Seven days in medicine: 31 October to 6 November 2018BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4686 (Published 08 November 2018) Cite this as: BMJ 2018;363:k4686
Cutting waits is a priority for 70% of UK adults
Meeting the 18 week target for accessing elective NHS treatment should be a priority, said seven in 10 respondents to a poll of 2060 British adults conducted by the research group ComRes. Over 530 000 people are currently waiting over 18 weeks for elective treatment, and this could reach a million by 2024. A coalition of health bodies, including the Royal College of Surgeons and the British Orthopaedic Association, called on the government to prioritise cutting waiting times for non-urgent treatment in the forthcoming NHS 10 year plan.
Five new AI centres are due in 2019
The UK business secretary, Greg Clark, announced that five new centres of excellence for digital pathology and imaging, including radiology, will be developed in Leeds, Oxford, Coventry, Glasgow, and London. They will use advances in artificial intelligence to find ways to speed up diagnosis and improve patient outcomes. Clark said, “The innovation at these new centres will help diagnose disease earlier to give people more options when it comes to their treatment, and make reporting more efficient, freeing up time for our much admired NHS staff time to spend on direct patient care.” The centres, which will be based at universities and NHS facilities, are expected to be up and running during 2019.
Practice declines in Africa but rises in Asia
The prevalence of female genital mutilation (FGM) in girls fell from 71.4% in 1995 to 8% in 2016 in east Africa; from 58% in 1990 to 14% in 2015 in north Africa; and from 73.6% in 1996 to 25.4% in 2017 in west Africa, an analysis published in BMJ Global Health found.1 In western Asia, however, FGM increased by 1% in 1997 and by 16% in 2013. Risk factors that could reverse the declining trend persist in some countries, said the authors, including poor education, poverty, gendered cultural forces, and the perception that FGM increases the chances of marriage.
Drug company is charged over parenteral nutrition
ITH Pharma, which supplies intravenous feed for babies, was charged with seven counts of supplying a medicinal product that was not of the nature or quality specified in the prescription and with failing to take all reasonably practicable steps to ensure that patients were not infected by contaminants. Twenty three babies at nine hospitals in northwest London developed a bacterial infection after receiving the total parenteral nutrition it supplied. Three died, but only one death was potentially linked to the feed. The company will appear at Westminster Magistrates Court on 17 December. (Full story doi:10.1136/bmj.k4649)
Equality and diversity
White UK doctors are more likely to get consultant posts
Black and minority ethnic doctors were less likely to be awarded a consultant position than their white counterparts in a survey of 487 physicians.2 It found that white British candidates had to apply for fewer posts (mean 1.29 v 1.66 in all other ethnic groups), were more likely to be shortlisted (80% v 66%), and were more likely to be offered a consultant post (77% v 57%). The survey was conducted by the Royal College of Physicians, the Royal College of Physicians of Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow.
Don’t exclude common hand procedures, says RCS
NHS England should not restrict access to surgery for carpal tunnel syndrome, Dupuytren’s contracture, trigger finger, or wrist ganglion, the Royal College of Surgeons urged. In July, NHS England proposed cutting funding for 17 procedures it considered unnecessary, to save money and to eliminate unwarranted clinical variation around the country. But the college was concerned—along with the British Society for Surgery of the Hand—that the evidence base for limiting access to surgical treatments for those four hand conditions had not been appropriately considered. (Full story doi:10.1136/bmj.k4653)
Acute flaccid myelitis
Doctors criticise CDC’s response to disease
US doctors treating cases of acute flaccid myelitis (AFM) criticised the Centers for Disease Control and Prevention’s (CDC) use of the word “mystery,” arguing that the evidence is at least enough to work on the assumption that AFM is often caused by the common enterovirus D68. AFM presents like polio, with flu or pneumonia symptoms followed by sudden weakness in the limbs. Cases have spiked in the September of every other year since the CDC began tracking it in 2014. This year the agency has seen 191 cases (72 confirmed), and cases have also been reported in Canada. (Full story doi:10.1136/bmj.k4633)
Trainee is suspended for sign-off fraud
A trainee doctor who used a senior nurse’s computer account to sign off assessments of his work in her name has been suspended from the UK medical register for 12 months. Joon Faii Ong was a foundation year 1 trainee working at Lister Hospital in Stevenage in December 2016, when he asked a ward sister to sign off a competency on his “e-tab.” She was distracted, and he completed the form himself. The General Medical Council had called for Ong to be struck off, but “the tribunal took into account the fact that Dr Ong’s dishonesty was opportunistic, rather than planned, and he was described as a good doctor.” (Full story doi:10.1136/bmj.k4664)
Man at risk of septic shock faces colostomy
A 43 year old doubly incontinent man should be given a colostomy, a High Court judge ruled, after hearing that doctors feared that he would otherwise die from septic shock within four to six weeks. Mr Justice Moor ruled that it would be “overwhelmingly” in the interests of the man, referred to as SJ, to have the operation. SJ has a history of psychotic episodes and possibly an autism spectrum disorder. The judge found that SJ lacked the capacity to take decisions about medical treatment. (Full story doi:10.1136/bmj.k4601)
CJD patient gets experimental treatment
The High Court gave the go ahead for a middle aged man with sporadic Creutzfeldt-Jakob disease (CJD) to become the first human worldwide to receive the novel drug PRN100. The drug, a humanised monoclonal antibody, has been in development since 2007 and has been tested on animals, but researchers have been unable to raise the funds for a clinical trial. Because of his condition the man, referred to as KG, lacks the full mental capacity to weigh up the risks and benefits of the treatment. But he, his family, the official solicitor as his representative, and University College London Hospitals NHS Foundation Trust all agreed that he should have it. (Full story doi:10.1136/bmj.k4608)
Attacks on NHS staff
New measures tackle workplace violence
NHS staff in England will be better protected from attacks and abuse under a new violence reduction strategy, the health and social care secretary announced. The most recent NHS staff survey showed that over 15% of employees had experienced violence from patients, their relatives, or the public in the past 12 months—the highest figure for five years. The health department said that the new zero tolerance approach would see offenders prosecuted quickly through a partnership between the NHS, the police, and the Crown Prosecution Service. (Full story doi:10.1136/bmj.k4603)
Many doctors don’t suggest e-cigarettes in cancer
Nearly a third of UK doctors and nurses would not recommend e-cigarettes to patients with cancer who already smoke, a survey suggested. A poll of 506 health professionals—including GPs, oncologists, cancer surgeons, practice nurses, and cancer nurse specialists—was presented at the 2018 National Cancer Research Institute Cancer Conference in Glasgow. Some 29% of respondents said that they would not recommend e-cigarettes to patients with cancer who smoke. Over half said that they did not know enough about e-cigarettes to make recommendations to patients.