Tuesday, July 31, 2012

Why your risk of dying in hospital will rise...

Why your risk of dying in hospital will rise by 6 per cent tomorrow

By Lucy Elkins

Lisa Whelan knew within hours of her Caesarean that something was wrong.
As her baby girl lay contentedly snuffling in a cot beside her, Lisa started suffering from ‘agonising stomach cramps — just about as bad as labour pains’. 

As the 32-year-old mother from Leeds recalls: ‘By the next day, my stomach was not only painful, it was swollen.
'It looked as if I was about to give birth to twins.

Turmoil: Doctors didn't spot Lisa Whelan's Caesarean complications
Turmoil: Doctors didn't spot Lisa Whelan's Caesarean complications. 'I had to spend five months in hospital,' she said

‘I’d had a Caesarean with my first daughter 11 years ago — and I just knew this wasn’t normal.’ 

The junior doctor overseeing Lisa’s care thought it was trapped wind, and prescribed peppermint oil and suppositories.

Another junior doctor sent her for an X-ray but could see nothing wrong.
Three days after giving birth, Lisa started vomiting.

‘It was only then that a surgeon reviewed my notes and they realised something was seriously wrong,’ she says.
But by then it was too late: Lisa’s bowel had been perforated and had become septic.

She was rushed to theatre to remove the infected parts and was given only a 20 per cent chance of survival. 

In the end, despite multiple operations, it was not possible to save any of her bowel.
‘I had to spend five months in hospital and was sedated for so long I did not realise I’d had my baby until she was around two months old,’ says Lisa.

‘I finally got home in March, 2011.’

Not only that, but Lisa now has to face the future with a permanent colostomy bag.
What makes it so galling for her is that the hospital has since admitted that had she not been left in the care of junior doctors, this might have been avoided.

Junior doctor error led to an even more tragic outcome for Anita and Patrick Bowyer.
Their 26-year-old son Ben underwent an operation in March 2010 to relieve pressure due to a build-up of fluid on his brain, caused by a benign cyst. 

Doctors at the John Radcliffe Hospital in Oxford inserted a device to allow the fluid to drain off. 

‘We were told at the time that this was a holding operation and that they would remove the cyst a few days later,’ recalls Patrick, a self-employed plumber.
‘However, the consultant neurologist who had been in charge of Ben’s case then went off to London to teach for a week.

‘Ben was put on to a neurosurgical ward and left in the care of doctors in their first or second year out of medical school.’

On the first Wednesday of August every year, the latest tranche of junior doctors is launched on hospital wards
On the first Wednesday of August every year, the latest tranche of junior doctors is launched on hospital wards

Although Ben was ‘screaming and writhing in pain’, these junior doctors failed to realise how much his condition was deteriorating.

A week after his operation, and in the absence of the consultant, Ben died.
The inquest into his death heard that the drain was taking fluid from one but not both sides of the brain, causing fatal brain damage. 

The juniors did not recognise this, and while one did try to find a senior consultant to ask what he should do, this consultant later told the inquest he hadn’t been given the proper facts.

‘If he had, he said he would have authorised immediate  surgery,’ says Patrick.
The medical director of Oxford University NHS Hospital Trusts has since apologised to the family, saying: ‘The staff looking after Ben failed to recognise his deteriorating condition, which led to his death.’ The hospital has offered the family compensation.

A ‘junior doctor’ is a newly-qualified doctor who has spent five years at medical school and is now learning the ropes, working independently in a two-year foundation course in a hospital. 

It can be a sharp learning curve, with sometimes disastrous results.
On the first Wednesday of August every year, the latest tranche of junior doctors is launched on hospital wards. 

On that day the number of mortalities among patients brought into hospital increases by 6 per cent compared with the previous Wednesday, according to new research carried out by Dr Foster Intelligence.

‘I wouldn’t want a relative of mine to be admitted into hospital in August,’ one nurse who has been working in hospitals for the past 13 years told the Mail.

‘The junior doctors arrive fresh out of university and are expected to get on with it and you can see that many of them are really nervous and unsure what to do. 

'Most of them are keen for help and advice, but some arrive on the ward and you can tell that the fact that they have qualified as a doctor has gone to their head, and they think they know it all.’ 

