Mentally ill die many years earlier than others

New research confirms that people with mental disorders have an increased risk of premature mortality. When compared to the general population, average life expectancy is respectively 10 and 7 years shorter for men and women with mental disorders. Read ScienceDaily article here

NIHR Signal Delayed umbilical cord clamping reduces hospital mortality for preterm infants

Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%.


This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.


From the NIHR Dissemination Centre

NIHR Signal Study raises questions about NHS “weekend effect”

The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness.

Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data.

Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate within 30 days was slightly higher for these admissions, it is likely that this was due to more severe illness. There was no difference in mortality for people who attended A&E but were not admitted.
NHS Trusts have been told by NHS England to reorganise services in line with “seven day working” to eliminate the weekend effect. These studies raise doubts as to whether such a reorganisation will achieve a reduction in mortality overall.

From the NIHR Dissemination Centre

Lung cancer patients living for longer than ever

A new report published by the Royal College of Physicians (RCP) finds that more lung cancer patients are living for longer than ever, with 37% of patients alive at least 1 year after diagnosis compared to a rate of 31% in 2010.

The National Lung Cancer Audit (NLCA) 2017 annual report finds more cancers are being diagnosed at an earlier stage, with one in eight lung cancers found at the very earliest stage.

There has been a rise in diagnosis in patients aged over 70, the age group in which most lung cancer is present. There has been a rise of 5% more diagnoses in this age group since 2007.

Exclusive: A&E doctors tell prime minister patients are dying in corridors

Clinical leads for emergency departments warn prime minister of premature deaths in corridors
A&E waiting time performance has dipped to between 45 per cent and 75 per cent at times
Doctors say winter preparations failed to deliver and call for significant funding boost

Senior doctors in charge of more than 60 hospital emergency departments have written to the prime minister warning of “very serious concerns” about patient safety amid the winter crisis, including a case of patients dying prematurely in corridors.

To obtain this article copy and paste the post into an email and send to libraryw@uhcw.nhs.uk

Risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders

Patient safety alert from NHS Improvement on the risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders.

Learning from deaths: case studies from trusts

NHS Improvement has put together a collection of case studies that show the range of activity that trusts are taking to implement the implement the requirements of Learning from Deaths, as well as the challenges they have faced and how they are seeking to overcome these.

NHS becomes first healthcare system in the world to publish numbers of avoidable deaths

The NHS will become the first healthcare organisation in the world to publish estimates of how many patients may have died because of problems in their care.

The data will be published each quarter by individual trusts. 171 of the 223 trusts in England have already released or are releasing their first estimates by the end of December.

Each trust will make its own assessment of the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems.

NIHR Signal Caesarean section is better for extremely premature breech babies but not necessarily for their mothers

Delivering extremely preterm breech babies (23 to 27 weeks) by caesarean reduced the risk of infant death or brain bleeds by around 40% compared with vaginal delivery.

Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.

From the NIHR Dissemination Centre

The investigation of stillbirth

This House of Commons briefing discusses the way that stillbirth is investigated at present and the government announcement about independent investigations in future.

National Vascular Registry 2017 annual report

The number of patients who die in hospital following an operation to repair an abdominal aortic aneurysm (AAA) continues to fall according to the National Vascular Registry 2017 annual report published by the Vascular Society of Great Britain and Ireland (VSGBI) and the Royal College of Surgeons (RCS). 

Of the just over 13,000 patients who had a planned operation to repair an aneurysm between 2014 and 2016, the proportion who died in hospital after surgery was 1.4%, which represents approximately 130 patients lives saved each year compared to figures published in 2012.

MBRRACE-UK Perinatal Confidential Enquiry: term, singleton, intrapartum stillbirth and intrapartum-related neonatal death

This report finds that the rate of term, singleton, intrapartum stillbirth and intrapartum-related neonatal death has more than halved since these deaths were last reviewed nationally in 1993. This represents a reduction of about 220 intrapartum deaths per year. It concludes that despite the fall in the mortality rate these deaths remain an important group for concern because, in the vast majority, the mother was directly receiving maternity care when the baby died or when the event in labour or birth occurred which led to the baby’s death.

New maternity strategy to reduce the number of stillbirths

The government has announced a new maternity strategy to reduce the number of stillbirths as part of plans to make the NHS the safest place in the world to give birth.

Families who suffer stillbirth or life-changing injuries to their babies will be offered an independent investigation to find out what went wrong and why. Full-term stillbirths will be investigated by coroners.

Stillbirth risk is doubled if pregnant women sleep on their backs in third trimester

New research published in BJOG: An International Journal of Obstetrics and Gynaecology suggests that the risk of stillbirth is doubled if pregnant women sleep on their backs during the third trimester.

The Midlands and North of England Stillbirth Study (MiNESS) is the largest study of maternal sleep position and risk of stillbirth. It looked at 291 pregnancies that ended in stillbirth and 735 women who had a live birth.

The findings suggest women who go to sleep on their back - known as the supine position - have a 2.3 fold increase in risk of late stillbirth (after 28 weeks of gestation) compared with women who sleep on their side.

RCOG position on PLOS Medicine study: Inducing first-time mothers aged 35 and over earlier could reduce stillbirths and neonatal deaths

A study published in PLOS Medicine has found that inducing first-time mothers aged 35 and over at 40 weeks could reduce the risk of stillbirth and neonatal death (the death of a baby 7 days after birth), when compared to current guidelines which recommend induction of labour between 41 and 42 weeks for all women regardless of age.

Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over...

Eight reasons why we need to think differently about cardiovascular disease in England

Despite significant success in reducing premature mortality from cardiovascular disease (CVD), it remains a major cause of death and disability in England.The British Heart Foundation looks at eight reasons why tackling undiagnosed medical risk factors, improving quality of care and reducing variation can change millions of lives.

Stopping antithrombotic therapy after acute upper gastrointestinal bleeding is associated with reduced survival

Postgraduate Medical Journal Published Online First: 03 November 2017. doi: 10.1136/postgradmedj-2017-135276

 

Antithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear.

The aim of this study was to assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes.

UHCW Research: Monika Widlak

Radiation risk with digital mammography in breast screening

This review estimates the risks and benefits of breast screening in terms of number of deaths due to radiation-induced cancers and the number of lives saved due to digital breast screening in the NHS Breast Screening Programme (NHSBSP) in England.

Learning from others: good practice when prescribing opioids in chronic pain

Long-term opioid prescribing for chronic non-cancer pain is becoming an increasing issue in England.

Faye's story puts these potential dangers into reality by describing, from her parents' perspective, the sequence of events that ultimately led to her untimely death from respiratory depression. They also outline the lessons learned by the GP practice involved in the case that they want to share with all healthcare professionals.

Please share these resources with those in your team involved in managing patients with long term pain, and encourage them to reflect on their own, and their teams, practice.

Each Baby Counts full 2015 report

The Royal College of Obstetricians and Gynecologists (RCOG) has published the first full Each Baby Counts report into all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015.