Shared concerns unite all sides of the euthanasia debate | Peter Beresford

Brigit Forsyth, the actor best know as Thelma in Whatever Happened to the Likely Lads? is currently playing a terminally ill musician on stage. Her character in Killing Time says she’s a “prime candidate for a one-way trip to Switzerland”. Forsyth has disclosed that her GP grandfather helped dying patients end their lives and that she is in favour of euthanasia. Her comments are the latest in a long line of opinions on legalised assisted dying reported in the press, which has a habit of oversimplifying the complex arguments for and against. And this seems to be damaging our ability to hold meaningful public debate on the subject.

With this in mind, a study funded by the Joseph Rowntree Foundation sought the views of people with strongly opposed opinions on the matter. Participants in both groups included people with palliative care backgrounds, older and disabled people, those from organisations concerned with care and support and individuals from academic, social work and policy backgrounds.

What emerged is a surprising amount of common ground. People with apparently polarised views on legalising the right to die often shared areas of interest and concern. It is these areas that should form the basis for further public discussion, argues the report, Assisted Dying: Developing the Debate, which is published on Wednesday by the Shaping Our Lives network of user-led groups, service users and disabled people.

Shared concerns included clear agreement that palliative care for terminally ill people is inadequate. Whether for or against assisted dying, participants showed a willingness to discuss quality of life for terminally ill people, the value placed on good-quality care, and how to invest in and provide access to this care in the face of economic inequality.

Participants recognised that the debate on legalising assisted dying was taking place in an unequal society: we often place lower social value on older, sick, and disabled people. The research identified a willingness to discuss prevailing societal values, including the concept of “being a burden” on society; the value society placed on social care and support work; and our social attitudes towards death and dying. “How should assisted dying be funded?”, “Where should it be performed?”, and “What methods and means of self-administering a fatal dose should be used?”, were just some of the common questions raised.

Despite disagreement about the extent to which detailed processes and safeguards should be included in assisted dying legislation, participants from across the spectrum of opinion generally agreed that the “how” questions were not being discussed in enough depth.

Areas of shared understanding also emerged when respondents discussed ethical and existential ideas around death and dying, including the psychological aspects of pain and suffering, both for individuals and their loved ones. “All participants had a wish to find the best way forward with compassion for people who are terminally ill, regardless of being for or against legalising assisted dying,” the report concludes.

The study shows that the issues are far more complex than much of the public debate has so far allowed. Death and dying is a core issue for human beings, and public debate must reflect this. It is time to embrace the personal, social, policy and ethical issues that participants have highlighted.

Back in the theatre, Forsyth’s dying musician is visited by a young carer (Zoe Mills) who feels it is her duty to help put older people out of their misery. According to the reviews, she comes to realise that life and death is more nuanced.

Shared concerns unite all sides of the euthanasia debate | Peter Beresford

New concerns over BPA as workers exposed to levels 70 times the average

Health concerns over Bisphenol A (BPA), a chemical commonly found in plastic packaging and the lining of food cans, are well documented. Previous studies have linked low levels of BPA to a variety of potential health issues, including obesity, diabetes and fertility problems. A 2008 ruling by the Federal Drug Administration (FDA) found that low exposure to the chemical is safe because it is generally ingested orally and thus eliminated from the body quickly, although research is ongoing to determine the chemical’s impact on human hormones.

However, a new study – the first of its kind in the US – has looked at the exposure levels of people who come into contact with high doses of BPA, and found that employees who directly handle the plasticizing chemical had urine levels of BPA around 70 times greater than that of the average US adult.

The federal study, carried out by the National Institute for Occupational Safety and Health (Niosh), looked at BPA levels in the urine of 78 American manufacturing workers employed at six companies that either manufacture BPA or use it to make other products.

BPA is used in the production of plastic food containers, the lining of food and soda cans, and in thermal receipt paper. Because of the ubiquity of BPA in food containers, and its ability to leach into food or drink, the estrogen-mimicking chemical can be found in the urine of most of the US population. In addition to finding it in urine, studies have found the chemical in breast milk and umbilical cord blood. BPA was originally researched as a potential source of synthetic estrogen before its current use in plastic manufacturing.

“The Niosh study is a wake-up call about the dangers of workplace exposure to BPA,” says Noah Sachs, a professor at the University of Richmond School of Law and director of the Merhige Center for Environmental Studies. “Every company that manufacturers BPA or uses it as a raw material has a responsibility to workers to prevent such excessive BPA exposures. Business-as-usual is putting BPA workers at risk.”

Studies surrounding the long term effects of BPA on health and reproduction have previously centered on consumer exposure. Pressure from consumer advocates led to manufacturers voluntarily removing the chemical from baby bottles and sippy cups in the US. The FDA eventually also banned it from baby formula packaging. Outside the US, a law prohibiting the use of BPA in food packaging of any kind went into effect in France in 2015. The US has attempted to pass similar legislation outlawing the use of BPA in all food containers, most recently with the introduction of the Ban Poisonous Additives Act of 2016.

While the Niosh study highlights the high levels of BPA found in US manufacturing workers, it does not assess any potential health effects from that exposure.
Previous studies in Chinese manufacturing workers, who had similar levels of BPA in their urine to the workers in the Niosh study, found that male employees who handled BPA had lower levels of testosterone, decreased semen quality and higher levels of self-reported sexual dysfunction.

While the Niosh study raises serious concerns, before there are any policy changes, regulatory bodies will require more research with a larger pool of subjects to show the consequences of BPA exposure in manufacturing workers, explained Lori Hoepner, assistant professor at Suny Downstate Medical Center School of Public Health.

Currently, the Occupational Safety and Health Association (Osha) does not set any workplace exposure limit for BPA. Without Osha exposure limits for the chemical, manufacturing workers who are concerned by their exposure to BPA don’t have any real recourse when to avoiding the chemical on the job. “Workers could request reassignment or more protective BPA handling equipment, but they could face retaliation or getting fired,” says Sachs.

To help convince Osha of the potential dangers of BPA exposure for manufacturing workers, a longitudinal study showing the impact of the endocrine disrupting chemical over time would be needed. But longitudinal studies are notoriously expensive and getting manufacturers to agree to the studies would be difficult, explains Hoepner. For example, collecting urine samples multiple times during the workday, as in the Niosh study, is disruptive for companies.

Any kind of policy change from Osha will take years, says Sachs. “We know from past experience that an Osha rulemaking to set a permissible exposure limit can often take five to seven years, with industry challenging it every step of the way.”

Ideally, Osha should initiate that rule making on its own because it is obligated by law to set a standard that assures, to the extent feasible, no “material impairment” of worker health, even if a worker is exposed to that substance for a lifetime.

While there may not be enough evidence yet for Osha to set limits for worker exposure to BPA, amid growing consumer concern over the chemical, scientists and manufacturers have explored alternatives. BPA substitutes like bisphenol F (BPF) and Bisphenol S (BPS) have been used in plastics that are labeled BPA-free to appeal to consumers. “BPA free is a misnomer,” explains Hoepner. “It should really say BPA substitute.” BPF and BPS are very similar in terms of chemical structure to BPA and there are indicators that they may have similar health effects.

Another alternative that has been studied by scientists is using plastic made from plants. “Studies have determined that it is possible to economically and beneficially switch to plant-based plastic,” Hoepner says. “It costs a lot at the start to make the switch but it pays for itself over time.”

