Risk of cot deaths rises five times if beds are shared

Sharing a bed with a newborn increases the risk of sudden infant death syndrome fivefold new research claims.
Risk of cot deaths rises five times if beds are sharedThe risk applies even if parents avoid tobacco, alcohol and drugs- other factors which are strongly linked to cot deaths.

The BMJ Open research Bed sharing with parents increases the risk of cot death fivefold even if the parents are non-smokers compared nearly 1,500 cot deaths with a control group of more than 4,500 parents.

Current guidance in the UK is that parents should decide where their baby sleeps, but says the safest option is in a crib or cot in the same room.

Many other countries, such as the US and the Netherlands, go further and say parents should not share a bed with their baby for the first three months of his or her life.

Prof Bob Carpenter, from the London School of Hygiene & Tropical Medicine, carried out the analysis and says the UK should now follow suit and “take a more definitive stance against bed-sharing for babies under three months”.

Prof Carpenter maintains avoiding bed-sharing would save lives – by his calculations, 120 of the 300 cot deaths that occur in the UK each year.

Current advice on Sudden Infant Death Syndrome (SIDS)

  • Place your baby on their back to sleep.
  • Cut smoking in pregnancy, including dads. Don’t let anyone smoke in the same room as your baby.
  • The safest place for your baby to sleep is in a crib or cot in a room with you for the first six months.
  • Never sleep with your baby on a sofa or armchair.
  • Do not let your baby get too hot, and keep their head uncovered.

Source: The Lullaby Trust

In his analysis, one or both parents had been sleeping with their child at the time of death in a fifth of cases.

Only one in every 10 parents in the control group said they had shared a bed with their baby.

Even in very low-risk breastfed babies, where there were no risk factors for sudden infant death syndrome (SIDS) other than that they had slept in their parents’ bed, 81% of cot deaths in infants under three months of age could have been prevented by not bed sharing.

Prof Carpenter says he is not suggesting that babies should be banned from being in the parents’ bed for comfort and feeding.

IVF success rates may be boosted by time lapse embryo imaging

Time lapse imaging- which takes thousands of pictures of developing embryos can boost the success rate of IVF, according to British research.IVF success rates may be boosted by time lapse embryo imagingThe article Retrospective analysis of outcomes after IVF using an aneuploidy risk model derived from time-lapse imaging without PGS was reported in Reproductive BioMedicine Online, can be used to select embryos at low risk of defects.

Scientists at the CARE fertility group say such informed selection can improve birth rates by 56%.

Other experts say the result is exciting, but the study of 69 couples is too small to be definitive.

The research followed the couples at the CARE fertility clinic in Manchester last year, when 88 embryos were imaged and implanted.

The process involves putting the embryos into an incubator and imaged them every 10 to 20 minutes.

Continual embryo monitoring through time-lapse imaging is aimed at selecting those with the lowest risk of aneuploidy – where the cells have chromosome abnormalities. Aneuploidy is the single biggest cause of IVF failure.

But this form of embryo screening is a predictive rather than diagnostic tool.

Couples at high risk of passing on a chromosomal abnormality may prefer to have Pre-implantation Genetic Screening. This invasive test removes cells from the early embryo for analysis. It costs around £2,500 on top of the £3,000 charged for conventional IVF.

The researchers classified the embryos as low, medium or high risk of chromosome abnormalities based on their development at certain key points.

Eleven babies were born from the low risk group (61% success rate) compared to five from the medium risk group (19% success rate) and none from those deemed high risk.

“In the 35 years I have been in this field this is probably the most exciting and significant development that can be of value to all patients seeking IVF,” said Prof Simon Fishel, managing director of CARE Fertility Group.

“This technology can tell us which embryo is the most viable and has the highest potential to deliver a live birth – it will have huge potential. This is almost like having the embryo in the womb with a camera on them.”

In standard IVF, embryos are removed from the incubator once a day to be checked under the microscope. This means they briefly leave their temperature-controlled environment and single daily snapshots of their development are possible.

Man with no shame NHS boss to retire

The man with no shame- NHS boss Sir David Nicholson has announed that he will retire next year.
Man with no shame NHS boss to retireSir David has announced he will step down in March 2014 from his position as chief executive of NHS England.

He has spent seven years in charge of the NHS, but in recent months has faced repeated calls to resign over his role in the Stafford Hospital scandal.

He spent 10 months in charge of the local health authority in 2005 and 2006 at the height of the problems which led to hundreds of needless deaths.

Soon after that, he was appointed NHS chief executive, before taking charge of NHS England, the body set up under the government’s reforms to take charge of day-to-day running of the health service.

