NHS put Millbrae under the scope        

Millbrae - Ayr’s 3XV and league champions of RBS West Division 4 last season - will take part in a charity match-up against a group of local health-workers, under the banner of NHS Ayrshire and Annan, on Friday 15 August (8pm) to raise money for Clic Sargent and the Neuroblastoma Society.

The NHS team


          NHS shake up plans 'not cost cutting exercise' insist health chiefs        
THE decision to permanently downgrade maternity services at the Horton General Hospital is not a cost cutting exercise, insist health chiefs.
          Campaigners unite as one to stop NHS shake up plans in Oxfordshire        
CAMPAIGNERS, the clergy and politicians came together as one voice in their passionate plea to stop controversial healthcare plans.
          Oxford MP disappointed patients' voice ignored over major healthcare plans        
AN OXFORDSHIRE MP said she is is disappointed patients haven't been listened to after a report into a major NHS shake-up recommended a raft of changes including a permanent downgrade of maternity services.
          Experiment in fear        

This sounds brilliant. A tv show based on exposing the mental influence of the tabloids Not just tabloids in general, with their z-list celebs and soap opera stars, but the most mind-sapping terror-inducing tabloid – the Daily Mail.

The film Supersize Me showed you are what you eat, but is it true that you are what you read?
New documentary The Daily Mail Diet aims to find out as it follows film maker Nick Angel giving up all TV, radio, print and online news sources for 28 days – except for the Daily Mail.

Mr Angel said: “It’s important to know what the Mail thinks, because it’s a lightning rod (or so it claims) to ‘Middle England’ – that ill-defined and slightly scary mass of people whose various incarnations include the ‘Moral Majority’ and ‘All Right Thinking People’.
“And in a sense, there’s a little bit of Daily Mail in all of us – who hasn’t felt their cheeks flush and blood boil when snapped by a speed camera or confronted with some maddening example of NHS bureaucracy?
“That’s what makes the Mail such a potent force – because while it’s loathsome, it’s also weirdly attuned to the dark heart of the British psyche.”

If you can get to see this programme, it sounds really worth watching.

By coincidence, it’s particularly relevant today. Following on from yesterday’s post here and Xanderg’s (of badnewsbible’s) excellent comments, the Daily Mail seems intent on lowering the bar below its even its own usual ant-limboing level.

The Tory leader is calling for the repeal of the Human Rights Act and the government is doing its best to pull the despotism rug from under the Tories by itself challenging the operation of the courts. Scenting success for its worldview, the Daily Mail has redoubled its attack, over the Chindamo case.

Here are three headlines from pages linking to today’s main Stephen Lawrence storyMail’s pages which carries the title ‘He’s no risk’: why jail boss backed Lawrence killer (I’m selflessly ploughing through this rubbish so you don’t have to. You can get the flavour of it from the headlines. But if you want to try an experimental diet of the Daily Mail, the link will take you to enough pages to undermine your will to live):
The quangocrats who let Chindamo stay (They are referring to the Immigration Appeals Tribunal, not previously known as liberal trailblazers.)
Chindamo’s Mafia gangster father awaiting trial for murder in Spain (Guilt by association, even though it seems the boy has barely seen his father since he was three.)
COMMENTARY: Has the law deprived Frances Lawrence of justice?

The Commentary refers to an editorial piece which tugs at the reader’s sympathy and emotions but signally fails to make any logical connection between sympathy for Frances Lawrence and their case for overriding EC law to deport Chindamo.

Why does justice for Frances Lawrence require that her husband’s killer doesn’t live in Britain? I know that Great Britain is a small island (compared to the land mass of Canada, say) but there are still about 65 million of us living here. The chance of accidentally bumping into him in Tesco’s is statistically pretty slim.

Just in case you think we are all certifiably mad in the UK, there’s a reasoned piece by Katie Ghose in the Guardian. This human rights hysteria threatens every one of us.

Once again we are in the grip of human rights hysteria. Variously blamed for allowing prisoners access to porn and preventing police forces from publishing photographs of suspects, the latest attack on the Human Rights Act relates to the decision not to deport Learco Chindamo, who is serving a life sentence for the murder of head-teacher Philip Lawrence in 1995.
Human rights have never been a passport to porn – nor were they an obstacle to the conviction or sentence of Chindamo, who is serving a minimum of 12 years for his brutal attack. But the truth takes a back seat when there are juicy headlines to be made out of human rights “lunacy”.


          Â£50m is being invested to help cut NHS waits        
THE NHS in Wales will get an extra £50 million this year to help cut waiting times.
          Drug & Alcohol Intake Coordinator - NHS Human Services - Lansdale, PA        
Ensure compliance with federal, state, county, payer and NHS regulations. Bachelor's Degree in human services related field.... $22.50 an hour
From Indeed - Mon, 12 Jun 2017 15:59:13 GMT - View all Lansdale, PA jobs
          Residential Aide - NHS - Ambler, PA        
Valid state drivers license. A current and valid driver's license is required for community based homes. Valid high school diploma....
From NHS Human Services - Tue, 23 May 2017 04:24:04 GMT - View all Ambler, PA jobs
          NHS Dental Practice Glasgow        
Our NHS dental practice in Glasgow is situated in Govan and has been running for over 40 years now. Being based where we are in Govan allows patients to reach us easily as there are good transport links nearby in the form of buses and an underground. The modern practice is fully equipped with the […]
          Dental Treatment on NHS Glasgow        
Our expert dentists have gained an outstanding reputation as one of the leading dental practices in Glasgow for the NHS dental treatment that we provide for patients. The dental treatment which is available on the NHS includes: 2 free examinations per year x-rays amalgam fillings scale and polish root canal treatment bridges/crowns extractions white fillings […]
          NHS Sedation Dentist Glasgow        
Being afraid of going to the dentist can mean different things to different people. There are some people who are anxious because they think that the treatment will hurt whilst there are others who have had a bad experience as a child and who think that the smells and sounds bring back those bad memories. […]
          Stretch marks are narrow streaks or lines that prepare on the surface of the skin        
Stretch marks are narrow streaks or lines that railroad train on the surface of the skin
They are oftentimes referred to past times doctors equally Stria or Striae together with Striae Gravidarum during pregnancy. The areas of the trunk most oftentimes affected past times stretch marks are the abdomen (tummy) , buttocks , together with thighs.

They railroad train when the the peel is stretched all of a abrupt together with the middle layer of your peel (the dermis) breaks inward places , allowing the deeper layers to exhibit through. The dermis tin endure stretched:
  • during pregnancy
  • as a outcome of weight gain
  • due to growth spurts during puberty
Stretch marks are oftentimes ruddy or majestic to start alongside together with volition gradually fade to a silvery-white color. They are unremarkably long together with thin. Read to a greater extent than virtually the characteristics of stretch marks.

Can I larn rid of stretch marks?
Most stretch marks are non especially noticeable together with volition fade over time. If you lot bring stretch marks that are unsightly or which comport on a large expanse of your trunk , in that location are treatments available. Creams , gels or lotions , Light Amplification by Stimulated Emission of Radiation surgical operation together with cosmetic surgical operation are all used to process stretch marks. However , in that location is piddling inward the means of medical show to exhibit that these treatments are effective , together with therefore it's of import to endure realistic virtually what they tin achieve. Also , Light Amplification by Stimulated Emission of Radiation handling together with cosmetic surgical operation are non available on the NHS , together with therefore handling tin endure expensive.

You should run across your GP if your stretch marks produce non seem to endure linked to weight gain or growth because they mightiness endure a sign of around other condition. In rare cases , stretch marks tin endure a caused past times atmospheric condition such equally Cushing’s syndrome or Marfan syndrome.

Preventing stretch marks
In around situations , such equally during pregnancy , it isn't possible to foreclose stretch marks. However , controlling your weight together with looking later on your peel tin trim your direct chances of developing them. Stretch marks are rattling mutual together with cannot endure prevented altogether. However , the next advice may assistance trim your direct chances of developing stretch marks.

Healthy weight
Gaining weight rapidly over a brusk menses of fourth dimension is i of the most mutual causes of stretch marks. Diets that crusade your weight to rapidly larn upwards together with downwards tin crusade stretch marks to railroad train because your peel is stretched past times the abrupt increases together with decreases inward your size. Therefore ,avoiding rapid weight gain together with weight loss tin assistance foreclose stretch marks from occurring.
If you lot postulate to lose weight , you lot should produce it slow past times eating a good for you lot , balanced diet together with getting enough of regular exercise. You should non lose to a greater extent than than 0.5kg (1lb) a week.

Skincare
Massaging your peel every solar daytime alongside moisturizer or a massage glove tin assistance better your circulation together with encourage novel tissue growth. It is too of import to swallow a good for you lot , balanced diet rich inward vitamins together with minerals , especially vitamin eastward , vitamin C , together with the minerals zinc together with silicon. These vitamins together with minerals volition assistance piece of job along your peel healthy.

During pregnancy
Stretch marks that railroad train during pregnancy are unremarkably due to hormonal changes that comport on your skin. However , gaining pregnancy weight steadily may assistance minimize the lawsuit of stretch marks. During pregnancy , it is normal for a adult woman to seat on weight over a relatively brusk menses of time. However , it is a myth that you lot postulate to 'eat for two' , fifty-fifty if you lot are expecting twins or triplets. You produce non postulate to larn on a special diet if you lot are important , but you lot should swallow a diversity of dissimilar foods every solar daytime to larn the correct residual of nutrients for you lot together with your baby. Your diet should endure rich inward wholewheat carbohydrates , such equally breadstuff together with pasta , equally good equally fruit together with vegetables. During pregnancy , your weight gain should endure tedious together with gradual. The sum of weight you lot seat on volition depend on the weight you lot were earlier you lot became pregnant. It is normal to gain 1-2kg (2.2-4.4lb) over the commencement 12 weeks of your pregnancy.

As a stone oil guide , during pregnancy , women who are:
  • underweight (have a BMI of less than 18.5) should gain 12.7-18.1kg (28-40lb)
  • a normal weight (have a BMI of 18.5-24.9) should gain 11.3-15.9kg (25-35lb)
  • overweight (have a BMI of to a greater extent than than 25) should gain 6.8-11.3kg (15-25lb)
  • Obese (have a BMI of to a greater extent than than 30) should gain 5-9.1kg (11-20lb).
Speak to your GP , midwife , or wellness visitor if you lot are worried you lot are non gaining weight at a good for you lot charge per unit of measurement , or if you lot are concerned virtually your stretch marks.


          Waiting lists for routine NHS treatment such as hip and knee surgery longest for a decade        
none
          Comment on April is Organ Donation Month: So Hope Will Live by Anna Michie        
Dear Mr Mark I have read your poem ' So Hope will live' and seek permission to have this read at NHS Tayside's Organ Donation Memorial Event to be held on 11 May in Dundee Scotland.
          Median: Media Relations Officer – In house - London         
to £36,000 : Median: interim Media Relations Officer – In house - London – to £36,000 My client is a world-renowned hospital (part of the NHS trust) known as a prestigi... London
          Median: Media Relations Officer – In house - London         
to £36,000 : Median: interim Media Relations Officer – In house - London – to £36,000 My client is a world-renowned hospital (part of the NHS trust) known as a prestigi... London
          Median: Interim Media Relations Officer – In house - London – to £175 day rate        
to £175 day rate: Median: Media Relations Officer – In house - London – to £36,000 My client is a world-renowned hospital (part of the NHS trust) known as a prestigious inte... London
           Enterprise efficiency framework: the English NHS         
Turner, Paul and Kane, Ros and Jackson, Christine (2013) Enterprise efficiency framework: the English NHS. British Journal of Health Care Management, 19 (11). pp. 540-544. ISSN 1358-0574
           Creating enterprise efficiencies in the NHS         
Turner, Paul and Kane, R. and Jackson, C. (2013) Creating enterprise efficiencies in the NHS. British Journal of Health Care Management, 19 (7). pp. 330-334. ISSN 1358-0574
          Theresa May is no friend of freedom: any Tory leader but May        
It's been just over a week and the UK still exists, and hasn't left the European Union.  That's a matter for the next government, as David Cameron, having promised to implement the outcome of the election, decided to wimp out completely.

It was widely assumed that as Boris Johnson had led the Vote Leave campaign, he would be in pole position to become Conservative Party leader, but that fell apart last week when his closest ally, Justice Secretary Michael Gove came to the (correct) conclusion that Johnson wasn't up to it.   As clever and witty and Johnson is, he isn't a man for detail and demonstrated in a column at the beginning of last week that his thinking was muddled and uncertain.  It also became clear that Boris was not trustworthy.  As Mayor he became addicted to vanity projects.  First a cable-car across the Thames that is barely used, then bespoke buses that no bus company would buy, so he got taxpayers to buy them for the companies.  He bought second-hand water cannons after the 2011 London riots that were not legal to operate in the UK, so remained idle, but maintained at taxpayers' expense.   He spent millions on a proposal for a vast new airport in the Thames Estuary to replace Heathrow, even though nothing in the statutory roles and responsibility of the Mayor includes aviation, and claimed businesses were "lining up" to pay for it, which of course was utter nonsense.  Finally, he embarked on a vast network of "cycling superhighways", taking away traffic lanes to accommodate cycling commutes for half the year (the other half the numbers dwindle because of the weather).  This has, in part, been responsible for increasing congestion and pollution, and cutting bus patronage.

In short, Boris is a showman, an intelligent raconteur and I'd even say he has mildly libertarian instincts, but as a Prime Minister, Chairman of Cabinet and chief negotiator with the European Union?  No.  He avoids conflict, his main approach to critics is to try to be witty or change the subject.  Expert debater, but loose with the facts.  This is why Michael Gove, a quiet, principled Conservative politician, who has cared little for his own image, decided to withdraw his backing and run himself.  Gove notably on BBC Question Time was questioning of the government he belonged to (as Cabinet Minister with collective responsibility) pursuing press regulation, because he was uncomfortable with government interfering with what newspapers could or could not publish.  

Yet the front runner is Theresa May.  Daughter of a Vicar, and the longest serving Home Secretary for decades.  She campaigned rather timidly for Remain, and while she is notable for her negotiating skills, she is frightening in her disregard for liberty.  

Her speech launching her campaign for leader alone should make just about anyone who doesn't have sympathies with the National Front, wonder...

"we should make clear that for the foreseeable future there is absolutely no change in Britain’s trading relationships with the EU or other markets. And until a new legal agreement is reached with the EU, which will not happen for some time, the legal status of British nationals living or working in Europe will not change – and neither will the status of EU nationals in Britain."

In other words, despite the Leave campaign making it absolutely clear that the legal status of any EU nationals living in the UK today would not change, she is putting it up for grabs.  Does it mean she could envisage having the Police knocking on the doors of families who have spent years working legally and peacefully to round them up and send them home?  Well an interview on ITV news/interview show Peston today made thing worse as reported by Fraser Nelson, editor of the Spectator:

Robert Peston: Now, there’s a lot of anxiety among migrants who’ve come here from the rest of the EU about whether they’ll be allowed to stay. There’s also quite a lot of anxiety among Brits living in the rest of Europe. What would you say to them?

May: What I’d say is that, at the moment we’re still a member of the EU, and the arrangements still continue, so there is no change to their position currently. But of course, as part of the negotiation, we will need to look at this question of people who are here in the UK from the EU, and I want to be able to ensure that we’re able to not just guarantee a position for those people, but guarantee the position for British citizens who are over in other member states, in other countries in Europe and living there.

Peston: So you would like people both… you’d like Brits abroad and migrants here to stay? Forever basically?

May: Well, nobody necessarily stays anywhere forever. But I think what’s important…

Peston: But at their choice?

May: What’s important is there will be a negotiation here as to how we deal with that issue of people who are already here and who have established a life here and Brits who’ve established a life in other countries within the European Union. And that is, their position at the moment is as it has been. There’s no change at the moment, but of course we have to factor that into the negotiations.

As Fraser Nelson, a Vote Leave supporter said:

Michael Gove and the rest of the Vote Leave leadership made this clear during the campaign: no deportations. Not even a question of deportations. Brexit was a vote to control immigration, to control the inflow: currently more than three times higher than Mrs May’s 100,000 target. But it was not a vote to boot out anybody, and to allow even the slightest doubt about that point is grossly irresponsible. Especially at a time when so many are trying to cast the Brexit vote in the worst possible light.

Britain needs these people; our NHS needs these people. We don’t keep them as a favour to Poland and nor should we ever dream of bargaining their residency in some game of diplomatic hardball. The EU may threaten deportation of Brits: it’s a corrupt and undemocratic institution which is why the 52pc of us voted to leave. But no British government should ever consider kicking out any of the two million EU nationals who are already with us..

Quite.  It's deplorable.

However, no one should be surprised.  May embraced the so-called "Snoopers' Charter" as she took every call from the Police, MI5 and MI6 for additional powers for surveillance as being in the public good.  Her proposals mean that a list of every website everyone in the UK visits must be held for at least one year with the Police having open rights to go through all those URLs, but needing a "warrant" to check the "contents".   Besides being completely draconian, it also shows an astonishing ignorance of the internet.  It's like saying I have a list of all the books you have read, but unless I get permission I couldn't work out what was in them.   

Former Liberal Democrat Minister, David Laws, said that between security and liberty, May always chose security, noting that former Home Security Ken Clarke often turned down requests for more powers from security services because "we would be a Police state".

Quite.

Gove is a good man, but I fear his quip that economic experts warning that leaving the EU were like the Nazis organising a smear campaign against Einstein makes him unsuitable to negotiate a new trading relationship with the EU.  He admits it was stupid, but for all his merits, he isn't the right man for the job.  The other three, Andrea Leadsom (pro-Leave ex. financial manager), Stephen Crabb (God botherer from Wales) and Liam Fox (Google Adam Werritty) all have pluses and minuses, more minuses than pluses in my book, but all of them are better than May.  

The contest is a process of attrition.  Conservative MPs vote on the candidates repeatedly, with the lowest polling dropping out until there are two.  I fear May will be one of them, and for now I just hope that whoever is the other can defeat her.

With the UK Labour Party led by a communist who is defying 80% of his Parliamentary party to remain leader, the country has no effective Opposition.   Make no mistake, Theresa May is an enemy of individual freedom, she is no "new Thatcher" and should not become Prime Minister. 




          Jeremy Corbyn the new communist Leader of the Opposition        
Ed Miliband's greatest failure as former leader of the UK Labour Party was not losing the 2015 election worse than Gordon Brown did in 2010, but in leaving it a new process for electing leader that has helped ensure that one of the least appropriate MPs in the House of Commons, now leads the Opposition.

To make it clear, Jeremy Corbyn has, for decades, been a bit of a joke.  One of the handful of MPs on the Trotskyite extremes of the Labour Party, who has never held any office in the Labour Party shadow cabinets, nor in government.  Not only was he never a parliamentary undersecretary under a Labour Government, but he was never a shadow spokesman either.  His views are not only well to the left of Tony Blair, Gordon Brown and Ed Miliband, but also Neil Kinnock and arguably also Michael Foot - whose 1983 election manifesto was famously the "longest suicide note in history".

As Conservatives guffaw at him becoming leader of a party, that only months ago it feared losing to, it's worth remembering some of his positions, but also the context within which "Corbyn-mania" has appeared.

Corbyn believes there is nothing worth doing that shouldn't be managed by the government.  He believes that education should be under the control of a National Education Service, wants all public schools under central control and would strip private schools of their charity status (and would prefer if they all closed down too).  He wants to abolish tertiary tuition fees and to guarantee all graduates a job.

He wants the multiple private railway companies and the gas and electricity companies to all be nationalised, without compensation to the owners.  He opposes "austerity" and is open to printing money to pay for large government infrastructure projects, mostly around more state housing and public transport.  He wants higher taxes, higher welfare payments and a massive programme of building council houses, and to introduce rent caps on the private rental sector.

He wants to reopen coal mines, ban fracking and wants a new "Green economy" funded by taxpayers. Yes, he believes in the environment and coal mining.

Suffice to say that a man who thinks Venezuela is a shining example, is an economics moron, but it is much worse than this.

Corbyn's approach to foreign affairs can be summed up by three points:

-  The Western world is the source of all of the world's ills;
- When other countries have dictatorships or wars, it is probably the fault of the Western world somehow;
-  Israel is the source of evil in the Middle East, or it is the USA.  Take your pick.

He says "the survival of Cuba since 1979 is an inspiration to the poorest in the region", forgetting of course that this is done on the backs of an authoritarian one-party state that imprisons and tortures opponents.  What else can be said of a man who called the murderous Sandinistas heroic?