Sir Bruce Keogh, medical director of the NHS, recently admitted that patients were at risk during this transition period, saying: ‘We recognise the change-over period in August puts patients at risk.

‘Junior doctors are under stress as they change from being a student to a professional, and they need help to adapt to a working environment when they’ve never done a job before.’

To try to put an end to the ‘killing season’, as this period has been dubbed, from next year junior doctors will have to shadow senior colleagues for four days before they start out. 

A pilot scheme in Bristol found this tiny change reduced the amount of mistakes made by junior doctors in their first four months at work by half.

The students benefited from familiarising themselves with the hospital, watching how seniors interacted with patients and nurses, and learning to locate life-saving equipment more quickly.
However, some believe there are other issues to addressed.
Indeed, it could be argued that it is a year-round problem. 

Another study carried out by Dr Foster Intelligence has found that in some hospitals the death rate at weekends rises by as much as 10 per cent — a time when, typically, senior staff are in short supply and it’s junior doctors who are in charge.

Lawyers involved with medical negligence cases have a high volume of complaints involving junior doctors.
‘Often they don’t seem to have the experience to see the severity of a situation,’ says Helen Hammond from Penningtons Solicitors.

‘In fairness, we also see quite a few cases where junior doctors are left to deal with a situation where they seek input from a more senior doctor but don’t get it.
'We also find that junior doctors are often left on their own during anti-social hours and help from a senior colleague is not that easy to find.’
This is a scenario Patrick Bowyer recognises.

‘At the inquest into Ben’s death, the two junior doctors involved were squirming and fearful,’ he says.
‘The point is, they did what they felt was right. The problem was there was no one of seniority around to guide them.’

In the past, too, medical students had more experience on the frontline with patients before they became junior doctors, says Dr Ben Dean, a registrar in orthopaedics based in Oxford, who himself qualified nine years ago. 

‘That changed when the General Medical Council took responsibility for a lot of a doctor’s training in about 2005;  it became more bureaucratic.
'Now there’s more formal  teaching, which is a good thing, but because of that there is less emphasis on clinical experience.’

It’s a problem junior doctors themselves recognise. 

When Dr Dean recently conducted a survey of 615 foundation doctors, a staggering 87 per cent believed that ‘incompetent trainees’ could still be allowed to pass the foundation stage because the testing was too focused on ticking boxes and less on core clinical experience. 

Another issue is the cut in hours. 

In 2009, a new European directive was introduced which capped the number of hours junior doctors can work to 48 a week.
‘Most junior doctors would be in favour of an increase in hours to around 50 or 60 per week, which would be better for doctors in terms of training continuity and better for patients in terms of continuity of care,’ says Dr Dean.

Junior doctors themselves recognise their limitations.
‘Part of being a doctor is recognising your limits and knowing when something is outside your competence and referring upward,’ says Dr Tom Dolphin, chair of the Junior Doctors Committee of the British Medical Association.

‘There have been some studies that suggest patients fare a little worse during the first few weeks of August, but that will also be contributed to by the fact that many other grades of doctor also rotate between hospitals on training programmes on the same day, and are therefore perhaps unfamiliar with the new hospital’s systems.

‘The problem is that training is not given much priority in a lot of hospitals and senior doctors are not being given time in their jobs to train their juniors.

‘Likewise, a lack of supervision overnight reflects understaffing and having too few doctors around to provide advice and support.

'Learning requires supervision.’ 

Currently, many patients may be cared for by junior doctors whose only supervision is by consultants at the end of the phone. 

As Carolyn Lowe of Henmans, the law firm that represented Ben Bowyer’s family, says: ‘We see far too many cases where junior doctors are left without adequate supervision and support.

‘They’re often put in charge of wards and expected to look after large numbers of patients — and, unsurprisingly, they struggle.
‘We welcome the shadowing scheme.

'However, one week just does not seem sufficient when patients’ lives are at risk.’

Saturday, July 14, 2012

Killer in your. Kitchen...

Killers in your kitchen: Gender-bending packaging, exploding floor cleaners and toasters more deadly than sharks...