Campaigners and MPs had called for him to resign after publication of the public inquiry into the failings, which involved the neglect and abuse of vulnerable patients.

The report published in February said the system has “betrayed” the public by putting corporate self-interest ahead of patients.

In March, Sir David, whose career in the NHS spans 35 years, told MPs on the Health Select Committee he was determined to carry on despite the furore over his involvement.

But in his letter to bosses announcing his retirement from the £211,000-post, he said “recent events continue to show that on occasion the NHS can still sometimes fail patients, their families and carers”.

He also said by giving such notice he hoped to give NHS England time to recruit a high calibre successor while continuing to give stability while the changes, which came into force in April, bed in.

But Julie Bailey, from the campaign group Cure the NHS, which has led the calls for the under-fire boss to resign, said that his position had been untenable since the publication of the public inquiry.

“It is fantastic news. This is the start of the cure for the NHS.  We can start to look to the future now. He was part of the problem – not part of the solution.  We now need a leader who will galvanise and inspire the front line, not bully them.”

Hygiene worries at cancer centres

Inspectors have expressed worries at the standard of hygiene and cleaning at Scotland’s largest cancer centres.
Hygiene worries at cancer centres
On a visit to the Beatson and Gartnavel General Hospitals, they found dust and debris- and were told by staff there were not always enough cleaners.

Healthcare Improvement Scotland also found many patients had not been given information about preventing infection.

NHS Greater Glasgow and Clyde (GGC) said it had drawn up an action plan to address the inspectors’ concerns.

HIS carried out the unannounced inspection at Gartnavel, which has 558 beds, on 26 March.

The site also houses the Beatson West of Scotland Cancer Centre with 170 beds.

In its report, the inspection team stated that it “observed good compliance with standard infection control precautions” in all the wards visited.

It continued: “However, on one ward we found a large number of full sharps bins awaiting uplift.  These were restricting access to the handwash sink in the sluice.”

“The senior charge nurse confirmed that there had been no collection the previous day (Monday) and that the portering department had been contacted to arrange collection. The senior charge nurse told us that this problem was not uncommon.”

The report also noted that on the day of inspection, the hospital was “generally clean”.

It continued: “However, in four of the nine wards and departments inspected, further attention to detail was required. This included high and low level dust and debris, particularly at floor to wall junctions.  In three of these wards and departments, staff expressed concern at the inconsistent provision of adequate domestic staff to achieve the required level of cleaning.”

The inspection resulted in three requirements – covering cleaning, information availability and record keeping – being made, which HIS expected NHS GGC to address “as a matter of priority”.

Organ donations rise in UK tripled in numbers

The number of living people giving one of their organs to a stranger almost tripled last year in the UK, according to new figures.Organ donations rise in UK tripled in numbersThe Human Tissue Authority (HTA) approved 104 so-called altruistic organ donations in 2012-13 compared with 38 the previous year.

The figures include the first case of someone giving part of their liver to someone they had never met.

Altruistic donations now make up about one in 12 of all living donations.

The total number of living donations, including those to family members or friends, rose from 1,217 to 1,243 over the same time period.

Diana Warwick, chair of the HTA, said donating an organ was a remarkable thing to do.

“Giving someone an organ is a brave and amazing gift. To do it for someone whom you don’t know is doubly so, and the huge increase in people willing to do so is incredible,” she said.

“The HTA works on more – and more complex – living donation cases every year and we expect this to continue. We remain committed to ensuring that people can donate organs with confidence.”

The HTA believes the number of living organ donations is rising, as public awareness spreads.

Lisa Burnapp, lead nurse for living donation at NHS Blood and Transplant, said donors were motivated by a decision to do something genuinely good for someone in need.

“The increase in non-directed altruistic living donors has exceeded all expectations and means that more patients can benefit from a successful transplant and enjoy life with their families and loved ones,” she said.

“This is an incredibly important gift and we are indebted to people who choose to donate in this way.”

There are currently about 10,000 people in need of a transplant in the UK, with three people a day dying due to the lack of suitable available organs, according to NHS figures.

Potential living donors undergo extensive medical and psychological screening.

This includes an independent check, which ensures that the donor understands the risks involved, is not under any pressure, and that no reward has been offered.

A&E must change or face collapse NHS warned

Urgent changes must be made to the way Accident and Emergencies (A&E) units are run – or the system could collapse, doctors and managers say.A&E must change or face collapse NHS warnedBoth the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system.

Funding and staffing have been highlighted as key issues.