What of his welcoming members of the IRA to the House of Commons weeks after the IRA bombed the Grand Hotel in Brighton, killing five people in 1984 (attempting to kill PM Thatcher)?  What of his colleague John McDonnell saying it was time to honour IRA bombers, because it was they who gave up the war and created peace?

He believes the UK should abolish its independent nuclear deterrent because it would "set an example" to countries like north Korea to disarm.  Is he stupid, or does he simply think that totalitarian socialist states have some good in them that can be appeased?

He talked of his friends at Hamas and Hezbollah, justifying it saying he calls "everyone" he meets friends and it is important, when seeking peace, to talk to all sides (the same excuse he gave for meeting the IRA).  He has yet to meet anyone from the Israeli Government of course (nor Ulster unionists, let alone paramilitaries).  Then again, he also donated to Deir Yassin Remembered, a campaign run by Holocaust denier Paul Eisen.  Corbyn vehemently rejects anti-semitism, and I believe he is genuine.  However, he associates and gives succour to anti-semites and those who want Israel "wiped off the map".  It's difficult to see how he reconciles this.

He would like the UK to withdraw from NATO because he opposes its "eastern expansion", ignoring that a key reason for that expansion are former satellites of the USSR keen to be protected from their former imperial master.   However,  he doesn't see Russia as being so bad.  Indeed, he thinks NATO has provoked it, by talking to Georgia about membership (of course it didn't happen, and part of Georgian territory is now Russian occupied), and Ukraine (ditto). 

He rails vehemently against Western imperialism, which means any military action by the West or Western states, but he never protests such intervention from Russia or Iran or China.   He opposed the UK defending the Falklands from a military dictatorship, indicating that in any conflict, he will tend to take the view that the "other side" probably has a point, and the UK (and the West) should relent.   

Of course, none of this is new, he's been a Marxist rebel for over 30 years, but he has backing, from a solid core of old-fashioned communists, who miss the USSR (think George Galloway, Ken Livingstone), and a new generation of airhead Marxists, brought up on the class, race, gender consciousness of identity politics in schools and universities, and using the internet to spread their hate filled ignorance.

Don't forget at the height of the Cold War, this sort of politics did gather nearly 28% of the vote.  For those joking that Corbyn and his views are "unelectable" consider what is in his favour that was not the case in 1983:

- Thatcher had barely won back the Falkland in a big show of patriotic success, which Labour had opposed.  There will be no winning war likely in the next few years;

- The Liberal Party was in a position to ally itself with a breakaway party from Labour (the SDP) and had been on the resurgence.  By contrast, the Liberal Democrats were almost wiped out at the 2015 general election and are moribund, and unlikely to present a credible alternative;

- The anti-NATO/anti-nuclear campaign in 1983 was in the context of taking on the USSR, which no longer exists as an example of "what socialists really want".  A whole generation of airheads have no idea about what life under the jackboot of Marxism-Leninism really is like;

- Far left voters partly drifted to the Greens and SNP in the last election, if Labour pulls back many of those voters, they will come close to the Conservatives in share of the vote - but with First Past the Post that might be plenty to win a majority;

- The demographics of the UK have changed, with more immigrants and ethnic minority voters who tend to support Labour, although that relationship is not as tight as Labour would hope, it is one reason Labour did relatively well in London at the General Election.

So don't rule him out completely, but then I fully expect the Conservative Party to not take advantage of this move to the far left, but rather engage in a sopping wet contest for the middle muddle ground of mediocrity.  It already has with its commitment to raising the minimum price of labour to the so-called "living wage" level (with some retailers already warning about how inflationary that will be, which will make the "living wage" even higher and so on).  It continues to engage in totemic wasteful projects like HS2, and a massively subsidised nuclear power station, whilst worshipping the NHS religion and playing corporatism and central planner with multiple sectors.  Too many in the Conservatives would rather win a massive majority for the sake of power than actually reverse socialism and state privilege wherever it may be.

With David Cameron standing down before the next election, is it too much to ask for a Conservative leader who actually is opposed to not only the policies, but the principles and rhetoric of the new Labour leader?

          Health bosses pledge they're tackling staff sickness levels        
SICKNESS levels among staff at some NHS trusts in the district were higher than the Yorkshire and England average, new figures have revealed.
          Stupidity Award of the Year: the UK’s NHS states that T3 has “little or no clinical value”        
The following Guest Blog post has been written by UK Thyroid Patient Carolyn and contributions added by Janie A. Bowthorpe ********************* … Continued
          Free NHS health checks        

If you are aged between 40 and 74, you are eligible for a free NHS Health Check. This assesses your risk of heart disease, type 2 diabetes, kidney disease and stroke. The appointment takes 20 minutes and includes a non-fasting … Read the rest


          SpeakInConfidence in use at Gloucestershire Hospitals NHS Foundation Trust        

SpeakInConfidence was recently featured in the Gloucestershire Hospitals NHS Foundation Trust staff magazine ‘Outline’ when the system has been introduced as part of a wider initiative to develop their Raising Concerns Policy. The following is reproduced from the magazine and with kind permission of Gloucestershire Hospitals NHS Foundation Trust. As part of our commitment to […]

The post SpeakInConfidence in use at Gloucestershire Hospitals NHS Foundation Trust appeared first on WorkInConfidence.


          East and North Hertfordshire NHS Trust enable two way candid anonymous staff dialogue with senior management        

Providing services for around 500,000 local people with the regional cancer centre supporting around two million people, East and North Herts NHS Trust (ENH) know that their 5000 members of staff are key to providing excellent patient care. As part of a continuous improvement plan for employee relations, ENH have implemented SpeakInConfidence to encourage staff […]

The post East and North Hertfordshire NHS Trust enable two way candid anonymous staff dialogue with senior management appeared first on WorkInConfidence.


          Barts Health Respond to Employees Requests for Improved Communication        

Two years ago, following the merger of three disengaged NHS Trusts, Barts Health became the largest NHS Trust in the country, serving a population of 2.5 million. Committed to providing excellent healthcare and to ending the historic health inequalities in east London, the Barts Health Executives knew they had a difficult task to stabilise the […]

The post Barts Health Respond to Employees Requests for Improved Communication appeared first on WorkInConfidence.


          The Nursing Times covers Barts Health use of SpeakInConfidence        

The Nursing Time noted that “The largest hospital trust in England has begun using an online system that encourages staff to discuss concerns and ideas directly and anonymously with senior managers. Barts Health NHS Trust launched the SpeakInConfidence system at the end of March to enable staff to have a private dialogue with a senior […]

The post The Nursing Times covers Barts Health use of SpeakInConfidence appeared first on WorkInConfidence.


          Health IT, under attack        
With the recent news of the WannaCry ransomware attack and how it particularly hurt UK hospitals, I figured it was appropriate to link to our writeup of An Academic Medical Center's Response to Widespread Computer Failure (PubMed / ResearchGate). This was our experience in the hours and days following a botched 2010 McAfee's antivirus update, which began attacking a core component of Windows, and rendering PCs unusable. While accidental, in many ways it resembled a cyberattack.

Of course, there's been great coverage of the attack and its implications. Halamka was quoted:

“By prioritizing clinical functionality and uptime, healthcare organizations may not always have the most up-to-date software. Thus, healthcare, in general, may be more vulnerable than other industries to cyberattacks, and the scope of the impact to the NHS in the U.K. illustrates the problem." 
He said that some mission-critical systems were built years ago and never migrated to today’s modern platforms. In 2017, there are still commercial products that require Windows XP for which few patches are available, he said.

Other useful perspectives on healthcare IT's vulnerabilities emphasize HIPAA / business associate concerns when accepting patches. Lessons abound. Hopefully we'll learn them well enough to prevent future episodes.




          History of Medicine        
This week we hark back to the days before NHS patient records and find out how illnesses in ancient Rome, Victorian London and 17th century Italy were treated. We also explore how the modern history of medicine is being recorded as it happens and how methods used to track DNA mutations can be used to the trace the evolution of ancient manuscripts.
          Lest we forget        
ON SEPTEMBER 17 I attended the Oxfordshire Health Overview and Scrutiny Committee (HOSC) meeting at County Hall, where with a colleague who works for the NHS at the Witney Community Hospital we both spoke to the councillors of our concern regarding the recent closure of the 30-bed Wenrisc Ward.
           The best type of protein to eat for a healthy diet         
The NHS reports eating protein before a workout can help repair and build muscle. Now nutritionists have revealed the healthiest type of protein source to eat, such as the leanest type of fish.
           NHS crisis: Number of patients waiting for surgery tops 4m         
Data showed 3.83 million patients on the waiting list for non-urgent hospital care in June - an increase of 20,000 on May. Experts have slammed the 'terrible' NHS England statistics.
           NHS psychologist sent a patient hundreds of racy emails         
Markus Themessl-Huber, of Dundee, likened himself to the aloof Fitzwilliam Darcy from Jane Austen's novel Pride and Prejudice as he seduced his troubled patient.
           UK NHS spending now matches that in other EU nations         
Healthcare spending amounted to 9.8 per cent of Britain's GDP in 2014 - a similar figure to that in other EU nations, according to an in-depth analysis by two economists.
           Plans for doctors to work in NHS appear to have scrapped         
The compulsory tie wasn't mentioned in the Department of Health's announcement on the future of medical training. Training a doctor currently costs the taxpayer around £230,000.
          Data guardian challenges legal basis for initial DeepMind NHS app data test        
Streams app, now live at London hospital for use in direct care, did not have appropriate legal basis to use patient information specifically for its testing phase, leaked letter argues
          Public sector employees get Wi-Fi boost with 'govroam'        
Wi-Fi service which evolved from eduroam likely to see major use in health and social care; NHS is fastest growing adopter
          OutSystems helps NHS PHP go digital         
NHS PHP has launched a mobile application and patient booking system that digitises its processes using OutSystems solutions
          Leave us alone        
I’M INCREASINGLY annoyed by the constant attacks on Wales by David Cameron and the Daily Mail. Cameron constantly refers to NHS failings in Wales which he blames on the Welsh Government. Clearly he is determined to convince the electorate that socialism does not work.
          Endo Pills - 18        
Informação cientifica de ação rápida - Ano 3 N° 18

Curso de Especialização em Endocrinologia - PUC
Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione

Prof.: Luiz César Povoa (A48)
Ricardo Martins Rocha Meirelles (A38)
Editores: Claudia Pieper (A22), Rosa Rita Santos Martins (A34) e Isabela Bussade (A8)
Editores Associados: Walmir Coutinho (A22) e Edna Pottes (A35)
Composição Gráfica: Wallace Margoniner

PESQUISAS SOBRE TELÔMEROS E RIBOSSOMOS RECEBEM NOBEL DE MEDICINA E DE QUÍMICA

O Prêmio Nobel de 2009 vem reforçar a necessidade que os médicos têm de rever sua opinião sobre temas relacionados à Genética. Cada vez mais se torna claro que a frase que Sócatres tanto repetiu e que muitos acham que era de sua autoria “Conhece-te a ti mesmo” envolve não só a parte psíquica como a biológica. Pesquisas sobre câncer, envelhecimento, resposta terapêutica a quimioterápicos, antivirais, antibióticos e susceptibilidade para doenças crônicas são hoje voltadas para o estudo do genoma humano e seu papel na fisiologia celular.

Telômeros são localizados nas regiões terminais dos cromossomos, constituídos de repetições em série da sequência (TTAGGG) e são importantes para a replicação dos cromossomos e para a integridade dos mesmos durante o processo de divisão celular; a manutenção dos telômeros é realizada pela telomerase, enzima responsável por adicionar a sequência (TTAGGG) nas extremidades dos cromossomos quando estas se perdem. Na ausência da telomerase as extremidades cromossômicas se tornam mais curtas levando a morte celular. Todo esse processo ocorre de modo fisiológico e cada célula tem sua quantidade de telômeros e telomerases necessários para seu tempo de vida, ou seja, os telômeros têm papel fundamental no controle do número de divisões que uma célula deve ter até sua morte. Nas células cancerosas a taxa de proliferação celular é acelerada, o que deveria diminuir os telômeros, entretanto estas células reativam a atividade da telomerase levando ao desenvolvimento do câncer.

O prêmio Nobel de Medicina em 2009 foi entregue a três doutores em Biologia Molecular: Dra. Elizabeth Blackburn (Departamento de Microbiologia e Imunologia da Universidade da Califórnia), Dra. Carol W. Greider (Universidade Jonhs Hopkins de Medicina, Baltimore) e o Dr. Jack Szostak (Instituto Médico do Hospital Geral de Massachusetts). As duas primeiras descobriram a telomerase em 1984 e desde então elas e o Dr. Jack Szostak vêm publicando trabalhos sobre a telomerase nos processos de envelhecimento celular e nas divisões celulares alteradas nas células cancerígenas, propiciando o desenvolvimento de novas pesquisas sobre envelhecimento e novas opções terapêuticas para o câncer.

Ribossomos: organela citoplasmática composta de RNA ribossômico e proteína, sobre a qual os polipeptídios são sintetizados a partir do RNA mensageiro (mRNA); são constituídos de muitas proteínas estruturais diferentes em associação com tipos especializados de RNA conhecidos como RNAs ribossômicos (rRNA) É nos ribossomos que ocorre o processo de tradução do mRNA. Essa tradução envolve ainda um terceiro tipo de RNA, o RNA transportador (tRNA) que faz a ligação molecular entre o código contido na sequência de bases de cada mRNA e as sequências de aminoácidos da proteína a ser codificada.

O prêmio Nobel de Química foi concedido a três cientistas: Venkatraman Ramakrishnan (Laboratório de Biologia Molecular MRC, em Cambridge, Reino Unido), Thomas Steitz (Instituto Médico Howard Hughes, na Universidade de Yale, EUA). E Ada Yonath (Centro Helen & Milton A. Kimmelman de Estruturas Biológicas e Biomoleculares do Instituto Weizmann, Israel). Estes pesquisadores realizam estudos sobre a estrutura dos ribossomos facilitando o entendimento de sua conformação e funcionamento, o que vem contribuindo para o entendimento de como agem os antibióticos nos ribossomos das bactérias e porque processos se cria a resistência bacteriana aos medicamentos, permitindo assim que sejam desenvolvidos novos antibióticos.
Rosa Rita Santos Martins


A EXPOSIÇÃO A SUBSTÂNCIAS OBESOGÊNICAS PREDISPÕE CÉLULAS TRONCO A TORNAREM-SE ADIPÓCITOS

A hipótese ambiental da obesidade propõe que a exposição pré e pós-natal à substâncias químicas ambientais contribui para adipogênese e obesidade. Os mecanismos essenciais para doença metabólica permanecem pouco compreendidos, mas muitos dados de estudos epidemiológicos humanos e em modelos animais indicam que a nutrição materna e outros estímulos ambientais influenciam no desenvolvimento e induzem mudanças permanentes no metabolismo e na suscetibilidade a doenças crônicas como diabetes.

Os compostos organoestânicos - Tributilestanho (TBT) são disruptores endócrinos, a exposição pré-natal a eles é uma conhecida causa de acúmulo de gordura em adultos. Usados amplamente na agricultura e indústria, os compostos organoestânicos têm entrado em grande quantidade no meio ambiente, deste modo, pesquisadores da Universidade da Califórnia, Irvine, liderados pelo Doutor Bruce Blumberg, buscaram definir melhor como a exposição pré-natal a TBT afeta a fisiologia nos adultos. Seus achados reforçam a hipótese de que atinge o feto durante o desenvolvimento do tecido adiposo e modifica o pool gerador do estroma multipotente em favor do desenvolvimento dos adipócitos.

Eles descobriram que, in vitro, TBT sensibiliza as células tronco multipotentes tanto de tecido adiposo humano quanto de ratos para sofrerem adipogênese. Em um modelo animal a exposição pré-natal modificou o comportamento das células tronco em favor da produção de adipócitos. A equipe de pesquisadores descobriu que a exposição ao TBT é associada a mudanças na metilação do DNA na população de células tronco multipotente, e que a exposição pré-natal ao TBT aumenta a expressão gênica adipócito-específica.

Em um artigo aguardando publicação no Molecular Endocrinolgy, os pesquisadores afirmam que a exposição ao TBT em fases precoces da vida altera o comportamento das células tronco em favor da produção de adipócitos. Estes resultados oferecem uma potencial explanação para as propriedades obesogênicas do TBT e ilustram como compostos xeonobióticos atingem o feto podendo afetar a adipogênese e obesidade.
Aline Isabel Rodrigues (C2)


MEDIDA DO OSSO CORTICAL E NÍVEIS DE SHBG EM HOMENS

O estrógeno e a testosterona exercem um papel conhecido no metabolismo ósseo e a proteína ligadora de hormônios sexuais (SHBG) parece ser outro possível fator determinante.

Os hormônios sexuais determinam o desenvolvimento e crescimento do esqueleto, além de atuar na manutenção após alcance do pico de massa óssea. Por esse motivo, pesquisadores do hospital universitário da Bélgica estudaram a relação entre os níveis de SHBG e as características ósseas de 667 homens saudáveis, na faixa etária de 25-45 anos.Utilizaram raio-X e tomografia computadorizada quantitativa analisando tíbia e rádio com parâmetros de osso cortical. Foram comparados os achados radiológicos com os resultados de SHBG, testosterona e estradiol. Após ajustes para as frações livres de esteróides, observaram que os maiores níveis de SHBG foram encontrados em indivíduos com maior densidade óssea cortical e maior circunferência do periósteo. Maior densidade mineral do osso trabecular também foi associada a menores níveis de SHBG. Esses resultados sugerem um possível papel da SHGB como fator independente na determinação da massa óssea.Porém, mais estudos são necessários para a confirmação desses dados e para definir se a SHBG teria um papel significativo ou apenas complementar no metabolismo ósseo.
Cláudia Mendes Guimarães Gontijo (C2)


IDENTIFICADOS NOVOS GENES DO DIABETES TIPO 2

Pesquisadores, avaliando o genoma dos genes da suscetibilidade ao diabetes mellitus tipo 2 (DM2), podem ter feito um grande achado. Um grupo internacional de pesquisa identificou 13 novas variantes genéticas que influenciam a regulação de glicemia; resistência insulínica e função de células beta - alguns dos quais parecem aumentar o risco para tal doença.

A colaboração, envolvendo centenas de cientistas em mais de 100 instituições na Europa, Estados Unidos, Canadá e Austrália, caiu no grupode Meta Análises relacionadas à glicose e à insulina (MAGIC - Meta Analyses of Glucose and Insulin Related Traits Consortium), que recentemente publicou dois artigos online no Nature Genetics.

Um artigo relatou uma meta análise envolvendo cerca de 50.000 indivíduos, com reprodução em outras 76.558 pessoas, mostrando nove novas variantes genéticas que influenciam a glicemia de jejeum (ADCY5, MADD, ADRA2A, CRY2, FADS1, GLIS3, SLC2A2, PROX1 E C2CD4B). Dentres estes, ACDY5 E PROX1 foram associados a risco aumentado de DM2.

O segundo estudo de glicemia após Teste de Tolerância a Glicose, identificou 3 novas variantes gênicas que influenciam os níveis de glicose (VPS13C, GCKR, TCF7L2), com ADCY5 sobrepujando as variantes achadas no primeiro estudo para serem associadas ao diabetes.

Os resultados nos dão novas direções para pesquisas futuras na biologia do DM2, que é um crescente problema de saúde pública no mundo todo", disse o diretor dos Institutos Nacionais de Saúde, Francis S. Collins, autor dos dois artigos.

De acordo com a Organização Mundial de Saúde (OMS) mais de 200 milhões de pessoas em todo mundo são afetadas pelo DM2, que mata mais de um milhão de pessoas por ano. Sua prevalência mais que dobrou nos últimos 30 anos, devido principalmente a um aumento da obesidade. Progresso em identificar e entender os genes envolvidos são a chave para combater o DM2.

Com mais genes identificados, podemos ver padrões surgirem", disse José Florez, pesquisador no Hospital Geral de Massachusetts e co-autor em um dos estudos. "Achar essas novas vias pode nos ajudar a entender melhor como a glicose é regulada, distinguir entre variações normais e patológicas na glicemia e desenvolver novas terapias.
Letícia Mauricio Garcia Japiassú (C2)


ADIPOCINAS NOS OSSOS

A doença que geralmente se manifesta em idosos, a Osteoporose, pode ter seus primórdios na infância e na adolescência. Fatores que alteram a formação ou reabsorção ósseas em jovens poderiam afetar, significativamente, o risco de fratura osteoporótica mais tarde na vida. A obesidade foi sugerida como um desses fatores, mas ainda não há um consenso se ela estaria ligada realmente à remodelação óssea.

