Doctor admits misleading medics over Pauline Cafferkey temperature

A doctor has admitted misleading other medics by concealing Pauline Cafferkey’s raised temperature before she became seriously ill with Ebola.

Hannah Ryan, who volunteered in Sierra Leone in her first year after graduating from medical school, was one of the medics who assessed Cafferkey following the Scottish nurse’s return to the UK in 2014.

Ryan wrote down a temperature 1C lower than it actually was during a “chaotic” screening process at Heathrow airport on 28 December 2014, a medical practitioners tribunal heard on Monday.

A raised temperature can be the first sign of Ebola, which can kill within five days. Cafferkey, who twice nearly died from the virus, went on to develop one of the worst cases on record for people treated in the west.

Cafferkey was cleared of misconduct over the recording of her temperature in September.

The tribunal in Manchester heard on Monday that Ryan recorded Cafferkey’s temperature as being 37.2C despite knowing it was at least 38.2C – above the average body temperature of 37C and higher than the 37.5C threshold requiring further assessment by a consultant in infectious diseases.

She later told another doctor there were no abnormalities in the temperatures of Cafferkey’s group of returnees, according to a written summary of the allegations by the General Medical Council.

Dr Bernard Herdan, the tribunal chair, was told Ryan’s conduct was “misleading and dishonest” and that her “fitness to practise is impaired because of [Ryan’s] misconduct”.

Ryan admitted misleading others and “acquiesced” in the wrong temperature being given but denies misconduct by her actions at the airport and during a subsequent investigation by Public Health England.

Fraser Coxhill, representing the General Medical Council, said Ryan and Cafferkey were one group among many British medics who put their own lives at risk by volunteering their medical skills and going to west Africa to help fight the outbreak.

Deployed on 22 November 2014, they were based at an 80-bed treatment centre in Kerry Town, working “tirelessly in dangerous and highly pressurised conditions” during which they “formed a strong bond of friendship”, Coxhill said.

But about a month later when they returned to the UK on the afternoon of 28 December, the Ebola screening area at the Heathrow terminal was “crowded, noisy and chaotic”.

In the queue to get clearance from PHE medics to be allowed to leave “murmurings of discontent and frustration” grew, the tribunal heard. There were concerns some Scottish medics would miss connecting flights to Glasgow due to delays in the screening process.

Trying to help PHE staff with the process, they agreed to take and record their own temperatures. Ryan took Cafferkey’s temperature, which was 38.2C – a warning sign for the Ebola virus.

The two medics and another nurse with them, Donna Wood, discussed the reading, “during which someone said, ‘Let’s get out of here’,” Coxhill told the tribunal.

Cafferkey’s temperature was then recorded as 37.2C, the form was passed to PHE staff and the medics went on their way.

However, in baggage reclaim there was further discussion between the medics, and PHE staff were contacted.

When Cafferkey’s temperature was taken again it was below the threshold. However, by this time she had taken paracetamol, which lowers body temperature. Cafferkey returned to Glasgow but the next day fell seriously ill with Ebola.

Four days later, Dr Nick Gent, from PHE, called Ryan to investigate what had happened at the airport. Ryan later admitted not telling him she had taken Cafferkey’s temperature and that it was above the threshold for possible Ebola infection.

Coxhill added: “Whilst there is no doubt that Dr Ryan is a practitioner of hitherto unblemished character who undertook important selfless work in Sierra Leone, it is submitted that the events of 28 December 2014 and 2 January 2015 appear to demonstrate someone whose first instinct is to mislead and be dishonest.”

Ryan’s involvement emerged during a misconduct hearing for Donna Wood, another volunteer medic who was suspended for two months in November after being found to have concealed Cafferkey’s raised temperature.

In evidence to the Nursing and Midwifery Council, Ryan said she was in shock after taking Cafferkey’s temperature in her left and right ears and finding it raised.

She told the NMC hearing in a written witness statement: “I asked Pauline if she was feeling OK. She said she was feeling fine.