Because of the large economic investment needed to make the switch, companies have been reticent to switch their plastic production. But as companies continue to face pressure to switch away from BPA, and consumers become more savvy and discerning about their plastic consumption, manufactures may eventually make the switch as a way to appeal to customers.

For now, there are no new guidelines around BPA exposure for manufacturing workers around the corner, though Sachs is hopeful that the Niosh study will prompt advocates to file petitions with Osha to set permissible exposure limits for BPA.

But, when it comes to any immediate changes, Sachs warns: “I’m not optimistic about any new BPA regulations under the Trump administration, which has already shown that it disregards scientific conclusions.”

New concerns over BPA as workers exposed to levels 70 times the average

Increase in serious IVF complications raises concerns over use of fertility drugs

Increased numbers of women suffered from a serious complication of IVF last year, according to official figures that raise concerns about the use of powerful fertility drugs.

In 2015, 60 women were admitted to hospital with severe ovarian hyperstimulation syndrome (OHSS), a 40% increase on the previous year. The condition, which is triggered when the ovaries swell up and leak fluid, is potentially life-threatening. Symptoms include abdominal swelling and pain, nausea, dehydration and blood clots in the legs.

Leading fertility doctors warned that the trend could be driven by doctors giving women stronger drugs to harvest more of their eggs, with a view to boosting the chances of a successful pregnancy.

Professor Geeta Nargund, a senior consultant at St George’s Hospital in London and medical director of Create Fertility, said: “OHSS is a preventable condition. The number should never go up, it should always go down in modern fertility practice.”

In the past decade the numbers of OHSS cases have been steadily falling as clinics have shifted towards milder treatments, but the latest figures suggest a reversal of this trend.

Nick Macklon, professor of obstetrics and gynaecology at the University of Southampton, believes the increase could be linked to recent improvements in embryo and egg freezing technology.

In theory, the ability to freeze eggs and delay transferring embryos until the ovaries have settled down should help avoid serious cases of OHSS, which can be worsened by pregnancy. However, it also provides a greater incentive for clinicians to obtain as many eggs as possible to maximise a couple’s chances of success, he said.

“This escape route may have encouraged clinicians to return to harder stimulation regimens,” said Macklon, adding that recent Human Fertilisation and Embryology Authority (HFEA) figures showing higher pregnancy rates when around 15 eggs are obtained may also have played a role.

During IVF, a woman is typically given injections of drugs designed to stimulate the ovaries into releasing eggs, which are then harvested, fertilised and either transferred back to the patient or frozen for future use. Some women are more sensitive to the drugs, however, and their ovaries are sent into overdrive, causing them to enlarge and release chemicals into the bloodstream.

Fluid from the blood vessels leaks into the abdomen, and in severe cases, into the space around the heart and lungs. Mild OHSS is common, affecting about one in three women, but the condition can result in serious health problems and -extremely rarely – women have died.

Blood tests are now used by clinics to predict who is at risk of OHSS, based on their natural levels of a hormone called AMH. “We might reasonably expect that the trend in incidence should therefore be down rather than up, so I think there is likely to be a real cause rather than statistical artefact behind the rise,” said Macklon. “The overall numbers remain very low compared with the past, but I think there is a message in these data to remain vigilant about preventing OHSS by avoiding high dose stimulation where possible.”

According to HFEA data, in 2014, 42 cases of severe OHSS were recorded, compared to 46 the previous year, but last year the figure rose to 60 cases.

The regulator classifies severe OHSS as a grade B adverse incident, one level below the most serious category, which includes the death of a patient or an embryo being transferred to the wrong woman.

Professor Adam Balen, chairman of the British Fertility Society and a spokesman for the Royal College of Obstetricians and Gynaecologists, said: “OHSS is a potentially serious complication of fertility treatment, particularly IVF. Most women will recover with pain relief; however, for severe cases, women may need to be admitted to hospital and given treatment to reduce their risk of developing blood clots, which is a serious complication of the condition.”

HFEA figures show a steady upward trend in the number of IVF cycles carried out annually, rising from 68,000 in 2014 to around 72,000 in 2015 (roughly a 6% increase), which might explain part of the increase in adverse incidents last year.

“I said ‘call my mum,’ and then ‘no, call an ambulance.’”

Lee Cowden, who suffered a heart attack as a result of OHSS. Photograph: Sophia Evans for the Observer

A decade ago, Lee Cowden, a primary school teacher from Surrey, was newly married and lying in bed with her husband, Iain, after a weekend away in Norfolk. “I remember sitting up in bed gasping and saying to my husband ‘I can’t breathe.’” she said. “We hadn’t been married that long and I said ‘call my mum,’ and then ‘no, call an ambulance.’”

Lee later discovered she had suffered a heart attack as a result of OHSS.

At 25 she had decided to start trying for a baby, because her diagnosis of polycystic ovary syndrome meant she would need fertility treatment. She had been prescribed stimulation drugs to induce ovulation, but when it hadn’t worked the clinic had doubled the dose.

The first sign that she was suffering OHSS was abdominal pains, but the clinic told her this was probably due to a benign ovarian cyst. In fact, her ovaries had become severely over-stimulated and this eventually led to a blood clot forming that travelled to her heart.

“I felt a stabbing pain between my shoulder blades, which I knew was a sign of a heart attack, but I thought: don’t be ridiculous, you’re 25,” she recalls.

Since then, she said, she has met many others who have suffered from milder forms of OHSS. “So many women … think overstimulation is part and parcel of treatment,” she said. “It’s not acceptable.”

Lee, now 37, made a good recovery – although she will take daily heart medication for the rest of her life – and went on to have IVF treatment using milder drugs. She conceived her daughter, Molly, who is now nearly ten. Two years later, she conceived naturally, and her second daughter, Ruby, is eight.

Increase in serious IVF complications raises concerns over use of fertility drugs

Junior doctors suspend strike plans due to "patient safety" concerns

Junior doctors have suspended plans to go on a series of five-day strikes to protest against changes to their contracts after a “vigorous debate” following a change in leadership.

The British Medical Association’s junior doctors committee (JDC) said it would not go ahead with the industrial action, but was “planning other actions over the coming weeks”.

The decision follows a challenge to the leadership of Dr Ellen McCourt, chairwoman of the committee, by doctors from Justice for Health.

McCourt fought off the challengers but there were changes to other members of the junior doctors leadership, who held a summit on Saturday to discuss their new strategy.

“After a vigorous, passionate, thoughtful and wide-ranging debate this afternoon, the JDC has decided to suspend industrial action while planning other actions over the coming weeks,” the committee said in a statement.

The decision was prompted by “feedback from members from every region in England, as well as the views of the wider profession, patients and the public in considering the next steps on the dispute”.

“Our primary consideration in coming to this decision has been our overriding concern about patient safety, the care we provide every day and the ability of the health service to deliver this care,” it added.

“To be absolutely clear, the JDC still opposes the implementation of the contract … The past few months have been difficult and frustrating and we know that members are anxious for information and practical support.”

Junior doctors have been in a long-running dispute with the government over its decision to change their contracts to make it cheaper for the NHS to provide weekend cover.

The health secretary, Jeremy Hunt, decided to impose the new contract on junior doctors, five of whom last week sought to have the decision overturned in the high court. Lord Justice Green’s ruling on that is due on Wednesday.

Union sources say hundreds of trainee medics voicing their concern about the proposed walkouts had led to serious fears that strike turnout would be poor and that the BMA would end up divided, weakened and lowered in public esteem as a result of the stoppages.