Recentemente, algumas provas evidenciaram a ligação dos hormônios derivados dos adipócitos – adipocinas, incluindo leptina e adiponectina – ao tecido adiposo e ao osso.

Esperando para expor mais sobre esses “culpados”, Xiaobin Wang, M.D., M.P.H., SC.D., do Children`s Memorial Hospital em Chicago, e seus colegas realizaram um estudo transversal em gêmeos chineses residentes em áreas rurais. Eles avaliaram 675 meninos e 575 meninas, com idades entre 13-21 anos, medindo seus níveis de adipocinas plasmáticas pela tecnologia fluxométrica xMAP (análise de múltiplos perfis) e medindo também massa gorda, massa magra e parâmetros ósseos (área do osso, conteúdo mineral do osso, área tranversal e módulo de seção) pela DEXA.

Em um próximo artigo a ser publicado no “The Journal of Clinical Endocrinology & Metabolism”, os pesquisadores descreveram uma relação entre a massa óssea e o nível plasmático de adipocinas. Especificamente, a adiponectina foi inversamente associada com o conteúdo mineral ósseo em indivíduos do sexo masculino, mas não em indivíduos do sexo feminino, após ter sido ajustada para a massa magra, peso corporal, IMC ou massa magra e massa gorda simultaneamente. A leptina foi inversamente associada à área óssea do corpo inteiro e da coluna lombar em meninas após ajuste para massa magra e massa gorda.

“Embora as relações entre adipocinas e ossos pareçam ser específicas para cada gênero”, os autores assinalam a possibilidade de que genes ainda não identificados até o momento ou influências ambientais possam estar envolvidos na patogênese da doença.
Paula Flecher Bittencourt Schlobach (C2)
          Hildegard Dumper joined Tim Woolliscroft's group        
Hildegard Dumper joined Tim Woolliscroft's group
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Co-producing Health

A forum for discussing how to most effectively bring together health professionals with service users to develop and deliver services connected to emerging NHS structures.  By health professionals I include ; health accademics and community health professionals as well as GP's and other NHS staff. I would also like this group to link discussion to how to effectively link evaluation and impact assessment to the development and delivery of co-produced services. See More

          UK Shadow Health Secretary Slams NHS Underfunding, Neglect by May Government        
UK Shadow Secretary of State for Health Jon Ashworth stated that NHS is crumbling with the country's Prime Minister Theresa May neglecting the needs of the national healthcare system and cutting funds necessary for its development.
          Minister of Health Visits Oncology Center in the UK in Preparation for Commissioning of Linear Accelerators        
Minister of Health, Dr. the honourable Dr. Christopher, visited the Christie NHS Foundation Trust’s Oncology Center in the United Kingdom, Monday August 7, 2017, to discuss best practices as it relates to oncology treatment. The visit formed part of the Minister’s overall plan to seek technical cooperation in several areas... Read More
          Welcome Home (The King's Sanatorium)        
It's time for another delve into English Edwardian history for The King's Ginger. This time, we're going back to a darker time, when tuberculosis was a scourge. Men, women, children, rich or poor - no one was safe, and a cure was not yet known. But the luckier (and not necessarily wealthier) victims of consumption did have more of a chance, thanks to a state-of-the-art sanatorium that bore the King's name...




Back in my teens, all I really knew about TB was that the leading lady in La Boheme had it and I got a very painful BCG inoculation against it. But in the early 1800s, TB was the cause of an astonishing twenty-five percent of all deaths in England. By the turn of the 20th century, rates of death from consumption were still high, with a vaccination more than twenty years away and a cure, almost fifty. It was only a couple of decades previously, that the medical profession discovered that TB was infectious. It was certainly had no respect for money or class status. But it's fair to say there was a huge difference in the treatment of poor TB victims and the wealthy ones. Both were isolated from society, but the poor went into sanatoriums that were essentially prisons or workhouses and the more well-heeled benefited from plush hospitals, relaxation, fresh air and sunlight.





It wasn't all bad news for the TB afflicted poor though, thanks to one philanthropic Royal. A certain hospital was founded in 1901, and officially opened on the 13th June 1906 by, you guessed it, His Majesty King Edward VII. The King's Sanatorium was the brainchild of the monarch himself, after he was given £200,000 to spend on charitable purposes following his accession to the throne in 1901. Inspired by similar TB sanatoriums overseas, Bertie wanted to found an institution which treated the poorer patients in pleasant surroundings to aid their recovery.

A couple of older images, from Purcell, the restoration architects
and the Midhurst & Petworth Observer


After a public competition to solicit ideas, the resulting hospital was the very embodiment of the latest clinical ideas (the aforementioned relaxation, fresh air and light). It was also really beautiful, designed by architect H Percy Adams in an Arts & Crafts style architecture by H Percy Adams, his then-assistant a young Charles Holden, who went on to design some of the most state-of-the-art London Underground stations in the 20s and 30s. He influenced Charles Rennie Mackintosh, among others.


The building was south-facing and featured two long wings and a central block with two bay windows. Brick, pantile, sandstone and wrought iron were all used - and there was (and still is) beautiful detail all over both the exterior and interior. From Royal crests on the drainpipes to Art Nouveau details on the tiling.

The gardens were designed by Gertrude Jekyll, who has featured on my blog before. They were specially designed to work in harmony with the architecture and to be therapeutic for the patients. Whether the layout of the grounds did much to heal TB-riddled lungs, I'm not sure, but the gardens do have huge historical significance and are listed on the English Heritage Register of Parks and Gardens.

Sadly, despite the lovely surroundings and the finest care, the lack of a real cure meant the prognosis wasn't amazing for TB patients at the time. Wikipedia states that in the sanatoria of the time, even under the best conditions, half of everyone who entered died within five years. Still, the hospital operated exclusively for tuberculosis patients until the cure was finally found, in 1946. TB was eradicated in the UK by the development of the antibiotic streptomycin (it remains a big problem across the globe today, sadly and has now become antibiotic resistant, but that's another story), and the institution became a modern NHS and private hospital in 1964 before closing in 2003.

It was sadly neglected for a number of years but is now facing a new lease of life as luxury flats - a phrase that sometimes strikes fear into the hearts of history-lovers...but luckily not in this case. It's being redeveloped by a company who does wonderful restorations of period properties. And I was lucky enough that the lovely people at City & Country let me have a poke about inside and outside (though unfortunately, only the back as the front is very much a building site, still and the gardens are being fully restored) for this piece!

The Edwardian wood panelling, parquet floors and tiling in the main building's entry hall has been fully restored. You might spot a familiar face in the portraits hanging below!

The communal areas have some amazing detailing (and windows).
Look what I found (it wasn't hard, it's right by the entrance)!

Had to bring along a bottle of King's Ginger to show the City & Country people, of course.

 On a very interesting side note, the current visitor's centre at the Estate is a house built specifically for King Edward to stay in when visiting the hospital. It is also, strangely enough, the childhood home of Griff Rhys Jones! He's written about it in his own book, but I found this article by Sandi Jones online, in which he describes it.

"Whenever I drive through West Sussex, I am instantly transported back into an era of cocktail parties, where women wore rustling silk dresses and ice crackled in elegant glasses filled with gin and tonic. Us children would be trussed up in itchy flannel shirts and ties, and stood, open-mouthed in wonderment, as we were offered Coca-Cola.
These weren’t scenes played out in our house, a small lodge nestled in a vast pine forest. No, these were the monthly events held at the mansion on the other side of the woods, occupied by Sir Geoffrey Todd, who ran the sanatorium that stood between our house and his.
My father was a junior doctor, specialising in diseases of the chest, and the “sani”, as we used to call it, had been specifically built and set up by King Edward VII to treat tuberculosis. It was a real showpiece, and the king was passionate about it; so much so that he would spend dirty weekends at the lodge with his mistress, Mrs Keppel. I’ve never understood quite how he managed it, as he was a rather stout fellow and the lodge was beyond tiny.
However, he loved being there, and decorated it to palace standards, adorning every surface with bright red paint and gold twiddles. I know this because when I drove my tin car too viciously at the skirting board, the white paint would chip off and a scarlet glimmer would shine through. “That’s the royal paint,” my mum would state proudly."

It's now adorned in beautiful William Morris wallpaper and regal green paint. It'll make a lovely home, once all the flats are sold, in the future.

That's your King's Ginger lot for this month! Thanks to City & Country for showing me around the flats and communal areas so I could get a real look at the Hospital. Until the next piece...

Fleur xx
DiaryofaVintageGirl.com
          Are we becoming too well informed to think?        
Today I came across a newspaper article in which we read how a body builder/personal trainer was advised by an NHS nurse that her BMI (body mass index) was too high and that she should eat less and exercise more. The newspaper article was accompanied by a picture of the body builder. She is what my sons call 'stacked'. Maybe you don't like that particular kind of body shape, and that's fine. But this woman has clearly worked very hard on getting her body to look the way she wants it to look. I'm pretty sure her body fat percentage is very low, but muscle weighs far more than fat, so a very muscular person, on the basis of BMI alone will register as overweight or even obese.


I think it's safe to say that the nurse in question made no effort to address the woman's unique case. She unquestioningly followed a single set of guidelines as issued by the NHS.


We seem to have guidelines for everything these days. So much so, that I wonder whether we're in danger of giving up the effort of thinking for ourselves.


Sometimes guidelines are treated as inflexible rules. I mentioned once before on this blog about a friend of mine whose baby was struggling with reflux problems. She was worried about him, because when she laid him down to sleep, he would spit up and start choking. Because I had a son with a similar problem (apparently it's quite common for baby boys to have a slightly underdeveloped valve between the end of the oesophagus and the start of the stomach - it usually resolves once they become able to sit up by themselves), I suggested that she try laying him down on his side with a rolled up towel behind him to hold him in position, so that if he spit up in his sleep, it wouldn't get caught in his throat. Her response was "Ooh, no. We're not allowed to do that. The health visitor says we have to put him down on his back." Not allowed to. Not allowed to make a decision in respect of your own child that is contrary to what the health visitor has recommended based on the guidelines handed down to her by a faceless organisation that has never met the individual child in question.


A few years back, we read glowing obituaries for a traffic engineer in Europe (I wish I could remember more details about him) whose view was that more information to drivers made roads less safe. He was credited with revolutionising traffic safety by removing most of the information given to drivers and allowing them to take ownership of their own driving habits.


Now that I have health and safety guidelines that tell me it isn't safe to stand on a chair on top of a desk to change a light bulb, and warning signs over the hot taps in public facilities telling me that the water is hot, and labels on bags of nuts telling me that they contain nuts... do I need to do any thinking for myself? Perhaps the rationale is that it frees up my brain for important things. But I maintain that the more we are protected from the possibility of making stupid choices, the less likely it is that we will make inspired ones.


I have no research to go on here, but I wonder if it isn't a bit like a sine wave. The ubiquitous 'they' are trying to remove the bottom half of the wave, but actually what's happening is that the entire wave pattern is getting flattened as the top half is reduced proportionately. Spike Milligan is reported to have hated the medication that took away the swooping lows of his bipolar disorder (or manic depression as it was known back then), because it also robbed him of the soaring highs. The two things aren't directly related, of course, but I wonder, if in the process of trying to move the whole wave upward, we don't actually just reduce its amplitude. And if we reduce it enough, will we all just, well, 'flatline' a la the movie Serenity?


Surely being allowed to make a few stupid mistakes, will encourage us to think a bit more? Surely looking at a competitive body builder, a nurse can set the BMI guidelines aside? Surely the mother of a baby with reflux can experiment to see what works best for her own baby?

          Friday 9 March 2012        

Allegra Stratton has been despatched to the Liberal Democrat Spring conference in Gateshead where Nick Clegg has told attendees that the bill has been changed "in a thousand ways" since it was first published. Will his audience agree, or will activists grasp their last chance to derail the NHS bill?

One year on from the crisis at Japan's tsunami-hit Fukushima nuclear plant Newsnight debates what should be the future of nuclear power.

And Paul Mason reports on the news that an investigation has been launched into an allegation of attempted fraud against welfare to work company A4e, the Department for Work and Pensions.