“I stood there in shock. It was like I was paralysed. I had no clear thought process. Ebola is such a horrible disease that every time you have a high temperature you worry, even when you know there’s no reason to.”

Ryan said only the three medics were present and that Wood “broke the inertia by saying something like, ‘I’m just going to write it down as 37.2 degrees’” so they could “get out of here and sort it out”.

The tribunal is expected to last 10 days.

Doctor admits misleading medics over Pauline Cafferkey temperature

Misleading data mars the debate on alcoholism | Letters

The recent focus given by the MPs Liam Byrne and Jonathan Ashworth to the plight of children and families of alcoholics has shed a welcome light on an important question – how best do we support individuals and families affected by substance misuse?

However, the use of exaggerated numbers to support the cause is misleading and unhelpful. Recent reports, including the Guardian’s (16 February) claimed 2.5 million children live with an alcoholic parent. Yet according to the references provided this is in fact untrue by a factor of more than three. The reference by an all-party parliamentary group on the children of alcoholics to a report by the Children’s Commissioner leads to data on hazardous drinking, not alcohol dependency. These are very different things – and it clearly states there are 700,000 children of dependent drinkers, not 2.5 million.

The reference also cites a report written in 2012 that relies on a study published in 2009 that no doubt used even older data. It ignores the fact that over the past 13 years alcohol consumption per head in the UK has fallen, harmful and binge drinking is down, and young people drink less than ever. UK society is becoming ever more moderate and abstemious. It would be far better to have a debate that is honest and balanced, not out of date, inaccurate or misleading.
Dave Roberts
Director general, Alcohol Information Partnership

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Misleading data mars the debate on alcoholism | Letters

MPs back fresh curbs on "misleading" formula milk marketing claims

A Scottish National party MP has received unanimous Commons backing for new legislation to curb “misleading and scientifically questionable claims” around the marketing of formula milk for babies.

Alison Thewliss introduced her proposal, which has cross-party support, via the 10-minute rule in the House of Commons on Wednesday. After gaining parliamentary approval with no opposition, she can now bring a draft bill for legislation governing the marketing of replacement breast milk products into line with World Health Organisation policy for a second reading before parliament in February.

Although the WHO introduced an international marketing code more than 30 years ago to prevent aggressive practices in formula milk promotion, the UK has never fully implemented it.

Thewliss, MP for Glasgow Central, said legislation was needed to tackle a legal loophole that allows “scientifically questionable” claims about the health benefits of formula milk to be printed in reputable medical and nursing journals.

Thewliss said: “I believe it is vitally important that parents get accurate information on the contents of formula milk, and the best way to prepare it safely. At present there is a worrying lack of independent scrutiny of infant and young child formula, as well as growing frustration about the industry marketing tricks and misleading claims being pushed on parents and health professionals alike.”

The move, which is backed by the chair of the Commons health select committee, the Conservative Dr Sarah Wollaston, has also drawn support from midwives.

Gillian Smith, director of the Royal College of Midwives Scotland, said that, as an MP for a city centre constituency where breastfeeding rates were low and health outcomes poor, Thewliss was to be congratulated.

Smith added that the UK as a whole continued to have higher rates of formula feeding than many other European countries. “I do think adverts for follow-on milk do influence mothers. We are not bad at initiating breastfeeding, but not so good at sustaining it, and there is a significant drop-off by six months,” she said.

While the benefits of breastfeeding in protecting infants from infection and diseases have been shown in countless clinical trials, there are still many instances when formula milk may often be safer or help to resolve nutrient deficiencies.

Thewliss insisted she came to the debate “with absolutely no judgment or attempt to tell other parents how to feed their children”.

She said: “I understand there is a genuine and sincere requirement for infant formula milk for mothers who can’t or indeed don’t wish to breastfeed, and any number of circumstances which lead parents and carers to choose formula.”

