vendredi 30 mai 2014
Improvements in blood pressure control may have prevented hundreds of thousands of major cardiovascular events
One cell's meat is another cell's poison: How the loss of a cell protein favors cancer cells while harming healthy cells
Rectal artesunate is probably beneficial in young children with severe malaria, but may be harmful in older children and adults
Comments by the new NHS England chief executive have been taken as meaning he might preserve small and community hospitals.
Jeremy Hunt evades questions on NHS funding, plus NHS England’s reshuffle, superheads fall out of favour and more points of note from the week in heathcare.
NHS England is backing clinician-led proposals which would see a reorganisation of specialist cancer and cardiac services across London and Essex.
Providers have breached the waiting time target for patients with suspected cancer starting treatment within 62 days following urgent GP referral for the first time since the target was introduced in 2009.
COMMERCIAL: Birmingham CrossCity Clinical Commissioning Group has closed a support service for palliative care following concerns it failed to reduce hospital admissions and providing value for money.
Full coverage and analysis of NHS England chief executive’s in-depth and wide ranging interview with HSJ, plus the rest of today’s news and comment
STRUCTURE: A second attempt to challenge in court the government’s decision to downgrade services at Stafford Hopsital has been launched this week.
WORKFORCE: North Staffordshire Clinical Commissioning Group has appointed a new clinical accountable officer.
Publication of an investigation into alleged wrongful manipulation of cancer patients’ waiting time data at Colchester Hospital University Foundation Trust is being held up by legal issues, HSJ understands.
STRUCTURE: Cambridge University Hospitals Foundation Trust has unveiled plans to reshape children’s services across the East of England after identifying an “urgent need” for extra bed and theatre capacity.
jeudi 29 mai 2014
Simon Stevens appears to welcome prospect of the NHS front line developing diverse ways of working and challenges system’s old certainties, argues Nuffield Trust chief executive, plus the rest of today’s news and comment
This week’s issue of HSJ magazine is now available to read on our tablet app.Download the HSJ app for iPadDownload the HSJ app for AndroidIn this we
NHS England is seeking to give up some of its patient safety functions, medical revalidation and responsibility for technology, its new chief executive has indicated.
The new NHS England chief executive has distanced himself from the organisation’s previously stated ambition to concentrate specialised services in “15-30 centres of excellence”.
NHS patients should be free to choose their provider whether public or private, Simon Stevens has said.
Simon Stevens has indicated the NHS has early plans to meet about half of the looming £30bn gap; and has suggested greater transparency may be driving a trend toward “patient champion” health secretaries.
Measles, one of the most contagious diseases in the world, was officially eliminated from the U.S. in the year 2000.
Nevertheless, we’re in the midst of a record-breaking year for measles in this country, according to a new report from the Centers for Disease Control and Prevention, with 288 confirmed cases so far.
There are two main reasons for the spike, said Anne Schuchat, M.D. (RADM, USPHS) assistant surgeon general, United States Public Health Service and director of the CDC’s National Center for Immunization and Respiratory Diseases, speaking at a telebriefing for reporters today.
First, she said, travelers are importing measles into the U.S. from other parts of the world, including Europe, Asia, Africa and the Pacific, notably the Philippines, which has been experiencing a large measles outbreak. In addition, Schuchat said, the imported measles is spreading within communities of non-vaccinated people.
From the agency’s weekly Morbidity and Mortality Report:
Most of the 288 measles cases reported this year have been in persons who were unvaccinated (69%) or who had an unknown vaccination status (20%); 30 (10%) were in persons who were vaccinated. Among the 195 U.S. residents who had measles and were unvaccinated, 165 (85%) declined vaccination because of religious, philosophical, or personal objections, 11 (6%) were missed opportunities for vaccination, and 10 (5%) were too young to receive vaccination.
When asked if the non-vaccinated U.S. residents who contracted measles had declined shots due to widely discredited information linking autism to the MMR vaccine, Schuchat said no, public health officials don’t believe that to be true.
Her bottom line message was clear, however: “This year we are breaking records for measles,” Schuchat said. “And it’s a wake up call. Measles may be forgotten but it’s not gone.” (She also added that if you don’t know whether you’ve had measles or the vaccine, it’s OK to get another MMR shot, unless it’s contraindicated, for instance, if you’re immunosuppressed or pregnant.)
Here’s more from the CDC:
A total of 288 confirmed measles cases have been reported to CDC, surpassing the highest reported yearly total of measles cases since elimination (220 cases reported in 2011) Fifteen outbreaks accounted for 79% of cases reported, including the largest outbreak reported in the United States since elimination (138 cases and ongoing).
The large number of cases this year emphasizes the need for health-care providers to have a heightened awareness of the potential for measles in their communities and the importance of vaccination to prevent measles.
