Half of care home residents are at risk of harm from mistakes made in giving out their medication, research suggests.A study of 345 elderly people in residential and nursing care around England, which recorded all of the drugs they took over three months, found that 90 per cent were exposed to at least one error.

Researchers at the University of West England Bristol and the University of Warwick found that 52 per cent of those in the study were exposed to “more serious” problems, such as untrained staff trying to give them another patient’s medicine.

Experts say that many people have to be taken to hospital every year because of mistakes in medication administration, and so the NHS could save millions if these trips were avoided.

Some trusts have tried to stop nurses being distracted on drug rounds by making them wear bright red tabards printed with the message “do not disturb”, but these led to fears that they could leave other patients feeling ignored.

Prof Ala Szczepura of Warwick University said: “Older people in long-term residential care are clearly at increased risk of medication errors.”

Deidre Wild, a visiting research fellow at UWE Bristol, added: “The majority of residents are cared for in a residential home with no onsite nursing staff. In such homes the management of prescribed medication is undertaken by social care staff who may have had no formal training in safe practice.”

The study protocol of a cluster-randomised controlled trial of family-mediated personalised activities for nursing home residents with dementia was published online in the journal BMC Geriatrics, looked at 13 care homes in the south west, midlands and north west of England, and analysed 188,249 attempts to administer drugs by staff.

Each resident received nine different drugs on average and were given medication 206 times a month. Each resident experienced 6.6 potential errors, with the most common being an attempt to give drugs at the wrong time.

However experts say many of the problems could be avoided with new technology which uses a barcode system to alert staff to potential errors. Staff scan each patient’s barcode identifier then scan the drugs sent out by the pharmacy to check they are being given the right dose at the correct time.

The number of patients killed or seriously injured by medical devices rose by almost a third last year, according to official figures.The statistics from the health products watchdog are likely to raise fresh fears about the safety of some types of surgery and medical technology, in the wake of the faulty breast implants scandal.

Overall the number of reports of “adverse incidents” involving devices received by the Medicines and Healthcare products Regulatory Agency rose by 13 per cent in 2010, to reach 10,280.

Of these, 301 cases were fatalities – a 50 per cent rise on the previous year – while 2,382 involved serious injuries.

Investigations by the MHRA showed that about a third of the incidents were down to the “healthcare establishment or user responsibility”, while a similar proportion were the fault of the manufacturer.

About a quarter of the cases involved “active and inactive implants” such as pacemakers, replacement hips, gastric bands and even contact lenses.

But the report also highlights the problems raised by French authorities over the safety of silicone breast implants made by Poly Implant Prosthese (PIP), which has led to a row between the Department of Health and private cosmetic surgery clinics over who should pay for their removal and replacement.

About 15 per cent of the incident reports involved problems with surgical equipment and a similar proportion was concerned with life support machines and incubators.

Other patients suffered problems with wheelchairs, artificial limbs, syringes and beds or hoists.

From: http://www.telegraph.co.uk/Deaths-and-serious-injuries-involving-medical-devices-up-29

You really can die of a broken heart- a new study shows that people mourning a close relative are 21 times more likely to suffer a heart attack themselves.A “perfect storm” of stress, lack of sleep and forgetting to take regular medication puts mourners at increased risk in the days after losing a loved one.

Scientists showed that after a significant person’s death, heart attack risks increased to 21 times higher than normal within the first day, and were almost six times higher than normal within the first week.

Doctor Murray Mittleman, a preventive cardiologist and epidemiologist at Harvard Medical School in the United States, said: “Caretakers, healthcare providers, and the bereaved themselves need to recognise they are in a period of heightened risk in the days and weeks after hearing of someone close dying.”

The researchers also found that the increased risk of heart attack within the first week after the loss of a significant person ranges from one per 320 people with a high heart attack risk to one per 1,394 people with a low heart attack risk.

The study is the first to focus on heart attack risk during the first few days and weeks after someone close died.

Grieving spouses have higher long-term risks of dying, with heart disease and strokes accounting for up to 53 per cent of deaths, according to previous research.

As part of the Determinants of MI Onset Study, researchers reviewed charts and interviewed patients while in the hospital after a confirmed heart attack between 1989 and 1994.