MPs back fresh curbs on "misleading" formula milk marketing claims

West Africa TB study claims are misleading | Letters

Your article (3 November) highlights a recent study by a network of researchers which claims that multidrug-resistant TB (MDR-TB) rates in west Africa are actually higher than estimates published by the World Health Organisation. These claims are misleading and unhelpful. The study is based on data collected from selected referral centres located in the capital cities of eight west African countries which typically have a concentrated level of the most difficult TB cases, including MDR-TB. To extrapolate nationwide resistance rates from such focused data is misleading and does not present an accurate picture of the problem.

The collection of data is vitally important for all diseases, for all countries, and west Africa remains a part of the world where MDR-TB surveillance data are most lacking. WHO estimates on MDR-TB are based exclusively on population-based surveys, such as those recently conducted in Nigeria and Senegal. They are designed to generate information representative of all TB cases over the entire country, not only in the hotspots. Evidence has shown that population-based surveys enable a better understanding of the overall epidemiology of MDR-TB.
Dr Matteo Zignol
World Health Organisation

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West Africa TB study claims are misleading | Letters

How A Misleading Headline On Mammography Generates Confusion

This week I’ve read some puzzling words about a digital mammography study published in the Journal of the NCI. The researchers looked at Medicare records – between women almost exclusively more than age 65.  They examined breast cancer screening strategies, detection and staging of new instances.

The investigators located no advantage of digital breast imaging, with or with no computer-assisted detection, among older females. No surprise. But like other ostensibly negative analyses of breast cancer screening, it is gaining traction on social media. This is occurring despite the paper’s lack of applicability to screening girls in their forties, fifties and early sixties.

Blue Sky Twitter (Photograph credit: mkhmarketing)

The study’s primary limits are two. First, that it is strictly about screening ladies more than the age of 65. In which digital mammography gives diagnostic value is in improving accuracy of screening younger ladies with dense breasts. Second, two many years of follow-up is not practically sufficient to inform anything at all about the benefits of screening.

Some examples of exactly where this study has gone wrong include Modern Healthcare, where a headline reads: “Digital mammography costlier, displays no detection-rate positive aspects.” Earlier this month, NPR’s ‘Shots’ hit closer to the reality: “Costlier Digital Mammograms May possibly Not Be Greater For Older Females.”

At the Incidental Economist weblog, Aaron Carroll, a pediatrician and wellness policy professional wrote: “We’re paying a lot more for screening mammograms. They are not producing a difference.” On social media, messages fly and get distorted. What prompted this brief post today was, this, on Twitter:

The consider-away message may lead a lot of girls, doctors and journalist to feel that digital mammograms are costly and not well worth it. But the examine @JNCI_Now says nothing at all of the sort.

How A Misleading Headline On Mammography Generates Confusion

Fiona Nash accused of misleading Senate yet again more than meals rating scheme

The assistant wellness minister, Fiona Nash, stands accused of misleading the Senate for a second time above her controversial intervention to remove a website for the new “healthy star” meals labelling system, a move that has embroiled the minister and her chief of workers in allegations of conflict of interest.

Nash advised the Senate 1 explanation she and her chief of workers, Alastair Furnival, had intervened to pull down the internet site was that a federal and state ministerial forum in December had taken “a unanimous selection to do an extensive expense-benefit analysis” and it was consequently “premature to have the web site live till this report was completed”.

But minutes from that forum meeting confirm accounts provided to Guardian Australia – that Nash unsuccessfully demanded a new regulatory influence statement be undertaken ahead of the new labelling method took result and then unilaterally informed the meeting she would be asking her division to undertake a cost-advantage analysis.

Minutes of the meeting state the forum “considered motions relating to conducting a RIS” which was “not agreed” and that Nash then “informed” the forum she would direct her department to do a expense-advantage evaluation.

Five states are understood to have opposed the minister’s proposal on the grounds an RIS would inevitably delay the scheme’s implementation. Nash lost a vote on the proposal 5-four. She was backed by Victoria, New South Wales and the Northern Territory. Between these efficiently opposing her had been the Labor governments in Tasmania and South Australia that are about to encounter elections.