Many junior doctors were also concerned that the long duration of the planned strike would put patients’ safety at risk and risk a backlash from the public if anything untoward happened in a hospital while they were protesting outside. Medics have also voiced confusion about the objectives of the stoppages, given that the union’s leadership backed in the early summer the new contract they had negotiated, only to see grassroots juniors reject the improved terms and conditions by 58% to 42%.

McCourt was elected as interim chair after the former leader, Johann Malawana, resigned after 58% of junior doctors rejected a compromise contract.

One senior BMA official said: “Junior doctors don’t want to put patients at risk and don’t want to go ahead with a five-day strike. Quite a few don’t want any more strike action at all. Even the few JDC members who still think that they can’t give up totally wanted the 5-day strike scaled down.

“Junior doctors don’t have the heart or the stomach for this anymore. They don’t see the point of industrial action. They feel let down and blame both Jeremy Hunt and the BMA equally.”

There is also mounting anger and confusion among junior doctors at what many see as the BMA’s lack of clear strategy in first electing to hold all-out stoppages of unprecedented duration without defining what their purpose was.

The Department of Health welcomed the suspension of the strikes, saying: “The best way to rebuild trust now is for industrial action to be called off permanently in the interests of patients – and we urge the BMA to do so.”

The strike action was originally planned for this month, but the first five-day walkout was cancelled after opposition from other members of the medical profession.

Opposition to the planned strikes came from the Academy of Medical Royal Colleges, which represents all the doctors’ professional bodies.

Junior doctors suspend strike plans due to "patient safety" concerns

Police raise concerns after letting vulnerable patient sleep in patrol car

A chief constable has expressed deep concern that a patient with serious mental health problems had to sleep in the back of a police car in a hospital car park because there was no bed available for her.

Katie Simpkins, 23, from Corsham in Wiltshire, was detained under the Mental Health Act for her own safety but there was no hospital bed available in the whole of the county. Officers allowed Simpkins to sleep under a blanket in the back of their patrol car and watched over her until a bed became available.

She and her husband, Tristan Simpkins, 25, released a photograph of her in the back of the police car to try to raise awareness of the lack of beds available in such situations.

The chief constable of Wiltshire police, Mike Veale, said officers were often having to take responsibility for vulnerable people with mental health problems who ought to be in the care of health professionals.

He said that in the past week officers had persuaded a 17-year-old girl with schizophrenia to come down from the roof of a car park, only to be told there were no beds available for her anywhere in the county. He also said officers held a man in a cell for more than 48 hours because there was no mental health care facility available for him.

Veale said: “A police officer is not the appropriate person to be dealing with a vulnerable member of the public who has an illness and poses a real risk to their own health and wellbeing. My police officers and staff face difficult, stressful and sometimes dangerous situations every day. They are not trained to provide specialist care to people with complex problems. They don’t know the background of these people, their medical history or their personal details.

“These issues have always been here for the police, and not just in Wiltshire, but are becoming more acute as austerity bites and there is increased pressure on social care and healthcare services.”

Police had detained Simpkins under section 136 of the act early last Saturday when she suffered a mental health crisis. Her husband said police rang round but could not find a place for her in a mental health unit.

They took her into the custody suite at Melksham police station until later on Saturday afternoon, when officers were told a bed was available at Green Lane hospital in Devizes. However, when they got there at 5pm they were told it was not ready.

Tristan and Katie Simpkins. Photograph: Tristan Simpkins/PA

Mr Simpkins said: “The hospital suggested she go back to custody and they would call when it was ready, but the police officer said custody is not the right place for her. He didn’t want to risk her missing the bed so he said they’d wait, and he’d wait with us.

“Katie had her medication, became drowsy and he let her sleep in the back of the police car with her blanket. When I saw her lying in the back of the police car I felt frustrated, but I’ve become used to it. I feel hopeless.”

He praised the way the police had tried to help. “It wasn’t their fault they couldn’t get a bed but these officers were all really lovely with her,” he said. She was finally admitted at 9pm.

Angus Macpherson, the police and crime commissioner for Wiltshire and Swindon, said: “This is not an isolated incident. Such incidents are happening once or twice a month [in Wiltshire]. The picture of Katie Simpkins huddled beneath a blanket in the back of a Wiltshire police car has understandably caused concern to the public. I have said it before and I will say it again: custody is simply not the right place for someone in a mental health crisis.”

Avon and Wiltshire Mental Health Partnership NHS trust confirmed there were only two beds available for people detained under section 136, which gives police the power to take a person from a public space to a place of safety.

A trust spokesperson said: “We work closely with the police to ensure they know the availability of places of safety. In this instance we were unable to provide a bed straight away and there clearly could have been better communication. We apologise and will be mindful of this in the future. Once the matter came to our attention, we made contact with Mr Simpkins to give him and his wife our full support.”

Last month the government announced that the Avon and Wiltshire trust was among those that had successfully bid for a share of a £15m fund to improve provision of mental health places of safety.

A Department of Health spokesperson said: “When a person is experiencing a mental health crisis they need the right care, in the right place and at the right time. We are fully committed to improving mental health services across the country.”

Police raise concerns after letting vulnerable patient sleep in patrol car

Secret documents reveal official concerns over "seven-day NHS" plans

The health service has too few staff and too little money to deliver the government’s promised “truly seven-day NHS” on time and patients may not notice any difference even if it happens, leaked Department of Health documents reveal.

Confidential internal DH papers drawn up for Jeremy Hunt and other ministers in late July show that senior civil servants trying to deliver what was a totemic Conservative pledge in last year’s general election have uncovered 13 major “risks” to it.

While Hunt has been insisting that the NHS reorganise around seven-day working, the documents show civil servants listing a string of dangers in implementing the plan – as summarised by a secret “risk register” of the controversial proposal that has prompted a bitter industrial dispute with junior doctors.

The biggest danger, the officials said, is “workforce overload” – a lack of available GPs, hospital consultants and other health professionals “meaning the full service cannot be delivered”, they say in documents that have been obtained by the Guardian and Channel 4 News.

The risk register and other documents also show that the DH sees the NHS’s 1.5 million staff, especially doctors, as a “barrier” to the high-profile but controversial ambition of increasing patients’ access to hospitals and GP surgeries at weekends “because they do not believe in the case for change”.

Hunt has angered hospital consultants and junior doctors over the last year by ordering them to work more at weekends in order to help deliver the seven-day goal, even though both groups are often on duty on Saturday and Sunday.

Juniors have held eight days of strikes to protest against a new contract Hunt is imposing on them which they claim ignores the need for extra doctors to enable the expansion of care he wants – a claim that the BMA said was vindicated by the documents.

Dr Mark Porter, leader of the British Medical Association, said the papers proved that government had ignored warnings from healthcare organisations, especially that a lack of extra staff and more funding would hinder progress. That it has also “disregarded its own risk assessment’s warnings about the lack of staffing and funding needed to deliver further seven-day services, is both alarming and incredibly disappointing”, he added.

He also seized on the DH’s admission in the documents that it still has not worked out what No 10’s objectives were. In pushing ahead with implementing the plan, Porter said: “[It] only goes to show that this was nothing more than a headline-grabbing soundbite set to win votes rather than improve care for patients.”

Shortly after the May 2015 election, David Cameron, the then prime minister, made a speech in which he referred on 18 separate occasions to his “plan” for a seven-day NHS. Fourteen months later, the BMA added, that the documents show that there was still a painful lack of detail.

