‘So what, what next?’ project to support people with autism, a learning disability or both

Local Government Association | August 2018 | The ‘So what, what next?’ project: supporting people with a learning disability, autism or both to use their skills and interests to play a part in the community

A project designed by the Transforming Care empowerment steering group to look at ways of supporting people with a learning disability or autism who have recently been discharged from hospital to explore their skills and passions and to find ways to contribute these to their local communities.

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Image source: local.gov.uk

The focus was on supporting people to use their strengths, become active citizens and to grow their independence. You can read the project report here, including ‘top tips’ for professionals and supporters (Source: Local Government Association).

Read the press release from the Local Government Association here 

Sick babies at risk due to lack of monitoring of breathing tubes

Foy, K. E. et al. |  2018|  Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey|  Anaesthesia| doi:10.1111/anae.14359

A new article that appears in the current issue of Anaesthesia finds that some special care baby unit may be putting babies health at risk due to breathing tubes not being monitored.

The study reports major gaps in optimal airway management provision in both pediatric intensive care, but particularly in UK neonatal  intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new ‘Never Event’ and has the potential to improve airway management.

The researchers used telephone surveys  from paediatric and neonatal intensive care units across England,  finding that less than half of specialist baby units had the equipment to measure carbon dioxide (capnography) coming from the lungs.

Summary

In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a ‘Never Event’ in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre‐intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was ‘available’ in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and ‘always available’ in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new ‘Never Event’ and has the potential to improve airway management.

The full article can be read at Anaesthesia 

In the news:

BBC News Sick babies at risk from lack of breathing tube monitoring

New report suggests e-cigarettes should be made available on prescription

In this inquiry, the Science and Technology Committee examine the impact of electronic cigarettes on human health (including their effectiveness as a stop-smoking tool), the suitability of regulations guiding their use, and the financial implications of a growing market on both business and the NHS | Commons Select Committee

This report reviews the current evidence base on the harmfulness of e-cigarettes compared to conventional cigarettes and looks at the current policies on e-cigarettes, including in NHS mental health units and in prisons. The Committee concludes that e-cigarettes should not be treated in the same way as conventional cigarettes.

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Members heard that e-cigarettes are an estimated 95% less harmful than conventional cigarettes and conclude that e-cigarettes are, too often, being overlooked as a stop smoking tool. The Committee has found that e-cigarettes are not a significant ‘gateway’, including for young non-smokers, to conventional smoking and do not pose a significant risk through second-hand inhalation.

Around 2.9 million people in the UK are currently using e-cigarettes, and it has been estimated that about 470,000 people are using them as an aid to stop smoking—and tens of thousands are using them to successfully quit smoking each year.

The Committee is calling on the Government to consider risk-based regulation to allow more freedom to advertise e-cigarettes as the relatively less harmful option, and provide financial incentives, in the form of lower levels of taxation, for smokers to swap from cigarettes to less harmful alternatives such as e-cigarettes.

Further, it is calling for a reconsideration of: their use in public places; limits on refill strengths and tank sizes; and the approval systems for stop smoking therapies such as e-cigarettes.

Full story: Commons Select Committee: Government missing opportunity with e-cigarettes 

See also: BBC News: E-cigarettes can be key weapon against smoking, say MPs

 

Doctors’ notes – a podcast by the BMA

BMA | August 2018 | Doctors’ notes – a podcast by the BMA

In the latest BMA podcast doctors reflect on their experience of working abroad.

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Image source: bma.org.uk 

The podcast includes learning about an anaesthetist who restores the sight of a young boy in Mongolia, a junior doctor who provides lifesaving treatment in a South African village, and a GP recounts her experience of training in the UAE.

Previous episodes are also available, topics include

Doctors with disabilities

Across generations

Head vs. heart

New beginnings

Behind bars

Doing the right thing

See BMA for full details

 

In Good Health

All Party Parliamentary Group | 2018 | In Good Health: A Report following the All Party Pharmacy Group’s 2018 Inquiry  into Long Term Conditions

The All Party Pharmacy Group’s Inquiry into Long Term Conditions heard from organisations representing patients with a range of long term conditions as well as pharmacists and organisations representing pharmacy, to understand how care can be improved for people with long term conditions, and what part pharmacy could play.