Health Secretary Jeremy Hunt said it was “very tough out there” and ministers would deal with it by “better joining up” health and social care.

The warnings come as fears grow over whether the NHS can continue to cope with rising demand.

Last week both ministers and the NHS regulator admitted the problems were a cause for concern.

A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four hour waiting time target.

The review by the College of Emergency Medicine – based on feedback from more than half the A&E units in the UK – said the scale of the challenge was the biggest for a decade.

It said there were shortages in both middle-grade and senior doctors. As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.

It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.

Meanwhile, the Foundation Trust Network (FTN) highlighted the funding system in England which penalises A&E units seeing a rise in patients.

Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.

But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of Pounds a year.

Across the NHS more patients are being seen, but the upward trend is perhaps the greatest in A&E.

The lack of out-of-hours GP care is the cause of rising demands on A&E.

Since 2004 GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care.

A lack of confidence in the service has meant patients have to turn to A&E when they have not always needed emergency care.

This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have got poor advice and been told to go to their local A&E for trivial reasons.

But this does not tell the full story. The ageing population means there has been a rise in long-term conditions – about £7 in every £10 spent goes on patients with problems such as dementia and heart disease for which there is no cure.

Obese women restricted in NHS IVF treatments

New NHS IVF treatment rules have been drawn up in Scotland.
Obese women restricted in NHS IVF treatmentsCouples who need help conceiving will be guaranteed two free infertility treatments from 1 July, however the treatments will only be available to those under 40, and it will not be offered to women who are obese.

In addition, couples need to have been in a stable relationship for two years and neither partner can smoke for three months before treatment begins.

Both partners also need to be methadone-free for a year before IVF starts

If either partner smokes they will need to have stopped before treatment is commenced

Women aged between 40 and 42 will be eligible for one cycle of fertility treatment if they have never previously undergone the procedure.

The new IVF criteria has been approved by the Scottish government.

The guarantees came as the National Infertility Group published a report with recommendations on new criteria.

The eligibility criteria for free fertility treatment in Scotland currently includes a female age limit of 39; the patient must not already have a child living at home; and they must have had less than three previous funded embryo transfers.

Scotland’s Public Health Minister Michael Matheson said the government was committed to “providing fair, reliable and faster access to IVF treatment”.

He insisted that it was important to end the different approaches across the country and to offer “equity”.

“We are investing £12 million over three years to help drive down waiting times for IVF treatments, and waiting times are already reducing in a number of NHS board areas.

“We also have to be responsible about the effects of smoking and obesity on pregnancy and beyond. Smoking not only reduces the effectiveness of IVF, but also doubles the risk of pregnancy loss.

“NHS boards will offer patients the support needed to make the lifestyle changes demanded of the new criteria.

“The safety of mother and baby is of utmost importance and the recommendations will ensure healthier outcomes for both families and babies born as a result of IVF treatment.”

111 health direct helpline has been very disappointing admits ministers

The new NHS health direct non-emergency advice line had a “very disappointing start” and is still not operating properly in several parts of the country Ministers have admitted.111 health direct helpline has been very disappointing admits ministersHealth officials have launched an investigation into the advice line after a number of potentially serious incidents, including three deaths, have been linked to the service.

Patients have complained about calls going unanswered and poor advice being given, with frivolous calls being passed on to ambulance services, while serious concerns did not receive a prompt response.

Speaking at the National Institute for Health and Care Excellence annual conference in Birmingham, Lord Howe, a Health Minister admitted that in some parts of the country, the service “fell down”.

He said concerns remained about the way the 111 line is operating in the south west and south east coast.

“We are worried about services in the south west and the south east coast but the rest of the country – we have got 90 per cent of the country covered by 111 – is experiencing a good, if not excellent, service all the time. So we need to get this in proportion.

“We are not happy with those two particular areas and NHS England are gripping it.  We have been very candid about where NHS 111 fell down, we did not want to duck that.”

The extent of the telephone line’s teething problems were laid bare yesterday when official figures revealed a stark rise in abandoned calls.

The number of people who hung up after waiting for more than 30 seconds increased from 6,976 in February to 29,100 in March, according to NHS England figures.

And the average call length also increased from 14.19 minutes in February to almost 18 minutes in March.

Although the total number of calls also increased by 140,000 during the same period as the 111 pilot scheme was adopted more widely, the proportion of abandoned calls increased from 3.2 per cent to 8.1 per cent, the figures show.

Last week, leading doctors warned that the “problematic” roll-out of NHS 111 has left patients not knowing where to turn to for help as posted in the Health Direct blog  NHS 111- warnings over seriously flawed health cover.

