Seven days in medicine: 9-15 August 2017

BMJ 2017; 358 doi: (Published 17 August 2017) Cite this as: BMJ 2017;358:j3892

Maternity services

Nine in 10 obstetric units have unfilled rotas

Some 88% of obstetric units in Britain surveyed from January to March said that they had had problems filling registrar rotas in the previous three months, the National Maternity and Perinatal Audit found. Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, described the rota gaps as “particularly worrying.” The audit found that 19% of services had no midwife led units and that 3% did not have a consultant led unit. (Full story doi:10.1136/bmj.j3855)

C-section may raise risk of hysterectomy complications

Women who have had one caesarean delivery had 31% higher odds of reoperation after hysterectomy than women who have had only vaginal deliveries, and women with two or more caesarean deliveries had 35% higher odds, a study of Danish nationwide registers found. Surgical complications were 16% higher in women who had had one caesarean and 30% higher in those with two or more, a study published in JAMA Surgery found. This supports efforts to prevent caesarean deliveries that are not clinically indicated, said the authors. (Full story doi:10.1136/bmj.j3804)

Cancer Drugs Fund

Three quarters of drugs are now approved by NICE

Of 24 drugs in England’s Cancer Drugs Fund that the National Institute for Health and Care Excellence (NICE) was asked to appraise, 18 have now been approved in final or draft guidance. Five drugs are still being appraised, and one has been withdrawn. Carole Longson, director of the NICE centre for health technology evaluation, said, “More cancer drugs than ever are being recommended for routine use because companies are working hard to provide cost effective solutions. We are also applying flexibility in cases where drugs show promise, meaning people get access through the new [Cancer Drugs Fund] while further data is generated.”

Bowel cancer

Deaths drop by a third

The rate of people dying from bowel cancer in the UK has fallen by more than 30% in the past 20 years, Cancer Research UK said. Bowel cancer was responsible for 38 deaths per 100 000 people in 1995, compared with 26 per 100 000 in 2015. Better treatment, improved public awareness, and improved diagnosis, partly due to the bowel screening programme, are responsible, the charity said.


Doctors must use hepatitis B vaccine sparingly

Doctors must use the hepatitis B vaccine only for people with the highest immediate risk of infection because of a global shortage, Public Health England advised. Its guidance says that babies born to mothers with hepatitis B are the highest priority for vaccination, and then people who think that they may have been exposed to hepatitis B should have an individual risk assessment. The measures are expected to last until the start of 2018. The addition of hepatitis B protection to the routine childhood immunisation programme, which was announced in July, is not affected by the shortage. (Full story doi:10.1136/bmj.j3801)

Most 5 and 6 year olds get flu vaccine in school

Just over half (53.6%) of UK children in school years 1 and 2 had a flu vaccination in 2015-16, Public Health England said. This was the third year of the roll-out of the paediatric vaccination programme that will eventually cover all children aged 2 to 6. Most children (55.6%) were vaccinated through a school delivery model, while 32.6% received their vaccine through GPs and 16.1% through pharmacies. Uptake was highest in the Midlands and East region and lowest in London.

Robotic surgery

Half of studies had undisclosed industry payments

Of all robotic surgery studies published in 2015 that had at least one US author (458 studies; 2253 authors), 240 (52%) had one or more author who received undeclared payments, a study in the Annals of Surgery found,1 comparing authors’ declared conflict of interest (COI) statements with industry reported payments in the Open Payments database in 2013-14. Only 21% of studies and 18% of authors with a COI had declared it in a COI statement. The researchers found that studies that had undeclared payments from the robotic company Intuitive were more likely to recommend robotic surgery than those that declared funding (odds ratio 4.29 (95% confidence interval 2.55 to 7.21)).


More Dutch patients ask for help when dying

Of all deaths in the Netherlands in 2015, 4.5% were the result of euthanasia, up from 1.7% in 1990, researchers wrote in the New England Journal of Medicine. The rate of physician assisted suicides doubled over the same period, from 0.1% to 0.2%. Euthanasia and physician assisted suicide have been legal in the Netherlands since 2002. Physicians’ assistance in dying is provided predominantly to patients with severe disease, but it increasingly involves older patients and those with a life expectancy of more than a month, the authors wrote.

In court

Trial will decide whether trust covered surgeon’s private work

Spire Healthcare, a private hospital company where the rogue surgeon Ian Paterson worked, launched a legal challenge against the Heart of England NHS Foundation Trust to determine whether the trust’s duty of care covered his private practice. Paterson’s prison sentence for unnecessary operations was raised to 20 years this month. Spire argues that the trust knew of Paterson’s activity from 2004 and should have told his other places of work. A spokesman said that the trial, which starts on 30 October, would be “a fair and efficient way” to determine the issues and to secure compensation for all claimants. (Full story doi:10.1136/bmj.j3846)

US researcher who shot dean gets 28 years

A former researcher at Mount Sinai medical school in New York who stalked, shot, and wounded the dean who had fired him for research misconduct has been sentenced to 28 years in prison. Hengjun Chao shot Geoffrey Charney in Chappaqua, New York, in 2016, six years after losing his job, and in June he was convicted of attempted murder. Chao’s defence lawyer called the sentence “grossly excessive for a man driven by a clinically diagnosed, defined psychiatric illness,” but the judge said that the crime’s premeditation warranted it.

Seven day NHS

Weekend services do not improve clinical outcomes

To examine effects on clinical outcomes from moves towards seven day services, researchers reporting in BMC Health Services Research looked at data from 159 trusts in England, 79 of which had made such changes in 2013-14, such as weekend outpatient clinics. They found that crude mortality rates, the average length of stay, emergency admission rates, and emergency department four hour breaches were similar between both types of trusts. Reorganising health services to mitigate a “weekend effect” should be put on hold until “more solid evidence” showed that they are effective, the researchers said.

Elderly care

Extra 71 000 care home places will be needed by 2025

Growing life expectancy means that older UK adults spend more years with substantial care needs, said an analysis published in the Lancet. In over 65s, the number of years spent with substantial care needs (medium or high dependency) nearly doubled from 1991 to 2011—up from 1.1 to 2.4 years in men and from 1.6 to 3.0 years in women. Although care is increasingly provided in the community, the study warned, at current rates of provision the UK is likely to need 71 000 more care home places by 2025.


Waiting list for elective surgery tops four million

The number of patients on waiting lists for elective surgery at NHS hospitals in England has passed four million for the first time in 10 years, official figures showed. NHS England said that 3.83 million people were on a waiting list for non-urgent hospital treatment at the end of June 2017 and that this was likely to exceed four million when figures were available from six more hospital trusts. In March 2017 NHS England relaxed the requirement for hospitals to treat at least 92% of patients on the waiting list within 18 weeks, to allow hospitals to focus on other areas such as emergency departments under pressure. (Full story doi:10.1136/bmj.j3861)

Worcestershire trust must make urgent improvements

The Care Quality Commission issued Worcestershire Acute Hospitals NHS Trust with a warning notice to make urgent improvements, after inspectors found that it had become standard practice to treat emergency patients in the corridors and that patient care had been compromised. The trust was placed in special measures in December 2015, and inspectors made unannounced visits in April to check on progress. The visits showed that, from December 2016 to March 2017, about 40% of patients being treated at Worcester Royal Hospital’s emergency department waited 4-12 hours to be admitted or discharged, more than twice the national average of 19%. (Full story doi:10.1136/bmj.j3786)


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