          NHS Special: What needs to give?        
A special debate on the current state of the NHS. Recorded in front of an audience at the BBC Radio Theatre London. The last few months have seen the service creaking under unprecedented demand, and there is likely to be worse to come. Something needs to give. Is it simply a matter of more resources, or do we also need to change our expectations of what the NHS provides? Is rationalisation and rationing the way forward? Dr Mark Porter discusses the issues with a panel including Clare Marx, president of the Royal College of Surgeons, Chris Hopson, chief executive of NHS Providers, David Haslam, chair of NICE, Prof Sir Nick Black, London School of Hygiene and Tropical Medicine and regular contributor Margaret McCartney GP. Issues discussed include whether the NHS should continue to be free at the point of use. Is there too much bureaucracy with too many bosses? Was the internal market evidence based, has it worked and was it fair? Rationing of treatments. And can the NHS be taken out of politics? Inside Health listeners set the agenda by emailing the programme - some of whom joined the audience - so thank you for all your input. Margaret McCartney writes: The NHS is never far from the headlines, but the last few months have depicted a service in crisis. It's been made clear that there will be no more money from central government - so what needs to give? Clare Marx, explained the angst of her members who wanted to operate on people but had been forbidden to. Nick Black, discussed the types of surgery that were now being placed off limits - like hip replacement surgery - even though they were very cost effective. Because of the way hospitals are funded, it is these useful operations that are being stopped rather than the much less cost effective prescription of some very expensive cancer drugs. Chris Hopson described tensions between the expectations being placed on the NHS to provide excellent care despite the funding gap to actually provide it. And David Haslam, chief executive of NICE, expressed his disquiet that patients could no longer expect a consistent service across the NHS. Instead, different Clinical Commissioning Groups decided themselves how many rounds of IVF to fund, for example. The result was a patchwork of provision, and was inherently unfair. Is rationing therefore the way forward? Some listeners had emailed in suggesting that the NHS shouldn't fund treatments for 'smokers, drinkers and the obese'. Others that people should pay for hospital meals, or there should be a charge made for GP consultations. We already have charges for some things - for example, prescriptions in England, or dental check ups for many people - but as Clare Marx pointed out, removal of teeth is the commonest childhood operation, so can we really say this policy has been successful? I don't believe that we have the evidence to show this is safe: the bureaucracy would be sizeable - I had to sign 12 bits of paper for a routine check when my kids and I last went to the dentist - and then there are unintended consequences. Paying for appointments turns us in to consumers - would doctors feel obliged to give us treatments that people want, even when they don't work well, aren't cost effective or do net harm? Listeners wanted to know if the NHS was over managed - and had strong opinions on how much could be saved if we got rid of middle managers in particular. But Chris Hopson pointed out that we spend less than the very efficient Germany on hospital managers, and Clare Marx said that hospitals are highly complex places needing a huge amount of organisation to run smoothly. For me it is a question of what managers are doing - is it of value to patients, or is it a waste of time? Nick Black argued that there was a great deal of waste still in the NHS - and suggested that the internal NHS market may have had some advantages to start off with, but now, the 4.5 billion a year estimated to be spent on it could be better used elsewhere. There is no doubt that the process of bidding and judging for commissioning costs time and money, but how to stop the problem of bad and wasteful policy in the first place? Could politics be taken out of the NHS? I was on my own, arguing that party politics had done avoidable harm to the NHS and that cross party working - as we see in the Health Select Committee and the National Audit Office - was possible. My fellow panellists argued that since the budget of the NHS was such a large amount of money it would be impossible to disentangle it from politics: but Chris Hopson pointed out that defence spending, for example, was ring fenced. The audience overwhelmingly voted to be taxed more to pay for the NHS. If we were sure that extra money would go on human level care, and not wasteful, non evidence based policy making, I would support it completely. But we are not, as a population, being given that option.
          Over-the-counter prescriptions, Virtual reality in rehabilitation, Sore throats and antibiotics        
Prescriptions for over-the-counter items cost the NHS millions each year; in 2015 paracetamol prescriptions alone cost £87.6 million. Mark talks to Paula Cowen, medical director at Wirral CCG, one of a growing number of Clinical Commissioning Groups that are asking GPs to restrict prescribing of these items, and to Andrew Green, a GP and the prescribing policy lead at the BMA, who has reservations. Virtual Reality is being harnessed to help people recover from serious brain injury following accidents or strokes, and in conditions like Parkinson's disease and dementia. Mark visits a clinic in Salford where they're using virtual reality in neuro-rehabilitation. And treating sore throats with antibiotics. Sore throats are common accounting for 1.2 million GP consultations every year in England alone - and they affect many millions more who don't see their doctor. Most are viral and self-limiting, but around 1 in 10 are caused by a bacteria and may benefit from antibiotics. The tricky bit is telling the difference between the two but a new pharmacy-based test and treat initiative may help. Mark speaks to Peter Wilson, one of the authors of the pilot study, and Margaret McCartney is on hand to examine the evidence.
          Why hernias, hands and varicose veins might not be treated on the NHS        
Hernias, hands and varicose veins might not be treated on the NHS as such interventions are now on the 'not normally funded' list. This list is where local commissioners show what they are not prepared to pay for, unless circumstances are exceptional. Such prioritising is also known as rationing. Dr Mark Porter investigates if this new layer of bureaucracy is a cost effective use of resources or just delaying inevitable operations with the possible risk of creating emergencies that could cause harm.
          Preventable deaths, Poo bank, Waterbirths        
Are preventable deaths in hospitals a good measure of the quality of care being offered to patients? It's estimated that there are 12,000 deaths a year in hospitals which could have been avoided, but what does that mean and should we be worried that that number could rise with the NHS under pressure? Mark Porter visits a 'poo bank' in Portsmouth where donated faecal matter is being frozen and stored for later use in patients with Clostridium difficile or C. diff. And midwife Mervi Jokinen and our own Margaret McCartney take a look at the evidence for waterbirths. Is giving birth in water less painful? And is it safe? Producer: Lorna Stewart.
          NHS under pressure, Breast cancer prevention, Lactose intolerance        
Do funding requests hinder surgery on the NHS? GP referrals to specialists for common complaints are checked by a panel to make sure they're appropriate, but can the admin for funding requests be more costly and time consuming than the operation itself? Mark Porter meets an eye specialist in Reading who argues that it can. Plus a new genetic test that has been developed to identify women at risk of breast cancer more accurately. And lactose intolerance: there's a burgeoning number of lactose-free ads and products in the shops, but is need driving the market - or marketing driving the need?
          Dying at Home, Familial Hypercholesterolaemia FH, Delirium        
Most of us say we'd like to die at home but few of us actually achieve this wish - something the NHS is keen to change. An award-winning GP surgery in Lancaster, The King Street and University Medical Practice, has transformed the way they care for patients reaching the end of their life, twice winning the Gold Standards Framework Quality Hallmark Award. Dr Nour Ghazal tells Dr Mark Porter what they've done to ensure their patients have a say in how and where they would like to die and Inside Health's Dr Margaret McCartney describes how important it is to broach that most difficult of subjects. Familial Hypercholesterolaemia, also known as FH means that you have inherited high cholesterol levels and the consequences of this, if you don't know about it, can be deadly. Over half of men with FH will have a heart attack before they are 55, a third of women with FH before they're 60. But a simple genetic test can identify the condition and with a good diet, exercise and lipid lowering drugs like statins, people can live long and healthy lives. Steve Humphries, Professor of Cardiovascular Genetics at University College London tells Mark that only 15,000 people in the UK have a diagnosis of FH but it's thought that almost a quarter of a million people could in fact have the condition. So the race is on to identify and diagnose the thousands who don't know that they're carrying the suspect genes. Lorraine Priestley-Barnham, an FH clinical nurse specialist at Harefield Hospital in Middlesex describes the cascade testing being rolled out across the country in a programme supported by the British Heart Foundation. And three generations of the same family, father Chris, daughter Joanne and grandson, six year old Alfie, tell Inside Health how they found out they have FH. Delirium - an acute confused state with hallucinations and psychosis - is incredibly common in hospitals. One in five patients can experience it, many more in intensive care. Fiona tells Mark about her own experience in ICU after major surgery last year, when she believed she was being held prisoner and experimented on. She tried to escape from the ward and her daughter, Catherine, describes how distressing it was to witness her mother in such a terrified state. Julie Darbyshire, Critical Care Research Manager at the University of Oxford has done some of the first research into patients' experience of delirium and ICU consultant pharmacist, Mark Borthwick, who has a special interest in the condition, tells Mark about the different types of delirium.
          Ministrokes, Midwife study, Cyclic vomiting syndrome, Noise in intensive care        
Several decades ago, if you had a mini stroke or a transient ischaemic attack, it wasn't unusual for your doctor to tell you to rest in bed with the reassuring words that you'd been lucky. Follow up was casual to say the least, because it was thought that your chances of having a major stroke within the month was negligible. Dr Mark Porter talks to Peter Rothwell, Professor of Clinical Neurology at the University of Oxford, whose research transformed the way mini strokes are treated. TIAs are now seen as medical emergencies requiring urgent treatment. Taking aspirin straight after a TIA, his team's research also showed, could reduce the chance of a major stroke over the next few days by a staggering 80%. Headlines this week from a New Zealand study suggested midwife-led births mean worse outcomes for babies compared with doctor-led care - contradicting other research in the area. Inside Health's Dr Margaret McCartney assesses the new study and concludes the evidence still points to midwife-led care providing reassuringly good outcomes for low risk pregnancies. Imagine being sick for hours, days at a time, recovering for a few weeks, only for the whole cycle to start again as regular as clockwork. Roger McCleery has Cyclic Vomiting Syndrome and every couple of months he's so sick he ends up in hospital, from where he told Mark about the life-changing nature of this unpleasant condition. Consultant paediatric gastroenterologist, Sonny Chong from St Helier Hospital in Surrey who has a special interest in CVS, outlines the possible causes and treatments. Hospitals are getting noisier but in intensive and critical care, 24 hour operations, the noise can be intense, as loud as a busy restaurant with peaks of sound as loud as a pneumatic drill. Researcher Julie Darbyshire, critical care research programme manager at the Kadoorie Centre for Critical Care at the Nuffield Department of Clinical Neurosciences, has been involved in efforts at intensive care units across the Thames Valley to identify excess noise and take steps to muffle it. Peter Edmonds tells Mark how much sleep he missed being in ICU when he was a patient and Matron and Clinical Director at Oxford University Hospitals NHS Foundation Trust, Matt Holdaway, outlines how staff have embraced efforts to cut noise levels.
          Personalised Medicine: Dose By Design        
Vivienne Parry asks if the NHS can deliver the benefits of genomic medicine for all
          Braintraining and dementia; Cluster headaches; Cancer rehab; #hellomynameis        
Every three minutes somebody in the UK develops dementia, so when it's claimed that tailored computer brain training can reduce cases of dementia and cognitive decline by a third over a decade, people sit up and take notice. The research claiming the 33% reduction for the group of people whose "processing function" was targeted for brain training, hasn't yet been published - so isn't peer-reviewed - but the preliminary data by a US team was presented to the Alzheimer's Association International Conference in Toronto this week. Dr Doug Brown, Director of R&D at the UK's Alzheimer's Society speaks from the Canadian conference to Dr Mark Porter and says there's widespread excitement about the potential of brain training to protect against dementia. Dr Margaret McCartney urges caution, warning it's too early to make claims before the full data is available. James is a young man with a high pressure sales job, but every year in the summer months he is crippled by agonising headaches. He's one of the 100,000 people in the UK who suffers from cluster headaches, so called because they come in disabling bouts, lasting for 4-6 weeks at a time. Inside Health visits a new one-stop multidisciplinary rapid-access headache clinic at St Thomas's Hospital in London, where James is getting treatment. Dr Giorgio Lambru, who heads the new service, tells Mark why it's so vital that patients with cluster headaches have to be seen, diagnosed and treated quickly. Years after cardiac rehabilitation became a standard part of therapy for heart attacks, the same post-treatment care still isn't routinely available for people who've had cancer, despite decade-old guidance from NICE suggesting that it should be. The UK's first clinical trial to measure holistic cancer care is hoping to provide the evidence that will demonstrate the type of support and rehabilitation that really works. Professor of Nursing Annie Young from Warwick Medical School and University Hospitals Coventry and Warwickshire NHS Trust tells Mark that after treatment, patients can feel abandoned and vulnerable. #hellomynameis is a hugely successful social media campaign which highlights the importance of healthcare staff introducing themselves to patients. It was launched by Dr Kate Granger after her experience of being in hospital. Kate died at the weekend from cancer, aged just 34. Dr Margaret McCartney describes the enormous impact of Kate's campaign throughout the NHS.
          Health checks, Fertility, Adjustment        
NHS health checks or 'mid-life MOTs' have hit the headlines as new research claims they are a success. The aim is prevention - of diabetes, heart attacks and strokes - but their introduction has been controversial amid criticism they are not evidence based or cost effective. Resident sceptic Dr Margaret McCartney debates the issues with National Clinical Advisor Dr Matt Kearney. And putting the family back into planning. As more couples leave it later before starting a family there is growing concern from fertility experts that many people don't know enough about when female fertility starts to decline. Professor Adam Balen and Professor Joyce Harper discuss the issues. And how accurate is the perception, often reported in the media, that fertility 'drops off a cliff' in the mid to late thirties? Professor Richard Anderson reviews the so called 'broken stick' study, a mathematical model which first defined the sharp drop off of female fertility. And another instalment of Inside Language where Dr Margaret McCartney and Professor Carl Heneghan examine the terms used in evidence based medicine and why they matter. This week, adjustment and how researchers allow for factors that might skew their findings.
          Preventive HIV therapy, Sugar tax, Bowel cancer, Surgery        
The average five-year-old consumes their own body weight in sugar every year in this country - a scary illustration of the scale of the sugar problem. The new sugar tax is supposed to tackle this, but what's the evidence that a tax on sugary drinks alone will make a difference? Dr Margaret McCartney reviews the evidence from other countries, which have also used fiscal measures to nudge their populations into eating a healthy diet. PrEP - pre-exposure prophylaxis - is the latest advance in the ongoing battle against HIV. Studies show this preventive HIV therapy can reduce the risk of HIV infection by 86%. So the announcement by NHS England that it wasn't its responsibility to commission the drug has been met by shock and disappointment. Sexual Health and HIV consultant, Dr Jake Bayley, tells Mark that PrEP is a game changer in preventing HIV in high risk groups and the news that it won't be rolled out nationally, as expected, means the UK is falling behind in HIV prevention. "We don't like to talk about our bottoms", Maureen Williams tells Inside Health is one reason why take up of bowel cancer screening across the country is so patchy. Maureen was one of the first people to receive the faecal occult blood test ten years ago as part of the roll out of the bowel cancer screening programme and despite having no symptoms, they found early stage bowel cancer. Ten years later Maureen campaigns for people to complete and return the potentially life-saving test. The clinical head of the Scottish Bowel Cancer Screening Programme talks to Mark about the new, simpler screening test called FIT, the Faecal Immunochemical Test, due to be rolled out in Scotland, and perhaps soon in the rest of the UK as well. Researchers in Taiwan have concluded that most patients who undergo surgery can start showering 48 hours after an operation - a finding that flies in the face of traditional thinking that scars need to be kept dry and under a dressing for a week or more, before getting wet. Consultant Surgeon Nicholas Markham from North Devon District Hospital details the dramatic changes for patients undergoing surgery, including keyhole surgery, changes in the use of anaesthetic, access to food and water and bed rest.
          Dementia advice, Antidepressants, Transplant organs, Vaginal seeding        
Millions of anti-depressants are prescribed every year and more than half of people taking them have been doing so for two years or more. But how do you know when you're better and how can you tell that the time is right to stop taking them? Withdrawal symptoms are often confused with a return of the original depression so careful tapering of medication is crucial. Tony Kendrick, Professor of Primary Care at the University of Southampton gives Dr Mark Porter a run down of what to do, and what not to do, when it comes to coming off medication. If you're 40 or above you're to receive dementia awareness as part of the latest Prime Minister's Challenge on Dementia 2020, just announced. The plans to include dementia education for middle aged people in future NHS Health Checks are aimed at making England - no plans as yet to replicate this in Scotland, Wales or Northern Ireland - the best country in the world for dementia care. Dr Margaret McCartney reviews the new proposals. Seven thousand people in the UK are currently waiting for life saving organ transplants - and every year 1200 die because there's a critical shortage of donor organs. It's meant that the transplant community has had to consider using organs that aren't quite as perfect as they would like. Poorer quality, older or damaged organs are now being considered when they would have been rejected in the past. Mark visits Rutger Ploeg, Professor of Transplant Biology at the University of Oxford at the Oxford Transplant Centre to find out about the pioneering work to treat, heal and re-condition organs using normothermic perfusion devices - essentially mini-life support machines that work at body temperature. Frederique Rattue was the first woman at her local hospital to use "vaginal seeding" when her fourth child was born by caesarean section a year ago. It's a practice that involves taking a swab from the mother's vagina and rubbing it over the baby's mouth, face and skin after birth and the theory is that vaginal seeding will restore the microbiota of infants born by caesarean section, boosting their gut bacteria and reducing the risk of allergies or obesity. Dr Margaret McCartney discusses the theory of vaginal seeding and the evidence that the practice leads to health benefits for the baby.
          Charles Bonnet syndrome, Co-proxamol, Meningitis B vaccine, Smart tablets        
Up to half a million people in the UK could have it, but it's a condition that hardly anybody has heard about: Charles Bonnet Syndrome. It happens to people who are losing their sight through age-related macular degeneration, cataracts, diabetic eye problems or glaucoma. They see vivid and often frightening visual hallucinations and these images are soundless. Judith Potts' mother Esme was in her 90's when she eventually admitted to her daughter that she was seeing frightening images of goblins and Victorian children all around her. Judith had never heard of the condition and as she tells Dr Mark Porter, neither had any of the health professionals taking care of her mother. Shocked that there was so little awareness about something that is so common, she set up an awareness group, Esme's Umbrella. Dr Dominic Ffytche, Clinical Senior Lecturer at King's College London's Institute of Psychiatry and an expert in visual hallucinations, tells Mark that a key area of research is why some people have Charles Bonnet Syndrome and others don't. Co-proxamol, or Distalgesic as it's better known, was a common drug for mild to moderate pain in the 1990's. But a decade ago, a review by the Medicines and Healthcare Products Regulatory Agency (MHRA) decided that it wasn't a good painkiller and it had very worrying side effects. Its licence was withdrawn and doctors were urged to switch patients onto different medication (although it could still be prescribed on a "named patient" basis). Dr Andrew Green, Chair of the Clinical and Prescribing arm of the GP committee of the British Medical Association tells Mark he's disturbed that nearly ten years after the licence was withdrawn, thousands of patients are still being prescribed co-proxamol at a high cost to the NHS while Bedfordshire GP Dr John Lockley defends continued and careful prescribing for a tiny number of patients who can't get relief from other medication. In a week in which hundreds of thousands of people have signed a petition calling for more children to receive the Meningitis B vaccine, Dr Margaret McCartney talks to Mark about the tricky decisions involved in planning immunisation programmes. Traditional bedside paper charts, which record and monitor patients' vital signs, have been replaced in Oxford hospitals with smart PC tablets. Clinical staff enter patients' blood pressure, heart rate and temperature on the tablet and the new "smart" system provides an early warning traffic light system, alerting them if there's a deterioration in the patient's condition. This means clinicians can prioritise care and another major bonus is that the same information is available, at the touch of a button, to medical staff across Oxford's hospitals. The project is called SEND - System for Electronic Notification and Documentation - and it's a collaboration between the University of Oxford and Oxford University Hospitals NHS Foundation Trust. Mark goes to Oxford and with intensive care consultant and SEND Project Leader Dr Peter Watkinson, sees how the new paperless system is working.
          E-cigarettes, Asherman's syndrome, Rugby        
The UK's first licensed e-cig, owned by a tobacco company, is now classed as a medicine paving the way for it to be prescribed on the NHS to help people quit. Robert West, Professor of Psychology at University College London and one of the world's leading experts on smoking cessation, and GP Margaret McCartney debate the issues. Asherman's Syndrome, a little known complication of surgery that is often missed but can cause infertility. Obstetrician Virginia Beckett explains how Asherman's Syndrome occurs and how it is treated. Rugby is growing in popularity, particularly among children, with 1.2 million of them now playing at schools and clubs in England alone. But at what cost? Rugby is rough and injuries are more common than most parents think. After her son and other young people were hurt repeatedly on the rugby field, Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London, explored the incidence of injuries. From her research she is now recommending an end to the contact element of rugby in young people. Rugby Football Union's community medical director Dr Mike England responds.
          Aspirin and heart attacks, BPPV vertigo, Patronising language, Carpal tunnel sydrome, Osteoporosis treatment        
Dr Mark Porter presents a programme devoted to questions from the listeners. Dr Mike Knapton from the British Heart Foundation answers a question about whether aspirin can protect against a second heart attack. A number of people asked about the treatment of vertigo. Vertigo is a symptom of a variety of conditions ranging from migraine and Meniere's, to strokes and tumours, but by far the most common is a condition called BPPV - benign paroxysmal positional vertigo. It is caused by debris floating around in the fluid in the balance sensors of the inner ear and typically affects people over 40. And there is a relatively simple way to treat it called the Epley movement, which is much underused. Dr Louisa Murdin, consultant in vestibular and balance disorders at Guy's and St Thomas's hospitals in London, explained how she uses the technique. Dr Margaret McCartney and Mark discuss why doctors sometimes use patronising language when talking to patients. Carpal tunnel syndrome - which normally eventually affects both hands - is caused by pressure on the median nerve as it passes under the flexor retinaculum ligament at the wrist - close to where the clasp or buckle on your watch would sit. The classic story is pins and needles affecting the thumb side of the hand and sparing the little finger, and often worse during the early hours of the morning. Dr Jeremy Bland, consultant in clinical neurophysiology at King's College Hospital London, and Kent and Canterbury Hospital, where he runs one of the few NHS clinics dedicated solely to carpal tunnel syndrome, explains why people wake up with symptoms and why wearing a splint can be helpful. Osteoporosis features regularly in our in-box - particularly concerns about bisphosphonates, the gold standard treatment for the bone thinning condition. Every year in the UK around 300,000 people break a bone - such as a hip or wrist - following a relatively trivial injury because their bones are weaker than they should be. Most are middle aged and elderly. Drugs like alendronate and etidronate are prescribed to make bones stronger after a fracture. Peter Selby, Professor of metabolic bone disease at the University of Manchester and a consultant at the Manchester Royal Infirmary, answers queries about how long these drugs should be taken.
          Asthma inhalers, Knee arthroscopy, Pelvic girdle pain, Medically unexplained symptoms        
Elite athletes are far more likely to use asthma inhalers than the general population. Do the stresses and strains of competition bring on asthma-type symptoms or does an inhaler give a performance advantage to individual sportsmen and women? Dr Mark Porter talks to sports physician Dr Babette Pluim about her review of the use of inhalers in sport. One hundred and fifty thousand knee arthroscopies are performed every year in the NHS with most of them involving surgery to smooth, remove or repair damaged cartilage, the meniscus. But there are concerns that we do too many arthroscopies in the light of evidence that intervention isn't always required. Andrew Price, Professor of Orthopaedic Surgery at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford, tells Mark when surgery is useful and Inside Health's Dr Margaret McCartney reviews the mounting body of evidence that has called into question some knee surgery. Dr Annabel Bentley, former Medical Director of Insurance at the private health insurers, BUPA, describes how, back in 2011, there was an instant (and subsequently sustained) reduction of 9% in knee arthroscopy claims. The drop came weeks before a new checking process, to confirm the surgery was in line with best practice, was introduced. Pelvic Girdle Pain is a condition that affects one in five pregnant women. It causes discomfort in the pubic region, the hips and lower back and gets worse as the pregnancy progresses. Some cases can be mild but more severe forms can leave a woman needing crutches, or even a wheelchair, to get around. But there is help out there and official advice is for women to get help early and not to suffer in silence. Mark visits the Rosie Maternity Hospital in Cambridge, and speaks to new mum Joanna Welham and Women's and Men's Health Physiotherapist, Claire Brown, about what treatment is available. Medically unexplained symptoms, sometimes known as MUS, cause problems for both patient and doctor, and they're common, up to a fifth of a GP's workload, and around half of all specialist referrals, costing the NHS more than £3 billion a year. Rona Moss Morris is Professor of Psychology as Applied to Medicine at King's College London and she believes the NHS fails such patients. She tells Mark what she thinks needs to change, starting with the name, MUS. Producer: Fiona Hill.
          Low NHS morale; Flying when pregnant; Sugary drinks & menarche; FGM        
With the NHS facing significant and enduring financial pressures, as people's need for services continues to grow faster than funding, what impact is all this having on NHS staff? New advice about flying if pregnant and new research that links drinking one can a day of a sugary drink to an earlier onset of puberty. Plus the sensitive issue of FGM.
          NHS Satisfaction Survey; NHS & cancer; Headphones volume; P4 Medicine        
Diagnosing Cancer - why does the UK still lag behind much of Europe and what is being done about it? The American dream - personalised medicine based on your genes. Plus do headphones damage hearing?
          A&E in winter, Fruit juice, Opioid drugs and chronic pain, No evidence, Obesity        
Should fruit juice be dropped from the 5 a day fruit and vegetable recommendations? A&E in a mild winter - why has the NHS been stretched to near breaking point over the festive period? Dr Mark Porter visits a busy pain clinic to find out why prescribed opioid painkillers for long term non-cancer pain often do more harm than good. And resident sceptic and GP Dr Margaret McCartney outlines her New Year resolutions.
          Private hospitals, Hyperbaric medicine, Sick day rules to reduce kidney damage, Warfarin        
As more NHS operations are done in the private sector, how much do we know about patient safety in private hospitals? Kits to self-monitor warfarin have been recommended by NICE, so why is the uptake so poor? Hyperbaric medicine - using high doses of oxygen to accelerate healing; And sick day rules - the medicines you should stop taking while you are unwell to reduce kidney damage.
          Antibiotics, Winter Flu, NHS Continuing Healthcare, Snoring        
Dr Mark Porter reports on sleep apps, can they help with common sleep problems such as sleep apnoea? A new study reveals the failure of antibiotics for simple infections. Margaret McCartney reviews the evidence and asks is it worth having a flu jab? Plus who is eligible for NHS continuing health care.
