My Christmas shift showed me the human connection behind medicine

My first medical on-call shift was on the evening of Christmas Day. Wary of what to expect, I joined my family for an early dinner with a cloud of trepidation hanging over it. The post-food cosy daze that everyone has after their traditional meal turned into the pre-work tetchy panic that every doctor has before a night shift.

I arrived at the hospital at 9pm to find remnants of Christmas cheer lingering on every ward. Boxes of half-eaten chocolates, needles starting to drop from Christmas trees, tinsel becoming unstuck and dangling from the walls, and families trickling away from the hospital after spending the day with their loved ones – it’s like you’ve arrived late at a party after everyone has left.

For the first few hours I was strangely enjoying my first medical on-call shift. It was a refreshing break from the daily grind of writing in patients’ notes what my consultant says on ward rounds and typing discharge summaries. I was reviewing and managing unwell patients, which is what I had been trained to do.

Fuelled by adrenaline, excitement, and those half-finished boxes of chocolates on the ward, I was in full flow. Please review this patient who is not producing enough urine: “urine problems – I remember the causes and treatment in a kidney lecture”. Please review this patient who’s got a temperature: “review patient, check the nursing observations, take some bloods, do I need to start some treatment straight away?”. Please review the ECG of this patient who’s developed chest pain: “reading ECGs – let’s decipher these squiggly lines step by step”.

I had just managed to clear the backlog of jobs when my bleeper barked into life: “Cardiac arrest, ward x. Cardiac arrest, ward x”. I immediately got off at the next floor and ran to the arrest call. By the time I got there, CPR had already started and my medical registrar arrived 20 seconds after I did. It was my first arrest call.

I took over doing compressions. Crack, one rib broken. Crack, another rib broken. At least I was doing good compressions. The consultant asked: “Can you get a blood gas from the patient?” Stab, the needle goes into the groin, nothing. Someone else has got it already. He continued: “Can you get the results please?” pH 6.9, lactate 11 – not good. I ran back to find the patient’s heart had successfully restarted.

At this point, a medical TV drama would cut to another scene. In reality, the patient’s heart was restarted but they were intubated and unconscious. The family later arrived and decided it would be in the patient’s best interests not to continue further care. I later certified death, feeling particularly poignant as it was Christmas, a time of celebration for a birth and new life. As I wrote the last entry in the medical notes, I saw the patient’s distraught family walk away from the ward, feeling their sadness as I signed my name and wrote the letters RIP.

With those swirling thoughts, I was no longer a doctor, but a ​person​ mourning the loss of another

Unyielding and relentless, I was bleeped again. My steps towards the next job got slower and slower as my brain swirled with thoughts of that arrest, that patient, and that family. The arrest call itself is a paradox – laid bare it is the most human act done in the most inhumane way. The act of trying to save someone’s life, of you pumping your fellow human’s heart, touches on the very essence of humanity’s common bond. The process, however, is as savage and barbaric as it is life-saving.

As part of the arrest call team, I was focused on my job of restarting the patient’s heart. That focus strips away the humanity of the patient, reducing life to lines on a screen and numbers on a chart. With each passing cycle, the focus intensifies until it changes into a mix of desperation and willpower – willing the tube to go in the lungs, the blood to flash back into the syringe, the pulse to return. And when it’s suddenly over, the humanity returns.

With those swirling thoughts, I was no longer a doctor, but a person mourning the loss of another. I stopped, turned around, sat in a quiet room and had a chat with one of the nurses who was also at the arrest call. We talked about anecdotes from the patient’s stay in hospital and our own lives. It felt refreshing to talk about the life that was lived in the face of the sadness of a life that was just lost.

Mentally and physically exhausted, I was glad to hand over the on-call bleeper at the end of my shift to the next bearer of that cross. As I walked out of the hospital, I reflected on every job I’d had during the night, still wondering how the family of the patient who died was coping and what the diagnosis would be of one patient I asked my registrar to review.

Nights are said to be one of the best learning experiences. At the end of my set of nights, I was comforted not only by the wealth of skills and knowledge I could take into the new year, but by the care I had given to my patients to make their Christmases that little bit better.

Everyone takes something different away from their medical on-call experience. I will always remember that behind every patient and medical diagnosis there lies a human connection that binds us all together.

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My Christmas shift showed me the human connection behind medicine

The psychology behind a nice cup of tea | Daniel Glaser

As the temperature drops, you might find yourself reaching for a hot cup of coffee or tea, or warm mulled wine or cider more often than usual. But this may not just be because of the obvious benefits of warming your hands around the cup and banishing the cold from your belly.

In fact, studies have shown there’s a psychological element to choosing hot drinks – they can actually make us feel cosier and friendlier. In an experiment, people were asked to rate strangers on how welcoming and trustworthy they thought they were. Holding a warm cup of coffee made them rate the strangers higher on these attributes, while holding a cold drink had the opposite effect.

Those holding hot drinks were also more likely to be generous, and less likely to display behaviour thought of as selfish. This is due to the strong linguistic and metaphorical links created in the brain by repeatedly using the words ‘warm’ or ‘cold’ to describe personalities.

The same applies with sweetness. People who have eaten something sugary are more likely to describe a person positively – as ‘sweet’. Time to put the kettle on, perhaps.

Dr Daniel Glaser is director of Science Gallery at King’s College London

The psychology behind a nice cup of tea | Daniel Glaser

GPs: Behind Closed Doors review – depressed about the NHS yet?

Meet Ricky. He has a knee injury, a stiff neck and a cough. He missed a consultant appointment because he is terrified of going to hospital. “I’m scared,” he confesses to Dr Jiwanji at Farnham Road Surgery in Slough. “I’m not going.” Meanwhile, his knee pain worsens. Also, he lives in a “disgusting” house. Someone keeps urinating in the hallway. Dr Jiwanji asks him what he needs. “A knee support and some physio,” Ricky replies. In a broken system, this is how a broken patient’s complex needs must be distilled.

Except, Dr Jiwanji explains: “We don’t provide knee supports. You have to buy them.”

“I’m on benefits,” Ricky replies. “I can’t afford it.”

So Ricky gives up on a knee support and Dr Jiwanji writes another referral letter explaining that Ricky will only be operated on under general anaesthetic. Welcome to a typical exchange in GPs: Behind Closed Doors (Channel 5, 8pm). Here’s another: a beleaguered receptionist listens to a woman’s complaint that her legs are killing her. “I might as well just sit in bed and die,” she announces. The receptionist continues to look at her screen. “Can you come tomorrow at 11.40am?” she eventually asks without looking up. The woman is delighted. She has hit the jackpot: a next-day appointment.

And so on, ad infinitum. This might be the most depressing programme on television. What is the point of it? To chill our hearts? Frighten hypochondriacs? Remind us that GPs, like the musicians on the Titanic, are doing their best in a bad situation? We know this, that the NHS, the last bastion of civilised life in this shattered country, is being dismantled even as each new episode airs and we repeat-dial our surgeries in the hope of a phone consultation. We don’t need to see a doctor examining a lump on Colleen’s hand to prove it.

Nevertheless, it continues. The GPs see a baby with eczema, a young woman experiencing seizures whose mum has recorded them on her phone, a man with concussion following a head injury, and another with a swollen leg that might be the result of fatal internal bleeding. Then there’s Leslie, who has hypersensitivity pneumonitis, otherwise known as bird-fancier’s lung. He used to keep 500 birds but is now so ill he has got rid of 300 rare species that were in his house. And got himself some squirrels instead. “No feathers,” he explains between sputum-laden coughs.

The dishy doctor of the practice – because there must be one – is Dr James. “He’s the delicious-looking doctor here,” Beryl giggles as she awaits a steroid injection, which she declares to be lovely. “I’m not sure about that,” Dr James quips. “Everyone here says I look like David Cameron.” This is pretty much the only heartwarming moment – and it features David Cameron.

By the time the programme finishes with a spoof-like update on the patients – Colleen’s lump has been removed, Sean’s potentially fatal swollen leg turned out to be muscle strain – I have figured out the potential of this excruciating show. It will become a government-endorsed project, on endless repeat on an obscure channel, allowing viewers to self-diagnose from the sofa and save NHS resources. Either that, or it is a good basis for an episode of Black Mirror.

Kids On The Edge (Channel 4, 9pm) is also a fly-on-the-wall series about an NHS service but with genuine heart and soul. A thoughtful and moving documentary following the specialised work of the Tavistock trust, the second episode takes us inside Gloucester House, an NHS-run primary school for children with severe mental, social and emotional health issues. Its 18 pupils have all been expelled. Gloucester House represents the end of the line, and like many such places, it turns out to be filled with rage, resolve, patience and hope.