The leader of the opposition in the Senate, Penny Wong, explained the minutes plainly advised Nash had misled the Senate. In a statement issued late on Thursday, Nash continued to insist the forum had “unanimously” agreed to a price-benefit evaluation but conceded her proposal for an RIS was “not agreed”.

The bitter fight above the minister’s intervention to consider down the website is fuelled by a belief among state governments and consumer groups that she is deliberately delaying the “healthy star” foods labelling – opposed by sections of the meals industry – until finally soon after the Tasmanian and South Australian elections, when conservative victories could give her the numbers to defeat it on the council.

The Tasmanian health minister, Michelle O’Byrne, told Guardian Australia Nash had “no correct to take down the website” and was “clearly hoping if she delays extended ample she will get a diverse outcome”.

South Australia’s well being minister, Jack Snelling, has written an angry “please explain” letter to Nash, about her controversial intervention.

Nash has previously been forced to right her authentic statement to the Senate, that Furnival had “no connection whatsoever” with the lobbying company Australian Public Affairs (APA).

Nash later conceded Furnival, who intervened to pull down the web site, was a “shareholder in the lobbying firm owned by his wife, Tracey Cain”.

APA has acted for Cadbury’s parent firm, the snack food giant Mondelez, as properly as soft drink business group the Australian Beverages Council. Furnival was once chairman of APA and chief economist for Cadbury, but Nash insists there is no conflict of curiosity simply because he “receives no income” from a “shareholding” in his wife’s lobbying firm and the firm has promised not to lobby her or the wellness minister, Peter Dutton. Guardian Australia has established he remains a director of one particular of the companies that helps make up the APA partnership.

Targeted for a second day throughout Senate question time on Thursday, Nash refused to say when she had learned of her staffer’s shareholding in the firm, or when she informed the prime minister’s workplace about it.

“All details close to my chief of employees was given to the prime minister’s workplace in accordance with suitable timing,” she mentioned, but would not be drawn on when that “appropriate time” was. She mentioned it was now “up to industry” no matter whether the June 2014 start date for the new program was met.

The food and grocery business has criticised the scheme for becoming too pricey and confusing, but has also worked with governments and buyer groups on the implementation of the new system.

Guardian Australia understands just hrs soon after the web site went reside last week, as scheduled and broadly anticipated by groups concerned, Furnival rang the division to have it taken down. When staff refused, on the grounds that they were underneath orders from the ministerial forum rather than the minister, Furnival went to the department’s senior executive ranks to intervene.

Guardian Australia more understands that on Wednesday obligation for the labelling scheme was moved from the public servants who have dealt with it for numerous years, and who refused to pull down the web site, to the Wellness Department’s 1st assistant secretary, Nathan Smyth.

In his letter, sent on Wednesday, Snelling “expresses concern” that the minister took down the site without having reference to the state ministers who are jointly responsible for it, and argues that, since the method is voluntary, and because it had been agreed by the ministerial council “I would appreciate your urgent response as to why the web site has been taken down, and I request that it be speedily reinstated”.

The Public Wellness Association chief executive, Michael Moore, mentioned he believed Nash was engaging in “delaying tactics to wait till following state elections that may well mean the ministerial council requires a new form”.

“That would match with an business agenda to avoid or delay the uptake of a method that will enable parents to know how healthy the meals is that they are putting in their children’s lunchboxes. The food sector doesn’t want to mount the direct argument against a system shoppers want, but they are trying to undermine it quietly,” he stated.

Investigation by Option showed 62% of consumers want the existing “daily intake” guides replaced with the well being star rating, and the client group says its study also demonstrates the existing “daily intake” scheme is ineffective.

Option campaigner Angela Cartwright stated her organisation was “not convinced by the government’s explanations for pulling down the internet site … and we know the food and grocery council is reluctant to apply this scheme”.