Patients answered questions about circumstances surrounding their heart attack, as well as whether they recently lost someone significant in their lives over the past year, when the death happened and the importance of their relationship.

The researchers estimated the relative risk of a heart attack by comparing the number of patients who had someone close to them die in the week before their heart attack to the number of deaths of significant people in their lives from one to six months before their heart attack.

Psychological stress such as that caused by intense grief can increase heart rate, blood pressure and blood clotting, which can raise chances of a heart attack.

At the beginning of the grieving process, people are more likely to experience less sleep, low appetite and higher cortisol levels, which can also increase heart attack risks.

Elizabeth Mostofsky, lead author of the research, said grieving people also sometimes neglect regular medications, possibly leading to adverse heart events,

She added: “Friends and family of bereaved people should provide close support to help prevent such incidents, especially near the beginning of the grieving process.  Similarly, medical professionals should be aware that the bereaved are at much higher risk for heart attacks than usual.”

Dr Mittleman added: “During situations of extreme grief and psychological distress, you still need to take care of yourself and seek medical attention for symptoms associated with a heart attack.”

Heart attack symptoms include chest discomfort, upper body or stomach pain, shortness of breath, breaking into a cold sweat, nausea or light-headedness.

However, Dr Mittleman said future studies are needed to make more specific recommendations based on the study which was published in Circulation: Journal of the American Heart Association.

From: http://newsroom.heart.org/pr/aha/grief-over-losing-loved-one-linked-221451.aspx

Carers are to be given legal rights under government plans to increase the assistance available to the six million Britons who look after other people.Ministers want to ensure that carers are given support to continue working or studying and to receive time off.

The rights of carers are expected to be put on the same legal footing as those of the people they look after.

There are estimated to be about six million people caring for husbands, wives, children, parents or neighbours, but the Government admits that “many do not get the emotional, financial and practical support they need”.

Paul Burstow, the care services minister, said: “Without the support of relatives and friends, many people who aren’t able to look after themselves would not be able to stay at home. Carers should have their needs looked after as much as the person they are caring for.

“A carer’s health often suffers because they don’t have time to look after themselves. Some often don’t have time to eat properly. So it’s vital we support them to look after their health and well-being.

He added: “None of this is rocket science. It is about the NHS seeing beyond the patient to support family carers. Carer stress is one of the biggest triggers for admission to care homes. That’s why we’ve given the NHS the clearest ever direction to make carers a priority.”

The details of the new rights for carers will be set out in the spring when the Government publishes its plans for reforming the social care system.

They are expected to include safeguards to ensure carers can work flexible hours and are not discriminated against in the workplace. Carers who are studying are likely to be able to ensure they receive state help at school or college.

A scheme that allows carers to take a break is also likely to be strengthened to protect leisure time.

“Caring is for many a full-time job,” said the Department of Health, “but many carers don’t realise they can get help and support from their community.”

A simple programme of assessing carers’ needs and providing tailored help to address them is expected to be introduced.

Ministers have promised to publish a white paper on elderly care reform in April next year.

From:  http://www.telegraph.co.uk/Carers-to-get-legal-rights-and-support-in-reforms

Thousands of elderly people are at increased risk of pneumonia this winter if they fail to brush their teeth regularly new research has found.The Dental Health Foundation has warned that poor oral hygiene could cause the respiratory infection after research found a link between bacteria in the mouth and the lung disease.

Dr Samit Joshi of Yale University School of Medicine found changes in bacteria in the mouth preceded the development of pneumonia.

He concluded that this process “suggests that changes in oral bacteria play a role in the risk for developing pneumonia”.

Pneumonia is thought to affect more than 620,000 people in the UK and claims the lives of around five per cent of those who contract the disease. Which means that it kills more than ten times the number of people who die in the UK from road accidents.

Although further research is required to determine the exact relationship between oral health and pneumonia, it is not the first time the two diseases have been linked.

Poor oral health has been associated with respiratory diseases for a number of years, as bacterial chest infections are thought to be caused by breathing in fine droplets from the throat and mouth into the lungs.

This can cause infections, such as pneumonia, or could worsen an existing condition.

Studies have even suggested a higher mortality rate from pneumonia in people with higher numbers of gum problems.

The findings of the study present further evidence that there’s a significant health risk to the elderly and the young, according to Chief Executive of the British Dental Health Foundation, Dr Nigel Carter.