          Back pain and paracetamol, blood thinning drugs, drug driving, kidney stones        
Mark Porter investigates a new research trial which shows that paracetamol doesn't help back pain. And why are blood thinning drugs being overused in NHS hospitals? New laws on limits for driving on prescribed drugs come into force in March 2015. Which prescription drugs are included and what does it mean for people taking them? Also in the programme, can any medications help get rid of kidney stones?
          Stress and pregnancy, CBT for insomnia, Cluster headache, Smoking and mental health        
Dr Mark Porter finds out why insomnia can often go untreated by the NHS despite there being a treatment that not only works but also doesn't involve drugs. There are nearly 11 million prescriptions for sleeping tablets in the UK every year but their effect isn't long lasting and people can find it hard to come off the tablets. Cognitive behavioural therapy has consistently been shown to be very effective at improving sleep in the long term but few people have access to it. Mark is joined by Colin Espie, professor of Sleep Medicine at the University of Oxford, and by professor Kevin Morgan, director of the Clinical Sleep Research Unit at Loughborough University, to discuss why insomnia is so neglected, and to talk about the success of methods to deliver CBT online using mobile and web technology. Also in the programme, Mark talks to Peter Goadsby, professor of neurology at King's College Hospital London, to find out what cluster headaches are, why they're so painful and why they can occur when the clocks change. He also meets Ann McNeil, professor of tobacco addiction at the Institute of Psychiatry, to bust the myth that smoking helps bust stress.
          Cancer of the cervix & HPV; Oral cancer & HPV; Eating late; Feedback on Sugar, Thrush, Cataracts; Scarfree operations        
A committee advising the Food and Drug Administration in the US has voted to change the way it tests women for cervical cancer by solely using a test that detects Human Papilloma Virus (HPV) rather than also using a standard smear test which looks for abnormal cell changes. The test is likely to become more widely used in the NHS than it is now. What advantages does it offer over smear tests and what difference will it make for women? Dr Mark Porter talks to Jack Cuzick, director of the Wolfson Institute of Preventive Medicine and GP Dr Margaret McCartney about the pros and cons. The HPV virus is responsible for a big increase in the number of oral cancers. Some researchers have even gone so far as to call it an epidemic. Mark talks to head and neck cancer surgeon Andrew Schache from the University of Liverpool to find out more about the reason for the rise in numbers. Also in the programme. You are when you eat. According to some diets, not eating in the evening can help you lose weight. But does the timing of when you eat really make a difference? Susan Jebb, professor of diet and population health at the University of Oxford, explains why the time you eat doesn't make a difference to whether you put on weight. Scar free surgery. Mark talks to Mikael Sodergren from Imperial College London, about the latest surgical innovation - natural orifice surgery. Surgery via natural orifices like the stomach and vagina can dramatically improve people's recovery after an operation reducing their pain and time in hospital. Currently only used in women, in the future it could be available for everyone with a robotic surgical device going in through the mouth and then being used to perform operations like an appendectomy via the stomach.
          Care data, New gastric balloon, Vocal dysphonia, Antacids        
Recent reports say that as many as 2 million people in England could be eligible for bariatric surgery. Dr Mark Porter investigates if a new gastric balloon swallowed in a capsule could be a valuable new tool for weight loss. Targeted for people whose BMI is lower than those who would be eligible for weight loss surgery, Inside Health finds out what the new balloon involves and asks two NHS bariatric surgeons - Sally Norton in Bristol and Guy Slater in Chichester - is this a boon to the arsenal of weight loss surgeons or is it a just slimming aid? Proton pump inhibitors are a family of drugs which reduce stomach acids to stop the symptoms of heartburn and ulcers. But they are being widely overused according to many gastroenterologists and doctors. Mark talks to gastroenterologist, Anton Emmanuel about the scale of the overuse, the potential side effects of being on them for too long as well as what people can do if they think they should come off the drug. Margaret McCartney and Mark Porter ask whether the anonymity of patient records on a new NHS database can be guaranteed? And using botox to treat vocal dysphonia, a kind of writer's cramp for the voice.
          Vaccinations, One-to-one midwives, Leg ulcers, Asthma inhalers        
How would you feel if your child's immunisations were linked to benefits or child care? In Australia, a full set of vaccinations is now a requirement for accessing most types of child care and claiming family tax credit worth around £500 a year. The only exception is if parents ask to be registered as conscientious objectors. Dr Steve Hambleton is President of the Australian Medical Association and explains how well these measures have been received. University of Sydney researchers have just published a new study adding to a body of evidence that pregnant women who see the same midwife require less intervention, have safer outcomes and are more likely to breastfeed their babies. They also save the healthcare system over £300. Professor Cathy Warwick, chief executive of the Royal College of Midwives, tells Inside Health that adoption of this "caseload" model in the UK has been slow. Around half a million people in the UK have some form of leg ulcer, and up until recently many would have them dressed in the community for years, without the underlying cause ever being diagnosed and treated. But this now looks set to change, as new guidance published by NICE recommends that if ulcers last more than two weeks, patients should be referred to a specialist vascular clinic. Like the one at Addenbrooke's Hospital in Cambridge, run by consultant vascular surgeon Mr Paul Hayes. Last year the NHS spent around £800 million on asthma medicines, but research suggests that at least half of people given the most common type of inhaler do not use them properly. This means their asthma remains poorly controlled and the NHS is wasting hundreds of millions of pounds. Mike Thomas is Chief Medical Advisor to Asthma UK.
          Parkinson's Disease, Breast cancer screening, Slimming pills, Sunscreens, Teeth        
Following Billy Connolly's announcement that he has signs of Parkinson's Disease, Inside Health reports from the World Congress of Neurology in Vienna where early diagnosis is top of the agenda. Suncreams and Cancer. After a long hot summer an evidence based look at whether sunscreens really protect against the lethal forms of skin cancer - melanoma. And slimming pills - why have two regulatory bodies on different sides of the Atlantic made different decisions about two diet drugs? As a new NHS information leaflet 'Helping You Decide' is given to women invited for breast screening, Dr Margaret McCartney - who has criticised previous versions - gives her verdict. And a definitive guide to the only true dental emergency - what to do if you or your child knocks out a front tooth.
          NHS Health Checks, Blood Service, Crohn's Disease, Gestational diabetes        
Dr Mark Porter reports on NHS Health Checks which are available to everyone between 40 and 74. Public Health England's Professor Kevin Fenton says this could save at least 650 lives, prevent 1600 heart attacks and 4000 cases of diabetes. Inside Health's resident sceptic Dr Margaret McCartney isn't convinced. We examine the truth behind rumours of a blood service sell off. Inside Health visits Addenbrooke's Hospital to answer a listener's query about Crohn's disease. Diabetes in pregnancy is a growing problem with potentially serious consequences for both the mother and baby. Mark meets a team which has developed an app to help women manage their diabetes.
          Obesity and Cancer, Fasting Diets and NHS 111        
Dr Mark Porter reports on NHS 111 - the new 24 hour urgent care number designed for the public to access urgent medical care. It was meant to go live across the whole of England this week but has been plagued by problems. And Inside Health's resident sceptic Margaret McCartney turns her beady eye to the latest fashion in the diet industry - fasting and so called 2 day diets. Popular - but what about the evidence? And obesity and cancer - there's growing understanding that being overweight is an important risk factor for a number of common cancers, but the relationship is never realy explained - Mark Porter turns his attention to one of the factors that might explain the link.
          NHS Reforms        
As part of NHS reforms doctors will be holding the purse strings from April 1st. In a special edition of the programme Dr Mark Porter finds out what the changes actually mean in practice. He meets GPs who have already been piloting some of the ways in which health services are commissioned to find out what they will mean for services on the ground. He also hears from GPs and hospital doctors about their concerns. One doctor says implementing GP commissioning is like flying a plane while it's being built. Why are GPs concerned and what could the changes mean for the future of our health services?
          NHS reforms, epilepsy and pregnancy, thermometers        
Dr Mark Porter questions Lord Howe, Minister for Health, as the government announces a U-turn to the NHS reforms following widespread concern that they would lead to privatisation by the back door, and the end of the NHS as we know it. Why women with epilepsy need to take extra care with their contraception, and the importance of managing their medication when they do get pregnant. And what sort of thermometer should you use when monitoring your child's temperature?
          Edge of space, Laparotomy, Tremor, Pyjamas        
Felix Baumgartner's record-breaking freefall from the edge of space was witnessed online by 8 million people around the world this week. The jump was well-planned and included equipment to enable him to breathe at high altitude and low pressure. Dr Kevin Fong is the Wellcome Trust Public Engagement Fellow, and Associate Director of the Centre for Altitude, Space and Extreme Environment Medicine at University College London. He says that a pressurised suit would prevent his blood from "boiling" at the so-called Armstrong line - where pressure in the atmosphere means that boiling point of water is the same as body temperature. A previous attempt in the 1960s almost failed - when the pressurised suit leaked, causing swelling in one hand. The chances of surviving a common type of emergency abdominal surgery are lower if you have the operation at night or over the weekend. The first report produced by the UK Emergency Laparotomy Network shows that the odds of survival vary tremendously between hospitals too - from a 96% chance of pulling through in the best units, to just 58% in the worst. The study involved 2,000 patients who had undergone the surgery at 35 different NHS hospitals. The patients who need this operation are often very sick - with a blocked bowel or suspected bleeding in the abdomen. Mike Grocott, who's Professor of Anaesthesia and Critical Care Medicine at the University of Southampton believes that this type of case should be given the best care possible - by a consultant surgeon and consultant anaesthetist. The published results are anonymised - but Dr Dave Murray who's a Consultant Anaesthetist at James Cook University Hospital in Middlesbrough, says data will be collected nationally and published in 2015, including the names of the hospitals. One listener - a former artist and puppeteer - emailed Inside Health about his recent diagnosis of essential tremor. He's finding the shaking of his hands embarrassing and wonders what can be done about it. Professor Leslie Findley, who's Consultant Neurologist at the Essex Neurosciences Unit at Queens' Hospital in Romford, describes the options - from beta blockers to deep brain stimulation. If you've ever spent time in hospital you may have worn an open-backed hospital gown - which often gapes in an undignified manner. But if you are a man on the urology wards at Solihull hospital in the West Midlands then you are in for a treat - pyjamas designed by the staff to preserve dignity and reduce the likelihood of complications. Consultant urological surgeon Mr Dev Sarmah is one of the team who came up with new design in response to a spate of blocked catheters in patients wearing conventional pyjamas.
          'SARS-like' virus, reflux heartburn, corrective baby helmets        
In Inside Health this week Dr Mark Porter asks whether headlines identifying a 'SARS Like' virus may cause unnecessary alarm. While this new virus and SARS are both members of the same family, virologist John Oxford explains that they are more like cousins that behave differently. And should you be worried about the shape of your baby's head? Lots of parents are. Margaret McCartney questions the growing trend for corrective helmets to treat so called 'flat head syndrome'. Plus Mark Porter visits the first NHS hospital to offer a new approach to treating heartburn.
          BP reax, fibroids, access to notes, botox        
As many as 2 million people in the UK may have been misdiagnosed with high blood pressure - getting treatment they don't need. But how many of them have so-called "white coat hypertension" - where their blood pressure shoots up at the very sight of their doctor or nurse? For patients with high readings in the surgery doctors can offer "ambulatory" machines for them to take home, which monitor blood pressure round-the-clock. Bryan Williams who's professor of medicine at University College, London, led the team which drew up the latest blood pressure guidelines for the National Institute for Health and Clinical Excellence, or NICE. He says that anyone considering monitoring their own blood pressure at home should take measurements both in the morning and evening whilst sitting down - and work out the average over four days. The British Hypertension Society has a list of approved home blood pressure monitors on their website. NICE has also just approved the use of Botox injections to help people with chronic migraine that hasn't responded to other treatments. But it's been a controversial decision - Botox is expensive, and no miracle cure. It was initially rejected and is still not endorsed by NICE's equivalent in Scotland. Consultant neurologist Dr Fayyaz Ahmad has had some success with patients at his private clinic outside Hull. One of them is Dawn Cook, who's just had her third round of injections. She's suffered from headaches since she was 7 years old. Would you like to read your medical notes? The Government has pledged that everyone will have online access to NHS records by October 2015. So will this change the way doctors write about their patients? Professor Steve Field - who's Chair of the NHS Future Forum and one of the driving forces behind the plan - hopes that it will mean more plain English that's easy to understand. His own surgery will give patients online access early next year. One in 4 women develop fibroids at some time - benign, non cancerous growths in the wall of the uterus which can cause heavy painful periods. Surgery might be suggested to help wtih the discomfort - using keyhole techniques via the abdomen or vagina - a procedure known as myomectomy. But in recent years some less invasive techniques have become available to help relieve symptoms.
          Steroids, the killing season, telehealth, Dupuytren's        
Apart from a few cases that hit the headlines, the use of anabolic steroids is rare among the athletes in the Olympic village. But in the wider society abuse has exploded, according to an expert from Liverpool John Moores University. Jim McVeigh - who's Deputy Director at the Centre for Public Health - says that anabolic steroid abusers are the largest group using needle exchanges. Anabolic steroids are naturally occurring hormones, like testosterone, which influence growth, physical development and the workings of the reproductive system. Abuse allows athletes to train harder for longer so they become bigger, stronger and faster. But those effects will not be seen if you don't exercise or fail to eat and sleep properly. The injected steroids are often combined with tablets. There are a number of side effects like a growth in breast tissue, acne, baldness and shrinking testes - as well as longer-term health concerns for the heart and kidneys. Although they share the same umbrella term - steroids - anabolic steroids are not the same as drugs from the corticosteroid family - found in cortisone joint injections and some types of creams for eczema, sprays for hayfever and inhalers for asthma. For the best chance of good recovery from strokes patients need to be treated within a few hours. In the Lake District new technology is giving suspected stroke patients access to specialists - using high speed broadband and video cameras. Dr Paul Davies is Consultant Stroke physician at the Cumberland Infirmary in Carlisle. He can assess a patient's scans and other tests over a video connection - with the help of nurses and doctors treating them locally. Thrombolytic - or clotbusting treatment - can be given if the stroke is one of the 80% caused by a clot. It's important to get this diagnosis right as the other 20% are the result of a bleed - which could be potentially fatal if thrombolysis is given. It's has been dubbed the Killing Season by some sections of the media - but Dr Margaret McCartney believes that August isn't as risky a time to be in hospital as the headlines claim. One study compared the number of deaths at the end of July and the beginning of August - but the difference wasn't statistically significant and could have been down to chance rather than a real harmful effect of new doctors. Inside Health listener and keen pianist Roger emailed the programme about Dupuytren's contracture - where the fingers curve into the hand and can't be straightened. A new treatment is becoming available on the NHS for this common problem which affects 1 in 10 people's hands. The only option used to be surgery but Mike Hayton, who's a Consultant Orthopaedic Hand Surgeon at Wrightington Hospital in Lancashire, is now carrying out collagenase injections on some of his patients. Up to 60% of Dupuytrens patients can benefit from the treatment - which helps to break down the collagen-rich cords so they can then be snapped a day or two later.
          GP Access, Telehealth, ICU, Sewage        
Do you have trouble getting an appointment to see your GP? If so, you are not alone. A Department of Health review from 2009 suggested that as many as 200,000 patients a day struggle to get a consultation with their doctor. And a quarter of those who want to book an appointment in advance simply can't. One Inside Health listener emailed us to ask why some surgeries seem to only release appointments on the day - a bit of a telephone lottery - and others do allow for some advance booking. Chair of the the Royal College of General Practitioners Dr Clare Gerada offers some insight. Monitoring patients in their own homes - telehealth - is one of the latest developments in general practice. The government hopes that the technology will help at least 2 million people over the next 5 years, saving the NHS more than a billion pounds. The £2,000 black boxes measure blood pressure, blood sugar levels and blood oxygen - information that's then sent over the internet to a medical professional. But the project to monitor patients with long term conditions like diabetes, heart failure and breathing difficulties hasn't got off to a good start and GP Margaret McCartney questions whether it will ever live up to the hype. The most seriously ill patients in hospital are looked after in Intensive Care - where they are given life-saving treatment and support with vital bodily functions like breathing. To help staff relieve anxiety - and enable staff to carry out procedures like inserting breathing tubes - patients are often sedated. Dr Chris Danbury from the Royal Berkshire hospital in Reading says it's important to get the level of sedation right - not too little and not too much. One consequence of the drugs and environment can be hallucinations and flashbacks - with some patients reporting dreams of being abducted by alien space ships. Specialist outreach nurses in Reading - like Sister Melanie Gager - are skilled at offering strategies to overcome this - including follow-up visits to the ICU for both patients and their families. Now that summer has finally arrived for most parts of the UK, if you are planning an outdoor swim then there may be hazards lurking in the water. Heavy downpours result in the release of sewage into the sea from overflow pipes - which can affect water quality for a couple of days. Inside Health reporter Anna Lacey met Pollution Control Manager Dr Robert Kierle on the banks of the river Axe in Weston-Super-Mare - and Surfers Against Sewage who are offering a free text service to alert would-be bathers about local measurements of any pollutants.
          Whooping cough, Cardiac screening, Antibacterials, Selfcare, Xbox        
Whooping cough is on the rise - but the official figures could be the tip of the iceberg, according to one doctor. Retired GP from Nottinghamshire Dr Doug Jenkinson has spent most of his professional life researching the condition which is also known as pertussis. He says that instead of around 1,700 cases every year, there could be tens of thousands. He personally has seen around 700 cases and a blood test available for the last few years has helped to confirm cases. The key to diagnosis is a cough which almost causes choking - sometimes with the characteristic whooping sound - which then subsides for a few hours. The cough can last up to 3 months. The cough can be dangerous for infants under the age of one - who can catch it from parents and grandparents. Dr Jenkinson suggests a vaccine booster could be offered to parents-to-be. Following the recent high profile cases of elite sportspeople collapsing with undiagnosed heart conditions should screening be made available to amateurs? Since the collapse of footballer Fabrice Muamba on the pitch earlier this year the profile of so-called silent heart conditions has risen. Sanjay Sharma is Professor of Cardiology at St George's Hospital - he works closely with the charity Cardiac Risk in the Young or CRY - and supports screening. CRY believes that screening will pick up an abnormality in as many as 1 in 300 youngsters - although it freely admits that the vast majority of these would never have gone on to develop a serious problem. And it is the resulting disruption to these children's lives that puts some people off screening, not least because they far outnumber those likely to be saved by the tests. Dr Anne Mackie is the Director of Programmes for the UK National Screening Committee. She says that she wouldn't even opt for screening for her own children Following last week's feature on unfounded rumours that toys were to be banned from GP waiting rooms to reduce the risk of cross infection, an Inside Health listener emailed the programme to ask about the evidence behind products marketed as killing germs on the various surfaces we touch at home. So what's the science behind adding antibacterial agents to household products? Dr Kamran Abbasi, Editor of the Journal of the Royal Society of Medicine reveals that there is no evidence to show that products labelled 'antibacterial' reduce the number of infections in the home any more than 'regular' cleaning products. GP Margaret McCartney explains why she thinks the latest campaign to encourage more self-care for minor ailments is wrong to imply that people who consult their doctor about dandruff are wasting NHS resources. The NHS 'Choose Well Summer' campaign says 'self care is the best option if you have a summer health complaint' and it's supported by the National Association for Patient Participation, who say it's all about 'empowering individuals'. The campaign was launched with headlines about the 40,000 visits in a year to GPs which were for dandruff. But what was really behind those consultations? And how good are we at looking after our own health? Computer games are being used to help people recover from strokes and brain injury, thanks to experts in Reading. Products like Microsoft's Xbox Kinect - which can recognise a player's movements - are being adapted by Professor Malcolm Sperrin at the Royal Berkshire Hospital. The technology allows patients to select an activity - from dancing to golf or ten pin bowling - and monitor their progress as part of their recovery. The charity Headway - which supports people with brain injury - is using the technology in the community to help people to recover at home.
          Red meat and heart health, carbon monoxide, screening, joints supplements        
A new study shows that a diet rich in red meat increases the risk of developing bowel cancer - so how much is too much? Professor Tom Sanders from Kings College, London, explains how a rise in obesity and an inactive lifestyle could be as much to blame as your favourite steak. This week 17 people - including 2 ambulance crew - were treated for suspected carbon monoxide poisoning at a food plant in Cornwall. The medical adviser to the charity CO Awareness explains how to protect everyone in your home from the accidental poisoning which can have catastrophic effects. NHS screening programmes are based on evidence - so that they target the right groups of people who are most at risk of developing a condition. But more and more private companies are offering tests like CT and ultrasound scans. Abdominal aortic aneurysm is a potentially lethal condition - where the main artery in the abdomen balloons and could burst. Many private companies offer screening for it - but vascular surgeon Hany Hafez from St Richard's hospital in Chichester believes that it's a waste of time and money for women and for men who are under 65 years of age. And Dr Mark Porter gets on a treadmill to answer a listener's question about whether running is truly good for his health - or will end up ruining his knees. Dr Kamran Abassi - the editor of the Journal of the Royal Society of Medicine - casts his expert eye over the evidence behind supplements which are supposed to help keep our joints healthy.
          Hospital infections, nutrition, gout, gluten, Shockwave, tennis elbow        
Dr Mark Porter demystifies the health issues that perplex us and separates the facts from the fiction. He brings clarity to conflicting health advice, explores new medical research and tackles the big health issue of the moment revealing the inner workings of the medical profession and the daily dilemmas doctors face. This week Mark examines the protocols for visitors to hospitals and asks whether there's any evidence that they help control the spread of infection - is there any science behind using the hand gels provided? Why do some hospitals ban flowers - and should you be able to sit on the hospital bed of your loved one? Martin Kiernan - Nurse Consultant in prevention and control of infection - helps to clear up the confusion. Inside Health discovers that gout - a condition associated with older portly men caricatured in cartoons and literature - is on the increase and striking much younger. And while it has been the butt of many a joke, it has never been a laughing matter - at least for those afflicted. And after the longest grand slam final in history just over a week ago, Mark Porter investigates a new treatment for Tennis Elbow that is used by the top players, Olympic athletes, and is available to mere mortals on the NHS in a handful of places. Plus Dr Max Pemberton investigates whether the explosion in the use of tablets, such as the i-Pad, has caused a similar elbow injury. An Margaret McCartney scrutinises new research suggesting that people with coeliac disease are not the only ones who can develop symptoms if they eat gluten containing foods. Gluten is a component of wheat, barley and rye, and responsible for triggering coeliac disease in around 1% of the UK population, causing problems that include bloating, diarrhoea, weight loss and fatigue. But there now appears to be another group of people with milder symptoms caused by gluten sensitivity - or gluten intolerance - the terms are interchangeable - but how do you identify them? Well certainly not with fancy High Street tests. Producer: Erika Wright.
          NHS bill, tinnitus, pedestrians, teenage info, Vitamin D, cough mix        
Inside Health covers the ongoing debate about proposed reforms to the NHS in England. This week Colleges representing nurses, midwives and physios have joined sceptical GPs and hospital specialists by announcing their opposition to the reforms. And, just out, a report by a cross party select committee on health questions whether current financial pressures make it too risky to implement the most radical changes in the Service's history. Health Minister Lord Howe talks to Dr Mark Porter in response to the criticisms from Professor Martin McKee and Dr Clare Gerada in last week's programme.. And an Inside Health listener emailed to ask why Tinnitus confuses patients as well as doctors. Dr Max Pemberton investigates. Plus why are teenagers - the most internet savvy generation of all - finding it difficult to access good health information in the internet? Psychologist Ellen Henderson at the University of Bath is one of the authors behind a new study looking at websites aimed at young people and offering advice on treating pain like headaches and period cramps. Vitamin D supplementation is currently recommended for all groups at particular risk of deficiency - such as pregnant and breastfeeding women and young children - but three quarters of parents, and more than half of doctors, midwives and health visitors are not up to speed with the latest guidance, so don't follow it. As Chief Medical Officer for England, Dame Sally Davies, writes to healthcare professionals highlighting the importance of vitamin D supplements Inside Health talks to Nick Bishop Professor of Paediatric bone disease at The University of Sheffield. Finally, our resident sceptic Dr Margaret McCartney explains why she doesn't rate over the counter cough mixtures. Producer: Erika Wright.
          Health bill, Memory, Resuscitation, Flu        
The programme that uncovers the real stories behind the health headlines, providing clarity where there's confusion. First, a subject that looks set to be in the headlines this week - growing disquiet about the Health and Social Care Bill and changes to the NHS which include the transfer of responsibility and resources to GPs. Many health experts simply don't understand the reforms, including international public health expert Professor Martin McKee who confesses in this week's British Medical Journal that he doesn't get it either. So what chance is there for the rest of us? It's not just bewilderment that's likely to hinder the implementation of the new Bill. There's active resistance from both hospital consultants and GPs. But what are the reforms going to mean for you? Dr Clare Gerada, the Chair of the Royal College of GPs, discusses this question with Mark. Mark Porter puts his mental agility to the test at the Research Institute for the Care of the Elderly in Bath to find out whether there's any truth behind recent headlines suggesting that our cognitive abilities start to decline from forty five. Professor Roy Jones tells Mark the results of his memory test. And GP Margaret McCartney explores the thinking behind Do No Resuscitate Orders, the record put in a patient's notes when staff feel that attempts to resuscitate them in the event of cardiac arrest are likely to do more harm than good. Finally, the holy grail to combat all flu viruses - a universal vaccine. Mark Porter visits the world's only Flu Camp where new versions of the vaccine are being trialled in volunteers. Professor David Salisbury, Head of Immunisation at the Department of Health, and Dr Kamran Abbasi, Editor of the Journal of the Royal Society of Medicine, join Mark to discuss the use of the current flu vaccine. Producer: Beth Eastwood.
          MRI (and still wobbling).        