By Michael Hanlon

Scientists at Exeter University claimed this week that non-stick frying pans could be bad for your health. A chemical used for their heat-resistant and stain-repelling properties was linked in research to a higher-than-normal incidence of thyroid disease.

Here, our Science Editor MICHAEL HANLON warns of all those other hidden dangers lurking in your kitchen. 

Damp dishcloths and sponges, left to fester for weeks on end, may contain several tens of thousands of individual micro-organisms per square inch.

In fact, a dirty damp dishcloth probably contains the highest concentration of pathogens anywhere in the house - including the inside of your toilet.

Beware: The kitchen is full of deadly objects and appliances
Beware: The kitchen is full of deadly objects and appliances
Wiping your surfaces with one of these feculent horrors will convert a clean and wholesome surface into something reminiscent of a Third World sewer.


An EU report produced in 2009 claimed young children are being exposed to potentially dangerous levels of hormone disrupting chemicals which can affect levels of certain vital body chemicals, particularly in boys.

'Oestrogen-like' chemicals, such as pthalates found in many common plastics, containers and packaging materials, Bisphenol-A (found in food packaging plastics and coating the inside of 'tin' cans) and the (now banned) PCBs still lurking in paints and electrical equipment have been blamed by environmental groups such as the WWF and Greenpeace for cancers, falling sperm counts and even an imbalance in the sex-ratio between baby boys and girls.


Hazard: Frozen food, once thawed, should be cooked and eaten - don't put the leftovers back in the freezer
Hazard: Frozen food, once thawed, should be cooked and eaten - don't put the leftovers back in the freezer

It is a rule everyone should know: Cooked flesh can be reheated - but only once.

If you make a casserole, by all means warm it up the next day but if there are leftovers from THAT warmed-up portion they cannot be reheated again.

Similarly, never, ever, re-freeze melted ice cream. When it melts and warms, ice cream provides an ideal breeding ground for various nasties including salmonella and listeria.

In fact, ALL frozen food, once thawed, should be cooked and eaten and never put back in the freezer.

Several hundred people a year worldwide are killed by their toasters, compared to eight or nine by sharks.

Toasters are potentially deadly because they contain exposed live electric elements and the way they work invites one of the commonest causes of serious home accidents - electric shocks caused when using a metal knife to prize out a slice of stuck toast.

Overstocking your fridge increases the chances of contaminating cooked food with microbes from, say, raw meat.

Always store the latter on the lower levels, to avoid the chances of blood dripping onto other foodstuffs.
Be aware of how long some foods have been in the fridge - decay is not always obvious. Avoid storing foods in plastic bags, which increase the speed of decay.

The open chip pan is one of the most dangerous objects most of us will meet in our lives.

Open chip pans are considered so dangerous that several local fire brigades offer 'chip pan amnesties' whereby they can be traded in for much safer enclosed deep-fat fryers.

If your chip pan does catch fire, remember the drill: turn off the heat, and cover the pan with a fire blanket or wet towel until the flames go out. Do not attempt to carry the flaming pan out of the kitchen or throw water on to it.

There is a second hazard related to deep-fat frying. Oil that is brought to the boil, allowed to cool and then reheated over and over again changes its chemical composition and can end up containing dangerous amounts of acyl radicals, chemicals linked to hardening of the arteries and heart disease.

Risk: Liquids heated in a microwave can be at a temperature higher than boiling point without bubbling
Risk: Liquids heated in a microwave can be at a temperature higher than boiling point without bubbling


There is no evidence that a properly used and undamaged microwave oven poses any health risk whatsoever.

Indeed, there is evidence that some microwaved food is better for you than food cooked by conventional means, especially boiled vegetables.

That said, microwaves do present a small risk. Liquids heated in a microwave can be at a temperature higher than boiling point without bubbling.

Some people have been injured by jets of boiling coffee erupting from microwaved mugs.

Enclosed containers should never be microwaved, and there is a risk of burns from exploding eggs.
Finally, there is a small risk of fire from the electrical arcing that can occur should metal items be placed in the oven.


Some American studies have drawn a link between chemicals found in certain plastic food wraps and storage containers and hormonal abnormalities, and even cancer.

