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Tuesday, November 1, 2011

Nurse sacked over Facebook photo

 A nurse was dismissed from Nottingham University Hospitals Trust after posting a picture of a patient on Facebook, it has emerged.

The case was one of 29 reported breaches of patient confidentiality at the trust over the past three years.

The figures from July 2008 to July 2011 were obtained under a Freedom of Information Act request from campaign group Big Brother Watch.

The trust said it took any breach of data protection extremely seriously.

A total of eight members of staff were dismissed over the breaches.

'Clear message'

Out of 29 the reported incidents, nine had no case to answer while the other 20 were investigated.

Peter Homa, chief executive of the trust, said: "We fully investigate all claims - and where there is found to be a serious breach of confidentiality, we have dismissed the member of staff involved.

"This is a clear message we give to all our employees.

"Since 2010 we have carried out a major campaign across both our hospitals to actively encourage staff and patients to report all suspected breaches of data protection and patient confidentiality.

"This saw a huge increase in reports at the time, but has since brought about a reduction in the number of breaches in our trust over the last year as we drive home the importance of keeping data secure."

The trust runs Nottingham City Hospital and the Queen's Medical Centre.

The highest number of reported breaches was found at NHS Lothian. Cumbria Teaching PCT had 39 and NHS Fife had 30.

A total of 420 trusts were surveyed but 74 did not respond.

Nutrition labels 'in wrong place'

  Nutrition labels should be placed in the centre of food packaging, rather than in one corner, if shoppers are going to read them, says a US study.

Using an eye-tracking device, researchers from Minnesota also found that the average consumer only reads the top part of a food content label.

They studied 203 people while looking at 64 different grocery products on a computer screen.

The Journal of the American Dietetic Association published the results.

In the study, participants were asked to view three elements on a typical food product - the nutrition contents label, a picture and list of ingredients, and a description of the product with price and quantity information - on the left, on the right or in the centre of the packaging.

One third of the participants each saw the nutrition label in one of those positions and were asked whether they would consider buying the product.

Participants were aware that their eye movements would be tracked, but unaware that the study was investigating nutrition information.

Position test

When the nutrition contents label was presented in the centre, subjects read one or more sections of 61% of the labels compared with 37% and 34% of labels among participants randomly assigned to view labels on the left and right hand sides of the screen.

In addition, labels in the centre of the product were seen to receive more than 30% more viewing time than the same labels when positioned to one side of the product.

The researchers also observed that most consumers view the contents of the label nearest the top more than those at the bottom of the label.

The study says that many more participants said they looked at the content of the nutrition labels than actually did when their viewing of the labels was tracked and measured.

Only 9% of participants actually looked at the calorie count for almost all products in the study, compared to 33% who said they did when asked.

Researchers Dan Graham and Robert Jeffrey, from the division of epidemiology and community health at the University of Minnesota, said: "The results of this study suggest that consumers have a finite attention span for Nutrition Facts labels.

"Although most consumers did view labels, very few consumers viewed every component on any label.

"These results differed from the self-reported survey responses describing typical grocery shopping and health behaviours submitted by the participants."

They also said the location of the labels on the packaging made a difference.

"Consumers are more likely to view centrally located labels and nutrients nearer the label's top.

"Because knowing the amounts of key nutrients that foods contain can influence consumers to make healthier purchases, prominently positioning key nutrients, and labels themselves, could substantially impact on public health."

A spokesman from the Food and Drink Federation said they were aware that consumers often do not read labels.

"Any research that adds to our understanding of what would encourage consumers to use the information provided is welcomed.

"The transferability of this research to the UK shopping experience is unclear, as the study is based on computer simulation and uses information in a format that is quite different from what is found on packs in the UK."

But she said: "We support the provision of clear, simple front of pack nutrition labelling which the authors conclude would address the concerns raised by their research."

'Shame on us nurses'

Care Quality Commission's recent report on what it called "alarmingly" poor care for elderly hospital patients, leading nurse Prof Ian Peate says in this week's Scrubbing Up that the profession should look again at how it trains people to look after older people.

Once again we read about the disgraceful care of our elderly and frail population and once again I cringe with embarrassment as I read how we abuse the people who we have the privilege to care for.