Have you ever had one?

I had one for my brain in Munich, because I sang, standing on my head, the Barbiere di Sevilla aria with all of the coloratura variations for Carnevale (rehearsal) and next morning awoke with a black eye.

The wonderful throat doctor whizzed me straight off for a scan and said that I must NEVER do it again and so I had to keep telling everyone that I mustn't do it although I did really want to.

I remember my shocking pink jumpsuit and hair twisted over to one side.

Then there was a full body scan, with a dye in one arm to arrive who knows where (it got very hot) and this takes about an hour and a half, but it's on your back, gently chugging through a huge polo mint machine......The Nuclear Scanner is even bigger...10 feet high.

I've just had a couple more MRIs, one privately and one publicly.

I climbed aboard with needles and tubes in an arm to lie face down, strapped in with no movement, and earplugs to defend the ears from very loud noise and vibration. You move through the machine for 40 minutes like that...in a sort of coffin. I explained that I was a singer and could they please tell me when I could get a good breath in, between the norm, but I couldn't hear what she was saying through the window and the heavy door which closes with a CLUNK. You are alone inside a huge magnet...had I really never had any metal inside me? and were all my hair clips out?

The private machine was quieter....if only they would explain everything first, but I couldn't understand the Indian lady anyway, and she was behind the window....CLUNK.

The NHS machine had broken down several times lately and I tried to make friends with it as it waited for me throbbing and pulsing.........was it going to have to do my heart's job for me?

 I was allowed a friend in the room, but no one wanted to come. It was indeed a sort of coffin, and I was strapped in head first and  face down but the vibration, noise and battering on my eardrums was tremendous, like being tied beneath an old train and a lawnmower. The dye going in was indeed hot and I didn't move and hoped the machine wouldn't either  They gave me a buzzer but I couldn't hear anything they said, and at the end a new girl came in and I never saw the people who had injected me and strapped me down originally. 

She said that some people take one look and won't go near it, many others stop half way through and won't go on. I'm not surprised. I only hope the images were clear and accurate, and that they will be very well interpreted. 

 Hungry, neither before nor after, I wished so much that someone had been there to take me home for a cup of hot, sweet tea. 

It was raining.......



          Spirits in the Medicinal World        
"Remote Presence" by Susan Palwick (Lightspeed, April 2017) is an SF/F novelette that draws heavily on the author's experience as a spiritual-care volunteer in an ER: "Every three years, the Joint Commission on Accreditation of Healthcare Organizations conducted a weeklong on-site accreditation survey of each hospital in the country. The survey was thorough, merciless, and struck apocalyptic terror into hospital administrators ... Roxanne blew out a sharp breath. 'We can't have revenants in the building. That's one of the requirements.'" Spiritual Care Volunteers: A Training Resource [PDF] is a manual produced by NHS Wales that offers more practical insight into healthcare chaplaincy.
          11-Year-Old Boy Receives the First Ever NHS Medical Pot Prescription         

It’s being heralded as a major breakthrough in medical cannabis policy for the United Kingdom, despite the fact that there is still such a long way to go. For the first time in history, the UK’s National Health Service has prescribed medical cannabis to an 11-year-old boy, in order to treat a severe and potentially deadly form of epilepsy.

 

It was back in 2016 that Billy Caldwell attended a consultation in California with a childhood epilepsy expert, who recommended that he be prescribed cannabis oil to help prevent and reduce the severity of his seizures. Medical cannabis having been legal in California for some time, Billy was able to try out the medicine for his condition towards the end of last year.

 

The medical cannabis was administered by the director of paediatric neurology at an LA Children’s Hospital, who provided Billy with a drug containing CBD – a non-psychoactive cannabis compound.  As has been the case with many others who have turned to medical cannabis for the treatment of epilepsy, Charlotte Caldwell, the boy’s mother, said that the results where nothing short of miraculous and borderline instantaneous. When the family returned to Northern Ireland, they asked a local GP to continue prescribing the same medicine, in order for Billy to keep using it after the batch taken home from California ran out.

 

The GP ultimately agreed to do so having received the required permission from the NHS, resulting in the first ever medical cannabis prescription for the United Kingdom.

 

“I'm very grateful because the only alternative that was left for us was to fly to the US and have Dr Douglas Nordli prescribe it from there and bring it back into the country,” said Ms Caldwell.

 

“We went down to our surgery today and picked it up. It was as simple as that, no one has broken any laws and the meds will be with us before Billy needs them on Friday.”

 

It’s stories like these that highlight the incredible significance of both intensive medical cannabis research and ensuring that medical cannabis products are made available on a global basis to anyone who could benefit from them. The vast majority of doctors and scientists all over the world have stated repeatedly that the untapped potential of medical cannabis is both extraordinary and tragic, given the way in which it remains so restricted and misunderstood in so many countries.

 

Despite having been legalised across the vast majority of the United States and vast swathes of Europe, medical cannabis in all its forms remains entirely out of reach and illegal in the UK. Critics continue to argue that cases like that of Billy Caldwell are entirely insufficient to verify the medicinal benefits of cannabis, despite overwhelming evidence to support any number of cases of a similar nature worldwide.

 

Speaking on television in the UK, Billy’s mother described the medicine that had changed her son’s life.

 

“It's two little bottles of oil. One is a CBD which is really good quality whole plant extract - no synthetics, no chemicals,” Ms Caldwell told ITV’s This Morning programme.

 

“And the other bottle is a THCA, which is the part that the controversy is about in our country - 0.2 is the legal limit but this is slightly over that level. It's working for him. Billy is just over 90 days seizure-free today.”

 

In the United Kingdom alone, more than 600,000 people are known to suffer from epilepsy in one form or another. Which makes the fact that medical cannabis is still not being prescribed or even tested to its fully extent anywhere across the country even more difficult to grasp.

 


          Weed Legalisation In the UK – They Can, They Might, They Should        

Each and every time the subject of cannabis legalisation in the UK is brought up, you can’t help but get a feeling of deja-vu. The reason being that the same debate has been raging for years, the same obvious benefits are common knowledge and the same stupid arguments against the idea are still perpetuated by Westminster types who still think we’re living in the 1930s.

 

The thing is though, ever since weed was made legal in Colorado and summarily became a global talking point that can no longer be swept under the rug, those that have for decades insisted legal weed leads to anarchy are slowly but surely running out of things to say. They told us that legal weed would destroy society – Colorado is doing better than ever. They tell us it’ll cripple the NHS – public health in Colorado is booming. And of course they say it will lead to far more smokers and drug users emerging – stats from Colorado suggest the exact opposite.

 

So, once again we’re finding ourselves in the midst of a debate which really only has one side for all involved parties. But what’s more depressing than anything else is that it’s coming down to the everyday person on the street to tell those that are supposed to be doing what’s best for us about the ways in which both they and we would be so much better off if common sense were to prevail.

 

Or if not common sense, how about real democracy? Why not just put the damn subject to a public vote and see what the UK wants – isn’t that how things are supposed to work?

 

Apparently not.

 

2.4 Billion Reasons


It’s always a bit of a shame when you have to bring things down to hard currency to formulate an argument, but money talks and b******t walks. Let’s be honest, if the UK government wasn’t interested in money above and beyond every other concern, there’s no way tobacco would still be legal. After all, what are the proven health benefits of cigarettes?

 

Exactly – there aren’t any.

 

Which is what makes the whole weed thing so much more difficult to digest. Here’s an asset that’s been proven in its effectiveness against all manner of conditions and diseases, which also happens to be massively less harmful and addictive than tobacco. Add into the mix the fact that weed taxation could bring in a massive £2.4 billion in tax revenues to the UK’s economy each and every year and you almost start tearing your hair out with frustration…WAKE UP!

 

Now, in the grand scheme of things £2.4 billion doesn't sound like a great deal – government types are always making mention of stupid sums of cash that eventually end up making no sense. But to put it into a few real-world examples just to illustrate what we’re missing out on, this £2.4 billion in tax revenue every year could put nearly 110,000 new police cars on the streets AND keep them running for four years. Alternatively, it could pay for over 10.5 million overnight hospital stays, or see a further 110,000 teachers put into work.

 

Or if you’d prefer, it could help pay the bills of millions elderly UK residents who are finding themselves having to either live in freezing cold homes or starve half to death having not been able to afford both food and fuel during this current economic crisis.

 

The Savings Go On


If that’s where it all came to an end, things would be bad enough, but there’s one more thing to take into account that’s just as infuriating. Over the past decade, there have been on average around 1,150 cannabis-related custodial sentences handed out in the UK for ‘offences’ of all shapes and sizes. The costs of looking after a single inmate for a year comes in at around the £45,000 mark, which in turn means we’re spending well over £50 million each year on what’s clearly a redundant cause. Prisons overcrowded, manpower wasted and money burned.

 

In terms of the legal processes required to get these people tried and convicted in the first place, you can add another £512 million to the tally. Yes, it’s all just a bunch of figures and money doesn’t count for everything, but what’s uniquely irritating in this case is the way in which these massive savings are guaranteed, evidence suggests the public would be far better off with weed being made legal and yet we’re still being handed the same tired and dated excuses as we were two decades ago.

 

Common sense dictates that to ignore all of this is simply to delay the inevitable; if the current government refuses to see sense, a future government surely will. While all this added cash isn’t likely to revolutionise the way the UK operates, it’s certainly a bigger step in the right direction than anything else we’ve got realistic access to right now.

 

 

 


          Free cyber security training for the NHS        
Yesterday's ransomware attack that infected so many trusts within the NHS was avoidable. There are complexities within that environment relating to updating software which I understand. Having said that though users are the first line of defence, as well as better filtering of emails before they arrive at users devices. I'm confident the patient data in the back end systems is safe. More can and should be done to prevent future attacks. Firebrand of course wants to help, training people quickly is the only reason we get out of bed in the morning.

Firebrand's cyber security portfolio of courses spans protection and detection as well as end user training. We are also unique in offering accelerated cyber security apprenticeships. As you probably know public organisations including the NHS need to have 2.3% of their staff on apprenticeship programs by 2020. A great way to spend their Apprenticeship Levy.

Firebrand would of course relish the opportunity of talking to any NHS trusts about cyber security training and apprenticeships. I appreciate this might seem like we're trying to profit from this situation. However I'm extremely proud of what Firebrand does. We've trained 65,000 people over 16 years. We've given them skills that make them better at their jobs or further their careers. I know what we teach on our courses makes businesses or government departments more secure, better prepared.

So I'm not going to apologise for this offer! We will give up to 10 NHS trusts one free cyber security course each in exchange for a meeting with a senior member of staff to discuss training and apprenticeships. We can bring a security expert with us if needed and we can explain the range of courses we offer and help you plan where you need skills. During the meeting we will figure out which free course you'll benefit most from. No strings other than agreeing to the meeting.

If you work for an NHS trust feel free to contact me via LinkedIn. The first 10 NHS trusts to contact me get the courses.

For background here's the video of my interview with BBC London News yesterday talking about what has happened at the NHS.




          5 things you need to do after the NHS hack        
NHS hospitals across England have been hit by a large scale cyber attack. A pop-up message demanding ransom in exchange for access to the infected machines.

NHS Digital said: “A number of NHS organisations have reported to NHS Digital that they have been affected by a ransomware attack which is affecting a number of different organisations".



Whilst it’s too late to stop the current hack, this is a wake-up call for all. In this post, we will identify the steps needed to secure your own information now and in the future.

This is what you need to do
Be wary of emails from the NHS:
 Now is the perfect time for cyber criminals to strike through a phishing attack. Avoid downloading or clicking links in any emails coming from NHS. Almost all malware is installed unknowingly by the victims themselves.

Change your passwords and security questions: Even if you haven't been hacked, change your password and security questions immediately. This is especially important if your email is connected in any way to your bank or a PayPal account.

Additionally, you should look to change the passwords in any other account that uses the same or similar security information. This ensures hackers cannot access other accounts through NHS information. It is also sensible to check your password recovery settings and ensure they have not been changed to a third party.

Avoid contacting your GP practice: Avoid contacting your GP practice unless absolutely necessary, your local pharmacy can provide free and fast advice for non-urgent conditions.

Update your security settings and run a security scan: This the time to make sure your computer is secure. Make sure you run a virus scan and have the most recent security updates on your operating system. If you don't have an anti-virus application, invest in a high-quality one like McAfee or Norton Antivirus. This is something you should be doing as best practice regardless of the issue.


Report it to the police: If you believe you have been hacked and are now the victim of identity theft or fraud, file a report with Action Fraud.

          Intern - Researcher / Practicus Ltd / Henley-on-Thames, Oxfordshire, United Kingdom        
Practicus Ltd/Henley-on-Thames, Oxfordshire, United Kingdom

The role will be to help the sales team identify the right business contacts within target sectors, typically those responsible for change and transformation initiatives. You will get to learn about key drivers within organisations and sectors, from the NHS to Insurance and you'll become familiar with a whole variety of functions from HR to Digital and Data.

This will be a steep and invaluable learning curve for someone with an interest in how the world of business works. Your research will fuel the activity of the sales team as they take your information and carry out business development off the back of it.

Applicants for these two roles should;

Be degree educated

Have a passion for learning

You should be very Internet savvy

Have excellent attention to detail

A "Can Do" attitude is an absolute must, as is the ability to take tasks and deliver against them.

The role is initially six month internship which for the right person could lead to permanent employment beyond. This is a buzzy fun environment, sociable and lively.

If this sounds like an opportunity that you're interested in, please send your CV and a covering letter to (see below)

This will be a paid Internship. You must be able to drive and have a car.

Employment Type: Permanent

Apply To Job
          RMN/RNLD - Complex Case / Real Staffing Group / Manchester, Lancashire, United Kingdom        
Real Staffing Group/Manchester, Lancashire, United Kingdom

A NHS client of ours is currently looking for a RMN Or RNLD CHC complex case manager for an immediate requirement.

The post holder will be responsible for arranging, monitoring and reviewing individual packages of care for people with complex Physical Health and Mental Health care needs.

You will also be responsible for advising and overseeing the implementation of care packages and complex care Packages

Present to panel on findings.

Review existing cases.

QIPP experience.

Experience of working in commissioning, and with patients, families and carers.

Excellent knowledge of the NHS Framework for Continuing Health care.

Working knowledge of S117 is desirable.

*PLEASE NOTE YOU MUST BE A REGISTERED MENTAL HEALTH NURSE OR REGISTERED LEARNING DISABILITY NURSE AND HAVE EXPERIENCE WITHIN CONTINUING HEALTH CARE*

If you have experience in the above and would be interested in this fantastic career building, rewarding position, then please do contact Ryah Westwood or submit your CV online.

Real Staffing, a trading division of SThree Partnership LLP | Registered office

Employment Type: Contract
Duration: 3 months

Pay: 250 to 300 GBP (British Pound)
Pay Period: Daily
Other Pay Info: competitive

Apply To Job
          Every time you hear of some Left Wing Nut Job talking about giving the government more control, remember this: "Governments are not in Control"        
Sweden's government is in crisis after a government agency accidentally leaked the entire country's personal details database by offshoring its storage without adequate safeguards. Two ministers have been fired and the entire government may fall.
Swedish prime minister Stefan Löfven confirmed on Monday that private information concerning citizens of Sweden had been exposed to serious security risks after the government outsourced IT services for the Swedish Transport Agency (Transportstyrelsen) to IBM in 2015.
IBM, in turn, left an astounding amount of information exposed to a number of unauthorized users around the world — including the names, home addresses, and photos of every member of the police, secret military units, information from the witness-relocation program, information regarding the weight capacity of all roads and bridges, and details regarding the specifications of all government and military vehicles (and their drivers).

Apparently, the transport agency mistakenly emailed their entire database of sensitive information to marketers in plain text. And upon realizing their error, the agency decided to merely ask subscribers to delete the old message and later sent out an updated one.

Spectacular as it is, the Swedish disaster is just the latest in a seemingly unending series of similar catastrophes of which the OPM records loss , Snowden defection, State Dept secret cable loss, NSA toolkit theft are but a few well known examples. The casualties flash past like milestones in a blur. Britain's NHS lost 100,000 patient records the other day. Pakistan's Prime Minister Nawaz Sharif lost his job today due to "documents leaked from a Panama-based law firm" proving he was corrupt. In an age where the media use unnamed sources to launder leaks and section 702 of the Foreign Intelligence Surveillance Act is allegedly used for political surveillance no one's secrets are safe. We appear to have entered the age of digital nakedness and not even politicians are immune. Hillary was supposedly robbed of her election by Russian hackers who stole her secrets and broadcast them though some of the losses may actually have been due the DNC's own careless selection of fraudsters to run their IT operation.

When the Hillary Clinton as Secretary of State runs her own unsecured private server for all her messages, when the Obama Administration uses the NSA to spy on its political opponents, when the Democrats in Congress hire a criminal Pakistani family to run it's IT services, and the Edward Snowden data leaks that have rocked the entire US government, the idea that giving the government even more control is positively scary.

These people are NOT the "best and the brightest,"  and they are not to be trusted.

Here is a list of the top ten (so far) biggest government data breaches.

10. State of Texas: 3.5 Million Affected (April 2011)
9. South Carolina Department of Revenue: 3.6 Million Affected (October 2012)
8. Tricare: 4.9 Million Affected (September 2011)
7. Georgia Secretary of State Office: 6.2 Million Affected (November 2015)
6. Office of the Texas Attorney General: 6.5 Million Affected (April 2012)
5. Virginia Department of Health Professions: 8.3 Million Affected (May 2009)
4. U.S. Office of Personnel Management (OPM): 21.5 Million (June 2015)
3. U.S. Department of Veteran Affairs: 26.5 Million Affected (May 2006)
2. National Archives and Records Administration (NARA): 76 Million Affected (October 2009)
1. U.S. Voter Database: 191 Million Affected (December 2015)

Hillary famously claimed she understood the implications of artificial intelligence and robotics but does she really? Did the Swedes really? It's entirely possible that, despite their show of outward confidence no one fully understands the changes we've unleashed, least of all politicians nurtured in bureaucracy. The death of privacy appears to be an externality of the information age just as pollution was the unintended consequence of the industrial revolution. Nobody knows how much it will cost and the elite doesn't know how to deal with it.