The most moving story features its longest standing pupil Josh, 11, who has a history of appalling abuse and neglect: at the age of three he was scavenging food for his two younger brothers. Adopted when he was five by a a lovely, tender gay couple called Stig and Phil, Josh is overwhelmed by rage and struggles to feel remorse. Josh’s behaviour deteriorates towards the end of term. He runs away on a school trip and says he feels as if he is going to burst. But the commitment of the workers, therapists, teachers, parents and children is nothing short of miraculous. “We’re fighting for Josh to have a future,” says Stig. And it doesn’t get more hopeful than that.

GPs: Behind Closed Doors review – depressed about the NHS yet?

The science behind a good nights sleep

Sleep is more than just a time for rest, the importance of sleep extends to almost every area of human physiology, physical processes of the body undertaken mostly during sleep range from areas such as the healing of muscle and organ tissue, the regulation of blood pressure, the ability of the body to regulate and respond to blood sugar levels along with the balance and delivery of specific hormones and chemical messengers. Mentally, sleep allows the brain to process thoughts, thought processes, store new experiences / memories, enhance emotional responses, along with optimizing the connections between brain and body functions.

Ongoing sleep deficiency is a great risk to society, and in the modern day where a good nights sleep is becoming an elusive luxury, we are seeing an ever increasing prevalence of disorders such as heart and kidney disease, diabetes, high blood pressure, and stroke.

Mentally, the effects of lack of sleep affect almost every aspect of the mind, from the ability to make clear decisions to attention span deficits, increased stress, anxiety and irritability, poor emotional responses, to more serious aspects such as depression, generalized anxiety disorder and even psychosis.

Some studies have shown that obtaining less than 4 hours sleep per night provides almost no benefit to our health, and with prolonged sleep within this range, negative effects begin to take hold.

The preferred level of sleep is between an absolute minimum of 5 and a maximum of 9 hours. This is because of the brain while asleep performs a variety of tasks under different brain wave states, and each of these states needs to be present for a specific amount of time each night for our bodies functions to be able to repair and recover.

Sleep and the effects of various brain wave stages

You may have heard of REM stage sleep before, this stands for Rapid Eye Movement and is a phase of somewhat chaotic and high-frequency brain waves which are most noticeable due to visible, rapid eye movements while asleep. REM is a sign that an individual is in a deep sleep state. However there are other areas of sleep associated with different brain wave patterns.

Beta brain waves are most commonly present while completely awake, and are associated with the ability to perform basic wakeful tasks, too much time spent in the beta state is known to create symptoms of stress and anxiety, while too little is commonly associated with symptoms of depression and poor cognition.

A stronger frequency of brain waves is known as Gamma waves, which are prevalent at times while awake when memory, learning and information processing is taking priority. Too long or too little amount of time the brain spends in a Gamma wave state is associated with similar negative effects as that of Beta waves.

Upon heading to bed, your brain moves from Gamma and Beta states, into a more uniform wave pattern known as Alpha waves, this brain wave state begins to bridge the gap between conscious thinking and the subconscious mind, it also induces a feeling of deep relaxation, and is the bridge between wakefulness and sleep.

Following the experience of the Alpha brain wave state, the brain then proceeds further into what is known as the Theta state, which produces an effect on the body of deep relaxation and hypnosis. The individual experiencing Theta waves can still be awake, and this state is known to produce enhanced creativity, intuition and a natural feeling of euphoria / well-being. The theta state is one of the most important for healthy daily function, too little provokes poor emotional awareness, both in self-awareness and in the observation of others, along with increased stress and anxiety.

The final sleep phase before REM is known as the Delta state. As we age, along with during the prevalence of psychological problems such as stress and anxiety, the brain becomes less accustomed to entering this stage. However, it is one of the most important sleep stages for regaining energy exerted during the day. Mentally a complete lack of Delta brain wave stage results in the inability to recover from stress and anxiety symptoms, leading to their continuation from day to day.

Throughout sleep, the brain normally fluctuates between Alpha, Theta and Delta stages, before entering REM, which is a combination of Gamma and Beta waves, each stage lasts around 5 minutes, and cycles continually throughout the night.

It is this continuation of various patterns which allow our bodies to both physically and mentally recover for the following day, and is vital to our overall health.

Health conditions such as sleep apnoea, continually interrupt this cycle throughout the night, causing problems for everyday health if not corrected.

Also important to note is the use of sedative drugs, although they can be important sometimes in the short-term, are known to alter sleep brain wave patterns significantly, especially the time spent throughout each sleep stage, there is also evidence they may even block entirely the Delta state in some people.

Sleep Hygiene

The awareness of correct sleep hygiene is becoming more common as the modern stresses of life begin to take hold and produce negative effects upon our health. Sleep hygiene involves a few common practices to ensure you obtain the best sleep possible and can assist you to avoid the health complications of poor sleep.

Sleep hygiene involves 6 equal levels of importance when it comes to maximizing the benefits and ability to obtain a good nights sleep, by following these steps, health problems related to sleep, both short and long term, can usually be avoided entirely.

For individuals where some of these stages pose a problem, addressing some of the other areas can also help to bring your sleep more in-line with a healthy sleep process.

1: Maintain a regular sleep schedule.

Ensuring you head to sleep, and also wake up, at the same time each day ensures the body produces a regular sleep pattern. By sleeping at the same time each night, the body begins to produce sleep hormones at the same time, roughly beginning around 6 hours before sleep occurs.

Sleeping at a different time each day often upsets this rhythm, and the beginning of the production of melatonin can be affected. While most of us only think of sleep as occurring at the end of a day, the body sees it as a continual and recurring pattern over 24 hours, of which the production of melatonin begins a long entrance into the preparation for sleep, and enables the sleep process to become one of a deep and restorative phase.

2: Prepare for sleep for around 30 minutes to 1 hour before heading to bed

Lowering the sensory input of your surroundings for 30 minutes to 1 hour before heading to bed is a great method for signaling to the body that sleep should begin. To achieve this, you should dim lights around you, lower any sources of noise, and do not partake in, or at minimum lower your exposure to, any situation or activity which may provoke excitement, stress or anxiety. By doing this for 30 minutes to 1 hour before sleep each night, the body can use this experience to signal the onset of your sleep phase and will provide a much more relaxing, lasting and restorative sleep.

3: Avoid naps during the day, especially in the afternoon.

If you regularly feel tired throughout the day, unless in a situation where a short nap is required, such as driving on a long journey to maintain concentration, try to keep yourself awake throughout the day until bed time. Morning naps or rests involving laying back and closing the eyes for 15 minutes or more may be fine. However if this is conducted in the afternoon, it can often lead to the inability to enter into the sleep phase easily that night.

4: Exercise assists sleep

Lack of exercise not only produces unspent energy levels throughout the day, which lingers at night time but also affect the bodies signal for requiring a good amount of sleep. By exercising daily, even for as little as a short 30 minutes walk, the body releases endorphins, which promote relaxation and euphoria, along with also providing a signal to the body that a good nights rest is required at the end of the day.

5: Restrict sensory input as much as possible within your room overnight

When it’s time for lights out and sleep, your body requires as little noise as possible to reliably initiate the sleep phase and to obtain the ability to keep you asleep for the full night. Ensuring your room is light free, and free from distracting sounds, such as clocks ticking, or something such as having the tv on in the background, even in another room while you are sleeping is very important.

Where this is not possible, such as when a partner has an issue with snoring, some preparation may be required, ear putty is normally the best method as it seals the ear shut completely, and should eliminate the majority of the noise. If you live in an apartment and there are street lights outside, upgrading to buying some high-quality blinds, or even wearing eye shades can help a lot.

Some people, however, prefer some noise to get them to sleep, in these cases, it is important to understand that a constant and stable sensory input can be just as helpful as no sensory input, regarding noise; this is commonly this is referred to as white noise. White noise is a constant, stable noise and can promote sleep in some people just as well as no noise at all. Devices which commonly emit a constant white noise are items such as humidifiers, fans and air purifiers, and can assist people who struggle with no noise environments to get to sleep and maintain sleep quality.

6: Sleep on a high-quality mattress and use quality pillows

Many people overlook the importance of a good quality mattress and pillows or invest in such things without realizing when it has come time to replace them. Most high-quality mattresses will last for up to 10 years before needing to be replaced. However, lower quality ones may expire in as little as 2 to 3. Mattresses should not only be comfortable, but support your body correctly when laying down. You should not sink into the mattress at a central point, but rather the shape of your body should sink evenly, so your back is straight when laying down either on your side, back or stomach.