Dr Carter said: “During the winter months we’re all susceptible to colds, coughs and chesty viruses due to the drop in temperature. What people must remember, particularly those highlighted as vulnerable, is that prevention can be very basic.

“Systemic links between gum disease and overall health have been well documented, and at this time of year keeping up good oral health can really help stave off illness.

“Simply brushing your teeth for two minutes twice a day using a fluoride toothpaste, cleaning in between teeth daily with interdental brushes or floss, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend will be a great starting point.

“If you have swollen gums that bleed regularly when brushing, bad breath, loose teeth or regular mouth infections appear, it is likely you have gum disease.

“If any of these symptoms persist, or signs of pneumonia develop, visit your dentist and GP immediately.”

The research was presented at the Infectious Diseases Society of America annual meeting in Boston looked at 37 subjects for a one month period.

Viagra helps ailing hearts to recover in a surprising way – by making them less stiff and allowing them to pump more efficiently scientists have learned.The impotency drug causes too-rigid heart chamber walls to become more elastic. The research explains how Viagra might benefit patients with diastolic heart failure.

People with the condition have abnormally inflexible ventricles, the heart’s major pumping chambers, that do not fill sufficiently with blood.

This leads to blood ”backing up” in the lungs and breathing difficulties.

Scientists found that Viagra activates an enzyme that causes a protein in heart muscle cells to relax.

The effect was seen in dogs with diastolic heart failure within minutes of the drug being administered.

Study leader Professor Wolfgang Linke, from the Ruhr Universitat Bochum (RUB) in Germany, said: ”We have developed a therapy in an animal model that, for the first time, also raises hopes for the successful treatment of patients.”

Viagra has a similar effect on blood vessels, which is why it was originally developed as a treatment for high blood pressure and heart disease.

The drug’s active ingredient, sildenafil, inhibits an enzyme involved in the mechanism that regulates blood flow.  However, the enzyme is slightly different in different parts of the body.

The British scientists behind Viagra found to their initial disappointment that it was not a great help to patients with high blood pressure. But it had a miraculous effect on men with erectile dysfunctin.

The drug successfully suppressed the enzyme phosphodiesterase (PDE) in the penis, increasing blood flow to the organ.

Prof Linke’s team found that it worked on the same enzyme in heart cells. This had the effect of causing a cardiac muscle protein called titin to become more elastic.

”The titin molecules are similar to rubber bands,” said the professor. ”They contribute decisively to the stiffness of cardiac walls.”

The research was initially published in the journal Circulation of the American Heart Association.

Almost half of emergency patients admitted to hospital with heart failure have a diastolic condition.

Various medical conditions can cause the ventricles to become ”stiff”. They include high blood pressure, blocked arteries, and cardiomyopathy heart disorders.

Sildenafil is already being tested on heart failure patients taking part in the Relax trial in the US.

Two senior paediatric pathologists say they have discovered vitamin D deficiency in a significant number of children who have died of Sudden Infant Death Syndrome (SIDS)- cot deaths.The two doctors, Dr Irene Scheimberg and Dr Marta Cohen, say that vitamin D deficiency and associated diseases such as the bone disease rickets could also explain deaths that are often thought to be suspicious.

Both doctors believe their findings merit further investigation and research.

The findings in children from London and Yorkshire followed the discovery by Dr Scheimberg in 2009 of congenital rickets in a four-month-old baby whose parents had been accused of shaking him to death.

Chana Al-Alas,19, and Rohan Wray, 22, were acquitted of murdering their son Jayden after the jury learned that his fractures, supposedly tell tale signs of abuse, could have been caused by his severe rickets. Dr Scheimberg also discovered rickets in Jayden’s mother.

In London, Dr Scheimberg discovered vitamin D deficiency in a further 30 cases. Vitamin D deficiency was found to be a cause of death in three cases. Cardiomyopathy, a disease of the heart muscle, was discovered in two small babies. A third died of hypocalcemic fits, a condition of low serum calcium levels in the blood caused by vitamin D deficiency.

Vitamin D deficiency was a co-existing finding in the sudden and unexpected deaths of eight children, so-called Sudden Infant Death or Sids; in five children with bronchial asthma and another five with combined bacteria-polyviral or polyviral infections. Two of the babies, including baby Jayden, also had rib fractures.