One study, in the early 1990s, suggested that food wrapped in Clingfilm could become contaminated with chemicals such as pthalates and a substance called DEHA if heated in a microwave - both substances are linked to increased cancer risk.

But these studies were controversial (other scientists found no contamination risk).
To be on the safe side, use glass containers or old-fashioned greaseproof paper and avoid plastic altogether.

Unhygienic: Microbial activity can continue at temperatures down to a few degrees below freezing
Unhygienic: Microbial activity can continue at temperatures down to a few degrees below freezing

We are usually aware of when food in the fridge has gone off - it starts to smell, and turn a funny colour.
But what happens in the freezer is usually far less obvious. Food, particularly meat, is often left to freeze, and forgotten - for months if not years.

For some foods this is fine, but it can create a hazard. Most people think that provided the food is frozen solid it cannot go off; this is not so.

Microbial activity can continue, albeit far more slowly, at temperatures down to a few degrees below freezing. Ideally a home freezer should chill food down to -18C or so, and even then it is important to be aware of the guidelines on maximum storage times.

The benefits of these chemicals probably outweigh any harm. But that doesn't mean we should not be aware that there are some unpleasant chemicals out there, particularly some of the organophosphates used to protect fruit and vegetables from pests.

While pesticide residues on fruit and vegetables are almost certainly in concentrations that will not do us any harm, it is always wise to wash these products before eating them.

And be aware that the 'natural' fertilisers, weed and pest-killing chemicals (such as copper sulphate) used by organic farmers can be just as toxic - if not more so - than the synthetic chemicals used by conventional farmers.

Under the typical kitchen sink can be found enough potentially hazardous chemicals to start a minor WMD programme.

Detergents, sanitisers, polishes, caustic sodas and other alkalis, drain unblocking acids and degreasers - all present potentially fatal hazards, particularly to toddlers.

Put a childproof catch on the door, throw away old bottles of chemicals and never use the same space to store food.

The chemical PFOA (Perfluorooctanoic acid) that's found in non-stick cookware and raised concerns about thyroid disease is also present in furniture, fabrics and some food packaging, where it's valued for its resistance to water and stains.

Sodium hypochlorite solution is an excellent disinfectant, cleaning agent and whitener.

Everyone knows that bleach is toxic if swallowed and can burn or irritate the skin and eyes.

But the greatest hazard with bleach is that when mixed with certain cleaning agents, particularly those containing ammonia, hydrogen peroxide or acids (examples include Harpic toilet cleaner and Jeyes Fluid products), the resulting chemical reactions can release large quantities of deadly chlorine and even nitrogen trichloride, an explosive.

A huge market exists for the numerous 'antibacterial' products aimed at that obsessive segment of the population that sees germs lurking in every corner.

Chopping boards and kitchen wipes may be impregnated with chemicals, typically triclosan (a phenol-compound), which, it is claimed, typically 'kill 99 per cent of germs stone dead'.

There are three problems here. First, triclosan itself has been linked to hormonal problems in animal tests.

Second, the one per cent of germs that survive the antibacterial onslaught are going to be tough little blighters, and within a few hours they will have divided and redivided and replaced other, feebler germs.

Finally, there is the 'hygiene hypothesis', which states that one possible explanation for the rise in auto-immune conditions such as asthma and eczema is that our children's immune systems are exposed to far too few germs at the formative stage.

Keep things clean, by all means, but don't go over the top.

Thursday, July 12, 2012

Warning, Olympic germs heading here!

Warning, Olympic germs heading here! Why health officials will be on high alert

By Lizzie Enfield

The conversation is one being repeated across the country: ‘Feeling hot and everything aches. Think I might have the flu.’

‘A colleague has just called in with similar. Have you seen a doctor?’

The difference here is that this interchange is played out over the internet on social networking site Twitter — and the Big Doctor is watching.

The reason for such heavy-duty surveillance is to prevent an outbreak of disease sweeping through the Olympic village - or indeed the nation
The reason for such heavy-duty surveillance is to prevent an outbreak of disease sweeping through the Olympic village - or indeed the nation

For this conversation could be the thing that alerts the Health Protection Agency to the outbreak of an infectious disease during this summer’s Olympics and Paralympics.