In the same way, neck support from high-quality pillows are very important, many people who use low quality pillows often double or triple up on them, however it is often worth spending a good amount of money on one to two pillows which allow your head to rest comfortably, but also support your neck evenly.

In the case of a quality mattress and pillows, the investment is one of your overall health, and sleeping with an either of low quality or past their lifespan, will degrade your sleep quality considerably.

Just as buying an ergonomic office chair is shown to prevent back and muscle injuries to office workers, a high-quality mattress, and pillows will improve your overall health and well-being.

If you enjoyed this article, please also take a look at the SleepJunkie.org website, for excellent tips on obtaining a quality sleep, along with how to identify and choose a high-quality mattress.

The science behind a good nights sleep

The Science Behind Skeletal Muscle Memory and Exercise

Imagine that you are a marathon runner, an Olympic swimmer or a professional football player for the NFL. (This shouldn’t be too hard to do as most of us have dreamed about this at one point or another in our lives.)

You train for months and months and even years to run a marathon, swim in the Olympics or play professional football. You train for hours and hours in the weight room, on the field or swimming laps. After years of this consistent training routine, you’re ready for that race or game.

After the event is over, you take a few months off. You rest up and help your body repair before beginning your next training session. After nine months of “rest”, you jump back into the weight room or dive in the pool.

Your muscles should be able to pick right up where they left off, right? Maybe not…

Do Muscles Retain Memory?

We all know the main benefits of exercise: fat and weight loss, building and toning muscle, lowering cholesterol and the risks for other diseases. However, there are also some little-known facts and benefits of exercise that make a big impact, such as improved cognitive functions, reduced depression and anxiety symptoms, sleep quality and even skeletal muscle function.

Although the benefits of exercise are seemingly endless, scientists and medical researchers are still puzzled with just how much regular and consistent exercise positively impacts skeletal muscle functions, and particularly the memory of muscle functions.

In fact, studies have shown that high-intensity and regular, consistent training results in many physiological, structural, biochemical, and transcriptional changes, although many of these changes aren’t permanent after a period of rest from training.

In contrast, other research has shown that regular, consistent, and repetitive exercise and training is often lost if and when an individual stops exercising, leading to the theory that skeletal muscles don’t retain memory.

What the Studies Show

A medical research team at the Karolinska Institutet in Sweden studied the impact of endurance training on the physiological, structural, biochemical, and transcriptional changes of skeletal muscle memory in endurance and high-intensity training.

As a part of the study, researchers recruited 23 individuals to participate in the study over a three-month period and a nine-month period respectively.

The first three-month training period, one leg underwent significant training. After nine months of careful study, 12 out of the 23 participants participated in a second training that involved training both legs.

After performing a biopsy from both legs before and after each training session, it was concluded that muscle cells represented approximately 3400 genes differently as a result of endurance, training, and exercise.

Data Analysis and Discovery

The data output and analysis of this study showed that the outcome of the performance tests conducted were collected at different points throughout the study. The trained leg that went through training through both time periods was compared with the untrained leg.

Although there were a number of transcriptional changes as a direct result and impact of exercise, after a nine-month period of no training or exercise, those specific exercise and training-induced differences were no longer present in the trained and untrained legs, leading medical researchers and biologists to believe that skeletal muscle cannot retain memory.

Authors of the study explain, “Although there were several differences in the physiological and transcriptional responses to repeated training, no coherent evidence of an endurance training-induced transcriptional skeletal muscle memory was found.”

Nothing Tastes as Good as GENES Feel…

Skeletal muscle is highly adaptable to different environments and conditions, such as regular, consistent endurance and even high-intensity training. In the study discussed, as well as many others, individuals who participate in regular exercise have a particular gene present in their skeletal muscle tissue.

The presence of this gene has piqued researchers’ interest levels, and their studies and persistent research have shown that this gene can be regulated with different variations of training.

This conclusion also shows that the presence of this gene is also associated with proteins, which are also present in the post-training skeletal muscle tissue.

Regular and consistent exercise actually changes the activity of the gene, promoting the development and presence of new proteins. Now, you would think that the proteins released by the gene would remain dominant and present even throughout a rest period, or a period without consistent training. However, studies are showing quite the opposite…

Anyone trying to get on the weight loss and fitness train have likely heard the motivating quote, “Nothing feels as good as skinny feels” to help them maintain discipline in eating right, dieting, and exercise. And although those skinny “genes” feel great after months and months of rigorous, highly intensive training, we may understand just really what happens with our “genes” when we give up exercise.

If we give up on exercise and forget all of our hard work and diets, those skinny “genes” become a distant memory – both on the inside and the outside.

In the End, We Are All Different…

Although extensive studies and research have been dedicated to the study we outlined above, the truth is that a global study has yet to be conducted. With that fact to consider, it is possible that other individuals who follow the same training and endurance track followed by a long-term period of rest may find that their muscles do “remember” a training sequence, making it easier to pick back up where they left off.

However, there is also a lack of studies and research that thoroughly investigate the results of consistent, regular training in the same individual.

All in all, these situations have gained the interest of medical researchers, biologists, and scientists, and we can certainly expect to see more time, information, and long-term research being dedicated to this theory.

The Science Behind Skeletal Muscle Memory and Exercise

World lagging behind on global health targets, researchers warn

Substantial change will be required in the way global epidemics such as tuberculosis and HIV are treated if the international community is to eliminate them completely by 2030, a study has found.

According to the report, published in the Lancet, nocountry has met any of the nine global health targets – including the elimination of major disease epidemics and the reduction of health issues like childhood obesity and intimate partner violence – laid down as part of the UN’s sustainable development agenda.

The study provides the first independent analysis of performance on sustainable development goal three, which calls on the world to “Ensure healthy lives and promote wellbeing for all at all ages”. The health SDG is one of 17 universal goals that replaced the millennium development goals (MDGs) after they expired at the end of 2015. Health-related indicators are present in 12 of the 17 goals, which have a 2030 deadline and consist of 169 targets and 230 indicators.

“This paper on the SDGs represents a baseline that informs health policy and decision-makers in all countries, as well as the UN,” said Dr Christopher Murray, director of Seattle’s Institute for Health Metrics and Evaluations (IHME), which led the study.

“It is essential that each year, over the next 15 years, nations be held accountable for the goals their leaders have committed to meet. This report contributes an important element to that accountability.”

Using data compiled by the Global Burden of Diseases, Injuries and Risk Factors study between 1990 and 2015, IHME researchers rated the progress of 188 nations on a score of 0-100. Their aim was to help governments, donors, health professionals and policymakers better identify successes and gaps in global healthcare delivery.

A median health-related SDG index of 59.3% was established, with countries in the highest quintile (over 71.5%) clustering in western Europe, high-income North America, and parts of Asia and Australasia. Iceland, Singapore and Sweden ranked highest overall; Iceland scored 85.5%, thanks largely to tobacco controls and a well-established public health system.

The bottom three countries – Somalia, South Sudan and Central African Republic – were all in Africa. Central African Republic scored 20.4% overall, recording 0% for hygiene, 2% for water, and 3% for malaria indicators.

Even developed countries, including the UK and US, did badly in certain areas. The UK, though fifth overall, fared poorly on childhood overweight, HIV and harmful alcohol consumption. The US scored far worse, ranking 28^th overall, a result shaped partly by deaths due to interpersonal violence and suicide. The US also ranked poorly among high-income countries on maternal, child and neonatal mortality.

A number of countries did better than expected between 2000 and 2015, including Timor-Leste, Tajikistan and Colombia. Others, including Syria and Libya, fared extremely badly, due to war.

The report also indicated that rapid economic growth alone did not necessarily make countries meet targets better. India came 143rd of the 188 countries included in the study, behind Comoros and Ghana.

“Our study is a starting point for further investigation on how and why countries are underperforming, or performing well, compared to the average,” said Professor Steven Lim of IHME, one of the report’s authors.

“This will be an annual effort to ensure progress is maintained and that lessons from successes are learned and rapidly transferred to other countries where progress is less impressive.”

The data showed varied progress among nations. More than 60% of countries have already met the 2030 targets on reducing maternal mortality (less than 70 deaths for every 100,000 live births) and child mortality (25 deaths per 1,000 live births).

But no country has met – or is likely to meet – the goal to completely eliminate tuberculosis or HIV by 2030. The authors warned that a “substantial change” in the current trajectory of HIV and tuberculosis indices, as well as “major technological leaps coupled with universal delivery”, would be required to meet the deadline.

