Hospital self-harm cases have steadily risen among men in England since 2008

Gray, E. BMJ Open Blog. Published online 28 April 2016.

The number of hospital cases of self-inflicted harm, such as cutting and overdosing on prescription meds, has risen steadily since 2008 in England among men, reveals research published in the online journal BMJ Open.

self harm
Image source: Geulayov, G. et al. BMJ Open.

But only around half of those who go to hospital after the incident receive a specialist mental health assessment, as national guidelines stipulate they should, the data show.

This is of particular concern as episodes of self-harm precede death in one in every two cases of suicide, the researchers point out.

The researchers base their findings on reported cases of self-harm among people aged 15 and older at five general hospitals in the cities of Oxford, Manchester, and Derby between 2000 and 2012. Self-harm includes intentional injury and overdosing on prescription drugs.

The three cities are all part of the Multicentre Study of Self Harm in England. Because they are socially and economically diverse, the study participants are reasonably representative of urban patterns of self-harm across the country, say the researchers.

During the 13-year study period, 84,378 episodes of self-harm involving 47,048 people were dealt with at the five hospitals. Well over half of these cases (58+%) were among women.

Almost four out of 10 people were under 25, and nearly two thirds (62%) were under 35. Almost a third (30%) were receiving some form of psychiatric care when they self-harmed.

Overall, rates of self-harm fell among women from 2000 onwards. They also fell in men, but only until 2008, after which they steadily rose, possibly because of the effects of the economic downturn, suggest the researchers.

The rates of self-harm closely mirrored patterns of suicide seen in the general population, for both men and women.

Read the full post here

Read the original research here

Violence against Health Care Workers – NOW@NEJM

Rothaus, C. Now@NEJM Blog. Published online: April 28th, 2016

Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored. According to the Joint Commission, a major accrediting body for health care organizations, institutions that were once considered to be safe havens are now confronting “steadily increasing rates of crime, including violent crimes such as assault, rape, and homicide.” Although metal detectors may theoretically mitigate violence in the health care workplace, there is no concrete evidence to support this expectation.

Violence against health care professionals in the workplace is underreported and understudied. Additional data are needed to understand steps that might be taken to reduce the risk. A new Review Article summarizes.

Image source: Now@NEJM

Clinical Pearl

• Which one of the four categories of workplace violence is most common in the health care setting?

Experts have classified workplace violence into four types on the basis of the relationship between the perpetrator and the workplace itself. Most common to the health care setting is a situation in which the perpetrator has a legitimate relationship with the business and becomes violent while being served by the business (categorized as a type II assault). The highest number of such assaults in U.S. workplaces each year are directed against health care workers. These episodes are characterized by either verbal or physical assaults perpetrated by patients and visitors against providers.

Read the full blog post here

Read the original research abstract here

Renewed call to tackle antimicrobial resistance

NICE. Published online: 21 April 2016.

The comment comes as NICE launches a new quality standard which aims to help healthcare professionals and organisations tackle the problem.

Antimicrobial resistance to antibiotics is one of the greatest dangers to our health. Dame Sally Davies, the UK Chief Medical Officer, has described the threat as “catastrophic”. It could lead to people dying from ordinary infections, and routine operations such as hip replacements becoming deadly due to the risk of infection.

Last week, the Chancellor George Osborne warned that unless radical action is taken, it could lead to 10 million deaths each year by 2050. This is more than the number of people who die from cancer.

Image source: NICE – PHE

Yet despite these warnings, recent figures show that the use of antibiotics in the UK is increasing. Between 2010 and 2014, prescriptions rose in both primary and secondary care, the sharpest rise of which was in hospitals. Consumption in general practice increased by 6.2%. And prescribing to hospital inpatients climbed by 11.7%.

NICE has published a new quality standard that aims to help reverse these trends and tackle the looming threat. The quality standard contains six statements which healthcare professionals can use to improve quality of care. It says that individuals and organisations need to work together to maintain the effectiveness of antimicrobials.

Read the full post here

Occupational health risks associated with the use of germicides in health care

Weber, D.J. et al. American Journal of Infection Control.Volume 44, Issue 5, Supplement, 2 May 2016, Pages e85–e89
Image source: Cade Martin, Dawn Arlotta // CC0

Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant Staphylococcus aureus, vancomycin-resistantEnterococcus, Clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical devices between use by different patients is also recommended.

Environmental surfaces and noncritical shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary ammonium compounds, improved hydrogen peroxides, and hypochlorites.

Concern has been raised that the use of germicides by health care personnel may increase the risk of these persons for developing respiratory illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms. Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants.

The scientific evidence does not support that the use of low-level disinfectants by health care personnel is an important risk for the development of asthma or contact dermatitis.

Read the abstract here

BMJ roundtable: How to fix out of hours care

BMJ talk medicine. Published online 28th April 2016.

he BMJ recently held a discussion between experts in the fields of general practice, emergency medicine, and paediatrics about the state of out of hours care in the UK, and crucially offered their vision for a better service.

Are children a special case, can urgent care ‘hubs’ be a silver bullet, is NHS 111 up to the job of triaging patients, do there enough clinicians involved in out of hours care, and are other countries doing a better job?