In Yorkshire, Dr Cohen found moderate to severe levels of vitamin D deficiency in 45 children, mostly infants aged less than 12 months, who died of natural causes. Of the 24 sudden infant deaths Dr Cohen investigated from this group, 18 – or 75% – were deficient in vitamin D.

Dr Scheimberg said severe vitamin D deficiency could make the bones of small babies very brittle and capable of fracture with little or no real force.

Dame Sally Davies Chief Medical Officer was quoted as “We need to investigate the vitamin D levels of these children carefully and the circumstances in which the bones fracture,” she explained.

“Obviously if you have bones that fracture easily then they will fracture easily they will fracture with any normal movement like trying to put a baby grow on a baby you will twist their arm. In a normal child you won’t produce anything. But in a child whose bones are weakened and [who have] an abnormal cartilage growth area, then it’s easier for them to get these very tiny fractures or even big fractures.”

Vitamin D is actually a hormone, and endocrinologists are experts in how the body is regulated by the hormone excreting glands – or endocrine organs.

Stephen Nussey is professor of endocrinology at St George’s Hospital at Tooting in south London. He believes that, despite repeated government recommendations on vitamin D supplementation, vitamin D deficiency is still not being taken sufficiently seriously by the authorities.

“Lizards are quite like humans in their vitamin D. Their dietary intake is pretty low and they need to have sun exposure and you need to have a light in the enclosure in which you keep your lizard of the right wavelength.

“If you don’t have one of those lights your reptile will get osteomalacia [adult rickets] very similar to humans. I guess the RSPCA would quite rightly prosecute you if you didn’t give your reptile vitamin D.

“But there’s no action taken against you if you don’t give it to your daughter. So that rather illustrates the importance placed on vitamin D for your reptile rather than giving it to your daughter.”

Earlier this week, the chief medical officer for England, Dame Sally Davies, wrote to doctors, nurses and other health professionals advising them to consider vitamin D supplementation for certain at risk groups, including pregnant mothers.

“We know a significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood. People at risk of vitamin D deficiency, including pregnant women and children under five, are already advised to take daily supplements. Our experts are clear – low levels of vitamin D can increase the risk of poor bone health, including rickets in young children,” she explained.

“Many health professionals such as midwives, GPs and nurses give advice on supplements and it is crucial they continue to offer this advice as part of routine consultations and ensure disadvantaged families have access to free vitamin supplements through our Healthy Start scheme.

“It is important to raise awareness of this issue, and I will be contacting health professionals on the need to prescribe and recommend vitamin D supplements to at risk groups.

From: http://multi-vitamins.eu/vitamin-d-deficiencies-linked-to-cot-deaths-sids

Penicillin doses for children need to be reviewed to take account of the fact youngsters are getting heavier meaning they may not be getting an adequate dose doctors have said.Dosing guidelines have remained unchanged for almost 50 years and are mostly based on children’s ages.

But experts argue that the dose a child needs is determined by their weight – and the average weight of children has increased.

It means that children may not be receiving a big enough dose of antibiotics to combat their infection.

Giving inadequate doses also encourages bacteria to become resistant to antibiotics making them harder to treat in future, it was warned.

The average weight today of a five-year-old is 21kg and a 37kg for a 10-year-old – up to 20% higher than in 1963, researchers at King’s College London sad.

The study, led by a team at King’s College London and St George’s, University of London, said they were “surprised at the lack of recent evidence” to support current dosing recommendations for penicillins.

Writing in the British Medical Journal (BMJ), they said ‘fractions’ of adult doses are calculated instead of basing the dose on the weight of the child who needs treatment.

The article said: “The widely used doses are still based on the original dosing principle of a big child = half an adult, small child = half a big child, baby half a small child.”

The team analysed the actual dose that would be received today based on age bands recommended in the 2010/11 British National Formulary for Children and the current weights of children based on 2009 Health Survey for England data.

The results showed doses could be strikingly low.

The authors also pointed out that many infections do not need treatment with antibiotics.

“Many of the five million children in England who receive oral penicillins each year may not need them, but those who do should receive them in an effective dose.”

Dr Paul Long, senior lecturer in pharmacognosy at King’s College London, said: “We were surprised at the lack of evidence to support the current oral penicillins dosing recommendations for children, as it is such a commonly used drug.