Researchers developed a socio-demographic index in order to differentiate progress made on the SDG index from progress that countries would have been otherwise expected to make. Based on income per capita, educational attainment and total fertility rate – key indices of a country’s development status – the index was highly predictive of health-related SDG indices. But it failed to predict interpersonal violence, self-harm and childhood obesity, with the authors warning that more research is required to understand what helps or hinders progress in such cases.

Devi Sridhar, professor of global public health at the University of Edinburgh, said that the SDGs may be more useful to donors and aid organisations than poor countries, warning that “global priorities risk over-riding local concerns and priorities”.

“Governments find it a tricky balancing act to manage pleasing donors with what their citizens are calling for, and ensuring that they are paying particular attention to marginalised communities who might have even specific needs to be met,” she said. “In the end, governments should be responsible to their communities rather than to external entities.”

World lagging behind on global health targets, researchers warn

Lyme Disease Could be Hiding behind a Dementia Misdiagnosis

Dementia is one of the most common medical complications that older adults face. In fact, 33 percent of seniors die as a result of Alzheimer’s or dementia. Therefore, it is no wonder that physicians immediately suspect dementia when people 65 or older begin to exhibit certain issues such as foggy memory and mood changes. However, as a case involving songwriter and actor Kris Kristofferson recently showcased, it is not wise to simply accept a dementia diagnosis without looking into other health problems that cause similar symptoms.

An in-depth interview with Rolling Stone recently revealed that Kristofferson had been erroneously treated for dementia for several years. During this time, his cognitive issues continued to worsen, including brain fog, being unable to keep track of conversations and constantly forgetting the names of people around him. Problems of this nature are commonly associated with dementia, so it took a long time for a doctor to question whether or not Kristofferson had been diagnosed correctly. After a test for Lyme disease, it became clear that the songwriter had never had dementia at all.

Unfortunately, the treatment that Kristofferson received for dementia actually caused a lot of his health issues. This showcases yet again why it’s so important to secure the proper diagnosis. According to Kristofferson’s wife, Lisa, it only took three weeks of being treated for the proper condition for him to recover a lot of his previously missing cognitive skills. Therefore, always ask questions, especially when you are faced with such a serious, life-altering condition. Remember that you do have other options, and it is vital not to blindly start any new treatments without doing some research first.

At least 300,000 people in the U.S. are believed to currently have Lyme disease, but the CDC has confirmed that cases are underrepresented due to issues such as a misdiagnosis. It is likely that many people do not get diagnosed because the earliest symptoms of Lyme disease, which include headaches, muscle pain, swollen lymph nodes, chills, joint pain and a fever, are often blamed on influenza instead. If you have any combination of these symptoms with a rash, though, it is imperative to go to your doctor right away and get checked for Lyme disease.

Infected ticks spread this medical condition, and it is surprisingly common for someone to be bitten without being aware of it. If Lyme disease goes untreated, the symptoms will progressively get worse. New issues such as irregular heartbeat, short-term memory problems, joint pain, Bell’s palsy and neck stiffness may appear within a few weeks or months of the tick bite.

Of course, the CDC recommends using an insect repellent that contains permethrin or DEET for protection against ticks. As we all know, this is akin to purposefully poisoning yourself with a neurotoxin. However, even the CDC has acknowledged that certain natural products can keep ticks from biting you. The best natural option appears to be oil of lemon eucalyptus, which has been proven to be effective for up to six hours. As we’ve previously reported, you may also receive the same level of protection by utilizing essential oils.

Although studies have shown that at least 300,000 Americans have Lyme disease, only 30,000 new cases are reported each year. In other words, the diagnosis rate is approximately 10 percent. This highlights how under-diagnosed this medical condition truly is and how critical it is to go to the doctor if you have any reason to believe you are experiencing the symptoms of Lyme disease.

Sadly, if you have been diagnosed with Lyme disease, you can expect a rough road. No one is ever cured of this medical condition, but there are several natural things you can do to help improve your quality of life. Mindfulness meditation is a great place to start. If you combine this with having a dietitian tweak your diet, it is possible to minimize flare-ups.

Author Bio

Jade Rich currently works at a Skilled Nursing Facility and Inpatient Rehabilitation Center. Her primary focus is providing elderly care, and she has worked with several dementia patients. Jade enjoys researching new medical information, and she was fascinated by Kris Kristofferson’s case and what it might mean for future dementia and Lyme disease diagnoses.

Lyme Disease Could be Hiding behind a Dementia Misdiagnosis

Cancer Council unaware tobacco giant behind FOI request on child smoking habits

Cancer Council Victoria says it had no concept a British American Tobacco worker was behind a freedom of details request for information on the tobacco use and acquiring habits of 1000′s of school children.

For the past 30 years, the council has surveyed youngsters aged among 12 and 17 about their age, gender and location, accessibility to income, alcohol and tobacco consumption and getting habits, and preferred brands.

The director of the Victorian Cancer Council, Todd Harper, stated a attorney had requested the survey information underneath the Freedom of Information Act, but the request was rejected since it was not in the public interest to release it.

Relevant: Australian teens major charge in eschewing consuming and smoking

It was not right up until Fairfax Media reported the lawyer had appealed towards the determination to Victoria’s Civil and Administrative Tribunal, that the council became mindful the attorney was an employee of the tobacco giant, Harper said.

“We had no idea that British American Tobacco was behind the request,” he said. “All we knew was it was an person from a law firm who wanted the information. I’m disappointed that the tobacco firm wasn’t upfront about its involvement.”

Harper stated the council was concerned that, as soon as manufactured public, the data could be utilized by tobacco and alcohol firms to acquire insight into the purchasing and drug consumption routines of younger folks, as nicely as the varieties of brand names that appealed to them.

The information is utilized by the Cancer Council to assist it recognize exactly where and how to direct publishing health messaging, as effectively as for scientific scientific studies. When mothers and fathers consented to their young children finishing the survey, the did so believing the information would be used only in the curiosity of public health, Harper explained.

Fairfax Media also exposed that the identical attorney utilised the Freedom of Information Act to get info from surveys of adult smokers in that state, which integrated queries about their attitudes toward smoking.

“The Cancer Institute NSW was compelled to give tobacco survey information requested underneath the NSW Government Info [Public access] Act,” its chief cancer officer, David Currow, told Fairfax.

A spokeswoman for British American Tobacco advised Guardian Australia the Victorian data request “wasn’t about children”.

“This is about plain packaging,” she stated. “We did not look for any individual data or info in respect of youngsters. We’ve asked for figures by way of a standard freedom of info request because we want to discover out if plain packaging, a measure introduced with out evidence and that straight influences our business, is possessing the effect the Australian government claims it is.”

In a globe very first, Australia passed plain packaging legislation in 2011, requiring all cigarette packaging to be stripped of marketing and branding, apart from the organization name and health warnings. All tobacco now comes in olive green cardboard containers with graphic overall health messages.

In a series of papers published by the Cancer Council in the BMJ journal Tobacco Control in March, plain packaging was related with an enhance in the variety of men and women pondering about quitting and trying to quit. The investigation also identified kids aged in between twelve and 17 found standardised packaging much less attractive.

An appeal date for the freedom of details request is nevertheless to be set.

Cancer Council unaware tobacco giant behind FOI request on child smoking habits

The Complex Story Behind Yet Another Disappeared Write-up At A Best Heart Journal

As soon as once again the European Heart Journal has “unpublished” an write-up without having any discover of retraction or explanation. Strangely, the article– Russian science via the prism of intelligence: is fraud even now achievable?– can still be viewed (at least for now) with a vestigial URL , but it can not be found via the typical channels on the journal internet site. The pages for the story on PubMed and the EHJ site now state: “This report has been temporarily removed.”

The article was very first posted on October 13, 2013. The writer is Alexander Kharlamov, a researcher who formerly worked in Russia and who now resides in the Netherlands. In December  2013 Kharlamov noticed that the report was no longer on the EHJ site. In response to a query he received the following response from the journal’s editor, Thomas Lüscher:

Dear collegue,

As this viewpoint raised a storm inside the Russian Society of Cardiology and the ESC, the ESC and its management Committee decided to give the President of the RSC to create a viewpoint ob behalf of the RSC. Until we recieve this piece, we are hiding your post. Once recieved the two viewpoinrs will be avialable on-line.

Very best regards

Thomas F. Lüscher, MD, FRCR

To date the EHJ has not published a response from the RSC (Russian Society of Cardiology) or republished the Kharlamov write-up.

Initially, this incident seems to reek of politics. Certainly, 6 months later on, in a subsequent letter to Kharmalov about the continued absence of the paper, Lüscher wrote:

I hope you recognize that the EHJ does not want to be involved in politics. We are a scientific journal and are pleased to discuss problems close to it, but we will never interfere beyond. I hope you can comply with this strategy of us.