In advance of the Games, officials have set up what’s been dubbed the ‘biggest health surveillance system in the world’. This will involve closely tracking our behaviour. 

Normally the health authorities rely on doctors and NHS helplines reporting outbreaks such as flu, but for the Olympics, they’ll be tracking information daily from out-of-hours GPs, walk-in centres, emergency departments, and even networking sites such as Twitter and Facebook.

The reason for such heavy-duty surveillance is to prevent an outbreak of disease sweeping through the Olympic village — or indeed the nation.

The influx of visitors is beginning, as more than 14,000 athletes from 205 Olympic teams and 170 paralympic teams start arriving. 

During the Games an extra four million people are expected to visit the capital; on the busiest day, Saturday, August 4, 700,000 spectators will be crisscrossing London to see events at 11 venues. 

‘That’s a lot of people, and people are very effective conduits for disease,’ says Dr David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.

‘Bacteria, viruses and parasites can travel while still in the incubation period — this means before they have started to cause symptoms. 

'This can range from 12 to 48 hours for the norovirus, also known as the winter vomiting bug, to several months for tuberculosis.’

Furthermore, those people will have come from all over the world. 

Around 17,000 competitors will be staying in the Olympic village, often sharing rooms, and they'll be at highest risk from outbreaks of flu, diarrhoea and vomiting 
Around 17,000 competitors will be staying in the Olympic village, often sharing rooms, and they'll be at highest risk from outbreaks of flu, diarrhoea and vomiting

‘There is a chance that diseases we don’t normally see in the UK will be coming in and circulating more quickly,’ says Dr Brian McCloskey, London director of the Health Protection Agency (HPA).

Prevention is key, say officials, and the HPA has been taking advice from other Olympic host cities as well as organisers of mass gatherings, ranging from the Hajj (the Islamic pilgrimage to Mecca) to music festivals and sporting events.

What has emerged is the importance of having high-quality and well-tested systems in place to monitor and respond to any outbreaks. 

This will enable officials to rapidly identify people with unusual symptoms, or any conditions that seem resistant to medication.

They can then alert healthcare providers and the public to symptoms to look out for and precautions to take. 

In the run up to an average flu season, increased reports of ‘flu-like illness’ from the usual channels of GPs and NHS helplines can give a two-week warning that flu is on  its way. 

With these systems being extended for the Olympics,  the legacy of the Games won’t just be sparkling new sporting arenas, but we’ll also have a far more comprehensive and effective health surveillance system for the future.

The HPA has also developed rapid testing procedures to identify harmful bacteria or viruses in the Olympic food or facilities. 

Cafes, burger vans and snack stalls surrounding event areas will face spot checks, while the Olympic arenas are already being monitored for Legionnaires’ disease. 

This potentially fatal form of pneumonia is caught by inhaling water droplets, and can be spread through contaminated air-conditioning units. 

The disease-control plans even include advising those attending the Games to ensure they are up-to-date with routine vaccines and ensuring messages about personal hygiene measures, such as washing hands thoroughly, are visible throughout the Games.

The good news is these events are fairly low risk for the general public, says Dr McCloskey. ‘More worrying are events like the Hajj where people spend several days living, eating and sleeping together so sickness and respiratory diseases spread very quickly.’ 

Experts believe the athletes are the most likely group to succumb to sickness. 

Around 17,000 competitors will be staying in the Olympic village, often sharing rooms, and they’ll be at highest risk from outbreaks of flu, diarrhoea and vomiting. 

British athletes have already been advised by the British Olympic
Association not to shake hands with other competitors in case they catch a bug that destroys their chance of winning a gold medal. 

The Games’ swimming pools will be tested regularly for contamination, and open water used for events such as long-distance swimming, rowing and sailing will be sampled, too. 

Owners of small boats will also be warned not to release effluent into the water.

But Dr McCloskey stresses that the public should focus on  enjoying the spectacle of the Games, as our health services are ready and prepared to deal with any eventualities.

‘It’s important for the public to realise the NHS coped well during other emergencies such as the bird flu pandemic, and we are working closely with NHS London and NHS Direct to react quickly to any threat to public health during the Olympic Games and beyond. 