“Children’s average size and weight are slowly but significantly changing, so what may have been adequate doses of penicillin 50 years ago are potentially not enough today.

“It is important to point out that this study does not provide any clinical evidence that children are receiving suboptimal penicillin doses that lead to harm, and we want to reassure parents of that.

“But what we are saying is that we should ensure that children with severe infections who need these antibiotics the most are still receiving an effective dose.”

The first ever National Audit of Dementia found a “shocking” lack of care delivery.It found that care was often delivered in an impersonal manner, staff ignored patients’ requests for help and staff were not trained sufficiently in the care of dementia patients despite figures showing one in four hospital beds is occupied by people with the condition.

Data from 210 hospitals in England and Wales was used in the report along with ward level data from a sample of 145 wards, over 2,000 staff questionnaires and observations of care on the wards.

Professor Peter Crome, the co-author of the report and Chairman of the National Audit of Dementia Steering Group, said that the report had “found problems across practically every aspect of care for patients admitted to hospitals with dementia.”

He added: “There were deficiencies in the assessment of people and there were deficiencies in the interaction betweem staff and patients.”

Hannah Clack from the Alzheimer’s Society called the report “shocking” and stressed the need for “a huge and radical shake-up of the way the NHS deals with people with dementia.”

She added: “People are going into hospital and they’re coming out worse in terms of their dementia and in terms of their physical health.”

The report recommended that all staff should have basic training in dementia, and that all hospitals should have Dementia Champions on every ward.

Up to 24,000 people with diabetes are dying unnecessarily every year, according to a new report.Most deaths could be avoided if they received better NHS care and if their condition was better managed, it said.

The report into death rates, from the National Diabetes Audit for England, found that women with diabetes are nine times more likely to die young than those without the condition.

Among women aged 15 to 34 with diabetes, death rates are up to nine times higher than the average for this age group.

And the report also found that two young people of both sexes aged 15 to 34 may be suffering an avoidable death every week.

An estimated 70,000 to 75,000 people with diabetes die in England every year – accounting for about 15% of all deaths.

Most deaths are related to the actual condition – diabetes can cause serious heart and kidney problems, as well as amputation of limbs and loss of eyesight.

The report said people are dying too early due to poor management of their condition.

This includes not receiving basic diabetic health checks on the NHS, having unhealthy lifestyles and not taking medication properly or understanding how to take it.

It argues that educating people in managing their condition reduces the risk that they will suffer dangerously high or low blood sugar, which increases the risk of complications but can also lead directly to death.

The gap in death rates between people with diabetes and those without become more extreme in younger age groups.

About one in 3,300 of all women will die between the ages of 15 and 34, but this risk increases nine-fold among women with Type 1 diabetes to one in 360.

Type 1 diabetes usually develops in childhood and patients need to take insulin injections.

Among women with Type 2 diabetes – linked to unhealthy lifestyles and obesity – the risk increases six fold to one in 520.

Men aged 15 to 34 in the general population have a risk of dying of one in 1,530, but this risk increases four-fold for those with Type 1 diabetes to one in 360, and by just under four-fold among those with Type 2 to one in 430.

Earlier this year the National Diabetes Audit found almost 450,000 children and younger adults (aged up to 54) with diabetes have high-risk blood sugar levels that could lead to severe complications.

The audit is managed by the NHS Information Centre and commissioned by the Healthcare Quality Improvement Partnership (HQIP).

The report also found a strong link between deprivation and increased mortality rates.

Among under-65s with diabetes, those from deprived backgrounds are twice as likely to die as those from more affluent areas.

Diabetes UK has compiled a list of 15 essential health checks and services and there are nine checks recommended on the NHS by the National Institute for Curbing Excpenditure (Nice).

These nine checks include blood sugar control, cholesterol, blood pressure, body mass index (BMI) and eye and foot examinations to check for diabetic complications.

The National Diabetes Audit has found that only around half of people (53%) with Type 2 diabetes and less than a third (32%) with Type 1 diabetes receive all nine checks.

Some 290,000 people in the UK have Type 1 diabetes and another 2.6 million are diagnosed with Type 2.

It is also estimated there are 850,000 other people with undiagnosed Type 2 diabetes.