Fewer but better clinics ‘will save more stroke victims’

Dozens of hospital stroke units should be shut and the service reorganised into fewer centres of excellence in order to improve care, the charity representing stroke survivors has insisted.

Centralising stroke treatment at a much smaller number of hospitals will increase patients’ chances of survival and reduce their risk of long-term disability, the Stroke Association says.

Juliet Bouverie, the charity’s chief executive, accused hospitals of risking lives by retaining stroke units when medical evidence suggests they should be moved. While reconfiguration is controversial, patients and their families generally understand that travelling longer distances to get a higher standard of care and reduce the risk of dying is worthwhile, she insisted.

“At the moment there are 126 hospitals in England which routinely admit stroke patients. That number needs to be reduced to somewhere between 75 and 100. But progress on that is very variable across the country and so unnecessary costs are being incurred and unnecessary mortality is happening,” she said.

She urged hospital and NHS chiefs to learn lessons from studies showing that scores of lives are being saved every year by the reorganisation of stroke units in the capital in the 2000s. “Previously there were more than 20 hospitals providing acute care in London and there was strong evidence that actually reducing the number of acute stroke units and creating a hub and spoke model [of bigger hospitals supporting smaller ones] on stroke would not only save lives but it would also save the NHS money.

“So they reduced the number of acute stroke units from 20 down to eight and the evidence shows that each year more than 100 patients extra are saved as a consequence. That’s now been replicated in Manchester, with equivalent numbers of lives saved.”

Tony Rudd, the national clinical director for stroke at NHS England, says: “The changes to stroke services in London have saved lives, proving it is right to concentrate expertise in selected centres. One advantage of the local planning arrangements is they can identify where there are opportunities to provide this more focused care for stroke patients.”

Centres of excellence would offer better care by having larger numbers of patients and would tackle the shortage of specialist doctors and nurses by concentrating them in fewer places. They could then offer patients clot-busting drugs and, potentially, 35 to 50 could undergo a new surgical procedure called mechanical thrombectomy, in which even large blood clots in the brain can be enclosed in a stent. Many more hospitals than the current handful should be offering the £7,000-a-time “game-changer” operation, said Bouverie.

Hospitals’ self-interest is “stalling” what should be an NHS-wide drive to improve stroke care, she claimed. “Too many hospitals are protecting their own interests and not doing what is in patients’ best interests. No hospital wants to give up some of those life-saving treatments, but it’s not in patients’ interests for these smaller hospitals to be delivering services.”

Too many of the sustainability and transformation plans drawn up by NHS leaders in 44 areas of England do not include clear ways of reorganising stroke care, despite evidence that fewer units reduce the risk of death and disability.

Hyper acute stroke units usually administer life-saving treatment for three days and then transfer patients to a stroke unit, with patients then moving to a rehabilitation unit or going home. Centres of excellence would help overcome the postcode lottery that means that 82% of stroke patients treated at Ipswich hospital, for example, receive clot-busting drugs within the recommended four hours but only 15% of those attending Wexham Park hospital in Slough.

Bouverie blamed the NHS for neglecting survivors after their discharge from hospital: “More than 46% of patients told us in our most recent survey that when they’re discharged from hospital they feel isolated and abandoned. They say that physiotherapy is not adequate and they’re not given access to the right psychological support. People are not getting access to speech and language therapy in a timely manner,” she added.

“Many stroke survivors have a physical disability, depression or psychological needs, suffer chronic fatigue or have aphasia, where they cannot speak. You’ve got stroke survivors at home with serious disability, often still in wheelchairs, unable to communicate, suffering the damaging psychological effects of what is a life-changing condition and not being given the proper support. ”

She criticised NHS bosses and ministers for refusing to draw up a strategy to reduce the UK-wide toll of 40,000 deaths caused by the 100,000 strokes that occur every year, despite the government’s pledge to reduce premature deaths. Stroke campaigners feel “ignored” because NHS England chief executive Simon Stevens is concentrating on improving cancer, mental health, maternity care and dementia services rather than prioritising Britain’s fourth biggest killer.