Yes I know there are some excellent examples of high quality outstanding care provided to people. But there is something seriously wrong here.

Nursing is well on its way to setting minimum standards for a degree level nursing programme and justifiably so, given the complexities of care and the demands the public rightly make in insisting on high quality, safe and effective care.

The Nursing and Midwifery Council (NMC) regulates nurses and midwives in the UK.

It sets standards for education, attempting to ensure that nurses possess the right skills and qualities when they start work as a qualified nurse.

What the NMC does not do is stipulate any mandatory requirements for elderly care. They leave this up to the individual educational institutions, so each will approach the teaching of elderly care in a variety of ways.

The time has come for the NMC to compel those running courses to stipulate how much time should be dedicated to the care of the elderly, in practice and theory.

There is a need to ensure that students of nursing - our future staff nurses who will be looking after me when I am older - are able to care confidently and competently for older people - geriatrics.

'High touch' - not high-tech

The art and science of gerontology has all but gone and this is a pity.

As a nursing student I was privileged to take a course that instilled in me the skills required to care for geriatrics patients, responding to their unique needs as people who have a number of concurrent illnesses and take a variety of medications.

If nurses get the care of older people right by applying the theory to practice, paying attention to feeding them and providing them with fluids, washing and cleaning them when they are unable to wash themselves, communicating with them and encouraging them through caring, kindness and compassion then caring for other patients will come naturally.

These are high level skills that require the nurse to apply scientific principles to the art of caring.

As a student I was assessed, on the job - by an experienced nurse - in caring for geriatric patients. But that specific check is no longer required.

We should not be ashamed, embarrassed or made to feel politically incorrect when using the term geriatric.

It is a speciality, with care provided by skilled practitioners, on the geriatric ward as opposed to a busy acute medical ward where high-tech is favoured and preferred over "high-touch".

We have witnessed our medical colleagues embrace so-called "soft skills" (communication skills, a good bedside manner) through their improved undergraduate education.

NMC take heed.

Demand the curriculum you validate has explicit elements of geriatric care in them, in the classroom and on the ward; direct that no student will progress if they do not pass the an elderly care part of their course; continue to reinforce the need for all staff to speak out when they witness substandard or abusive care but also insist that those who speak out are supported.

Shame on us nurses.

We need to say sorry to our patients and to tell them what we are going to do to get it right, and we need to be brought to account each time we fail to provide care that is compassionate, kind and humane.

Warning over HIV home test kits

 Home HIV testing kits have been illegal in the UK since 1992 Illegal home testing kits for HIV are giving people incorrect results, the Medicines and Healthcare products Regulatory Agency (MHRA) has warned.

It said there were issues with other tests for sexually transmitted diseases which were legal but might also be inaccurate.

The body is investigating a UK website which is selling the tests.

The Health Protection Agency has written to some of those affected to say the tests are unreliable.

Sales records gathered during the investigation showed that about 500 tests for sexually transmitted diseases - such as HIV, chlamydia and syphilis - had been sold.

It warned that as well as home HIV tests being against the law, the other tests did not meet European regulations.

Concern Continue reading the main story
These kits may be unreliable and there is a significant risk they could be providing the user with a false result”

End Quote Susanne Ludgate MHRA Susanne Ludgate, MHRA clinical director of devices, said: "We're concerned that there may be a number of self-test kits being sold online that may not be compliant with the relevant piece of legislation and we're urging people not to consider the internet as a method of anonymous testing.

"These kits may be unreliable and there is a significant risk they could be providing the user with a false result.

"The instructions for use might also be incorrect or confusing and not adequate for someone trying to use the kit in their home."

She said people should check for the "CE mark", which shows the tests have been approved.

The Health Protection Agency has contacted those known to have ordered the kits.

Dr Fortune Ncube, from the HPA's blood borne viruses department, said: "If anybody feels they have put themselves at risk they should contact their local GP or go to their most convenient GUM clinic, where they can receive a full screen for all STIs, including HIV.

"Rapid and confidential tests, as well as sexual health advice, are available through the NHS without charge."

GM mosquitoes show fever promise

 Environment correspondent, BBC News  Pakistan is the latest country to see a dengue outbreak, with thousands of cases in Lahore alone Genetically modified mosquitoes could prove effective in tackling dengue fever and other insect-borne diseases, a UK-based scientific team has shown.

