Seven days in medicine: 23-29 November 2016BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6433 (Published 01 December 2016) Cite this as: BMJ 2016;355:i6433
Excess winter mortality halved last year
Excess winter deaths from December 2015 to March 2016 totalled 24 300, almost half the number during the same period the previous winter, which saw the highest number of excess winter deaths in 15 years (43 850). Data from the UK Office for National Statistics showed similar levels of reported flu activity in both winters. Anne Campbell, health analysis and life events statistician, said that the fall in excess mortality “was mainly due to the most prevalent strain of the flu virus impacting younger people rather older people.”
Bed occupancy remains above recommended levels
The percentage of beds occupied in hospital wards that are open overnight exceeded 89% in the second quarter (July to September) of 2016-17, figures from NHS England showed. Last year’s equivalent figure was 87%. In 2000-01, overnight hospital bed occupancy averaged 84.7%. Health experts advise that occupancy levels should ideally be under 85%.
NHS England backs CCG’s surgery restriction policy
NHS England gave the green light to plans by the Vale of York clinical commissioning group (CCG) to require obese patients and smokers to make lifestyle changes or wait 12 months for surgery. To avoid a delay to their surgery, patients with a body mass index above 30 will need to lose 10% of their weight and smokers will be required to quit for two months, for which support will be provided. Despite the new criteria Shaun O’Connell, a local GP and a clinical lead at the CCG, assured patients that “there is no ban and no blanket policy . . . People who do not wish to access the support services or fail to meet the criteria will not be denied their operation—decisions about what is in the best interests of their health will be made on a case by case basis.” NHS England was able to mediate in the decision because the CCG is under special measures.
Colour changing bandages aim to spot infection earlier
Four UK hospitals are testing bandages that change colour if a wound is infected, as part of a clinical trial. The bandages, developed at the University of Bath, can detect infection earlier, allowing improved treatment for burns patients and less antibiotic use. Swabs and dressings used at Southmead Hospital Bristol, Bristol Royal Hospital for Children, Chelsea and Westminster Hospital, and Queen Victoria Hospital East Grinstead will be tested to see how they react to infections.
“Designer vagina” doctors will not be prosecuted
Three doctors alleged to have carried out “designer vagina” procedures on adult women who paid for the surgery for cosmetic reasons will not be prosecuted under UK legislation that outlaws female genital mutilation, the Crown Prosecution Service said. These cosmetic operations are carried out widely in the United Kingdom, and police began to take an interest after Theresa May, then home secretary, told MPs in 2014 that the Female Genital Mutilation Act 2003 covered cosmetic surgery. (Full story doi:10.1136/bmj.i6390)
Alzheimer’s drug hopes are dashed
Hopes that solanezumab, a failed Alzheimer’s drug, may prove effective in patients with mild disease seem misplaced after a phase III trial in this group produced no significant benefits. The monoclonal antibody targeting amyloid plaques had not reversed the disease in an earlier phase III trial in 2012, but close examination of those results had shown that it may have slowed progress. This prompted the manufacturer, Eli Lilly, to launch a further trial in patients with mild disease, but it announced on 23 November that the results showed no significant slowing in cognitive decline when compared with placebo. (Full story doi:10.1136/bmj.i6362; and see Sixty seconds on . . . solanezumab, doi:10.1136/bmj.i6389)
Oral cancer rates rise by two thirds
Rates of oral cancer have increased by 68% in the past 20 years from eight cases per 100 000 people in 1992-95 to 13 per 100 000 in 2012-14, figures from Cancer Research UK showed. Men over 50 are the most likely people to have oral cancer, with 41 cases per 100 000 in 2012-14, and women over 50 also show increased risk, with 18 cases per 100 000. (Full story doi:10.1136/bmj.i6369)
Microcephaly may appear after birth
Infants exposed to the Zika virus in utero and born without microcephaly may develop Zika associated microcephaly and other neurological complications after birth, researchers from Brazil and the United States warned. They described the cases of 13 infants born in northeastern Brazil with normal head size: 11 who came to clinical attention because their head circumference decreased from 33 cm to 32 cm, and two who were referred at ages 5 months and 7 months because of concerns about their neurodevelopment. (Full story doi:10.1136/bmj.i6333)
No health funding in autumn statement
The UK government’s failure to commit new funding to the NHS and social care in its autumn statement will put patient care at risk, health and social care leaders warned. Stephen Dalton, NHS Confederation chief executive, said, “The Treasury has missed a golden opportunity to ease the strain on the NHS.” And Jane Dacre, president of the Royal College of Physicians, called the failure to acknowledge the current pressures “alarming.” (Full story doi:10.1136/bmj.i6356)
NHS fraudsters must repay £650 000
Four perfusionists, jailed for two to four years for defrauding the NHS, have been ordered to hand over their assets or face more time behind bars. The four worked at Basildon Hospital’s Cardiothoracic Centre and were also the directors of a private company, London Perfusion Science, which they used for private work at other NHS hospitals while they were already being paid to work at Basildon, UK. Basildon Crown Court determined that they had not worked 14 000 (45%) of the hours they had been paid for, and it ordered that the NHS must be compensated a total of £519 539.51 (€609 000; $646 000), with an additional £59 000 paid to the Treasury.
More support for new mums with mental illness
Simon Stevens, NHS England chief executive, announced that £40m (€46.7m; $49.7m) will be allocated to 20 areas of England this year to fund new specialist community mental health services for pregnant women and new mums, and a further £20m will be allocated next year. The money will also help provide “buddying” and telephone support from mothers who have had similar issues. The aim is to reach 30 000 more women a year by 2021. NHS England is also commissioning four new mother and baby units for women with mental health conditions.
High demand for voluntary euthanasia in Quebec
More than 300 people will have assisted deaths in Quebec, Canada, in the first year since the procedure was legalised in December 2015—three times more than the 100 predicted, said Gaétan Barrette, the province’s health minister. Quebec City had more requests than Montreal—which Barrette, a former radiologist, attributed to the secularism of the nominally Catholic francophone Quebecois, who largely threw off church influence in the “Quiet Revolution” of the 1960s. Assisted dying became legal in the rest of Canada in July 2016, but Quebec is the only region that requires the lethal dose to be injected by a doctor. (Full story doi:10.1136/bmj.i6331)