Though governments pretend to be in control the facts suggest otherwise. Part of the problem is the government's habit of power. They've had it for so long they think it is theirs by right. Bureaucrats want the public to remain unprotected by encryption, the better to keep the public safe, though probably the better to keep everyone under control. And they're not succeeding. ...

          When the NHS catches a computer bug are security services to blame?        
There is no doubt that the delays and disruption caused by the NHS computer virus could have been avoided. The government could have used a fraction of the multi-billion security budget to enable hospital trusts to update… More
          LCD information screens, or is it garbage?        
So here I boringly am having a boring wait for an outpatient clinic at the Whitt. Did I mention that it's boring? Ah yes, good, because it is.

Hurrah! The National Health service has provided a lovely big screen to provide information and stave off boredom. Ahem, yes indeed.

On the screen are lots of adverts. These cover a range of topics - some are straight NHS information, for example smoking and depression services, infection control in hospitals, welcome to this department, and so on. Others are just ads, but with I guess the intention that they're at least potentially relevant to people sitting here bored off their skulls (did I mention the boredom?) so there are dentists, hotels, estate agents and quite a few minicab firms.

The NHS stuff is mostly well-made and coherent. The commercial stuff is more variable - some of it's good, some is poorly designed and/or illiterate.

So far so good - it's mostly not a bad service, though I note that there really are are quite a lot of screens … if you were to watch it because you were looking for a particular piece of information, you might get to wait quite a long time for it to come round. I think this limits the usefulness if the service; indeed, if you can't use it easily to find out information then why is it there? Maybe it could just be pictures of flowers and bunnies instead, if its main function is really to be wallpaper? But them you couldn't charge businesses - other perhaps than flower suppliers and bunny breeders? - to put their ads up here. Hmmmm.

Here, though, is the real showstopper. Well it's two of them, really, but they are not unrelated.

There are two menu-like bands top and bottom of the screen. They are independent of the main screen content. The top one has, prominently, the time and date, and the lower one has a short scrolling message.

The message says:

"Welcome to the department. Watch this screen to see up to date waiting times."

This is an excellent idea - indeed if I were given the choice I'd prefer some information on waiting times to more minicab adverts. And you certainly see this message plenty, as it's the only item in its own little scrolling section so it repeats every 16s or so. Sadly it doesn't seem to have got past the "excellent idea" phase as the promised waiting times never actually appear. You can watch all their lovely ads as long as you like, but you don't see any waiting times. I could do with this as it's now 35 minutes after my appointment time and still not a squeak. So, without wishing to be horrible, I do feel that this part of the service is a complete failure, as it makes a promise on which it does not deliver.

The other problem is simple, amusing and really quite pathetic. Remember the top band with the date and time in? Well, the clock is half an hour slow. If it's now 1220 then the clock claims it's 1150. Like, connected, man. That says it all, really: once we've seen that we don't really need to know much more about how this service is used and valued, because it isn't. It is mostly a waste of space, a nice little earner wearing the stolen clothing of an information system. I diskard it.



          Essex £50m NHS legal claims bill        
In the past two years, more than £50m has been paid out following legal claims against the NHS in Essex.
          I love Lewisham Hospital - but that's not why it should be saved        
The below is a comment I posted on this Guardian article, about the widespread misconceptions on WHY people are fighting for their local hospitals:

***

As a supporter of the Save Lewisham Hospital campaign, and the broader fight to Save our NHS, I really have found the patronising rhetoric that MPs have used when talking about local peoples' reactions to NHS reconfigurations to be extremely offensive.

I was born in Lewisham Hospital. But I don't for one minute think that, in and of itself, is relevant to any debate on its survival.

What is relevant, in my opinion, is that my birth, my mum's second, became very complicated quite out of the blue and it was due to the expertise of the maternity staff, way back in 1986, that we're both alive. If the proposals go through and another mum goes through a similar experience to what my mum went through all those years ago, she will have to be shipped off to a hospital six miles away to get emergency treatment. That's not sentimental; that's just a fact.

I agree that it's not helpful when local MPs use emotive language about how "upset and angry" their residents are about service downgrades, as if that's going to make any difference. It just feeds into the (wrongful) belief that protests against changes are mere outpourings of emotion, rooted in sentimentality.

Speaking on Lewisham Hospital in Parliament a couple of weeks back, Lord Patten said: "On every occasion, however understandable, attachments to institutions and to buildings that have been there for a long time are always trumped by patient outcomes and patient care"

I completely agree. Problem is, the Lewisham A&E decision was nothing to do with patient care and all to do with money. Lewisham campaigners aren't campaigning simply because they have an "attachment" to Lewisham Hospital. They are campaigning because the decision to downgrade it has been rushed, has not been backed up by "clear clinical evidence" (one of the Tories' four tests) and is opposed by every single local GP and clinician on the grounds that it puts lives at risk.

Bruce Keogh said that a smaller A&E at Lewisham Hospital would still see up to 75% of patients. He also (apparently) told Jeremy Hunt that the overall South London Healthcare Trust changes could save up to 100 lives a year. Lewisham consultants wrote a formal letter to him asking him to back up his claims. His reply contained not a single figure - instead, he said that "It's not an exact science".

That is why we are fighting for Lewisham. Not because the hospital is "the heart of the community", or because we don't understand the need for change or tough choices, but because the decision to downgrade its services has been made for the wrong reasons and if we allow the plans to proceed, people will pay with their lives.

[end rant]




          Why Jeremy Hunt made a terrible decision on Lewisham Hospital        
On 31 January 2013, health secretary Jeremy Hunt announced he had approved the downgrade of Lewisham A&E to a "smaller" A&E and the downgrade of the existing maternity unit to a mid-wife led unit. Throughout his announcement, he continually re-asserted that his decision was made on the advice of NHS medical director Professor Sir Bruce Keogh.

Many papers and website have inaccurately described this decision as a "partial victory" or a "compromise". This isn't true. The "smaller" A&E is essentially the urgent care centre originally proposed by Matthew Kershaw dressed up in different language. It still would not be able to see serious cases such as meningitis and pneumonia. The mid-wife led unit was the TSA's original recommendation and has been strongly opposed by campaigners from the very beginning. It would mean that, should a pregnant mother go into a seemingly "low-risk" labour (if there is such a thing??) which suddenly runs into serious complications, they will have to be transferred to another hospital to receive the necessary emergency care, rather than being treated at Lewisham as is currently the case.

Despite the Conservative Party's emphasis on "localism" and Jeremy Hunt's own assertion that NHS decisions should be made in consultation with local people and local clinicians, it seems that the entire basis of the health secretary's final decision was "Sir Bruce said...". This is despite the fact that 90% of respondents to the TSA's draft report opposed the Lewisham Hospital proposals, as did all local clinicians.


DUBIOUS STATISTICS


A quick look at the statistic and claims made by Sir Bruce and then regurgitated by Hunt reveals some very dodgy looking stats. Below are the main ones:

1) the changes to maternity and emergency care would result in the average blue light transfer times in south-east London increasing by one minute(by supersonic jet perhaps?)

2) accessing consultant-led maternity services will involve an increase in journey times on average of two to three minutes by private or public transport (an extra 2-3 minutes to travel an extra 6 miles? Really??)


3) the new free-standing, midwife-led unit at Lewisham Hospital will be able to deal with a minimum of 10% of existing activity and up to 60% of current activity (no clinical evidence provided)


4) the new smaller Lewisham Hospital A&E can continue to see up to 75% of those currently attending Lewisham A&E (no clinical evidence provided)


5) the overall proposals could save up to 100 lives per year through higher medical standards (no clinical evidence provided)


SIR BRUCE'S LETTER


There are a couple of interesting points in Sir Bruce's letter to Hunt (which can be found here: https://www.wp.dh.gov.uk/mediacentre/files/2013/01/SLHT.pdf) that make it clear that these proposals cannot go through:

a) "The TSA [a new one will be appointed now Kershaw has landed a cushy job as a hospital CEO] and local clinicians must be able to articulate clear and understandable plans for the public to reassure them that acutely ill patients, particularly from the Lewisham area, will be able to access high quality services in an emergency."

- Well, given that local clinicians are unanimous in their opposition to the proposals, this is pretty much an impossibility, no?

b) "I should make it clear that patients who have a potential to deteriorate ... would not be appropriate for this facility [the smaller A&E]."

- Erm, someone might need to remind Sir Bruce that ALL patients have the potential to deteriorate. As such, surely he's actually confirming what we all know to be true: a smaller A&E simply cannot work in practice.
          Dear Mr Hunt...        

Sooooo the consultation was an utter shambles! In addition to the protest on Saturday 26 Jan, everyone supporting the Save Lewisham Hospital campaign can write to Jeremy Hunt and share their views (probably best to keep it polite..!) Details can be found at: http://www.savelewishamhospital.com/write-to-jeremy-hunt-and-your-mp-outside-lewisham/ 

My letter is below (yes, I got caught up in a rant)

***

23 Jan 2013
Dear Mr Hunt,
I am writing to you with regard to the Trust Special Administrator report on the proposed reconfiguration of the South London Healthcare Trust, in particular reference to the proposals pertaining to Lewisham Hospital.
I’m well aware that most likely this letter will not be read by you but by a member of your staff (if that), and that, in response, I will most likely receive a standard statement stating merely that you’re considering the proposals. 
I am also aware that you will have heard many arguments – that the TSA far overstepped his remit, that Lewisham is a successful solvent hospital, and that the proposed changes will have potentially fatal consequences on the local population – before. As such, I would like to look at this issue from a different perspective and will do so briefly in the hope that, should this letter actually reach you, you will endeavour to read it in its entirety.
You have stressed on numerous occasions the important of the four tests. In the House of Commons on 8 January 2013, you said:
  • “[W]ere there to be any changes, we would need to be satisfied that they would have strong, local, clinical support”
  • “I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met.”
  • [We introduced the four tests as] “an additional safeguard to make sure that reconfigurations were not done without local clinical support”.

As I’m sure you are by now more than aware, the TSA’s report fails ALL four tests. But what is important is that you made these statements on the record, publicly and definitively. You will not be able to backtrack on these promises unnoticed.
We are one of the most deprived boroughs in London and yet the Save Lewisham Hospital campaign have secured consistent national coverage on our campaign ever since 10,000-15,000 people attended the demonstration on 24 November 2012, including:
BBC
ITV
Guardian
Daily Mail
Times
Telegraph
Daily Mirror
Regardless of political leaning, all coverage has been critical of the proposals. Look at the comments from Guardian readers, and then those from Daily Mail readers – they are equally opposed to the changes and equally critical of a Conservative government that would allow them to proceed.
The proposals were also a key topic of debate on a recent episode of Question Time broadcast on 10 January 2013 which was watched by three million people. The panel was unanimous in its opposition to the proposals, and NHS was a top UK trend on Twitter immediately following the show.
If you are even considering accepting the Lewisham Hospital proposals, you are heading for a PR nightmare. The country is watching your decision very closely at a time where confidence in the Conservative Party to stick to campaign promises is at an all-time low. This is the highest profile case of its kind in recent history. Should you approve these proposals, you are saying to every single voter in the country that, regardless of the four tests and your promises that NHS reconfigurations must have local support, if you deem it necessary, you can and will close down any NHS services you like. Is this the message you want to give to the electorate?
***
There seems to be a view that Lewisham residents are opposed to the proposals because they (a) are emotionally attached to their local hospital and don’t want to services removed; (b) don’t understand the urgent need for change given the SLHT’s dire financial situation; (c) aren’t willing to offer any alternatives. All the aforementioned points are completely inaccurate.
We are well aware that the SLHT’s financial situation is completely unsustainable and that something has to be done. We are also aware that sometimes difficult decisions have to be made to solve such large-scale problems. Local GP commissioners have been very clear that they understand the need for change and are more than willing to work with QEH to come up with a sustainable, workable solution that does not put the lives of patients at risk unnecessarily. We the public are also very clear that we oppose the proposals, not for reasons of sentimentality, but because they are dangerous proposals based on incomplete, inaccurate and flawed data. You said on the 8th January that the four tests were introduced because you “wanted to avoid what had happened so often, including in my own constituency—an alliance of Health Ministers and NHS managers riding roughshod over what local people wanted”. Should you approve these proposals, this is exactly what will be happening.
FAILURE OF THE FOUR TESTS
1) The most evident failure is that of the first test: support from GP commissioners. From your emphasis on local support during your speech on 8 January, I take this to mean “support from LOCAL GP commissioners”. As has been made very clear to you, local GP commissioners are unanimous in their opposition to the proposed closures at Lewisham A&E. http://www.savelewishamhospital.com/ccg-responses/
2) The proposals also fail the second test, strengthened public and patient engagement. The public were given little time to respond to the consultation. The proposals with regard to Lewisham Hospital were obfuscatory to the extreme – many (including myself) did not understand what was actually being proposed at first. A crucial piece of data on which the public consultation was based was also flawed - a fact only acknowledged after the public consultation period was closed. The final report states:
"Analysis included in the TSA’s draft report suggested around 77% of University Hospital Lewisham’s current A&E activity would remain at the hospital under this scenario. However, a number of responses to the consultation suggested that this estimate was too high. Therefore, further analysis was undertaken and, based on practice elsewhere in London, a revised figure of 50% has been used for the modelling that underpins the TSA’s recommendation."
There is a significant difference between 50% and 77%, I’m sure you will agree. Most local clinicians believe that the actual figure is yet lower than 50%, at around 30%. And if this figure was so substantially wrong, how can we trust any of the data in the report?
3) The recommendations are underpinned by a clear clinical evidence base
They are not in the slightest, as has already been outlined to you by local clinicians. More views can be found here: http://www.savelewishamhospital.com/specialists-say-no/
4. The changes give patients a choice of good quality providers.
These changes do exactly the opposite. QEH is already severely over-stretched and simply cannot cope with the extra patients. Travel times for Lewisham residents to reach QEH have also been severely underestimated. The TSA has also significantly underestimated the flow of patients to Kings College Hospital in Camberwell, should the proposals be approved, as has been stated by Harriet Harman in her letter to you (http://www.harrietharman.org/opposing-lewishams-ae-and-maternity-closure-on-behalf-of-patient). From a personal point of view, I can tell you that as a Sydenham resident, I would not consider travelling to QEH for emergency care.
I hope the issues outlined above, and the sheer size and high profile nature of the opposition to these proposals, in addition to the many other letters you will be receiving and meetings you will be having, are enough to convince that these proposals must be rejected.
I look forward to a prompt response, and eagerly await your decision on 1 February.
Kind regards,
Shannon Hawthorne, Lewisham resident.

          Oxfordshire medics join campaign against NHS reforms        
FIVE Oxfordshire doctors are among 240 medics to sign their names to a letter vowing to campaign to unseat 50 coalition MPs at the next election over the government’s unpopular NHS reform bill.
          Sit-in protest over NHS reforms        
CAMPAIGNERS against a radical shake-up of the NHS staged a sit in at the county’s primary care trust headquarters today.
          Protesters against NHS and Social Care bill stage sit-in        
CAMPAIGNERS against a radical shake up of the NHS are staged a ‘sit in’ at the county’s primary care trust headquarters.
          Dementia Assessment and Referral Data Collection May 2017        
Dementia Assessment and Referral data collection – May 2017 The May 2017 data for the Dementia Assessment and Referral data collection in England by NHS England were released on 2nd August 2017 according to the arrangements approved by the UK Statistics Authority. The collection’s purpose is to improve the identification of older patients with dementia […]
          Critical care bed capacity and urgent cancelled operations: monthly situation reports, June 2017        
Today NHS England published the latest statistical information relating to critical care bed capacity and cancelled urgent operations for June 2017. This information is gathered from providers within NHS Trusts, NHS Foundation Trusts,  and Independent Sector Organisations. The data includes: number of available and occupied adult critical beds number of available and occupied paediatric intensive […]
          Diagnostic Imaging Dataset, July 2017        
Today NHS England published the Diagnostic Imaging Dataset for the 12 month period up to March 2017. Data includes breakdowns of NHS imaging activity undertaken in England, as well estimates of GP usage of direct access to key diagnostic tests for cancer such as chest imaging and Brain MRI. Further information and the data is […]
          Direct Access Audiology waiting times for May 2017        
NHS England today released the Direct Access Audiology waiting times for May 2017. Data are published on Direct Access Audiology patients whose referral to treatment (RTT) pathways were completed during May 2017 (completed pathways) and on those patients who were still waiting at the end of May 2017 (incomplete pathways).
          Combined Performance Summary, May 2017        
Performance statistics for May 2017 were released at 9.30am on Thursday 13th July covering the following: the NHS 111 service; ambulance quality indicators; A&E attendances and emergency admissions; waiting times for diagnostic tests, referral to treatment for consultant-led elective care, cancer services; delayed transfers of care; and early intervention in psychosis. A combined performance summary is […]
          Diagnostic Imaging Dataset, June 2017        
Today NHS England published the Diagnostic Imaging Dataset for the 12 month period up to February 2017. Data includes breakdowns of NHS imaging activity undertaken in England, as well estimates of GP usage of direct access to key diagnostic tests for cancer such as chest imaging and Brain MRI. Further information and the data is […]
          GP Patient Survey Dental Statistics; January to March 2017, England        
In January to March 2017, 2.2 million adults were asked about their views on NHS dentistry. Participants were asked if they had tried to obtain an appointment with an NHS dentist and, if so, whether it was with a practice they had been to before and if they had been successful. They were also asked […]
          GP Patient Survey 2017        
GP Patient Survey 2017 Aggregated data for January 2017 to March 2017 NHS England together with Ipsos MORI, have today published the latest Official Statistics from the GP Patient Survey. The survey provides information on patients’ overall experience of primary care services and their overall experience of accessing these services. Results are based on aggregated data […]
          Dementia Assessment and Referral Data Collection April 2017        
Dementia Assessment and Referral data collection – April 2017 The April 2017 data for the Dementia Assessment and Referral data collection in England by NHS England were released on 5th July 2017 according to the arrangements approved by the UK Statistics Authority. The collection’s purpose is to improve the identification of older patients with dementia […]
          Come and tell us what you think        
SWEP - Tuesday, May 12, 2009, 07:58

This is Local Newspaper Week.

It is a seven-day celebration of the crucial role newspapers and their websites play in our communities.

Throughout the week we will be focusing on what your local newspapers (Evening Post, Llanelli Star and Carmarthen Journal) and websites (thisissouthwales, thisiscarmarthenshire, and thisisswansea) mean to you.

And we would love to know your thoughts on what you love about us, what you would not be without, what you enjoy the most and what you would like to see more of in the future.
We believe we have a vital part to play in the community, but we need your help and support to continue doing it.

Please post any comments you have below.

Also, if you have any pictures of you or colleagues reading one of our newspapers at work, home, or, perhaps, somewhere unusual, then please send them to paul.turner@swwmedia.co.uk.

Thanks!