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Image source: app.org.uk

The Inquiry and this report should be seen in the context of the Group’s most recent publications on community pharmacy reform and the role of pharmacy in the
NHS’s Sustainability and Transformation Partnerships.

This report makes four recommendations for Government, that will create a context in which services can be developed to improve outcomes for people with long term conditions. These recommendations should not delay or replace negotiations on the community pharmacy contract, but our expectation is that the Government will enter negotiations with these recommendations firmly in mind.

The report is available from the All Party Parliamentary Group here 

New resource for patients newly diagnosed with type 1 diabetes

NHS Digital | August 2018 | Type 1 diabetes 

NHS Digital have developed a new interactive resource for patients with type 1 diabetes. The resource is intended to equip people with Type 1 with the knowledge and confidence to manage their diabetes. 

The section on ‘newly diagnosed- things to help’ which includes resources on how to inject insulin, checking blood glucose levels and appointments and check ups as well as useful advice around living with the condition. They are encouraging healthcare  professionals to refer newly diagnosed patients, their parents and carers to the site as a ‘one stop shop’ for Type 1 Diabetes support. 
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NHS Digital type 1 

Related:
NHS Digital Get Support 

Artificial intelligence can detect eye disease as accurately as expert doctors

NIHR | August 2018 | Artificial intelligence can detect eye disease as accurately as expert doctors

Researchers from Moorfields Hospital , DeepMind Health and University College London,  used artificial intelligence (AI)  to create a system that is capable of recognising signs of eye disease as accurately as expert doctors. The AI system was trained so it was able to learn how to  identify features of over 50 eye diseases and decide how patients should be referred for treatment. In the study doctors also reviewed the eye scans, showing that the AI was able to make the right referral more than 94% of the time. The system offers benefits to patient care as it could  help make sure serious eye problems are treated as early as possible.

 

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Dr Pearse Keane, consultant ophthalmologist at Moorfields Eye Hospital NHS Foundation Trust and NIHR Clinician Scientist at the UCL Institute of Ophthalmology said:

“The number of eye scans we’re performing is growing at a pace much faster than human experts are able to interpret them. There is a risk that this may cause delays in the diagnosis and treatment of sight-threatening diseases, which can be devastating for patients.”

“The AI technology we’re developing is designed to prioritise patients who need to be seen and treated urgently by a doctor or eye care professional. If we can diagnose and treat eye conditions early, it gives us the best chance of saving people’s sight. With further research it could lead to greater consistency and quality of care for patients with eye problems in the future.” (Source: NIHR)

Visit NIHR for the full news story 

See also:

Moorfields Hospital Breakthrough in AI technology to improve care for patients

The research has now been published in Nature 

Abstract

The volume and complexity of diagnostic imaging is increasing at a pace faster than the availability of human expertise to interpret it. Artificial intelligence has shown great promise in classifying two-dimensional photographs of some common diseases and typically relies on databases of millions of annotated images. Until now, the challenge of reaching the performance of expert clinicians in a real-world clinical pathway with three-dimensional diagnostic scans has remained unsolved. Here, we apply a novel deep learning architecture to a clinically heterogeneous set of three-dimensional optical coherence tomography scans from patients referred to a major eye hospital. We demonstrate performance in making a referral recommendation that reaches or exceeds that of experts on a range of sight-threatening retinal diseases after training on only 14,884 scans. Moreover, we demonstrate that the tissue segmentations produced by our architecture act as a device-independent representation; referral accuracy is maintained when using tissue segmentations from a different type of device. Our work removes previous barriers to wider clinical use without prohibitive training data requirements across multiple pathologies in a real-world setting.

 

Full reference: , J. R., Romera-Paredes, B., Nikolov, S., Tomasev, N., Blackwell, S., … & van den Driessche, G. |2018 | Clinically applicable deep learning for diagnosis and referral in retinal disease| Nature Medicine| 1.

Rotherham NHS staff are able to request a copy of the article here