A Difficult Story

But a much more cautious examination of the unique post leads to the suspicion that this story is a bit more complicated and raises questions each about the internal peer review method at the EHJ and about the original paper. Quite just, the Kharmalov paper is a mess, in critical need to have of editing and peer overview, if not significant surgical procedure. Some of its points seem to be really worth consideration: cardiovascular wellness in Russia is a nationwide disgrace, funding for investigation is overshadowed by funding for the intelligence services, and cardiovascular research has misplaced prestige in the submit-Soviet era.

But other statements are very problematic. What, for instance, does this statement indicate?

Russian science faces the issue of fraud in one more dimension, a dimension of the counteraction to the national governmental authorities, and specifically the Federal Safety Service (FSB formerly the KGB).

The following passage is particularly dense, and prospects to the inevitable suspicion that Kharlamaov is at least partly motivated because his very own investigation into “theranostics of atherosclerosis employing uniform multifunctional noble metal nano particles,” what ever that could suggest, has not been properly acquired.

The Russian government is significantly far more concerned with concerns of nationwide security, and not with the wants of the population or with biomedicine.

Every single single discovery, for instance in biomedical industries or nanotechnologies, right away gets a national treasure. The ideal illustration of such restrictions is presented by the classified outcomes of NANOM studies4,5 in Yekaterinburg (Russia). The group at the Ural Institute of Cardiology has identified a new method for theranostics of atherosclerosis using uniform multifunctional noble metal nanoparticles. Near-infrared optics and plasmonic photothermal treatment are capable to replace traditional strategies of imaging and management of atherosclerosis, such as percutaneous interventions and coronary artery bypass surgical procedure. Scientists in Yekaterinburg can’t exchange the raw data with other colleagues abroad simply because of limitations issued by the Russian federal authorities.

Right after studying this kind of a passage the inevitable query to request the journal is: did any person really read this paper prior to publishing? Was it peer reviewed?

It shouldn’t need to be stated but the time for peer review is ahead of publication, not after. The EHJ would have been properly justified in rejecting the post or demanding main revisions. But by publishing the post and then removing it with out explanation or a retraction the journal doubles its culpability, since it now seems to have a seriously flawed editorial process and it appears to have yielded to political pressure.

As I described at the prime of this publish, the EHJ has removed articles or blog posts before without observe or explanation. The earlier incident is very distinct however. You can go through my coverage of that incident here and here.

The Complex Story Behind Yet Another Disappeared Write-up At A Best Heart Journal

Talking about mental wellness: "So considerably of this is behind closed doors"

When he was 22, Chris Gethard thought each and every day about killing himself. He considered about it so usually that sooner or later it didn’t even feel weird any a lot more. Then, one day, he pulled his vehicle more than to the side of a bridge. He was ready to jump.

Alternatively, Gethard known as his ex-girlfriend, who advised him he had to get aid immediately, and that if he did not by morning, she would get in touch with his mother. Gethard had told his dad and mom he was acquiring aid at Rutgers, but once he acquired residence, he informed his mom that this was a lie, and that he was really depressed all the time.

That was 11 many years in the past. Gethard is now 34, a skilled comedian at the Upright Citizens Brigade Theater and on tv demonstrates like Broad City. He’s a single of the fairly lucky ones. That evening on the bridge – and later, when he was diagnosed with bipolar disorder – his mother and father had well being insurance coverage that covered him. Now, he is ready to shell out out of pocket for a therapist of his deciding on, although he’s wholesome enough that he barely feels the need for their bi-weekly meetings. And in the approach of his own recovery, since of the several obstacles to acquiring the most fundamental degree of psychiatric care in the US, he’s grow to be a remote caregiver for other individuals struggling with their personal psychological illness.

America’s psychological overall health care crisis: crucial facts, day 3

Final 12 months, an anonymous stranger posted on the Tumblr webpage for a cable accessibility show that Gethard hosts, and explained they were suicidal. Gethard responded quickly with more than 6,700 words in which he detailed some of his personal darkest moments. In the first six months soon after the post went on the web, he could barely preserve up with the deluge of emails he received. Now, each couple of days, he gets a message from other strangers who credit him with helping them.

It’s “shocking and heartbreaking”, Gethard says, to see so many people reaching out to him just since of his response to a single anonymous particular person.

“It just exhibits how behind-closed-doors so a lot of this things is, and how men and women are a lot more comfy reaching out anonymously to a largely unsuccessful comedian, rather than speaking to their personal parents or friends or doctors,” Gethard told the Guardian. “It was actually sort of sad when I recognized that.”

Gethard’s post is nevertheless 1 of the best results if you search the web for his name – or for a morbid cocktail of phrases such as “suicide” and “Tumblr”.

“There are so many places you are supposed to be in a position to go talk to a person about this things, if you happen to be feeling it, but I received so several messages from men and women who explained it was the initial time they talked about it with anyone – and it was me.”

The people who adhere to the guidance Gethard provides them – which is always: speak to someone – are frequently faced with a number of obstacles in the way of truly obtaining the most basic sort of mental overall health care: seeing a therapist.

Chris Gethard, at home in Brooklyn, New York. Photograph: Raya Jalabi/The Guardian

While the Inexpensive Care Act manufactured some modest steps in the direction of removing the roadblocks to psychiatric care – and the Obama administration has, far more lately, issued new rules that have also had an effect – it did not repair a chaotic financing program that discourages therapists from accepting insurance and can make it tough for several people to get therapy they require.

If the men and women who reach out to Gethard finish up looking for care – and are lucky adequate to have insurance – there are still standard hurdles that can discourage an previously vulnerable particular person.

“The inefficiency of the American overall health care technique puts a unique burden on mentally unwell individuals, because they are significantly less ready to cope with the complexity and discover the care they need to have,” says Dr David Spiegel, a professor and associate chair of psychiatry and habits sciences at Stanford University’s school of medication.

Even the vital first phase of searching for a therapist is not as simple as picking and choosing from dozens of insurance organization-trusted physicians.

Personal insurers are known for delivering listings of in-network therapists that contain mental well being clinicians who are, for any quantity of other causes, not obtainable to provide treatment in the place at which they are listed: some have moved, other individuals retired in rare cases, they’re still on the checklist even right after they’ve died. These so-referred to as “phantom networks” of mental health specialists imply that finding an in-network therapist can involve a process of rejection and confusion that might last for days or even weeks.

“If a good deal of the psychologists and other psychological overall health specialists depart the network, sufferers can not find the care,” says Alan Nessman, senior particular counsel at the American Psychological Association. “It saves the firm in not only paying out decrease charges, if individuals can not entry care, that really saves the organization cash and is horrible for the mental health shoppers.”

Psychiatrists are, increasingly, leaving the insurance coverage networks – all of them – and choosing to accept cash only. A December 2013 examine showed that 55.three% of psychiatrists take insurance, in contrast to 88.seven% of other physicians.

A important part of this trend is the influence insurance coverage firms wield more than mental overall health care, an influence that leads therapists to think about not accepting insurance so they can operate in an surroundings that offers much more money for significantly less problem.

Insurance acceptance costs – chart

Insurance coverage firms have greatest energy in excess of a clinician’s advised care strategy and carry out utilization reviews to figure out if the program is of “medical necessity” to the patient – who, of course, they have never met.

“Nowadays, a number of companies identify that most psychological overall health care will take spot inside of specified parameters, so they may allow it go for ten, twenty sessions, then the management kicks in: ‘You know, this individual has been seeing you for a while, and we believe they require much less care now,’” says Nessman.

Psychological overall health experts aren’t just overwhelmed by insurance business intervention they are, compared to their peers in other healthcare fields, paid much less, as well.

Doctor compensation by specialty – chart

In which principal care medical doctors invest an regular of 18.53 minutes with a patient, a talk treatment session typically runs 45 minutes to an hour, cutting down the quantity of individuals a therapist has time to see and the volume of cash they can make.

Also, reimbursement charges have a tendency to be reduced for psychological health solutions, providing clinicians small incentive to accept insurance over money payments that are considerably a lot more costly for a patient.

Therapists who pick to accept insurance have to personally file a lot more paperwork and make more verification calls to insurance businesses than physicians in other specialities, because therapists working private practices usually operate independently and really do not use workplace staff. So clerical duties, which are not billed, can get up hours of a clinician’s day. “There’s a whole lot of men and women who really do not get insurance since they really don’t want the headache issue,” says Dr Steven S Sharfstein, a former president of the American Psychiatric Association and president of the Sheppard Pratt Wellness Technique in Baltimore.