A spokesman for the foods and grocery council stated the council believed the new technique was “not but prepared to be implemented”, that a price advantage evaluation was needed before it started and that “the evidence that this method will change buyer behaviour is not however settled”

Tracey Cain, Furnival’s wife and APA owner, stated in a statement on Wednesday that “since his resignation and appointment as a chief of personnel with a commonwealth minister [Furnival] has drawn no salary, dividend or revenue share from this business. Following his appointment, the procedure started to transfer Alastair’s shareholding to me as his former co-director. Because final September, Australian Public Affairs has not manufactured representations to both wellness minister, their offices, or the Wellness Division and has created no representations to any other minister of the commonwealth in relation to the overall health portfolio.”

The government’s “standards for ministerial staff” call for that workers “divest themselves, or relinquish control, of interests in any personal firm or enterprise and/or direct curiosity in any public organization concerned in the spot of their ministers’ portfolio responsibilities”.

Nash also conceded that Furnival had not declared any conflict of curiosity at the meeting of federal, state and New Zealand ministers on 13 December, which Nash chaired and Furnival attended.

“Yes, I can verify it was an item on the agenda. Yes, I can verify that I was chairing the meeting. Yes, I can confirm that my chief of employees did not declare an interest.

“I was completely aware of the romantic relationship in between my chief of employees, APA and his previous role within Cadbury and the confectionery business … my chief of workers complies with appropriate internal requirements underneath the statement of standards for ministerial staff,” Nash stated on Wednesday.

The guidelines for the ministerial council state that “members and supporting employees have a accountability to disclose and get realistic measures to stay away from any conflict of interest, real or apparent, in connection with their membership or help of the Forum or its subordinate bodies”.

Nash, who mentioned she had consulted the prime minister’s office on the matter, insisted Furnival’s APA connections did not represent a conflict of interest.

APA is a partnership registered with NSW Fair Trading. NSW Fair Trading records demonstrate APA’s partners are 3 companies – APA Pty Ltd, Strategic Troubles Management Pty Ltd and Centre for Litigation Communications Pty Ltd.

Australian Securities and Investment Commission paperwork present that Furnival is a director of Strategic Issues Management Pty Ltd along with Tracey Cain, who is also secretary.

The prime minister, Tony Abbott, took “on notice” concerns about the affair on Thursday.

Fiona Nash accused of misleading Senate yet again more than meals rating scheme

Misleading Healthcare Graph

As healthcare is so dominant in the information, I want to show an instance of a confusing and misleading graph from a hospital. Figure one demonstrates the benefits for the very first 6 inquiries from a survey of the patient experience measures from the Hospital of Special Surgery. This demonstrates that a single graph can be acceptable by itself but puzzling or even misleading when positioned in a group of graphs. The particular issue with this group is the use of distinct scales, ranging in highest values from 70% to a hundred%.

Figure one. Misleading Group of Graphs Supply: http://www.healthgrades.com/hospital-directory/new-york-ny-manhattan/hospital-for-special-surgery-hgst6cf97b36330270#Satisfaction Click to enlarge

Every single panel presents the percentage of patients at the Hospital for Specific Surgery that gave the hospital a rating of 9 or 10 and compares that worth to that of the nationwide regular of hospitals.  Note that each bars in every panel have the exact same scale so that the comparison inside of panels is legitimate. A reader may possibly also be interested in the comparisons of ratings of distinct inquiries for the exact same hospital for illustration, whether or not individuals are more pleased that the hospital employees often explained medicines or that the individuals felt that their discomfort was constantly nicely managed. The bar for explaining medicines is longer than the bar for controlling soreness for both the Hospital for Unique Surgery and for the nationwide common. Nonetheless, the labels display that individuals are much more pleased with the management of soreness. These figures are visually misleading since their scales differ.

Groups of graphs ought to use steady scales, colours, order of classes and other graphical elements. At times this is not feasible simply because the values in the different panels vary so considerably. See The Elements of Graphing Information by William S Cleveland or my Creating Much more Efficient Graphs for guidance on handling this scenario. Just because a single panel is acceptable does not mean the graph with several panels is also acceptable.

Misleading Healthcare Graph