The papers also show that senior officials at the Department of Health:

• Fear the seven day plan might fail to deliver its stated aims, which include improving the quality of hospital care at weekends and reducing death rates among those admitted for treatment as an emergency on Saturday or Sunday. “It is possible that the programme delivers the planned outputs, but this does not result in the desired change (delivering against the plan but missing the point),” one states.

• Voice concern that there is also a risk that even if weekend services are successfully enhanced, that “patients do not report any difference/improvement in their experience [of] out of hours and at the weekend”.

• Worry that Britain’s decision on 23 June to leave the European Union “may adversing (sic) impact upon the delivery of the 7 Day Services programme, particularly with regards to workforce and finances” because the NHS employs 55,000 staff from around the EU.

A DH spokesman said: “Over the past six years eight independent studies have set out the evidence for a ‘weekend effect’ – unacceptable variation in care across the week. This government is the first to tackle this, with a commitment to a safer, seven day NHS for patients and£10bn to fund the NHS’s own plan for the future, alongside thousands of extra doctors and nurses on our wards.”

A department source added: “A risk register by definition details all potential issues under a worst-case scenario to help the government develop robust plans to ensure we meet our promises to the electorate, but we are confident our programme for a safer seven-day NHS is on track‎, and will deliver real benefits for patients.”

Hunt has persistently championed the idea of a seven-day NHS. On 25 April the health secretary told MPs of “the government’s determination to be the first country in the world to offer a proper patient-focused seven-day health service”. In that speech he specifically rejected “the concern that a seven-day NHS might spread resources too thinly”.

That was unfounded, Hunt said, because the government has increased doctor numbers by 10,100 since 2010 and would add a further 11,420 to the headcount by 2020.

The documents also show that privately some of Hunt’s most senior civil servants worry that the pledge to increase the NHS budget by £10bn by 2020-21 will not be enough to deliver the promised NHS expansion by 2020. The risk register notes that much of the £10bn will not reach the NHS until near the end of this parliament and thus not be immediately available to fund the changes. “This could result in ‘back loaded’ delivery increasing the risk that deadlines for completing roll-out [between now and 2020] are missed,” they say.

Several of the risks reveal damaging internal disagreements among those taking forward the seven-day drive, including over what the purpose of the plan is. That included tension between the DH and Downing Street in May when Cameron was still in power. In a section of the risk register headed “scope creep”, which was last reviewed on 10 May, it says: “The planned objectives and scope of the programme do not meet the expectations of No10/Cabinet Office, meaning that they may continue to change. This could lead to an inability to deliver the desired outcomes to the agreed timescales.”

Prof Chris Ham, the chief executive of the King’s Fund, rejected Hunt’s insistence that the £10bn was enough to deliver a seven-day NHS by 2020.

“It is not credible to argue that it can continue to meet rising demand for services, maintain standards of care and deliver new commitments such as seven-day services within its current budget,” he said. “Implementing seven-day services is a laudable ambition but is not realistic unless additional funding becomes available and workforce challenges can be overcome.”.

The shadow health secretary, Diane Abbott, said: “This is a shocking indictment of the Tory government’s plans. They pressed ahead with their proposals even when campaigners and NHS staff argued they were unworkable. It has now been confirmed by the advice the government received from its own civil servants.

“This is a scandal. The government is undermining the NHS with plans it knew to be unworkable.”

Abbott said she would be contacting Hunt to see if he had misled parliament.

Secret documents reveal official concerns over "seven-day NHS" plans

Two-year-old returned to UK from Guinea amid FGM concerns

A two-year-old girl thought to be at risk of being subjected to female genital mutilation has been returned to the UK from west Africa following moves by police and a family court judge in England as well as Dutch embassy staff, lawyers say.

Concerns were raised after the child – whose family have links to the Netherlands – was recently taken from her home in England to Guinea, a high court judge heard on Friday.

Lawyers said the Metropolitan police launched an investigation, a family court in London made a female genital mutilation (FGM) protection order and Dutch embassy staff made arrangements to get the girl out of Guinea.

Related: England had 5,700 recorded cases of FGM in 2015-16, figures show

Details of the moves made to ensure the girl’s safety were revealed by lawyers representing the Met at a private hearing in the family division of the high court in London.

Barrister Zimran Samuel, who led the police legal team, told Mr Justice Moylan that a man had been arrested and released on bail pending further investigation.

A judge is due to analyse the case again at another family court hearing in the near future.

Moylan said the girl would undergo a medical examination and that all evidence from police and family members should be gathered so that facts could be established.

The judge said details of the case could be reported – but that the girl could not be identified.

Judges began to make FGM protection orders in the summer of 2015 following changes in the law.

Samuel, a specialist in FGM litigation, said last year that the orders could “make a very real difference”.

He said they were aimed at protecting potential victims rather than punishing offenders.

They could put barriers in front of people who posed a threat and could give comfort and support to vulnerable females, he said.

“FGM protection orders, which were originally one of several recommendations made by the Bar human rights committee, can make a very real difference where the criminal law has historically failed. The criminal law is intended to punish perpetrators after FGM has happened,” Samuel had said.

“The new civil orders allow for intervention to prevent potential victims from being subjected to FGM in the first place.

“Further, the underlying thinking behind civil protection is to encourage girls at risk to come forward without feeling that the full force of the criminal law will necessarily be brought against those closest to them.

“A judge in the family court has a high level of discretion and flexibility in how these cases progress, with the fundamental aim of protecting those at risk.

“Importantly, the new legal provisions protect girls who live in the UK not only from FGM which may be committed in this jurisdiction but in fact anywhere in the world. It is an offence to breach an order, regardless of where FGM is committed,” he had said.

Two-year-old returned to UK from Guinea amid FGM concerns

Breast Cancer Chemotherapy Varies Broadly: Review Raises Concerns About Early Remedy Alternatives

Final month, the Journal of Clinical Oncology reported that 6 chemotherapy regimens generally provided to patients with early-stage breast cancer vary extensively in their side effects. The researchers identified that some drug combinations are much more very likely to lead to hospitalization than others.

The discovering, whilst hardly surprising, points to the value of sufferers and physicians obtaining fuller discussions about chemotherapy alternatives. An accompanying editorial emphasizes that most individuals are probably to live for a long time after preliminary treatment for breast cancer, and possibilities abound, chemotherapy selections need to be much more granular than is normal in practice.

The takeaway is that major differences exist between chemotherapy therapy regimens that are routinely provided to sufferers with early-stage breast cancer. Taking “it,” chemotherapy, is not an all-or-none choice.

This issues simply because above 230,000 men and women – practically fully, but not solely females – will get a new breast cancer diagnosis this 12 months in the United States. Most will have early-stage disease. And even though numerous of individuals folks will consider if they ought to have chemotherapy, or not, extremely few will ask their oncologists details about particular drug combinations.

Their hesitation is understandable. The chemotherapy regimen names sound like gobbledygook, acronyms loaded with A’s for Adriamycin (aka doxorubicin), C’s (cyclophosphamide), T’s (docetaxel, a taxane most usually branded as Taxotere) and P’s (paclitaxel, one more taxane, aka Taxol). Yes, it gets confusing. The medicines can be offered in distinct combinations, at distinct doses and frequencies, this kind of as each two weeks, or each three weeks. There are several permutations. This is the sort of issue that oncologists examine, and sufferers seldom know considerably about just before starting treatment.