‘The Games may be bigger than any event we’ve seen before, but the risk they pose in terms of public health is only slightly increased.’

Warning heart rhythm patients are at risk of strokes..

Warning heart rhythm patients are at risk of strokes because GPs take 'easy' option of prescribing aspirin

By Jenny Hope
Thousands of people with the most common heart rhythm problem are at risk of strokes because GPs are taking the ‘cheap and easy’ option of prescribing them aspirin, experts warn.

Their report estimates that a total of 360,000 with a life-threatening heart condition called atrial fibrillation (AF) are going untreated or wrongly using aspirin.

AF affects around 1.2million Britons, and causes around one in seven first-time strokes.

Warning: Thousands of people are at risk of strokes because GPs are wrongly prescribing aspirin
Warning: Thousands of people are at risk of strokes because GPs are wrongly prescribing aspirin

It causes the upper chambers of the heart to beat much faster than normal and out of rhythm, which allows blood to pool and generate tiny blood clots that can trigger a stroke.
A new report says anti-clotting drugs are the most effective way of stopping AF strokes, yet GPs persist in prescribing aspirin. 

Dr Alan Begg, a GP with special interest in cardiology who helped produce the report, said studies show that aspirin is less effective but is ‘cheap and easy’.

He said: ‘It is extremely concerning that GPs often seem to be choosing the “easy option” rather than better stroke protection.

‘Even experienced doctors falsely believe they are fully protecting people by recommending aspirin, but in AF it does not offer the best protection against strokes.’

While anti-clotting drugs are not the best solution in every case, the report says three out of four patients in Britain could be taking them, but only half are doing so.

Cheap and easy: GPs persist in prescribing aspirin because even though experts recommend anti-clotting drugs
Cheap and easy: GPs persist in prescribing aspirin because even though experts recommend anti-clotting drugs

The remaining patients are prescribed aspirin or given no treatment at all, which means 360,000 are still at risk of stroke.

The cost of such strokes to the NHS is £11,900, says the report.

Consultant cardiologist Dr Paul Kalra from Portsmouth, a member of the panel of UK experts that produced the report, said the NHS now recommends new anti-clotting drugs in addition to warfarin, which has been used for decades.

He said aspirin carries the risk of bleeding on the brain and for some patients ‘could be doing more harm than good’.

He said: ‘People with AF who are at moderate to high risk of stroke should not be taking it.

‘Some people are on aspirin for other good reasons, for example after a heart attack or for peripheral vascular disease.

‘But anyone taking aspirin should check wih their GP why they are being prescribed it now there is a choice of anti-coagulants available.’

Rachel Seyler, of the Stroke Association charity, said: ‘Whilst many patients with AF don’t show any symptoms, key signs to look out for include your heart beating irregularly, shortness of breath and heart palpitations.’

Change your passwords now...

Change your passwords now: Nearly half a million Yahoo account details leaked online by new hacker group

  • Unknown group claims Yahoo's security is 'lax'
  • Passwords and emails posted online
  • 450,000 Yahoo users at risk
By Rob Waugh

A  hacker group has posted online the details of 450,000 user accounts and passwords it claims to have stolen from a Yahoo server.

The passwords could pose a severe security risk to Yahoo users if they use the same password and email combination across other sites.

The information was posted by a previously unknown hacker group.

Hacked? A hacker group has posted online the details of 450,000 user accounts and passwords it claims to have stolen from a Yahoo server
Hacked? A hacker group has posted online the details of 450,000 user accounts and passwords it claims to have stolen from a Yahoo server

The Ars Technica technology news website reported that the group, which calls itself D33DS Company, hacked into an unidentified subdomain of Yahoo's website where they retrieved unencrypted account details.

A Yahoo spokesperson declined to comment.

The affected accounts appeared to belong to a voice-over-Internet-protocol, or VOIP, service called Yahoo Voices, which runs on Yahoo's instant messenger.
The Voices service is powered by Jajah, a VOIP platform that was bought by Telefonica Europe BV in 2010.

The hackers' website where the original claim was made,, was not available later on Thursday. 

It was registered in February. Industry website CNET reported the hackers as saying the breach was intended as a 'wake-up call and not as a threat' and that Yahoo's security was lax.

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