With a lot more therapists not accepting insurance coverage, there are fewer choices for folks who can not afford to spend out of pocket. There are a good deal of men and women like that. There are also a whole lot of men and women who really do not have insurance and can not afford to shell out out of pocket – that is why the majority of mental well being solutions are publicly funded.

But possessing the cash to get support does not guarantee you will be able to find somebody to offer it. The Inexpensive Care Act will give much more men and women accessibility to mental health remedy, but there nevertheless will not be enough clinicians to deal with them. Far more than 77% of US counties have a severe shortage of mental well being experts, according to a 2006 UNC study.

Unmet want at county degree – map

Alan Ellis, a researcher on the research, says that demographic shifts in the surveyed counties and the influence of the recession on the workforce could have affected the numbers because the analysis was performed. “These elements notwithstanding, we suspect that the general picture these days is similar to what it was in 2006,” Ellis says. Stanford University’s Spiegel says if the therapist shortage continues, “there will be much more folks beneath-diagnosed and untreated for significant psychiatric disorders that are treatable.”

The result of the shortage of therapists, and of the comparatively minimal amount of therapists who accept insurance, is particularly negative basically because of the nature of mental well being remedy. Every single doctor-patient relationship needs some degree of trust, but people with mental sickness can frequently have some trouble trusting individuals, and therapy can require them to open up to a stranger about the most intimate details of their lives. That means finding a therapist with whom they truly feel comfortable, a hard task when there are so few to start with.

“You’re speaking to the person about yourself, the things that are crucial to you, the things that make you vulnerable, that you could truly feel concerned about, that you might truly feel ashamed about, that you don’t know how to handle – all kinds of factors where you may have negative feelings about the issues you are talking to the particular person about,” says Dr Lynn Bufka, a clinical psychologist and APA’s assistant executive director for practice, research and policy. “You require to trust that they are going to hold people ideas supported and risk-free.”

Gethard’s partnership with his very first, in-network therapist was a lot more clinical than he desired, but it was his only selection at the time. Gethard was taking medication he named “life changing” and, with treatment, was feeling the greatest he had in a even though, so he accepted a three-month tv task in LA. When the work was extended, another good results, his therapist informed him that he couldn’t prescribe the medicine in California and that if Gethard wasn’t coming to see him, he couldn’t support him.

America’s mental health crisis: join the conversation

Gethard returned to the north-east, told the therapist he did not trust him, and asked to be weaned off the medication.

3 years later on, he had a three-day panic assault. A friend’s father, who worked at a mental wellness hospital, assisted him uncover a physician on day three. This time, it was an individual he trusted.

For the previous 7 many years, he has paid out of pocket for an out-of-network therapist he likes. It charges him about $ 350 a month and he is grateful that he is fortunate adequate to be able to afford that. He pays for medication with a prescription insurance plan.

“I appear back on that and think that’s actually a shame – to hit a breaking level where I knew I required assist and then to ultimately seek it out only to locate it out, in northern New Jersey … There’s most likely countless numbers of physicians, but since of the healthcare program, I only have a number of limited alternatives and they had been with men and women who produced me feel unpleasant.”

That might clarify why 1000′s of men and women – a lot of of whom admit they’d not heard of him just before – flip to Gethard when they’re seeking for someone to speak to.

To every particular person who sends him a message, and each and every fan who approaches him following a display, Gethard says that if they can talk to him, they can talk to a family member, friend or therapist.

“It’s almost certainly the point I am most proud of, that I have turn out to be somebody men and women turn to for help and that I’ve taken time to provide it, but it also tends to make me actually unhappy that I am an individual folks turn to,” Gethard says. “Because I am a really, quite reduced-level comedian that 99.9% of the population has never heard of and when I initial place stuff out there it was out of necessity.”

Talking about mental wellness: "So considerably of this is behind closed doors"

Care for people dying in hospitals: the information behind the audit final results

There is a “substantial variation in the common of care for people dying in hospitals” across England, according to the results of a new audit which calls for ‘widescale improvements’ in finish of daily life care.

Health Editor, Sarah Boseley writes:

Fewer than half of NHS individuals who were in their final hrs or days have been informed that they had been dying by hospital personnel, according to a critical report from the Royal University of Doctors (RCP), even though a significant variety of households and family members are left feeling they have no emotional support.

The report also highlights the continued lack of professional palliative care at weekends, ten many years on from Good recommendations that it ought to be provided 7 days a week.

The National Care of the Dying Audit for Hospitals, led by the Royal School of Physicians (RCP) in collaboration with the Marie Curie Palliative Care Institute Liverpool (MCPCIL) was funded by Marie Curie Cancer Care and Public Well being England. The report states:

Although each patient has diverse requirements, and some will want far more ache relief than others for instance, there should be no variation in the quality and provision of companies, or coaching in the care of men and women dying in hospitals. The audit displays that key enhancements want to be created to guarantee far better care for dying men and women, and greater assistance for their households, carers, pals and those critical to them.

About half of all deaths in England happen in hospitals according to the Workplace for Nationwide Statistics (ONS). The audit found that despite longstanding nationwide suggestions from the National Institute for Health and Care excellence (Wonderful), only 21% of hospital websites had accessibility to encounter-to-encounter palliative care providers 7 days per week. 73% presented encounter-to-encounter palliative care services on weekdays.

Only 28% of trusts had techniques in spot for mandatory training for nurses in care of the dying and only 19% for medical doctors. The audit recorded that 82% of trusts provided some kind of coaching in the prior yr, whilst 18% had not presented any. Practically half (47%) of Trusts did not have a named board member with accountability for care of the dying.

It also identified that 87% of individuals had documented recognition that they had been in the final hours or days of daily life, but discussion with sufferers was only documented in only significantly less than half (46%) of those considered capable of discussing this. Communication with families and close friends was recorded in 93% of cases and on average, these discussions occurred 31 hours prior to death.

27% of the participating trusts undertook a nearby survey of bereaved relatives: of individuals finishing the questionnaire, 76% reported getting quite or relatively concerned in decisions about care and therapy of their household member. Practically a quarter, even so, did not come to feel they were involved in decisions at all.

63% of respondents said that the all round level of emotional assistance provided to them by the healthcare crew was very good or exceptional, although 37% considered it was honest or poor. General, 76% mentioned they felt adequately supported in the course of the patient’s last two days of existence, practically a quarter did not.

Other crucial findings from the audit are below:

• Only 21% of patients capable of getting the conversation have been asked about their spiritual needs, and only 25% of family members/carers asked about their own demands


• Most individuals (63-81%) had medication prescribed ‘as required’ for the five important signs typically seasoned close to the end of life: discomfort, agitation, noisy breathing, problems in breathing, nausea and vomiting. Not all patients require the medication and in the final 24 hours of daily life 44% acquired discomfort relief and 17% medicine for shortness of breath


• 59% of individuals were clinically assessed to see if they essential artificial hydration, but discussions with the patient was only recorded with 17% of individuals capable of discussing it. The circumstance was discussed with far more than twice as numerous (36%) family members and buddies. Artificial hydration was in location for 29% of sufferers at the time of death


• 45% of patients were clinically assessed to see if they needed artificial nutrition, but discussions with the patient was only recorded with 17% of individuals capable of obtaining the conversation. The situation was discussed with 29% of relatives and pal. Artificial nutrition was in location for seven% of individuals at the time of death


• Only 47% of Trusts reported having a formal structured procedure in location to capture the views of bereaved family members or close friends prior to this audit

What did the audit assess?

The new audit evaluated:

• The quality of care received right by 6,580 individuals who died in 149 hospitals in England among one Could and 31 Could 2013. This was done by reviewing the case notes of a sample of sufferers and is not the total variety of individuals who died in hospital throughout this time. The audit only covered expected deaths


• Outcomes from questionnaires completed by 858 bereaved relatives or close friends, asking about the treatment method of their relative, their involvement in determination producing, and the assistance accessible to them. The questionnaire was distributed by some hospitals concerned in the audit, and the benefits have been aggregated nationally


• The organisation of care which includes availability of palliative care services, numbers of staff, instruction, and responsibilities for care.

The table below displays the final results of only three of the clinical audit important performance indicators (KPIs) employed in the NCDAH audit. You can see the info by hospital believe in, they are listed in alphabetical order. You can find full table of the outcomes which includes each clinical and organisational KPIs final results by hospital trust in the downloadable spreadsheet.

Download the data

• Information: download the total spreadsheet

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Care for people dying in hospitals: the information behind the audit final results

Ban Ki-moon puts UN bodyweight behind Guardian-backed FGM campaign

The UN’s secretary general, Ban Ki-moon, has mentioned he will use the scope and influence of the United Nations to advertise a Guardian-backed campaign which aims to increase international efforts to carry an finish to FGM.