But perhaps they should. Current posts point to the fact that sufferers may be legitimately concerned about the fees of a variety of cancer therapy options. Some recommend that medical professionals ought to by some means know or discover the answers to their sensible financial inquiries. But what about the physical, health-relevant side effects of the medication?

The new research looked at a variety of combinations of what’s called adjuvant – or extra – therapy for breast cancer following surgical treatment. As reviewed in the paper, several randomized controlled studies have established that providing chemotherapy to a newly-diagnosed breast cancer patient, soon after surgical procedure for invasive tumors of at least a specified size, lowers the probabilities that the tumor will spread or otherwise recur.

The major finding was that for females under age 65 with early-stage breast cancer, the fee of hospitalization for chemotherapy-related problems ranged among six and 10 percent. The differences between regimens have been statistically considerable. In older females the hospitalization charges have been drastically greater for all regimens evaluated, ranging among about 13 and 24 percent.

As the authors contemplate, the probability that patients will develop side results may be predicted, in part, by their age and other health problems, in addition to which medicines they’re prescribed and the doses given. Taxotere, for instance, has turn into a much more well-liked drug in current many years and tends to trigger neuropathy. Adriamycin, an older drug used for treating many cancer varieties, might lead to heart issues and lower blood counts, sometimes dangerously. Like other chemotherapy drugs in its class, Adriamycin slightly raises the recipient’s probabilities of developing leukemia later on on, specifically if it’s offered in mixture with radiation therapy.

6 bottles of distinct types of cancer drugs (source: Wikipedia, adapted from a National Institutes of Wellness picture)

To carry out this retrospective examination, which was admittedly constrained in its scope, the investigators culled information for patients with Stage I, II or III breast cancer found amongst 2003 and 2007. They used two databases: one particular for those more than age 65 (a Medicare-linked registry) and these underneath 65 years (MarketScan). Based on coding for diagnoses, chemotherapy drug bills and hospitalizations, the researchers established when patients who acquired certain drug combinations entered the hospital inside of 6 months of remedy.

Hospitalization, per se, is usually a brief-phrase side impact and was the only measured end result in this examine. Neutropenia, meaning a reduced white blood count accompanied by fever, is another quick toxicity of some chemotherapy regimens that can be relatively easy to assess. Mouth sores and hair reduction, and nausea, occur during treatment method and then go away. But things like frailty, or depression, or extended-term cognitive defects, neuropathy – these can be tougher to measure and know.

This paper does not cover newer medicines normally offered in Her2 positive cases, at times in blend with the older “A” “C” and “T”-like chemotherapies. And it is worth noting a shift in latest years toward prescribing endocrine treatment, occasionally with out chemotherapy, for girls with hormonally- sensitive small tumors. The examine does not examine toxicities of anti-estrogens, like Tamoxifen, or aromatase inhibitors, of which there are a number of on the marketplace. But they, also, have considerable side effects, some subtle, which warrant detailed evaluation.

Regardless of whether a patient gets “AC,” as I did eleven years ago, or “T+AC,” or “dose-dense AC + P” or a newer routine may possibly seem like a trivial decision to an oncologist who provides these medication to ladies with early-stage breast cancer like butter on bread, algorithmically primarily based on his or her community’s neighborhood practice. But the variations in outcomes – in excess of the long and short phrase – are worth examining additional.

My conclusion is that this retrospective examination doesn’t offer ample details, in itself, to manual any woman’s selection about chemotherapy. Or a doctor’s guidance. But it suggests that we need to collect much more nuanced information, above years and decades, about how girls fare after remedy for early-stage breast cancer.

Breast Cancer Chemotherapy Varies Broadly: Review Raises Concerns About Early Remedy Alternatives

Survey reveals managers" concerns about integrating wellness and care

Integration requirements mechanisms that assistance interaction – vertically amongst generalists and professionals, and horizontally between acute, main and social care. Photograph: Harish Tyagi/EPA

Moves to integrate overall health and social care are regarded by many to be the turnkey remedy to take the strain off our healthcare system. The drive in direction of closer integration of solutions does makes sense – with an ageing population and 1 in three older people residing with a persistent situation, it is vital that we seem at the architecture in area to supply great top quality, successful and compassionate care. Anything at all that can counter the ongoing fragmentation of providers, reduce duplication and allocate assets in a far more efficient way is to be welcomed, specifically as it must lead to improvements in patient care. The situation has been made rather convincingly by the leaders in our healthcare system.

However, producing integrated care a reality will fall to our overall health and social care managers. Making sure that they really feel relaxed, indeed good, about the move towards closer integration is paramount. It was relatively regarding that in spite of the case becoming created for integration, in our most recent survey of Institute of Healthcare Management (IHM) members, more than half stated they didn’t think that integrated care would take the pressure off the NHS. If we are to make integrated care a actuality it is critical that we pay attention to managers’ considerations. Digging beneath this statistic there lay a lot of reputable worries about integrated care that need to be addressed.

Doubts were raised about whether the Greater Care Fund will be utilized for its intended function, to assist lessen occupancy in expensive acute companies and increase care pathways. Health and wellbeing boards in England have to approve proposals on how the money are used locally, but managers doing work for acute providers, particularly basis trusts, are concerned about their lack of involvement as proposals are designed, and are wary that the funds would not be utilized to accomplish the significant step changes necessary.

Yet another nervousness centred close to the heavy workloads designed by the want to set up new infrastructures for collaborations and integration amongst the overall health and care sectors. Managers pointed out that staffing and monetary resources have been currently stretched to breaking stage. There was a prediction that there could be some “patch protection” on various sides and each and every would want to shift the cost to the other. This may well lead to delays in integration.

A lot of IHM members also signalled their anxiousness about whether everybody concerned in the integrated care agenda was becoming completely consulted and, provided the considerable changes that had been currently underway in the NHS, whether or not the timescales envisaged for its implementation have been reasonable.

Such concerns are to be expected, however. Managers did make clear their total assistance for the ideas behind the move to integration, as nicely as their belief in its prospective to provide a much more co-ordinated strategy to the way solutions had been delivered, but they also flagged considerations and our leaders have to get note.

There is significantly that we can do to help managers on the journey in the direction of integrated care. It is crucial that well being and social care leaders produce an setting in which managers can act a lot more collaboratively. Integration will require mechanisms that help ongoing interaction between practitioners and managers throughout well being and social care – vertically among generalists and specialists, and horizontally amongst acute, principal and social care.

This will need help which includes the creation of networks to facilitate studying and improvement. For instance, managing integrated teams requires a diverse kind of skills and expertise than managing single teams. It may possibly also require the creation of new roles doing work across specialist boundaries, to assistance integrated delivery.

Integration rightly has the likely to increase patient care and outcomes for the public considerably in a way that all managers are completely signed up to, but appropriate leadership, co-ordination and sources are going to be essential to make sure the complete prospective of the initiative is realised.

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Survey reveals managers" concerns about integrating wellness and care

New Evidence Fuels Concerns About The Security Of Niacin

The string of failures– for HDL therapies in general and for niacin in particular– continues unabated.  The publication of the main results of the HPS2-THRIVE trial, along with new information from the AIM-HIGH trial, provide no evidence of a beneficial effect for niacin but do fuel concerns that it may cause serious adverse effects.