The Royal College of General Practitioners said patients have “lost confidence” in the new number before it is even fully up and running across England.

The service was supposed to be rolled out on April 1, but officials were forced to relax the deadline after it emerged that many of the advice lines – which are run by 44 individual local bodies across the country – were not ready to “go live”.

And, more than a month on, seven of the regional bodies are still not even ready to start giving advice to patients in their areas.

NHS will collapse if elderly bed blocking continues claims health minister

The NHS will collapse without decisive action to get more elderly people out of hospitals, Norman Lamb, the health minister, has warned.NHS will collapse if elderly bed blocking continues claims health minister Mr Lamb, the care minister, said Britain’s system of health and social care is becoming “dysfunctional” and could “buckle under the pressure” unless radical changes are made to the way it operates.

He issued his warning amid growing concern that Accident & Emergency (A&E) departments and ambulance services are failing to cope, with rising numbers of patients forced to endure long waits.

Last week one of Britain’s most senior A&E doctors said units had begun to feel like “war zones” while the head of the NHS and social care watchdog said such services were “out of control”.

Regulators have also announced a review of the NHS funding system for which currently means that hospitals are paid to keep patients in hospital rather than discharging them to their homes or to care homes.

Mr Lamb said the NHS and social care system was under “huge pressure” from an ageing population, with high numbers suffering complex and chronic conditions and that tackling it was “the challenge of the 21st century”.

Mr Lamb said that addressing the funding system so that hospitals did not have a financial incentive to hang on to patients would be a priority.

“The hospital gets paid for a patient arriving in hospital but there is no incentive for them to leave,” he said.

Mr Lamb said the failure of health and social care to work together meant worse care for elderly people and wasted scarce resources.

The Lib Dem minister said: “At the moment the system is horribly fragmented and that means bad care – distress, crises occurring that could be avoided, massive disruption to people’s lives. If we carry on as we are the system will collapse.”

Mr Lamb’s warnings came as the government announced a review of services for elderly patients which could see elderly patients given their own personal NHS worker to oversee their care.

A single “named individual” would manage all care needs for elderly patients from arranging physiotherapy to home help and medical treatment.

The system of paying doctors by results will also be overhauled to focus on rewarding improvements in patients’ health rather than simply completing specified activities.

Waist to height ratio better than BMI for weight test

Your waist should be no more than half the length of your height- according to experts who claim that having too large a trouser size can dramatically shorten your lifespan.Waist to height ratio better than BMI for weight testMeasuring the ratio of someone’s waist to their height is a better way of predicting their life expectancy than body mass index (BMI), the method widely used by doctors when judging overall health and risk of disease, researchers said.

BMI is calculated as a person’s weight in kilograms divided by the square of their height in metres, but a study found that the simpler measurement of waistline against height produced a more accurate prediction of lifespan.

People with the highest waist-to-height ratio, whose waistlines measured 80 per cent of their height, lived 17 years fewer than average.

Keeping your waist circumference to less than half of your height can help prevent the onset of conditions like stroke, heart disease and diabetes and add years to life, researchers said.

For a 6ft man, this would mean having a waistline smaller than 36in, while a 5ft 4in woman should have a waist size no larger than 32in.

Children in particular could be screened as early as five using the waist-to-height ratio to identify those at greatest risk of obesity and serious health conditions later in life, it was claimed.

Researchers from Oxford Brookes University examined data on patients whose BMI and waist to height ratio were measured in the 1980s.

Twenty years later, death rates among the group were much more closely linked to participants’ earlier waist-to-height ratio than their BMI, suggesting it is a more useful tool for identifying health risks at an early stage.

By comparing the life expectancies of various groups of people at different waist-to-height ratios, they were able to calculate how many years of life were lost as people’s waistlines increased.

For example, a man aged 30 with a waist-to-height ratio of 0.8, representing the largest one in 500 men, stood to lose 16.7 years of life due to their size.

A 50-year-old woman with the same ratio, accounting for about one in 150 women of the same age, would lose 8.2 years of life on average.

Dr Margaret Ashwell, whose previous research has suggested that the waist-to-height ratio could be a better tool than BMI for predicting a range of diseases, presented her findings at the European Congress on Obesity in Liverpool.

She said: “If you are measuring waist-to-height ratio you are getting a much earlier prection that something is going wrong, and then you can do something about it.

“The beauty is that you can do it in centimetres or inches, it doesn’t matter. We have got increasing evidence that this works very well with children as well, because whilst they grow up their waist is growing but also their height.”