In a meeting with the 17-12 months-old Bristol student Fahma Mohamed, the face of a campaign to place education at the heart of tackling FGM in the Uk, Ban explained he would back the Guardian’s move to support similar grassroots campaigns led by neighborhood media in other nations.

Praising the Guardian’s “inventive and courageous” campaigning journalism, he mentioned: “For me this is the way journalism can make a distinction. Whatever the UN can do to support the campaign we will spare no efforts.”

Final week the training secretary, Michael Gove, met Fahma and other members of the anti-FGM charity Integrate Bristol at the Division of Education and agreed to write to every single major and secondary headteacher in the nation, drawing their focus to safeguarding recommendations and providing distinct information about FGM. The campaign is now set to move on to the global stage, with hopes that its profitable campaigning model, which harnessed classic and social media and activism, can be replicated in other countries.

Ban Ki-moon puts UN bodyweight behind Guardian-backed FGM campaign

What is the man behind the 5:2 diet program going to consume next?

His programmes, generally in the Horizon strand, have also carried out a lot to popularise the idea of “self-experimentation” – when the doctor carries out the process himself.

Mosley’s latest such venture, which hits our screens tomorrow night, is not for the faint-hearted, and surely not for these nevertheless consuming their evening meal. Michael Mosley: Infested! Living With Parasites includes our man travelling to a backstreet abattoir in Nairobi, Kenya, in purchase to consume some beef infested with the cyst of anything called Taenia Saginata. It is very as disgusting as it sounds – especially when Mosley later on swallows a small camera to see that the cyst has created into a fully fledged metre-lengthy beef tapeworm, swimming around in his reduce intestine. It seems to be like an elongated piece of tagliatelle jiving for the camera. Fortunately, the tapeworm is killed off with a pill prior to it is permitted to full its journey by means of Mosley’s intestine.

“The producer, and the researchers at Salford University were very keen, but my wife was very unkeen,” he admits. “It was when I commenced speaking about ‘nocturnal emissions’ that she mentioned ‘no’.” (Weak-stomached readers, seem away now.) “They generally crawl out in the middle of the evening.”

I am relieved to hear that his wife, Clare, though a practising GP, who even provides him suggestions for programmes, will put her foot down. “My wife vetoes some of the far more insane tasks. She vetoed the thought of infesting myself with pubic lice,” he says. At this point I squeal in horror. “They would have been on my arm,” he says, a touch defensively.

To be honest, the programme does reveal fascinating details about how parasites unlock the secrets of evolution. For instance, entire body lice, which are located only on humans, not on apes, produced only 100,000 years in the past in response to homo sapiens adopting clothes.

But even though Mosley’s willingness to do the most disgusting or intense issues for our enjoyment makes for very good television, does it not often flirt with gimmickiness?

“This is almost certainly as far as I would go,” says Mosley, who is a trained medical doctor. “But it had a purpose. I was genuinely contributing to a piece of research, which is essential to me. Normally speaking, almost everything I do has a significant basis to it.”

It is also, occasionally, quite profitable. His most well-known task, of program, was the 5:two diet plan, which demonstrated how you could lose excess weight, excess fat and – possibly – elongate your existence by “fasting” on two days of the week, eating usually on five.

Mosley, once again, undertook the experiment himself. He anticipated the show on intermittent fasting to, like most programmes, make a “few ripples” or even “disappear without a trace” – mostly due to the fact it was broadcast throughout the summer season of 2012, on the evening of the Olympic 200m ultimate starring Usain Bolt.

Yet the concept “has continued to resonate in the most unlikely way,” in element – he gratefully admits – thanks to The Day-to-day Telegraph commissioning him to publish an article the week it aired. “That was the very first time I utilized the phrase ’5:two diet’. And I feel that is what kicked it off.” And in what fashion. The spin-off books have sold more than one particular million copies and been translated into 32 various languages, even though half the nation seems to have become a Mosley disciple. “It is genuinely wonderful. I enjoy it,” he says. “People end me and tell me how effectively they are carrying out on it.”

He has kept with it, shedding a stone and half and ridding himself of the shadow of diabetes, which aided to destroy his father at the age of 72. Nonetheless, he did drop the diet when sharing his intestine with a tape worm. A note to his fasting devotees, however: it is a myth, he adds, that the parasite acts as a diet regime aid, despite rumours that Maria Callas, the opera singer, swore by the method.

The royalty cheques for 5:2, he insists, are not that tremendous. “I am not going to be buying a yacht with them,” he says. “At the moment, we are making an attempt to see if we have enough funds to put the deposit down for a flat for our eldest little one. It is that boring and pathetic, I am afraid.”

You can inform that riches have not gone to his head, or definitely not his wardrobe – he turns up to our interview in a shirt with a frayed collar, a battered pair of trousers and scuffed shoes. However he enjoys the “showboating” factor of presenting television programmes, for him the joy is in influencing the scientific debate, not currently being on the front cover of Radio Instances.

At 1 stage of his daily life Mosley even flirted with the thought of the priesthood. “I come from a prolonged line of religious people, specifically on my mother’s side, bishops and missionaries, so I was fairly religious until finally I was about twenty,” he says. “I spent a whilst on [the island] Iona and other Christian communities. I was browsing for God, then I didn’t uncover God – or at least God didn’t find me.” Nonetheless, he says he “doesn’t disbelieve” and is fascinated in the position that faith – and the placebo effect – has in healing men and women.

In the occasion, he went a quite various route. Following PPE at Oxford, the degree selection of David Cameron and Nick Clegg, Mosley grew to become a City banker, ahead of becoming bored and retraining as a psychiatrist, but only practised briefly. He ended up as a researcher and then a producer of tv programmes.

Becoming a presenter only came about because he could not locate somebody to front a programme about the historical past of medicine that he was building, so he did it himself.

Because he 1st stood in front of a camera much less than a decade in the past, he has gone some way to popularising medical analysis. “Brian Cox has made physics attractive, and I would hope the stuff I do encourages some men and women.” He surely has a Tiggerish enthusiasm, which not only makes him an engaging presence on screen, but also restless – continually on the hunt for a new undertaking.

His two large passions are diabetes and dementia – “the two are intimately intertwined” – and he is curious as to regardless of whether carrying out The Telegraph crossword has any position to perform in maintaining his brain lively. “There is some excellent evidence. Anyway, I like carrying out the crossword and Sudoku.”

The quick venture, nevertheless, is to bring property a new pet for the youngest of his 4 children, 14-12 months-outdated Kate, who shares his lack of squeamishness and desires to turn out to be the next David Attenborough.

She, he tells me, gleefully adopted the leech employed in the parasite programme (feasting on Mosley’s arm) and christened him Lenny. Sadly, Lenny the leech “ended up escaping his aquarium and being eaten by the loved ones cat”.

Mosley exhibits me the jar with Lenny’s substitute. Effectively, it is far better than a tapeworm, I suppose.

‘Michael Mosley: Infested! Living With Parasites’: BBC Four February 19 at 9pm

What is the man behind the 5:2 diet program going to consume next?

Smoking in vehicles: the hidden agenda behind the ban | Zoe Williams

‘It stamps into public lore an image that so fixates conservative opinion – that of the negligent parent.’ Illustration by Belle Mellor

I imply, really – who would not pick the interests of a youngster, in a auto, in excess of people of a smoker, wishing to smoke whilst driving? Young children are cute, whilst smokers are grey, stupid people who smell of 70s pubs. It really is a child protection problem, not a civil liberties issue – the rights of individuals who do not have a selection should come prior to these who are totally free to make idiotic alternatives at any time. This week’s free of charge vote in the Commons – 376 MPs voting for a ban on smoking in automobiles, 107 towards – underlined this: right-contemplating folks defend kids.

In reality, this is not about child safety or civil liberties. It is dressed up as a clash amongst those two titanic, so often oppositional, concepts but anybody with a passionate – or even reasonable – curiosity in either would have a lot far more pressing worries.

In perspective: secondhand smoke is implicated in 1 in 5 situations of sudden infant death. Because smoke is a lot more intense in a modest, enclosed area, it is logical to assume that babies are more endangered by smoking in vehicles than by smoking elsewhere.

Nevertheless, the smoking figures are virtually constantly in constellation with other variables – factors surrounding or inherent to the kid, from bad housing to low birth fat. Birth bodyweight is of course connected to smoking in pregnancy, but again other aspects, such as maternal education, age and class, have an effect. A study in Ohio discovered mould spores in the lungs of sudden infant death victims and midwives regularly say that mould is hazardous. Kia Stone, a young mother profiled in the Guardian’s Breadline Britain series 18 months ago, misplaced her daughter shortly afterwards. A huge mushroom was even now increasing out of the damp plaster in the bedroom when she received house from the autopsy.