In HPS2-THRIVE, published in the New England Journal of Medicine, the combination of extended-release niacin and laropiprant (Tredaptive, Merck) was compared to placebo in more than 25,000 high risk patients already receiving statin therapy. Patients in the treatment group had significant reductions in LDL cholesterol (10 mg/dL), significant increases in HDL  (6 mg/dL), and significant reductions in triglycerides (33 mg/dL). But there was no difference in the rate of major vascular events (13.2% for niacin-laropiprant versus 13.7% for placebo, RR 0.96, CI 0.90 – 1.03, p=0.29).  There was also no significant difference in an exploratory analysis of patients with low HDL and high triglyceride levels who might be expected to benefit the most from niacin therapy.

There were signs of harm associated with niacin-laropiprant. Serious adverse events occurred more often in the combination group (55.6% versus 52.7%, p < 0.001). Diabetes complications were especially concerning. Among patients who had diabetes at the start of the trial, serious complications related to diabetes occurred in 11.1% of patients in the treatment group versus 7.5% of patients in the control group, a 55% increase. Among patients who did not have diabetes at the start of the trial, there was a 32% increase in the diagnosis of diabetes in the treatment group (5.7% versus 4.3%).

Niacin therapy was also associated with significant increases in infections (8% versus 6.6%, p< .001) and bleeding (2.5% versus 1.9%, p < 0.001). These findings came as a surprise to the investigators. There were also significant increases in other, previously known adverse effects of niacin, including gastrointestinal, musculoskeletal, and skin-related adverse events.

The troubling findings of HPS2-THRIVE were not contradicted, and were at least partially confirmed, by a new analysis from the AIM-HIGH trial published in the correspondence section of NEJM. The trial randomized more than 3,400 patients with stable coronary artery disease to extended-release niacin (Niaspan, AbbVie) or placebo in addition to simvastatin and, if needed, ezetimibe. The trial was stopped early for lack of efficacy.

In their new analysis the AIM-HIGH investigators report a significant increase in serious infections (8.1% versus 5.8%, p=0.008) and a nonsignificant increase in serious bleeding events (3.4% versus 2.9%, p=0.36). But there was also a significant increase in all bleeding events in AIM-HIGH (10.1% versus 8.1%%, p=0.04).

The AIM-HIGH authors were reluctant to conclude that the new adverse effects seen in HPS2-THRIVE were also a genuine problem in AIM-HIGH. The findings, they wrote, “should be considered to be provisional and exploratory.” But the HPS2-THRIVE authors were more certain:

In light of the consistency of the results with those from previous trials of niacin alone, we believe that the findings from HPS2-THRIVE are likely to be generalizable to all high-dose niacin formulations. Although niacin might still be relevant for particular patient groups (e.g., patients at high risk for vascular events who have high levels of LDL cholesterol), any potential benefits should be considered in the context of the observed hazards.

Much of the initial discussion about HPS2-THRIVE revolved around the relative importance of the niacin and laropiprant components of the drug. In an accompanying editorial, Donald-Lloyd Jones writes that  ”the consistency of the overall findings with earlier trials of niacin alone suggest that niacin is the major problem.”

What now should we make of niacin and the HDL cholesterol causation hypothesis? On the basis of the weight of available evidence showing net clinical harm, niacin must be considered to have an unacceptable toxicity profile for the majority of patients, and it should not be used routinely.

The failure of the niacin trials, as well as other HDL-related trials, “lends further credence to the notion that HDL cholesterol is unlikely to be causal.”

Sanjay Kaul said that because the results of these trials have been known the lack of efficacy “is not surprising.” The safety findings, however, are “noteworthy.”

The increase in adverse events, including infections and bleeding, observed in HPS2-THRIVE likely represents an underestimate given that only about 50% of those screened were enrolled in the trial (one-third withdrawals on active drug). I do not agree with the AIM-HIGH investigators assertion that the significantly increased risk of infection and numerical excess in serious bleeding should be considered provisional and exploratory. AIM-HIGH, like most other lipid lowering trials, was powered for efficacy and not safety assessments. Lack of a significant difference in safety outcomes in inadequately powered studies should not be viewed as reassuring. Instead, safety should be assessed by examining the 95% CI and ruling out unacceptable harm. The difference in serious bleeding of 3.4% vs 2.9% results in a risk ratio of 1.19 (0.82, 1.73). In absence of any efficacy outcome benefit, I would argue that not being able to rule out a 73% increase in serious bleeding is unacceptable and points to an unfavorable benefit-risk balance. One has to also take into consideration that an absolute difference in the serious bleeding rate of 0.55% was observed in about 1/8th the number of patients enrolled in HPS2-THRIVE (difference in bleeding risk was 0.7%). Had AIM-HIGH enrolled as many patients as were enrolled in HPS2-THRIVE, this difference would have been statistically significant. If one were to count bleeding events of any severity in AIM-HIGH, the increase in risk would be statistically significant: 174 vs 137, risk ratio 1.25 (1.01, 1.55), p=0.04.

Bottom line, given the undesirable benefit-risk balance of extended release niacin, it is hard to make a case for it as frontline therapy in patients evaluated in these trials.

Another interesting observation is lack of efficacy in patients with mixed dyslipidemia (elevated TG and low HDL) in HPS2-THRIVE. In contrast, a beneficial effect was observed in AIM-HIGH. This could be related to different cutoffs for elevated TG or low HDL used in the 2 studies. Alternatively, the positive finding in AIM-HIGH might be spurious (false positive) given the overall null result!

New Evidence Fuels Concerns About The Security Of Niacin

Diabetes charity concerns warning in excess of well being checks

Diabetes View unveiled less than half of patients in 27 places of England get all of the checks. Photograph: Hugo Philpott/PA

A charity has expressed concern that numerous diabetes individuals are not currently being provided vital well being checks made to avoid critical issues.

The proportion of sufferers in every region who acquire all eight recommended annual overall health checks varies wildly across the country, Diabetes Uk explained.

In some spots less than a single in 5 folks with the issue get all eight checks advised by the Nationwide Institute for Wellness and Care Excellence in contrast with 78% in other places.

These assessments can avoid patients from building “devastating” complications of diabetes such as amputation and blindness, a spokesman said.

The charity’s instrument, Diabetes Watch, which permits patients to evaluate care in their location with surrounding spots, exhibits that significantly less than half of patients in 27 places of England acquire all of the checks.

At the other end of the scale there are 25 areas where 70% of sufferers acquire all eight checks.

In mid Essex, just 18.5% of individuals obtain all eight checks, the charity said.

But in Stafford 78.three% of individuals are receiving the advisable amounts of care.

Barbara Young, chief executive of Diabetes Uk, stated: “It is critical that everyone with diabetes gets these checks at least as soon as a yr, so it is deeply worrying that the proportion getting them varies so broadly from spot to area.

“Taking into consideration how they can support stop devastating well being problems this kind of as amputation and blindness, possessing a fourfold difference among the best and worst carrying out places is basically not good sufficient. If more than 70% of men and women with diabetes in places with considerable overall health issues are receiving the checks then there is no good cause why this ought to not be occurring all over the place.

“But as things stand, the postcode lottery of diabetes checks means many 1000′s of folks are missing out on essential healthcare that has the likely to identify troubles early ample for them to be treated.

“We want clinical commissioning groups that do not give these checks to sufficient individuals at the moment to set out how they program to boost the predicament and for the Government to describe how it is going to guarantee people with diabetes can be assured they will get excellent good quality care, wherever they dwell.