Fewer but better clinics ‘will save more stroke victims’

Why Washing Dishes by Hand May Lead to Fewer Allergies

Households worldwide now have extra incentive for getting family members to do the dishes: It could prevent the development of allergies. A new and preliminary study, published in the journalPediatrics, adds to an increasing body of evidence that suggests getting a little dirty does the immune system some good. That thinking is known as the “hygiene hypothesis,” which speculates that the reason kids develop so many allergies today is because their environments are just too clean. Without exposure to bacteria early in life, children’s immune systems don’t become as hardy as they could be. Research over the years has linked a variety of early lifestyle factors, like having pets, eating fish, and living on a farm to a significantly lower risk of developing allergies. Now this new study suggests that hand washing dishes might be the next behavior to add to the list. “If you are exposed to microbes, especially early in life, you stimulate the immune system in various ways and it becomes tolerant,” says study author Dr. Bill Hesselmar of Queen Silvia Children’s Hospital in Gothenburg, Sweden. “We thought [hand washing dishes] might be important, but we didn’t know, so we asked that question.” Hesselmar and his team surveyed the parents and guardians of 1,029 Swedish children ages 7 to 8. They discovered that children in homes where the family hand-washed the dishes instead of using a machine were less likely to have allergies. Only 23% of children whose parents used hand dishwashing had a history of eczema, compared with 38% of kids whose families mainly used machine dishwashing. The researchers also found that the result was amplified when kids ate fermented food or food bought directly from farms. Though the study is only observational and can’t confirm causality, Hesselmar and his team have a few speculations. It’s not necessarily that the kids are washing the dishes themselves and becoming exposed to bacteria. That might be one form of exposure, but as Hesselmar notes, some of the kids might be too young for that chore. Instead, it could be that long-term use of hand-washed dishes does the trick. Prior research comparing the cleanliness of dishes washed by hand to those washed by machine has shown that machine washing is more efficient and leaves fewer bacteria behind. Living in a household that hand-washes means family members are eating off of plates and cutlery that have more bacteria, and therefore more microbial exposure. Families who hand-wash may also have other lifestyle factors that contribute to a lower allergy risk. The researchers note that overcrowded housing, low socioeconomic status and immigration status can also be linked to fewer allergies, as well as possibly different modes of dish washing.

“The study was really well done and caveated well, while simultaneously suggesting new areas of research and interesting models,” says Jonathan A. Eisen, a professor at the University of California at Davis. Eisen, who was not involved in the study, is an expert on exposure to microbial communities.

The study still leaves a few questions unanswered, like why hand washing was only associated with a lower likelihood of eczema and not other allergy-related symptoms like asthma, or why the effect was so significant even though dish washing requires the use of soaps, possibly even antibacterial products. Hesselmar says they are asking the same questions and hope to continue looking into the link.

Read next: This ‘Peanut Patch’ Could Protect Against Peanut Allergies

This story originally appeared on Time.com.

Why Washing Dishes by Hand May Lead to Fewer Allergies

Britain has fewer hospital beds than most European countries, OECD says

There are fewer hospital beds in Britain than most other European countries, with much less than half the number of many, a report has found.

In accordance to the Organisation for Economic Co-operation and Advancement (OECD), the United kingdom had 3 hospital beds per one,000 individuals in 2011, with Ireland getting the exact same amount.

This was far behind the majority of other nations on the continent, with Germany having 8.three per 1,000 individuals, Austria seven.7, Hungary 7.two, Czech Republic six.eight and Poland six.six.

Estonia (5.three) Slovenia (4.6) also had significantly more, with only Sweden obtaining a reduce amount, at 2.7 per 1,000 population.

The figures present that the amount of hospital beds has progressively fallen in Britain because 2000 when there had been four.one per one,000 folks.

As well as a lack of beds, the NHS also has to contend with so-known as “bed blockers” who get up beds that could be utilised by other folks. Several elderly people have unnecessarily extended stays in hospital since social care providers are not in a position to support them once they are discharged.

Last October individuals needing important health-related care in England missed out on almost 80,000 days in hospital beds due to the fact they had been getting taken up by individuals who have been well sufficient to be moved on, NHS England stated.

Chris Hopson, chief executive of the Basis Believe in network, which represents NHS hospitals, stated the OECD figures demonstrate they are working close to complete capability.

He told the Day-to-day Telegraph: “There is no slack in the technique and trusts are consistently juggling their sources to meet patient demand.

“We have to stay away from scenarios exactly where elderly people are moved from one bed to the up coming, or forced to endure long waits on trolleys, but it is not simple since of the pressure the system is below.”

Britain has fewer hospital beds than most European countries, OECD says

Fewer hospital admissions for tooth decay in fluoridation locations – research

A kid undergoes a dental check out. Photograph: Alamy

As several as 45% fewer youngsters aged one to 4 are admitted to hospital for tooth decay in areas where water is fluoridated than in individuals exactly where it is not, giving fat to the argument that fluoridation is a safe and powerful public health measure, a review has identified.