The male mosquitoes are modified so their offspring die before reproducing.

In a dengue-affected part of the Cayman Islands, researchers found the GM males mated successfully with wild females.

In Nature Biotechnology journal, they say such mating has not before been proven in the wild, and could cut the number of disease-carrying mosquitoes.

Dengue is caused by a virus transmitted by the Aedes aegypti mosquito as it bites.

The World Health Organisation (WHO) estimates that there may be 50 million cases each year, and the incidence is rising, with some countries reporting what the WHO terms "explosive" outbreaks.

As yet, there is no vaccine.

Radiation damage

As far back as the 1940s, it was realised that releasing sterile males into the wild could control insects that carried disease or were agricultural pests.

The Aedes aegypti mosquitoes that carry dengue cannot be curbed by bednets or indoor spraying

When females breed with the sterile males rather than wild fertile ones, there will be no viable offspring, meaning there are fewer mosquitoes around to transmit the disease.

In the 1950s, the screwworm fly was eradicated from the Caribbean island of Curacao using males sterilised by radiation.

But the technology has not worked so well with disease-carrying insects.

Generally, the sterilising process weakens the males so much that they struggle to mate; the wild males are dominant.

Oxitec, a company spun off from Oxford University, uses a genetic engineering approach.

Continue reading the main story
This study is the first to show that the mosquito population could be suppressed this way”

End Quote Dr Raman Velayudhan WHO Offspring of their GM males live through the larval stage but die as pupae, before reaching adulthood.

In the latest study, the research group - which includes scientists from Imperial College London and the Liverpool School of Tropical Medicine - released batches of GM mosquitoes in 2009 in an area of the Cayman Islands where Aedes aegypti are common, and dengue sometimes present.

A proportion of the eggs collected from the study area in subsequent weeks carried the introduced gene, meaning the biotech mosquitoes had mated successfully.

The GM males made up 16% of males in the study area, and fathered 10% of the larvae; so they were not quite as successful as the wild males, but not significantly worse.

"We were really surprised how well they did," said Luke Alphey, Oxitec's chief scientific officer and a visiting professor at Oxford University.

"For this method, you just need to get a reasonable proportion of the females to mate with GM males - you'll never get the males as competitive as the wild ones, but they don't have to be, they just have to be reasonably good."

The GM larvae also carry a fluorescent gene that distinguishes them from wild relatives

"This study is the first to show that the mosquito population could be suppressed this way," said Dr Raman Velayudhan, a WHO dengue expert.

"The fitness level is much better [compared with previous attempts] - it is almost the same as in wild mosquitoes," he told BBC News.

Cognizant that genetic engineering is a technology that carries the potential for risks as well as benefits, the WHO is finalising guidance on how GM insects should be deployed in developing countries, which it expects to release by the end of the year.

The "death gene" is turned off during rearing in Oxford - and turned on in the field

The field seems to be hotting up, with other research groups recently creating Anopheles mosquitoes that are immune to the malaria parasite they normally carry, and making male Anopheles that lack sperm.

Malaria is a prime target for these approaches simply because it is such an important disease; but arguably it is more needed in diseases such as dengue where there are few alternatives.

"For malaria, there are effective alternatives like bednets, but they won't work for dengue because the mosquitoes bite during daytime," said Dr Alphey.

"We don't advocate [GM mosquitoes] as a 'magic bullet' that will solve all dengue in one go, so the question is how it fits in as part of an integrated programme - and for dengue, it would be a huge component of an integrated programme."

Funding for the Oxitec approach has come from a number of sources including private investors, charities, Oxford University and governments, and the Cayman Islands authorities were willing to take part in the field trial.

Death by feedback

The genetic approach used to create the mosquitoes is a system known as tetracycline-controlled transcriptional activation (tTA).

The tTA gene is spliced into the insect's genome in such a way that the protein it makes increases the gene's activity - a positive feedback loop.

The cells make more and more tTA protein - and in doing so, have little capacity for making any other proteins. Eventually, this kills the insects.

When the male larvae are reared at Oxitec, this process is turned off by keeping them in water containing the antibiotic tetracycline, which inhibits the feedback process.