“We also hope that by providing individuals with diabetes details about how care in their area compares to other places, our Diabetes Observe instrument can help empower them to hold their local NHS to account.”

Diabetes charity concerns warning in excess of well being checks

Number of United kingdom war veterans in search of help for mental overall health concerns on the rise

The number of Afghanistan veterans searching for aid for psychological health issues surged in 2013 and is most likely to peak once again this year as the British military ends its 13-12 months conflict in the nation, according to new figures published on Monday.

There was a 57%improve in the quantity of ex-military personnel needing treatment method from the charity Fight Anxiety, which had a record 358 Afghanistan-associated referrals last year, compared with 228 in 2012.

The amount of Iraq veterans needing aid also rose by almost twenty%, even although British troops ended combat operations in the country 5 many years ago, and left altogether in 2011.

Commodore Andrew Cameron, chief executive of Fight Tension, additional that he expected the numbers to more improve above the coming years and the United kingdom had to put together for the escalation. Most psychological well being concerns get time to emerge, and armed forces veterans are often unwilling to admit they want aid.

“These statistics show that, despite the fact that the Iraq war ended in 2011 and troops are withdrawing from Afghanistan later this yr, a important number of veterans who serve in the armed forces proceed to relive the horrors they experienced on the frontline or during their time in the armed forces,” Cameron mentioned. “Day in, day out, they battle these hidden psychological wounds, frequently tearing families apart in the method.”

Even now, Fight Tension is taking on new situations from veterans who fought in conflicts from an earlier generation, this kind of as the Malayan Emergency, which ended in 1960, and the 1982 Falklands war.

But the vast vast majority of its recent caseload of five,400 patients comprises veterans from Iraq, Afghanistan and Northern Ireland, with sharp rises in referrals from all three in recent many years.

Cameron stated that one-fifth of all veterans were probably to want support for some form of mental illness and that it could consider far more than a decade ahead of signs presented themselves. “They have faced special challenges and call for, and deserve, professional support to help them conquer these problems. Nonetheless, with demand for our companies presently increasing, Fight Pressure faces a true challenge. We are planning for solutions at or over the recent level for at least the next five many years, and we do not count on to see demand for assistance tail off in the close to potential,” he stated.

Combat Pressure compiled the statistics to mark its 95th anniversary. It has worked with veterans of every conflict considering that the 2nd planet war, and has found that, on average, servicemen and women wait 13 years right after leaving the military ahead of in search of aid. It has supported twenty,326 veterans, including soldiers, sailors and air crews who fought in Aden, Korea and the Iran-Iraq war. Much more than 83% of individuals needing therapy have served in the army, and three% of the total are females.

Military charities are bracing themselves for an improve in referrals now that the Afghanistan conflict is drawing to a close, with circumstances ranging from depression to submit-traumatic anxiety disorder.

Fight Stress said it had only one referral in the 1st 12 months of the conflict in 2003 and two the 12 months right after. But with tens of thousands of troops having deployed to the nation more than the past decade, those numbers have improved sharply, especially more than the past three years.

It estimates that 42,000 Uk troops who served in Iraq and Afghanistan may build a psychological health situation more than the coming decades.

The charity has treated one,300 Afghanistan veterans so far and has 662 in its care. It has obtained one,968 circumstances involving Iraq veterans and is treating 806.

Standard Sir Richard Dannatt, chief of the basic staff when British forces had been fighting in Iraq and Afghanistan, said: “There is no doubt that fight, whether or not in Northern Ireland, the Falklands, the Gulf war 90-91, Bosnia, and elsewhere, has always developed psychiatric casualties, just as it created ‘shell shock’ in the very first world war.

“Our operations in Iraq and Afghanistan have, and will, make a sharp upturn in such psychiatric casualties. How a lot of, no one particular genuinely knows.

“The Ministry of Defence will always attempt to speak the figure down for budgetary and compensation motives. But psychiatric injuries ought to be widely recognised and talked about.”

Dannatt explained that former soldiers had been typically caught up in a “culture of coping alone” and that it essential to be recognised that there have been as well many former combatants who ended up in jail as murderers, or as suicide victims.

He argued that it was needed to make psychological well being therapy far more rapidly available: “If you break a leg, you don’t wait 6 weeks for a fracture clinic appointment. The same have to apply in the mental well being location.”

The MoD has launched many campaigns to challenge the stigma associated with psychological overall health problems, which includes 1 named “Will not Bottle it Up”. It has presented funding for Fight Stress – and a lot more neighborhood psychiatric nurses are currently being employed to enhance local community outreach teams.

“We are committed to offering everyone who serves in our armed forces all the support and help they need,” a government spokesman mentioned, including that £7.4m had been invested to increase mental well being providers offered to former soldiers. It was the aim of the government “to even more minimize the stigma of mental illness” and to motivate more veterans in require to come forward.

The Tory donor and peer Lord Ashcroft was commissioned by the prime minister, David Cameron, to write a overview of companies for armed forces veterans, which was published in February.

He mentioned that greater awareness of the problems faced by veterans “may possibly be contributing to the perception of a bow wave of PTSD instances”.

He extra: “There is a widespread public perception that veterans are probably to be physically, mentally or emotionally damaged by their time in the armed forces. This in itself constitutes an pointless added hurdle for services leavers, restricting their options by lowering expectations of what they can do.”

Number of United kingdom war veterans in search of help for mental overall health concerns on the rise

There is a culture of acceptance about mental wellness concerns in academia

It is all also widespread to see PhD college students operate themselves to the stage of physical and mental illness in buy to complete their studies. It is significantly less typical to see PhD college students who really feel that they are beneath such strain that the only alternative is suicide. But it does happen. There is a culture of acceptance all around psychological well being troubles in academia – and this wants to modify.

Following the completion of my PhD and a brief stint as a postdoc, I have lately taken up a new job as a researcher advancement officer at a research-intensive university. Teams like ours are relatively common in universities, thanks to funding supplied following the publication of the Roberts Report in 2002.

The team I operate on gives individual and expert growth possibilities to the researchers at the university including the PhD college students, postdocs, and lecturers. Like most researcher growth teams, the majority of our coaching focuses on the postgraduate college students. We run an yearly programme of training sessions and workshops developed to aid college students transition to the life of a researcher, make it by means of the official (and unofficial) milestones of their PhD, and emerge as effectively-rounded, employable folks with a selection of job alternatives.

When the circumstance calls for it, we are shoulders to cry on.

Yes, I now get paid to relive the worst encounter of my life, and hope that I can use that experience to support other individuals. On a daily basis, I meet PhD students who truly feel underequipped in one way or another.

Ideal case scenario: they are doing properly in their PhD, and have come to the researcher improvement programme for guidance about the following steps in their lives and careers. They come to us for some advice about volunteering, turning into a mentor, acquiring operate knowledge, generating use of their present networks, what it really is like to have a job outdoors academia and so on.

Much more frequently than we’d like, they arrive for a session about “developing and preserving an successful relationship with your supervisor” with puffy red eyes, lack the self-confidence to participate in the session, and depart at the finish without having obtaining uttered a single word.

Worst situation scenario: we in no way meet them at all. Or one day, they quietly depart the university with out their qualification.

Last weekend, there was a funeral. Two of the parishioners from my family’s nearby church neighborhood suffered the loss of their son, we’ll contact him J.

J had suffered with mental health problems all through his daily life, and had lastly taken his personal lifestyle. He was studying for a PhD at the time. From what I recognize, J was a brilliant pupil who did exceptionally properly at undergraduate level. Hence, getting accepted to do a PhD.