The state of out of hours care can best be described as ‘patchy,’ with some, even most, people receiving good and timely care although from a confusing plethora of different bodies – walk-in centres, urgent care centres, out of hours centres, telephone consultation and – that most recognisable of all NHS brands – Accident and Emergency. But there are also very serious deficiencies attributed to core problems identified by our experts below.

Around the table were: Clifford Mann, president of The Royal College of Emergency Medicine and an emergency medicine consultant in Taunton in Somerset; Neena Modi, professor of Neonatal Medicine in the Imperial College, London and president of Royal College of Paediatrics and Child Health; and Professor Martin Roland, professor of Health Service Research at the University of Cambridge and who has 35 years experience as a GP.



via BMJ Talk Medicine

E cigarettes as substitute for smoking

GPs  advised to promote e-cigarettes ‘as widely as possible as a substitute for smoking’ by the Royal College of Physicians (RCP), following a comprehensive review of available evidence

E-cigarettes should be used as a viable harm reduction strategy to help patients give up on the ‘addictive and lethal’ habit of tobacco smoking, according to the RCP’s Nicotine without smoke report.

image source:

Assessing the scientific evidence, public policy, regulation and ethics of e-cigarettes, the RCP concluded that they are not a gateway to smoking and do not result in the normalisation of smoking.

The report does warn that any long-term or rare side effects of vaping will not become apparent until e-cigarettes have been in widespread use for several decades, but states the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.

Read the full report, Nicotine without smoke: Tobacco harm reduction

See also:

Air quality

B0005807 Smoke ring blown off by Mt Etna during eruption

Image source: Paul Gunning Wellcome images//CC-BY-NC-ND 4.0

The House of Commons Environment, Food and Rural Affairs Committee has published   Air quality: Fourth Report of Session 2015–16.

This report found that poor air quality is damaging the UK’s environment and harming the nation’s health: emissions have declined significantly over many decades, but not far enough to prevent the early deaths of 40-50,000 people each year from cardiac, respiratory and other diseases linked to air pollution.

Related: BBC News report


Commissioning of specialised services

The National Audit Office has published The commissioning of specialised services in the NHS. The report reveals that spending on specialised services has increased at a much greater rate than other parts of the NHS.

The report highlights that although NHS England took responsibility for commissioning these services three years ago, it still does not have an agreed overarching service strategy, consistent information from all providers on costs, access to services and outcomes or how efficiently services are being delivered. The report finds that a number of factors are creating financial pressures for specialised services including the increasing volume of effective but expensive new drugs, and increasing demand for these services.

image source:

Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain

Yamada, K. et al. BMJ Open. 2016. 6:e010356

Objectives: Working is a common cause of chronic pain for workers. However, most of them need to continue working despite the pain in order to make a living unless they get a sick leave or retirement. We hypothesised that the therapeutic effect of vocational rehabilitation may depend on psychosocial factors related to the workplace. To test this hypothesis, we examined the association of work-related psychosocial factors with the prevalence of chronic pain or health-related quality of life (HRQoL) among workers with chronic pain.

Methods: We examined 1764 workers aged 20–59 years in the pain-associated cross-sectional epidemiological survey in Japan. The outcomes were (1) chronic pain prevalence among all workers and (2) low Euro QoL (EQ-5D <0.76; mean value of the current study) prevalence among workers with chronic pain according to the degree of workplace social support and job satisfaction. Workplace social support and job satisfaction were measured using the Brief Job Stress Questionnaire. Multivariable-adjusted ORs were calculated using a logistic regression model including age, sex, smoking, exercise, sleep time, work hours, body mass index, personal consumption expenditure, intensity of pain and the presence of severe depressive symptoms.

Results: Chronic pain prevalence was higher among males reporting job dissatisfaction compared with those reporting job satisfaction. No difference was observed among women. Chronic pain prevalence did not differ between workers of either sex reporting poor workplace social support compared with those reporting sufficient support. Among workers with chronic pain, low HRQoL was more frequent in those reporting job dissatisfaction. Similarly, low HRQoL was more frequent in patients with chronic pain reporting poor social support from supervisors or co-workers compared with patients reporting sufficient support.

Conclusions: Work-related psychosocial factors are critical for HRQoL in patients with chronic pain.

Read the full article here

NICE safe staffing guidance halt sparked safety fears among nurses

Merrifield, N. HSJ. Published online: 25 April 2016

The suspension of safe staffing guidance produced by the National Institute for Health and Care Excellence has left almost three quarters of nurses worried that patient safety will suffer, a UK-wide survey has revealed.

After the work was brought to a halt by NHS England last year, organisations were told guidelines that had already been produced for acute adult inpatient wards and maternity units should be upheld.
Credit: Jennifer Van-Schoor – Nursing Times // via Unison/HSJ

However, only 17 per cent of survey respondents working on an adult inpatient ward in an acute hospital in England said their organisation continued to use the guidance, HSJ’s sister title Nursing Times reports. Almost two-thirds –said they did not know whether their employer was continuing to use it or not.

Unison, which carried out the survey of 2,708 nurses on 9 February, said the suspension of the NICE guidance had caused “mass confusion” in acute settings.

Read the full article here