Locally, Anne Roach, with the Massachusetts Department of Health, says there have been 8 confirmed cases of measles among state residents so far this year.
And more from the agency news release:
“The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated,” said Dr. Schuchat..“Many of the clusters in the U.S. began following travel to the Philippines where a large outbreak has been occurring since October 2013.”
Of the 288 cases, 280 (97 percent) were associated with importations from at least 18 countries. More than one in seven cases has led to hospitalization. Ninety percent of all measles cases in the United States were in people who were not vaccinated or whose vaccination status was unknown. Among the U.S. residents who were not vaccinated, 85 percent were religious, philosophical or personal reasons.
The large number of measles cases this year stresses the importance of vaccination. Healthcare providers should use every patient encounter to ensure that all their patients are up to date on vaccinations; especially, before international travel.
More than ever health care providers need to be alert to the possibility of measles and be familiar with the signs and symptoms so they can detect cases early.
“Many U.S. health care providers have never seen or treated a patient with measles because of the nation’s robust vaccination efforts and our rapid response to outbreaks,” said Schuchat.
Patients who present with fever and rash along with cough, runny nose, or pink eye should be evaluated for measles; especially, if the patient is unvaccinated and recently traveled internationally or was exposed to someone else who has measles or recently traveled. If healthcare providers suspect a patient with measles, they should immediately isolate the patient to help prevent the disease from spreading, immediately report the case to their local health department and collect specimens for serology and viral testing.
Timely vaccination is the best way to prevent measles. Infants and young children are at high risk of getting a serious case of measles. CDC recommends two doses of measles, mumps, and rubella (MMR) vaccine for everyone starting at age 12 months. For those travelling internationally, CDC recommends that all U.S. residents older than 6 months receive MMR vaccine, if needed, prior to departure.
Measles is a serious respiratory disease that is highly contagious. Anyone who is not protected against the disease is at risk, especially if they travel internationally. Measles is still common in many parts of the world, including countries in Europe, Asia, the Pacific, and Africa. Worldwide, an estimated 20 million people get measles and 122,000 die from the disease each year.
Stevens uses first major interview to warn that “deep seated structural problems” will require parts of the NHS to “completely reinvent what we mean by a hospital”
Row between commissioners and a private midwifery service sparks calls for “urgent clarification” around commissioning rules, plus the rest of the day’s news and comment
The AP reports the not-so-great results of a new study on the health of residents who live near Logan International Airport. The bottom line is that respiratory problems that look a lot like asthma appear to be more prevalent among children who live in this “high exposure” area compared to those living further from the airport. For adults, the likelihood of developing chronic obstructive pulmonary disease was higher among those living in close proximity to the airport.
Produced by the state Department of Public Health, the report focused on 17 communities within a five-mile radius of Logan: Boston, Brookline, Cambridge, Chelsea, Everett, Hull, Lynn, Malden, Medford, Melrose, Milton, Nahant, Quincy, Revere, Saugus,
Somerville, and Winthrop.”
From the report:
•Among children, study results identified some respiratory effects indicative of
undiagnosed asthma (i.e., probable asthma); children in the high exposure area
were estimated to have three to four times the likelihood of this respiratory
outcome compared with children in the low exposure area.
•Among adult residents, individuals diagnosed with chronic obstructive pulmonary
disease (COPD) were statistically significantly more likely to have lived in the high
exposure area for three or more years.
•There were no statistically significant differences in cardiovascular outcomes in the
study population across the high, medium, and low exposure areas.
•There were no statistically significant differences with respect to hearing loss in
either adults or children for those living in the high exposure area compared to the
lowest exposure area.
Here’s more from the AP:
The state Department of Public Health said in a report…that chronic obstructive pulmonary disease was statistically significantly higher for adult residents who had lived near the airport for three or more years.
The study also found that children living near the airport were three to four times more likely to report asthma-related symptoms.
The study was based on interviews with more than 6,000 adults and more than 2,000 children in 17 communities within five miles of the airport.
The Massachusetts Port Authority, which runs the airport, has taken several measures over the past several years to reduce air pollution from airport property.
WORKFORCE: Imperial College Healthcare Trust has appointed a new medical director after Professor Nick Cheshire stepped down from the role.
COMMERCIAL: Bristol Clinical Commissioning Group has approved plans to award contracts for its community mental health services to 18 organisations under a “system leadership” model thought to be the first of its kind in the UK.
STRUCTURE: The health secretary has given the go ahead for a controversial shake-up of maternity services in North Yorkshire which was opposed by a cabinet colleague, according to local councillor.
WORKFORCE: The chair and accountable officer of Wirral Clinical Commissioning Group have temporarily “stepped away” from their posts while NHS England conducts a probe into the group’s leadership, the CCG confirmed this afternoon.