Once at the new university, J struggled to keep on track with his postgraduate scientific studies. He took a couple of breaks from research to attempt to recover his psychological health. Sadly, he committed suicide before he finished his PhD.

I are not able to say that it was the pressure of his studies that drove J to that decision following all, I did not know him. But I do know what performing a PhD is like.

I have skilled the effects on my psychological wellness, and I have witnessed the culture of acceptance surrounding this problem.

Amongst the men and women I do know who have completed PhDs, I have witnessed depression, sleep problems, consuming issues, alcoholism, self-harming, and suicide attempts. I have noticed how troubles with mental well being can go on to have an effect on physical overall health. During my PhD I noticed changes to my skin, and changes in my menstrual cycle which persist to this day.

Let us not overlook that in the bulk of cases, all this comes at a time when you are probably to be struggling from monetary instability, or are forced to make uncomfortable modifications to your personalized circumstances to accommodate your research.

We have all joked about seeing the sleeping bag tucked underneath the lab bench. These concerns are common. Shockingly, they are also commonly accepted.

Several PhD college students consider the see that if you’re not performing overnight experiments, missing meals, or binge drinking, you are not doing it correct.

“Some individuals select to have a social daily life whilst they are carrying out their PhD. And that is Ok. But I’m not,” a single of my fellow PhD students tells me.

Who else is supposed to aid you? Your supervisor? “A blemish on my career,” is how one academic referred to their expertise of supervising a pupil who produced mental overall health issues for the duration of their scientific studies.

Psychological wellness issues are typically not perceived to be something to do with supervisory inadequacies. It is critical to bear in mind that academics who are PhD supervisors did not make it to their current rank due to the fact of their outstanding supervising skill. They acquired to that place by being an exceptional researcher, and winning some funds.

Plainly, you can not spending budget for empathy. Nowadays, I say that we ought to not accept this.

It is not Okay for PhD students to turn out to be so impacted by their studies that they destroy themselves.
It is not Okay for PhD students to maintain the culture of operating oneself to the point of sickness.
It is not Ok for academics to wash their hands of the situation.

In my new role, I have noticed students asking:

“How do I tell myself that it truly is Ok to get time for me?”
“Have I worked so difficult that sickness has turn out to be normal?”
“How can I recover my relationships with my pals and family?”

In spite of this, I see college students and academics who view the researcher advancement services as unnecesary. I see college students who think about using our solutions as an “admission of defeat”. To come to us, is to announce that you are not a perfect researcher. I see college students ashamed to admit to their peers that they had come to any of our sessions, allow alone found them useful.

I see students forcibly eliminated from our sessions by their supervisors. I see major academics decline to promote our services, for concern that men and women will use them. I see students who truly feel like it is not Okay to admit that they are not Okay. And this is not Ok.

I watched my family try out their ideal to assistance J’s household when they got the news, and attempt to help 1 another when we have been alone. They reminisced about the bright young boy they had watched growing up, and wondered what had took place to him.

On the day of his funeral, automobiles lined the streets of the sleepy village the place he and his loved ones had lived, to the level in which visitors was interrupted. The church was overflowing. Men and women had come in their hundreds, from miles close to, to spend their respects to the young guy, and mourn his early passing.

What will you do to end scenarios like this from occurring once again?

If you have been affected by any of the issues mentioned in this piece, make contact with Samaritans or Nightline.

This content is brought to you by Guardian Skilled. Searching for your following university function? Browse Guardian jobs for hundreds of the most current academic, administrative and research posts.

There is a culture of acceptance about mental wellness concerns in academia

Examine Raises Concerns About Transfusions In PCI Patients

A really large observational review raises crucial questions about the position of transfusions in PCI sufferers in the US.

In a study published in JAMA, researchers from Duke and Yale analyzed data from much more than two.25 million percutaneous coronary intervention (PCI) procedures at more than one,400 hospitals. The information came from the CathPCI Registry, a big ongoing research that contains  a significant proportion of all cardiac catheterization procedures in the US.

The all round transfusion price was 2.14% but there was a really wide variation in transfusion practice patterns, ranging from to 13%. A huge bulk of hospitals (96.three%) had a transfusion fee of much less than 5%, and a lot more than a quarter of hospitals (25.5%) had a price of much less than 1%. Following accounting for variations in patient qualities, the median transfusion fee was two.5%.

As anticipated, transfused sufferers were older, far more most likely to be female, and were more probably to have other medical situations. In addition, they had been more probably to have an MI, stroke, or death in the hospital. This association remained important following adjusting for differences and irrespective of regardless of whether they had had a bleeding occasion. Nevertheless, transfusion was found to be beneficial in individuals who had bleeds and preprocedure hemoglobin levels beneath ten g/dL.

In the discussion of their findings the authors note that “there appeared to be individuals who underwent transfusion in the absence of clinical bleeding occasions and patients who underwent transfusion with nearly regular post-method hemoglobin values.” Transfusions, they wrote, “may have been driven more by local practice patterns than by clinical necessity.”

Along with earlier findings from smaller research, their benefits recommend that “further investigation is necessary to obviously delineate the proper use of transfusion in sufferers undergoing PCI.”

In an e-mail interview the senior author, Sunil Rao, acknowledged that the study “is observational and therefore has limitations inherent to all observational studies.” Asked about his personal clinical practice in this region, Rao explained:

Regarding our own practice, we routinely use bleeding avoidance strategies (appropriate dosing, targeted anticoagulants, radial access) in purchase to lessen the threat for transfusion post PCI. In individuals who are steady publish PCI (no chest discomfort, no lively bleeding) we comply with our transfusion protocol that recommends transfusion only if the hemoglobin is equal to or less than eight g/dl ( hct equal to or significantly less than 24%). This is based on other observational data and as we mention in the paper, these information can be subject to confounding. So we really want randomized trial data to guide practice.

Examine Raises Concerns About Transfusions In PCI Patients

Over a million men and women with mental well being concerns are out of operate and claiming advantages

It recommended that British employers should carryout workplace screening for depression and anxiousness.

800,000 individuals are currently signed off sick from function and claiming disability benefits for mental health problems. A even more 400,000 men and women are claiming other out of function rewards do so because of mental health causes, the Government mentioned.

Britain has the highest price of disability claimants in the planet and the report states that psychological well being is now the most widespread explanation for a man or woman to claim. Up to 370,000 Britons move onto disability positive aspects every 12 months, with close to 38 per cent listing psychological sickness as the main cause for their declare.

Ministers describe the figures as “frighteningly high” and “sobering” admitting that the Government needed to do far more to provide providers that would bring men and women off disability benefits and back into function.

Mark Pearson, the deputy of the director of the OECD, stated that ignoring the effect of psychological well being on the British workforce would be “a key financial error as effectively as social error” for the country.

Norman Lamb, the care minister, explained that the hundreds of thousands of pounds that are misplaced and the number of people impacted by mental sickness are “difficult to humanise” and mentioned men and women require to be conscious of the “painful effects on people’s lives.”

He explained: “These figures stick in our mends simply because they sound frighteningly higher in scale… a massive challenge for society.”

“Perhaps it is less complicated when thinking about the 1.2 million people at the moment acquiring state financial support due to the fact of mental health illness to comprehend the desks, the chairs, the store counters – row soon after row of them empty.”

Over a million men and women with mental well being concerns are out of operate and claiming advantages