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News

Seven days in medicine: 10-16 July 2019

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4712 (Published 18 July 2019) Cite this as: BMJ 2019;366:l4712

Clinical negligence

NHS pay-outs of £2.4bn prompt call for reform

Medical defence experts urged the UK government to hasten reform of the legal process for clinical negligence claims, as figures showed that the cost to the NHS in England rose again last year. The annual report by NHS Resolution (formerly the NHS Litigation Authority) showed that the NHS paid out £2.4bn (€2.7bn; $3.0bn) on clinical negligence in 2018-19,1 up by £137m from the previous year. The number of claims remained relatively stable, and the increase was largely due to high value claims. (Full story doi:10.1136/bmj.l4688)

Abortion rights

MPs vote to liberalise NI laws

The UK parliament voted overwhelmingly to liberalise abortion laws in Northern Ireland and bring them into line with the rest of the UK, after Stella Creasy, a Labour MP, put down an amendment to the Northern Ireland Executive (Formation) Bill. Abortion law is devolved to the Northern Ireland assembly at Stormont, and the government had argued that it was up to the assembly to change the law, but the assembly has been suspended since January 2017 amid a political deadlock that shows no sign of ending. (Full story doi:10.1136/bmj.l4674)

General practice

Patient satisfaction is high despite pressures

Some 82.9% of patients rated their overall experience of their general practice as good, in results from the latest GP Patient Survey of nearly 800 000 patients in England. Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said, “It is a testament to the incredible efforts of GPs and their teams that patient satisfaction has remained so high—especially given the intense resource pressures currently facing our profession and the strenuous circumstances our colleagues are working under.” (Full story doi:10.1136/bmj.l4687)

E-cigarettes

Use is linked to risk of smoking relapse

Electronic cigarettes are associated with smoking fewer tobacco cigarettes and a higher likelihood of quitting them—but also with a greater risk of smoking relapse, showed a French study published in JAMA Internal Medicine.2 Follow-up of 5400 daily smokers showed that those who used e-cigarettes regularly considerably reduced the number of cigarettes smoked each day when compared with non-users, and they were 67% more likely to quit (odds ratio 1.67). But, among the 2025 people who had stopped smoking tobacco, those using e-cigarettes showed a higher risk of relapse (adjusted hazard ratio 1.70) over two years of follow-up.

Mental health

Added screen time may boost adolescent depression

Increased use of social media and computers and longer television viewing were linked to higher rates of depressive symptoms in adolescents, but playing video games did not increase depression, a Canadian study found.3 “To our knowledge, this study is the first to use developmental data from a large sample of adolescents to examine the association between four types of screen time and depression,” said the study authors, led by Elroy Boers at the University of Montreal’s department of psychiatry.

NHS England extends schools’ mental health support

The government announced 124 new mental health support teams for 48 areas around England as part of a programme to improve mental healthcare provision for school pupils. Each team will support around 20 schools and colleges in their area to provide quicker access to specialist services. And a £9.3m (€10.3m; $11.5m) training scheme for teachers will be rolled out nationally to raise awareness of mental health concerns and improve referral to specialist help.

Sepsis

Death rates fall in hospitals with mandatory treatment protocols

Death rates from sepsis fell more quickly in hospitals in New York state after introducing a state-wide mandatory treatment protocol than in states without such regulation, a study showed.4 Jeremy Kahn, lead author from the University of Pittsburgh, USA, said, “For the first time, state officials are enshrining in regulations that hospitals must follow certain evidence based protocols when it comes to sepsis. And our study finds that, at least in New York, it seemed to work.” The retrospective study, reported in JAMA, examined more than a million hospital admissions for sepsis.

Public health

NHS has new legal duty to prevent knife crime

NHS trusts, local councils, and education representatives will have a “public health duty” to prevent and tackle the root causes of serious violence such as knife crime, said the UK Home Office. Sajid Javid, home secretary, announced the new legal duty this week, which will hold organisations to account rather than individuals such as teachers, nurses, or other frontline professionals. The prime minister, Theresa May, said that the new duty “will ensure all agencies work together to share intelligence and identify warning signs, so we can intervene earlier and protect young people.”

Waiting times

Political “vacuum” undermines care in Northern Ireland

The lack of a functioning government and a “culture of centralisation” are impeding efforts to improve the health and care system in Northern Ireland and are obstructing efforts to reduce long waiting times, a report from the Nuffield Trust found. The think tank noted that Northern Ireland was significantly the UK’s worst performer on waiting times, as patients were nearly 50 times as likely to wait over a year for care as in Wales, which was the next worst performer.

Legal news

GP gets eight month suspension after treatment errors

An experienced GP partner was suspended from the UK medical register for eight months, after a tribunal found that he had committed serious clinical errors in the treatment of four patients. Simon Caswell was found to have inappropriately increased a patient’s fentanyl patch from 50 μg to 100 μg in one step, when the British National Formulary advises changing dosage by increments of no more than 12.5 μg or 25 μg at a time. In another case the tribunal found that he had prescribed sodium valproate to a woman of childbearing age, when the BNF counsels against this. (Full story doi:10.1136/bmj.l4689)

Doctors have new statutory duty to report deaths

From 1 October doctors in England and Wales will be under a statutory duty to report to the senior coroner any deaths that occur in certain circumstances.5 The reform follows recommendations from a post-Shipman public inquiry, which revealed weaknesses in the death certification system. Most doctors already notify deaths in the circumstances outlined in the Notification of Deaths Regulations 2019, said the Ministry of Justice. These include where the cause of death was unnatural or unknown, where the identity of the dead person cannot be ascertained, where the person died in state custody, or where another doctor is required to sign a death certificate but will not be available within a reasonable time.

Anaesthetist injected partner with “noxious substance”

Hossam Metwally, an anaesthetist and pain specialist, was sent to the crown court on charges that he had injected his partner with a “noxious substance” that left her in a critical condition. Kelly Wilson was admitted to a hospital intensive care unit after being injected with unspecified controlled drugs during what the prosecution alleges was a “ritual.” Metwally is accused of carrying out the injection at the couple’s home in Grimsby, UK. He was remanded in custody to appear at Grimsby Crown Court on 5 August. (Full story doi:10.1136/bmj.l4628)

Infectious disease

Congo measles outbreak kills almost 2000

A measles outbreak in the Democratic Republic of the Congo has killed more people there than the Ebola outbreak, new government figures showed. Some 1981 deaths from measles were confirmed in the country this year, compared with 1641 from Ebola. Both outbreaks are in the country’s troubled north east, and measles is especially concentrated among displaced children living in temporary camps. A measles vaccination campaign is about to start in those camps, targeting 67 000 children. The 2011 Ebola epidemic in west Africa, which killed over 11 000 people, was also later shown to be accompanied by an even greater death toll from a surge in other diseases, as health services were overwhelmed. On 15 July a first case of Ebola was found in Goma, a city of two million, in a man who entered a bus. The other passengers have been quarantined.

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