No one even collects figures for mould as a chance issue – separate from damp and leaks. Bedrooms that are too sizzling are also a aspect, as is frequent home moving, and living in overcrowded conditions, B&ampBs or hostel accommodation. The connection isn’t created – presumably by way of sheer lack of interest – that buildings in which people can’t control the heating are often also scorching or as well cold.

Considering that the connection between sleeping position and sudden infant death was produced in the 90s, really small has been explained that is radical, simply because almost everything left to say issues difficulties considered to be “intractable” – which is shorthand for “connected to poverty”. We cannot blame the coalition for that attitude, which has obtained for years – but skyrocketing numbers living in squalid B&ampBs, or households moved repeatedly by councils and slung into flats a hundred odd miles away, in anticipation of the housing advantage cap? These are all charges the government is ready to shell out, without a doubt pays enthusiastically.

Secondhand smoke is also blamed for ear infections, meningitis, asthma and eczema. Malnutrition, for comparison, can trigger all these factors and fairly a lot every little thing else, indirectly, by putting children under constant physical (in no way mind psychological) pressure without a doubt, meals poverty in this nation, in accordance to David Taylor-Robinson of the University of Liverpool, has “all the indications of a public wellness emergency”, with hospital admissions as a end result of malnutrition practically doubling in the past four many years. Where are the Conservative MPs tweeting their humble calls for guidance about that?

Almost all the Tories so fervently towards smoking in cars are simultaneously quite sanguine about foodbanks. Six weeks ago nearly 300 MPs voted against a motion calling on the government to reduce dependency on emergency meals assist. It is challenging to observe, with out the alternative of yelling and swearing, how disingenuous this is, how slimy and mawkish for a government content to dwell with the concept of men and women residing in squalor, in fuel poverty, going hungry, all of a sudden to locate itself unable to bear the concept of a kid in a smoky car.

But even those who care about smoke and poverty – let us get in touch with them, for brevity, the opposition – want to be far more mindful ahead of they rush into this territory. The extent of in-automobile, little one-centric smoking is unknown. Its influence is unknown, there currently being no sensible way of figuring out regardless of whether a child acquired a particular condition from a home or a vehicle. This is the definitive contemporary non-situation, the phenomenon that sounds so undesirable we needn’t difficulty ourselves with how widespread it is.

It stamps into public lore an picture that so fixates conservative viewpoint – that of the negligent mother or father, the one particular who may possibly profess to care as much about their young children as you or I, but is just waiting for society’s back to be turned prior to smoking all more than them.

Who tends to make the ideal parent? The middle class, of program: in the suggestions loop of the bourgeoisie, their behaviour (breastfeeding, lengthy maternity depart and effectively-planned paternity leave) begets greater bonding, prospects them to care far more, which leads to even greater behaviour. (Well, it is apparent, is not it? Middle class folks in no way smoke all above their children in enclosed spaces – in the rather circular logic that comes about, as soon as “middle class” is synonymous with “accountable”, smoking at all makes you no longer authentically middle class.)

This is a narrative that runs in a straight line from the fascination with parenting courses (typically prescribed for dad and mom towards whom there is no case but poverty – as if failing to be rich enough have been in itself evidence of inadequacy in this area) to the dark, usually – but not constantly – tacit suggestion that some people only have children in the very first place for the kid advantage.

Progressive politicians have to consider it as a principle that mother and father really like their young children with the very same intensity irrespective of cash flow bracket, and they must make this principle the basis of their political exercise. They are trapped time and once more, by the apparently innocuous language of threat management, into positions that, created to demonise behaviour, in fact demonise a class.

Twitter: @zoesqwilliams

Smoking in vehicles: the hidden agenda behind the ban | Zoe Williams

Signed up and nonetheless uninsured: how Obamacare leaves consumers behind

Eve Campbell was established to beat the final-minute December rush, not for Christmas buying or airline tickets, but for Obamacare. With the 23 December deadline to sign up for health insurance coverage successful on New Year’s Day looming she completed her enrollment – or thought she did. 

“I did notice on the final computer screen it mentioned, ‘We will be sending you far more components,’” Campbell told the Guardian. “So I have been waiting for the materials.”

Although she waited, Campbell logged back onto the exchange hunting for – and not discovering – a way to do one final, extremely crucial factor: shell out for the coverage for which she’d signed up. Last but not least, far more than two weeks later, Campbell heard from her insurer, Empire Blue Cross Blue Shield.

“I acquired a letter on New Year’s Eve, and it explained: ‘Thanks for deciding on our plan but we nevertheless haven’t received your first premium payment,’” Campbell said. The letter included instructions to the insurer’s site in which payments could be created, and Campbell submitted hers that identical day.

Campbell is not the only person to efficiently total an application for well being insurance coverage via either the federal or a state exchange only to grow to be baffled by the Reasonably priced Care Act’s two-phase system. Shoppers store for coverage through a marketplace set up by the federal government or the state in which they reside, and then, when they think they are accomplished, they have to leap across the web to the internet sites of their personal insurers in order to spend their first month’s premium, without having which they are not truly covered.

In fact, confusion about this concern was so frequent that, days following Campbell submitted her application, insurers nationwide agreed to postpone the payment deadline from 31 December to 10 January. Had the deadline not been extended, these who had not however paid as of 1 January would have had to start off the enrollment method all in excess of once again. 

Now, time is once once more expanding quick for consumers like Campbell. By Friday, most insurers will finalize the last of the enrollments for coverage starting one January of this yr. And then they will discard the applications of any individual who has not presently paid them straight for coverage, leaving some individuals who considered they’d completed almost everything proper without having health insurance coverage. 

The payments method, a lot of which was left to the final minute, could also show a problem for the Obama administration, as it could undermine what had been a comparatively effective attempt to compensate for the troubled handful of weeks that the exchanges – and these who attempted to entry them – skilled last fall.

In the course of Healthcare.gov’s initial week as a totally functioning web site, soon after the 1 December relaunch, more than three.7 million men and women logged on to the site to get their opportunity to select a healthcare program. As of 29 December, about 850,000 Americans had utilized for coverage through state exchanges and 1.one. million via the federal one particular.

Come mid-January, if there are sufficient missed payments and discarded applications, these numbers may look very diverse. 

Healthcare.gov reminds buyers to enroll by 23 December for coverage starting as quickly as January 1. Photograph: Jon Elswick/AP

As a outcome of all the technical troubles with the techniques thus far, thousands of folks have signed up for healthcare coverage numerous times. Numerous others who believe they are covered will find out soon that, because they didn’t pay that first premium on time, they are not. The full extent of the dilemma will most likely not be identified for some time, specially due to the fact some insurers, mindful of the delays, have extended their deadlines yet again, moving them to later on this month. California’s exchange, Covered California, has completed the very same for all of the plans provided via its technique. 

In an try to lessen the quantity of incomplete applications, insurance firms close to the nation, joined by the administration and the states that set up their very own exchanges, have invested the previous couple of weeks doubling up on efforts to remind men and women to spend their initial month’s premiums. 

Their first piece of advice: check your physical mailbox.

“If an individual who believes they’ve been enrolled doesn’t receive a letter from us right after a week or so, that’s a flag for them,” said Cynthia Michener, an Aetna spokeswoman.

Inside of a week of submitting their application on the exchange, Aetna buyers now get letters informing them of “the value of producing their first month’s premium payment”, such as “an invoice for that original premium payment and details about their various payment possibilities”, Michener told the Guardian.

Blue Shield of California also sent out letters requesting payment from everybody who enrolled.

“We are working closely with Covered California and taking numerous actions to remind members that their initial month’s premium needs to be paid by January six to ensure a January 1 powerful date and steer clear of gap in coverage,” Mia Campitelli, a spokeswoman for Blue Shield of California, explained. The firm noticed a “surge in payments” commencing in the 2nd week of December, she added.

Robert Laszewski, president of Well being Policy and Strategy Associates, says the insurers he has spoken to have obtained 50% of the required payments, up from 15% in December. In accordance to him, the enhance in payments obtained can be attributed to the approaching due date as nicely as to the reality that bulk of people who enrolled by means of the exchanges did so in mid- to late December, and would have obtained any letters or invoices from their insurers some time right after that. 

“Fifty % is not an alarming quantity right now. There is no explanation to hit the panic button just but,” explained Laszewski, noting the most latest delay in payment deadlines. 

Signed up and nonetheless uninsured: how Obamacare leaves consumers behind