When the males breed in the wild, however, tTA genes in their offspring are fully active.

In principle, a process that allows larvae to hatch and stay alive for many days should be more advantageous than the traditional approach of producing infertile eggs, as the larvae will consume food that could otherwise be used by viable larvae from the union of wild males and females.

The next step in the work is to demonstrate that deploying GM males does suppress the insect population enough that it is likely to have an impact on dengue incidence.

New NHS Board 'will compare' GPs

 Health correspondent, BBC News  Patients will be able to compare practices The new NHS Commissioning Board, which is at the heart of the government's controversial NHS reforms in England, is due to start work.

The board, which will at first operate in a shadow form, will aim to help patients "shop around" and compare GPs.

It will take on the day-to-day running of the NHS, with a staff of around 3,500 and overall responsibility for NHS care worth £80bn.

But critics say the board could prove unaccountable and overbearing.

Its role includes overseeing the new clinical commissioning groups led by GPs and other clinicians who will "buy" care within the NHS, and organising the treatment of complicated conditions such as heart transplants.

Sir David Nicholson, chief executive of the board, said: "We'll publish information about general practice, so you can compare what your GP provides compared with others in the area and nationally.

"We think this will be a very powerful mechanism for patients to make choices about which GPs they use.

"If you've got a long-term condition, you might want to think in future about different GPs and whether they're providing a full range of service for that condition."

Sir David added: "We know that there are always teething troubles when you are issuing clinical data. People are concerned about the quality of it, and inevitably we'll have to discuss this with GPs.

"But I think that we can get over all of that, and do a really good job for GPs and patients."


The new board and its duties go to the heart of recent rows in Parliament about how the health secretary's role will change under the Health and Social Care Bill.

Sir David said: "Whilst the secretary of state has overall responsibility for the NHS, and for setting up the architecture to make that happen, he will also set out a mandate for the board.

Continue reading the main story
"They will need to manage the very real risks that finances might get out of control and waiting times might get longer”

End Quote Prof Chris Ham, King's Fund "That will give a sense of what the government and the public can expect from the NHS. Then it's down to the board to deliver it.

"I expect the board to be quite a high-profile public organisation, engaged openly in the way that it does its business.

"It is very important that the board meets in public, and that it engages with the public.

"With the best will in the world, the electoral cycle is a critical issue for politicians.

"Hopefully the board can think beyond the electoral cycle, and give the NHS the sort of consistent framework that it needs to really improve services for patients."

'Great pressure'

The head of the King's Fund think tank, Professor Chris Ham, said: "During this transition over the next few years, there'll be a strong central grip by David Nicholson and the board.

"They will need to manage the very real risks that finances might get out of control and waiting times might get longer.

"It will be some time before the new clinical commissioning groups are ready and able to take on the responsibility.

"After that time, will the board be prepared to let go and hand over the power to the groups?"

Sir David Nicholson has been chief executive of the NHS in England since 2006.

He said he did not want to micro-manage -- and he revealed it was the substantial savings challenge facing the NHS that was keeping him awake at night.

His name has become attached to the "Nicholson challenge" which is asking the service to generate savings of up to £20bn during the next four years.

Sir David said: "We need to make sure that we completely rethink the way that we provide healthcare, so we can cope with the greater demand.

"There's great pressure on the NHS. We have never made savings on this major scale before.

"I absolutely understand that people in the NHS are feeling quite hard-pressed. But if people are making short-term cuts, it's because they haven't planned.

"They'd better learn quickly that they have to plan for a future which does not have huge amounts of growth for the NHS."

Happier people live longer lives

A study of 3,800 people aged 52 to 79 found that those who rated their happiness the highest were significantly less likely to die in the following five years than those who were least content.
Even after taking into effect the impact of age, disease and lifestyle factors on people's happiness, researchers found that the happiest group had a 35 per cent lower risk of death than the least happy.
Although the results do not prove whether happiness actually causes longer life, they back up previous research which links wellbeing and a positive outlook to longer life.
Prof Andrew Steptoe, who led the study, said: "The happiness could be a marker of some other aspect of people's lives which is particularly important for health.
"For example, happiness is quite strongly linked to good social relationships, and maybe it is things like that that are accounting for the link between happiness and health."
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