Public Overall health England (PHE), a Division of Overall health company, also located that on typical there had been 15% fewer 5-yr-olds and 11% fewer 12-12 months-olds with tooth decay in regional authority regions with fluoridated water. The respective figures rise to 28% and 21% when deprivation and ethnicity, critical factors for dental overall health, are also taken into account.

Sue Gregory, PHE’s director of dental public well being, said: “These findings highlight the crucial contribution that water fluoridation helps make to children’s dental well being and general wellbeing. It is notable that the advantages of this public wellness measure seem to be best for children living in the most deprived regions of the country. This is important for decreasing the large differences we see in dental health between deprived and much more affluent regions of the nation.”

About six million folks live in places with fluoridation schemes, some of which have been in place for a lot more than 40 many years. The level of fluoride is adjusted to 1mg per litre, or 1 component per million, in an work to decrease tooth decay.

Some have argued that water fluoridation can potentially lead to harm, like bone cancer in boys, bladder cancer, hip fractures and tooth stains, and that it should not be imposed on individuals against their will.

The report looked at the comparative prices of hip fractures, kidney stones, cancers, Down’s syndrome births and all-lead to mortality and located no variation, concluding that there was “no evidence of harm to well being in fluoridated areas”.

PHE is legally needed to check the results of water fluoridation schemes on health and produce reports at least each 4 many years. It mentioned there were sizeable inequalities in the incidence of tooth decay among affluent and deprived communities.

“This report gives further reassurance that water fluoridation is a risk-free and successful public overall health measure,” mentioned Professor John Newton, PHE’s chief knowledge officer. “We will use this report as a basis for discussions with neighborhood authorities on the scope and articles of even more reports and on the function of fluoridation as a public health measure.”

Fewer hospital admissions for tooth decay in fluoridation locations – research

United kingdom has fewer physicians per individual than Bulgaria and Estonia

Final summer time MPs on the Wellness Select Committee warned that only a single in 5 casualty wards in England had enough consultants on duty, leading it to conclude that “A&ampE departments are in crisis”.

Rehana Azam, GMB National Officer for the NHS mentioned: “Adequate is enough, there can be no much more cuts to spending budget or staffing.

“There is so much stress on NHS employees due to the fact of the shortage and the massive amount of sufferers they deal with. It is really worrying, especially as we are dealing with the toughest winter in years.”

Dr Paul Flynn, Chair of the British Healthcare Association Consultants Committee, explained: “Policy makers need to get a grip on NHS workforce preparing.

“Projected imbalances amongst distinct specialties will have severe implications for patient care and we are already seeing the effect of workers shortages in key regions this kind of as emergency care.

“In addition, despite the pledge to safeguard front-line companies, a lot of employers in the NHS are freezing recruitment in response to financial pressures.”

Dr Flynn said that staffing amounts should be aligned to meet “the shifting demands of patients” and tackle issues such as workload pressures and function-lifestyle balance that may well be deterring health-related graduates.

“Doctors in the NHS face increasingly tough, substantial pressured and demanding work environments, often with limited sources and gruelling workloads. Only by creating doing work practices and environments secure and sustainable will the NHS be capable entice and retain the required number and mix of physicians,” he stated.

In accordance to OECD data, the amount of doctors per head of population in the United kingdom has been growing from just 1.9 per 1,000 in 2000, when European common stood at two.9.

The United kingdom has witnessed much more fast development than other individuals, narrowing the gap towards the European average, which had grown to three.4 per one,000 in 2010.

The OECD says the amount of medical professionals in the Uk enhanced once again in 2011, to 2.eight per one,000. Evaluation by Plaid Cymru final 12 months showed Wales had the fewest doctors per one,000 at 2.five, although England and Northern Ireland had two.7 per 1,000. Scotland by contrast dragged up the average, with 3.one per one,000.

A Division of Wellness spokesperson mentioned the amount of doctors in the NHS was increasing. “The amount of medical doctors in the NHS has gone up on regular by three.5 per cent every yr above the previous 10 years, and there are more than 6,600 far more physicians than in Could 2010.

“At the very same time, the amount of admin personnel, managers and senior managers has fallen by nearly 23,000.”

United kingdom has fewer physicians per individual than Bulgaria and Estonia