurology, University College London, said: "Epilepsy affects over 50 million people worldwide and approximately a third of these people have epilepsy that is not adequately controlled by our present treatments.
"This discovery offers a whole new approach to the treatment of drug-resistant epilepsies in children and adults."
Simon Wigglesworth, deputy chief executive at Epilepsy Action, said: "We know the ketogenic diet can be a highly effective treatment for children with difficult to control epilepsy and it is starting to be used for adults.
"The diet is high in fats and low in carbohydrates and the balance of the diet needs to be carefully worked out for each child. Although some children manage the diet very well, others find the diet unpleasant and difficult to follow. Children can also experience side-effects including constipation and weight loss.
"The identification of these fatty acids is an exciting breakthrough. The research means that children and adults with epilepsy could potentially benefit from the science behind the ketogenic diet without dramatically altering their eating habits or experiencing unpleasant side-effects.
"We look forward to seeing how this research progresses."

cancer networks


Clinical networks which oversee the care of cancer, heart and stroke patients in the NHS have had their budgets and staff cut, figures show.
Some of the groups say they are postponing projects due to uncertainty from the changes made in England.
The data comes as a result of Freedom Of Information (FOI) questions put to the networks by Labour.
Ministers are confident the networks - set up to improve care and prevention of disease - will continue to do so.
But the shadow care minister, Liz Kendall, claimed the figures showed the networks were "in chaos" and facing "huge uncertainty about their future".
There are currently 28 cancer networks and 28 stroke and heart networks - both areas will be condensed into 12 groups across England after April, with diabetes joining heart and stroke care.
'Scaled back'
More than 75% of the clinical networks responded to the FOI request.
The cancer teams said funding had been cut by around 25%, and 73 staff had been lost since 2009.
The teams looking after heart and stroke care said their funding had been cut by 12% and 38 posts had gone in the past three years.

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The fact that the Board is putting £42m into the networks is a sign of how important we think they are.”
Prof Sir Mike RichardsNHS Commissioning Board
Ms Kendall said: "Ministers have repeatedly promised to protect the funding for clinical networks. The government should be working to support these local specialists."
The networks have been credited with improving and streamlining care for patients at a local level, and making their treatment more straightforward if they have to attend several hospitals.
Examples of achievements include reorganising stroke services so fewer patients die, and speeding up X-ray results for faster cancer diagnosis.
In the FOI responses, the networks say programmes they use to support doctors and nurses are already being scaled back - examples given include a chemotherapy nurse post not being replaced and community training programmes in rehabilitation after stroke no longer running.
'Unsettling times'
An oncologist from Yorkshire, where the new network will cover the whole of the Yorkshire and Humber region, said: "I never dreamt that a leviathan such as what is being proposed would be the plan.
"The new network will be too big to be able to reflect local capabilities and needs, yet too small to have the authority of national guidelines."
The NHS Commissioning Board plans to give funding worth £42m to four clinical network areas from April.
They will be cancer, cardiovascular disease, maternity and children's services, and mental health -including dementia. Posts for new clinical directors for different disease areas are due to be advertised next week.
The national director for cancer, Prof Sir Mike Richards, who will be the board's director for reducing premature mortality, acknowledged that cancer networks would have a "smaller proportion" of the networks' budget in the future - and he admitted the coming weeks would be "unsettling and difficult" for staff who might receive notices of their jobs being at risk.
He said: "Everybody recognises that the networks have played a huge part in delivering change. They have been a very important channel between the patients and doctors, and the Department of Health.
"I am confident that in the future the networks will continue to play their important role.
"The fact that the Board is putting £42m into the networks, as against the current £33m, is a good sign of how important we think they are.
"Although cancer networks will have a smaller proportion of the budget in the future, there are still backroom efficiencies that can be made, to make things work more effectively. Increasing the footprint of each network will make them more cost-efficient.
"I do recognise this is a time of maximum uncertainty, particularly with staff being put on notice. The next few weeks will be difficult."