Comments (26)
As "a vital part of the community" the post should be judged by the same standards as it expects from public bodies. Unfortunately it fails this test and has been in decline for years. Poor research, lack of knowledge of Swansea, lazy recycling of articles, tabloid headlines sensationalising stories, need I go on. Would like to see the reaction to this on the front page! My money is on. "Post readers tell us we are the best!"
Richard, Swansea
commented on 12-May-2009 13:13

What happened to the readers letter section, something I enjoyed reading.
Anne, Georgia, USA
commented on 12-May-2009 13:08

Another vote here for bringing back the letters page on the website. Also, I'd like to see Heather from Mumbles given her own column.
P.Lazarou, Bonymaem
commented on 12-May-2009 12:45

I agree that the same stories are recycled which is frustrating. It would be nice to see balanced coverage with regard to the NHS etc, the paper is quick to go to town on anything negative but rarely does the same for positive stories - they tend to be a statement of fact only (and no, I dont work for the NHS). I too am sick of seeing these poor victims pointing helplessly at some random item - 9 times out of 10 they only go to the Post in an attempt to get some money out of whoever they think is to blame - shame on you for reporting it - you are just encouraging them. The name Evening Post is a bit of a joke now too. The paper is printed overnight and available to buy in the morning so hardly the news of the day.I agree that if you are going to have a website - print the stories rather than the habit you have recently adopted of printing a couple of sentencesCant disagree with the comments about your building - its vile!
J, Swansea
commented on 12-May-2009 12:26

more stories about swansea and the areas around it.more decent reporters.try and put your advertising on just a few pages they seem to be on every page.i like the website though because you dont have to pay 40p every day for a load of adverts and poor reporting
geoff, mumbles
commented on 12-May-2009 10:34

Go back to broadsheet formula, print the paper on the morning of the day of publication or stop calling it The Evening Post (perhaps The Morning Post would be more appropriate) Bring back the Sporting Post printed on a Sat after the games and available to read by around 6.30pm
Steve, Neath
commented on 12-May-2009 10:28

Bring your price down! I haven't paid for the Evening Post for many years. The post is only a local rag and you charge the same prices as the daily papers. For shame!
Jim, Swansea
commented on 12-May-2009 10:23

I enjoy the E.P. and take a daily look at your web page. As stated by other readers though, it is a pity that the E.P. is now printed in England. The news isn't "news" when we get now as it used to be. I expect that down to economics, it's a shame though as the E.P. should be a "our" local rag
Gloria, Swansea
commented on 12-May-2009 09:11

If i want up to date news about Swansea i look at the BBC web site which is updated 24 hrs a day.Since the printing of the post t has moved out of Swansea the news in invariably stale.Who wants to read a supposedly evening paper at 7 am. When the post was printed in Adelaide st we had a number of editions throughout the day and of course the "Late night final".Sorry Northcliffe newpapers you do not provide an up to date source of news to West Wales.
Derek, Swansea
commented on 12-May-2009 03:43

i miss the local gossip from the various areas around neath.why is it that you only print favourablr comments from the web site in EP?
byron, neath
commented on 11-May-2009 21:08
I agree with Paul (West Cross).Please reinstate the "Readers Page",on the website,some really interesting comments made by citizen's who may be without web facillities.
roy r, swansea
commented on 11-May-2009 19:32

The EP website needs improving/upgrading.....if a website is available it must be functioning on a level with the paper. At the moment, you have cut the readers letters (!!) and you direct readers to look for additional details of newstories on the following day!! If you have a story to report, REPORT IT in full at the time. The EP, rather than keeping up with progress, has taken ten steps backwards. Oh and for goodness sake, reinstate a proper bereavements section so that we do not have to wade through dozens of identical announcements for the same person - all we need is to know that a death has occurred and the date and time of the funeral.
clarysage50, Somerset
commented on 11-May-2009 18:55

what you love about us: when you talk up the positives about Swansea Bay - positive news stories.what you would not be without: sports news esp. live text report onlinewhat you enjoy the most: as abovewhat you would like to see more of in the future: more stories that do not stereotype, do not judge, do not make a mountain out of a molehill ... and that do share good news! And finally...Sort your building out!
Anon, Sketty
commented on 11-May-2009 17:06

You used to have a lady writer who used to write loads of interesting articles and features about Swansea but I have not seen her writing in the Post for several months. Without such interesting articles I personally gave up reading the Post as I am not interested in paying money to read endless adverts and endless stories from estate agents talking rubbish about house prices and why they think Swansea is worth such silly asking prices. I want to read interesting articles about local people.
Bob, Sketty
commented on 11-May-2009 16:57

Could you please reinstate the "Readers' Letters" page on the website?
Paul, West Cross
commented on 11-May-2009 16:28

i would like to see more headline grabbers like that front page story you ran about the woman who bought a burger from macdonalds that was rare. now thats real reporting for you. keep up the good work EP.
steve, swansea
commented on 11-May-2009 16:07

Try and be less small-minded and parochial, the fact that some minor celeb once visited Caswell or had a Granny from Gowerton is not particularly newsworthy and does not mean that Swansea is somehow responsible for their success.
Glen, Margam
commented on 11-May-2009 15:26

Totally agree with B.S's point 3.The majority of the "hard done by" victims you write about are lazy good for nothings who don't work or do anything constructive with their lives. Then a brick comes through their window and they are on the front page of the Post pulling a ridiculous pose pointing at a brick. Come on Editors half of you must be educated????
SHA BUDGE, swansea
commented on 11-May-2009 14:57

A little more investigative journalism would be good.
caebrwyn, Llanwrda, Carms
commented on 11-May-2009 14:42

I always read the EP because it is the only paper that gives local news. However I feel there has been a marked decline in the standard of journalism over the past years. It seems like journalists are appealing to the tabloid readers by sensationalising stories and stirring up trouble between the tax payer and statutory organisations such as Swansea Council and NHS. Also, the EP is not truly up to date with local news as it once was due to the fact that it is printed overnight before the news of the day has actually happened.
DD, Swansea
commented on 11-May-2009 14:35

I totally agree with comments by Dav. The building is an eyesore and is in a prominent position in te city. You reported several years ago that the building was to receive a facelift? You've not mentioned anything since and so why haven't you done it? You quite rightly highlight the issues with the bus station but people see the great improvements taking place around the bottom end of the city centre and then see your building slap bang in the middle.
Martin, Swansea
commented on 11-May-2009 14:02

I totally agree with the comments of Dav,Swansea. The Evening Post building is an eyesore. It is in a prominent position and you reported some years ago that it was to undergo a facelift? You report, quite rightly, about the state of the bus station but when are you going to do something about your building?
Martin, Swansea
commented on 11-May-2009 13:45

A good source of local news but there are areas in which you can improve:1/ Avoid being melodramatic and over-using words such as 'SHOCK, HORROR, DRAMA, ORDEAL'. Just give us the news and we'll be the judge of how 'shocking' it actually is.2/ Avoid recycling the same news. Recently you've printed stories about swine flu and the lad off Britain's Got Talent almost every day and it's starting to get very tedious now as it was not major news in the first place.3/ Cut down on publishing 'victim stories' with pathetic people whinging about how they stubbed their toe & have to find someone to blame.4/ I find your celebrity column to be uninteresting and the sort of thing you'd expect from the worst of the tabloids.
B.S., Penllergaer
commented on 11-May-2009 13:32

more positive news about Swansea!
Angela, Sketty
commented on 11-May-2009 13:01

More attention to basic grammar would be top of my list
Matthew, Swansea
commented on 11-May-2009 12:59

It would be nice to see the Evening Post improve the aspect of its building as a key gateway landmark to the City.
Dav, Swansea
commented on 11-May-2009 12:38
          NHS BLOOD DRIVE - October 11, 2017        
 
          NHS BLOOD DRIVE - October 11, 2017        
 
          BDRN thanks South Staffordshire and Shropshire NHS Foundation Trust        

BDRN’s Professor Lisa Jones was delighted to have the opportunity to speak to service users, carers and staff of South Staffordshire and Shropshire NHS Foundation Trust at their Coffee Morning to Celebrate Research in May. South Staffordshire and Shropshire NHS Foundation Trust continues to be a great supporter of BDRN and many service users from Read More ...

The post BDRN thanks South Staffordshire and Shropshire NHS Foundation Trust appeared first on BDRN.


          NHS BLOOD DRIVE - December 13, 2017        
 
          NHS BLOOD DRIVE - December 13, 2017        
 
          NHS BLOOD DRIVE - February 14, 2018        
 
          NHS BLOOD DRIVE - February 14, 2018        
 
          NHS BLOOD DRIVE - May 9, 2018        
 
          NHS BLOOD DRIVE - May 9, 2018        
 
          Punishing the Conservatives        
A Conservative government has caused the greatest political and economic disaster in 50 years. The Prime Minister responsible, David Cameron, has resigned. Theresa May's ministers are consistently suggesting that the vote to leave the European Union means the withdrawal from all EU mechanisms- the "Hard Brexit". The result will be the exit of the car industry from the UK and severe damage to the City of London.

It is totally irresponsible.

It will cost the country millions of jobs and billions of pounds. The Tories now own the Brexit fiasco.

Voters are noticing: some major shifts in local elections suggest that the Liberal Democrats may be recovering fast.

Just maybe the new Tory programme of back to fifties- imperial measures, grammar schools et al- may end up destroying the party that is proposing this drivel. Backward looking provincialism deserves nothing more than contempt.

I bloody hope so.

In other news.

Last night hundreds of children went to sleep alone and hungry in the Jungle at Calais- a humanitarian mess that the UK is responsible for. Last night the food banks were doing good business. Last night the NHS faced just another day of strain and pain. Last night millions of workers in the UK were facing renewed threats to their livelihood because of the Brexit fiasco. 

This morning the British right wing press: 80% supporting the Conservatives and funded by five off-shore billionaires, decided that the marriage split of two actors was the chief story their readers needed to know about.

Contemptible. Disgraceful. Outrageous.
          Agreement will protect North West NHS staff from attack        
A NEW agreement to help protect nurses, doctors, ambulance crews and other NHS staff from assault and abuse in the North West has been introduced.
          Learning and Skills Exhibition 2014        


I went to the Learning and Skills Exhibition at Olympia this year.  It is a popular event that's co-located with the Learning Technologies Exhibition and Conference and both days were very busy.

The exhibition is free to enter and there were a large number of seminars running in parallel across 10 open theatre areas.  These were being run by commerical training providers and although this meant that they included a certain amount of 'selling', by and large, I found the content well presented and a good way of taking the pulse about what's going on in the L&D market.  It was also a great networking event.  I bumped into a lot of people both on the stands and as attendees and had some interesting chats with old and new contacts.

The things that I saw which interested me were...

Social learning using user-generated video

Fuse Universal and Phones4U gave a lively presentation about the use of user-generated video to help develop sales effectiveness.  The video link that I've added does a good job in making the case for this type of social learning.  What I can't find online is the video that was shown at the conference,  produced by one of Phones4U's frontline sales people.   It was creative, full of energy and contained lots of context-specific content with sales tips and tricks.   

Online Coaching Development


The University of Cambridge's Institute of Contunuing Education (ICE) presented their online approach to coach development.  The title of the presentation was 'Can you really learn coaching skills online?'

Given that this was a presentation about their online learning programme, then the answer was 'yes' of course.  What really interested me was the analysis from research done with students about their levels of discomfort with self-disclosure in discussions.  The continuum was from: working 1:1 with another person face-to-face (most comfortable) through working in trios, groups of up to 5, groups of 6 or more to online (least comfortable); the results were just over 70% for 1:1 to about 20% for online working.

What impressed me was that the presenter acknowledged the virtue of workshop-based coach development but also pointed towards an alternative approach using online methods.  The course uses Skype to create a 'bubble' for paired coach/coachee practice with the facilitator also present providing verbal feedback, through the Skype channel, to the trainee coach.    The rest of the learning group/set could listen to the conversation through headphones and were invisible to the coaching pair.  They were able to add their written feedback about the coaching practice. 

The point in all of this is that if you want to develop coaching skills and you can get along to a traditional workshop then this approach has a lot going for it.  But not everybody can work this way and the online model demonstrated a compellling alternative that replicated the 1:1 'safe space' for self-disclosure using Skype and also encouraged good deep learning processes from those observing through the written feedback process; an additional benefit being to the trainee coach of a permanent and reviewable record of the feedback for continuing reflection and learning.  

Ignite


Ignite is the name for a particular type of event that has been held in around 100 cities worldwide, organised by volunteers, at which participants speak about their ideas and personal or professional passions according to a specific format.  The tagline is '...enlighten us, but make it quick'.  Each speaker is allocated five minutes of presentation time and is accompanied by 20 presentation slides. During the presentations, each slide is displayed for 15 seconds and then automatically advanced.  To see examples follow these links Ignite Cardiff  Ignite Showreel

At the session I saw there were 6 speakers and the topics covered were: The best training event ever - NHS Couch to 5k programme, Skills@School, Life as a Digital Apprentice, Avoiding the Mariah Carey Syndrome, Being Your Best Self and The Baloney Detection Kit - Bertram Forer's Personality Test.

Reflections about format? Positives: lots of content in a short space of time, redundancy for the listener is minimised, encourages presenters to practice because the slides' advance is uncontrollable. Negatives - creates tension for the speaker  - I noticed that several of the presenters rushed and on many occasions were waiting for the next slide to advance; creates tension for the listener - I found myself paying a lot of attention to anticipating the next slide than necessarily concentrating on the speaker.

Overall, I thought that this was an interesting idea that has value as a learning process both for the presenter and the listener. 

   
     
          A Leicester Square Business Man Given Tax Bill After Donation        
A grieving widower who raised more than £2million to help refurbish a world-leading cancer hospital was hit with a VAT bill for almost £500,000, he revealed today.
Jimmy Thomas, 78, said it was it was “diabolical” that hospitals were forced to pay the tax as he called on David Cameron to change the law.

The co-founder of the Hippodrome Casino in Leicester Square - next door to the world famous Leicester Square Cinema - gave £2.3million to the Eliss Ward at the Royal Marsden Hospital in Chelsea, where his wife Alma was treated before her death in 2008 at the age of 74.

His funding drive was launched because she was “embarrassed” at the quality of facilities, in which “beds were so close together doctors had to nudge a neighbouring bed out of the way to pull a privacy curtain into place”. He said his had even offered her diamond ring to help pay for improvements.

His donation was spent on renovation work on the 18 NHS beds on two private rooms on the ward, but was subject to 20 percent VAT because it was classed as rebuilding – meaning that he had raised an extra £460,000.

Mr Thomas said:” it is diabolical. It just seems so deceptive. I have sat next to David Cameron at lunch and explained this atrocious state of affairs. So far, there has been no response and frankly I am tired of waiting. He vowed he would not take money from the sick and vulnerable to fill the financial black hole, and that's exactly what he continues to do. The fact that a world-leading hospital, at the very pinnacle of treatment excellence,should be hit with a VAT bill just to improve facilities for essential NHS care is criminal. The law must be changed.”

Last month at the nearby Leicester Square Hotels, Chancellor George Osborne rowed back on plans to hit churches with VAT on improvements and alterations, prompting calls for similar arrangements for hospitals. Lib-Dem MP Sndrew George said he would raise the case with ministers having pressed for changes before. The department of Health said that while hospitals can recover VAT on maintenance and repair costs, exception does not apply to rebuilding or refurbishing.

Treasury sources suggested tax changes were a matter of the Chancellor in the Budget, but tressed European law did not allow the Government to introduce new zero ratings for VAT. However, the rate could still be cut.

A spokesman said: “The Government has made a commitment to increase health spending, investigating an extra £12.5billion to improve services and safeguard the future of the NHS.” Mr Thomas donated the cash through the Alma Thomas Memorial Fund. The Ellis Ward is due to reopen on Friday after a year of refurbishment and redesign.  

          Run community hospitals as social enterprises and save the NHS millions        

16 June, 2014 | By Tracey Bush Give social enterprise a greater role in the provision of local healthcare and you can energise staff, save the NHS money and bypass the red tape that holds back innovation, argues Tracey Bush NHS England chief executive Simon Stevens talks about reinventing community hospitals, not preserving them. So, […]

The post Run community hospitals as social enterprises and save the NHS millions appeared first on Make it happen.


          NHS Community Grants        

Has your community or voluntary group been working to involve patients and the public in improving health care services? Have you got some good practice to share? NHS England is launching a new community grant opportunity. NHS England is seeking to make grant awards to showcase good practice around patient and citizen participation in healthcare. […]

The post NHS Community Grants appeared first on Make it happen.


          Hearing aids on the NHS        
For as long as most of us can remember there has been a lengthy wait for a NHS hearing assessment and the subsequent fitting of NHS analogue hearing aid, with many people waiting many months to complete the process.
The more recent introduction of digital hearing aids has greatly improved the performance of modern hearing aids. However this has also lead to an increase in demand from new users and those looking to upgrade their current analogue hearing aids. This increased demand has impacted service levels and many NHS waiting lists have increased as a result.
It is a Government commitment to ensure assessments for hearing aids are made within a six weeks. Unfortunately this target only relates to the first stage of the process and makes no difference if patients have to endure months on a waiting list before prescribed hearing aid is actually fitted. Lengthy delays between assessment and fitting can also lead to the need for a re-assessment at the time of fitting.
The RNID estimates that around five hundred thousand people are currently waiting to have digital hearing aids fitted by the NHS.

The RNID also said:

"We remain seriously concerned about the capacity of the NHS to meet the Government’s aim of ensuring that no-one waits more than 18 weeks for a hearing aid fitting by the end of 2008."

There main area of concern is that the push to meet these new targets may result in a fall in the quality of the service offered.

As a result many people in the UK choose to opt out of the NHS service and buy their digital hearing aid directly from a retailer who can offer instant services.


Hearing Aid Repairs St Louis MO
          Units to free NHS emergency space        
Units for people who are not well enough to be sent home but do not need to be admitted as inpatients are opened in Bangor and Wrexham hospitals.
          Canadian-born visible minority youth face an unfair job future        

Data from the 2011 National Household Survey (NHS) which replaced the long- form census indicate that racial status remains a significant factor in shaping advantage and disadvantage in the Canadian job market and in influencing the overall level of poverty and income inequality.

Put bluntly, non-whites do significantly worse than whites, in part because of racial discrimination.

With the aim of promoting employment equity, census data on employment and incomes have long been collected for “visible minority” persons defined as those other than Aboriginal peoples who are “non-Caucasian in race or non-white in colour.”

In 2011, one in five (19.1%) of all Canadians belonged to visible minority groups, up from one in six (16.2%) in 2006. Due to the changing mix of immigration since the 1970s, almost one quarter of young people age 20 to 24 now belong to a visible minority group, and this proportion is much higher in big cities.

The NHS data likely understate pay and income differences between whites and non-whites due to under-sampling of lower income groups, and are not directly comparable to census data from previous years. This is unfortunate since other Statistics Canada surveys of earnings and income such as the Labour Force Survey do not gather data based on racial status.

NHS data show that the incidence of low income for non-whites in 2010 was 21.5% using the Low-Income Measure (LIM), much higher than the 13.3% rate for whites. The incidence of low income was higher than the overall visible minority average for Chinese Canadians (21.6%) and Blacks (26.2%).

The median total income of non-whites in 2010 (half received more and half received less) was just $20,153, or one third (32%) less than $29,649 for whites.

A major factor behind these significant differences in income is the fact that many non-whites are recent immigrants who experience difficulty gaining recognition of non-Canadian educational credentials and work experience. 

However, while members of visible minority groups are more likely to be recent immigrants than other Canadians, a high and rising proportion of non-whites were born in Canada.

40% of visible minority youth age 20-24 were born in Canada and thus have the same educational experience as other Canadians. Many others came to Canada as young children and were mainly educated in Canada. But they still encounter greater problems in the job market than whites.

2011 was a year of partial recovery from the Great Recession of 2008-09, and the overall unemployment rate averaged 7.8%.

The NHS data show that the unemployment rate in 2011 was 9.9% for visible minority workers compared to 7.3% for white workers, a difference of 2.6 percentage points. The difference in unemployment rates between visible minorities and white workers was significantly greater for women (10.6% vs 6.7%) than for men (9.3% vs 7.8%).

The unemployment rate in 2011 was especially high for Arabs (14.2%), Blacks (12.9%) and South Asians (10.2%).

A high level of education did not narrow the unemployment rate gap between visible minority and white workers. In fact the gap (7.9% vs 4.1%) was greater for workers with a university degree.

Strikingly, there was a big difference in unemployment rates in 2011 between visible minority workers who were born in Canada and white non-immigrants – 11.8% compared to 7.4%.

The gap was a bit smaller but still significant for young visible minority workers age 20 to 24 born and educated in Canada and white workers in the same age group also born and educated in Canada – 17.2% compared to 14.1%.

This racial difference in unemployment rates for non-immigrants obviously cannot be explained with reference to the under-valuation of foreign educational credentials and work experience which affects immigrants. 

Nor can it be explained by levels of education, given that visible minority Canadian-born young people are more highly educated than their white contemporaries.

The fact that non-whites clearly operated at a disadvantage in the job market in the aftermath of the Great Recession in 2011 may reflect overt racial discrimination in layoffs and in hiring, or the fact that white youth have closer social connections to potential employers.

Previous studies based on census data, notably by Grace-Edward Galabuzi of Ryerson University, have carefully shown that race is a significant independent factor influencing success in the Canadian job market. The fact of discrimination is, of course, hardly unknown to those who are on the receiving end, and Canadian-born visible minority youth are likely to be especially angry.

One possible solution is to enact employment legislation requiring employers to take proactive measures to eliminate discrimination and to promote more inclusive hiring practices. Such legislation still covers federally regulated employers, but Ontario's employment equity act was repealed in 1995 by the Harris government.

We are storing up trouble if we fail to discuss how to promote employment equity when the labour force is becoming ever more diverse, and the fact of discrimination is apparent.

Photo: dps. Used under a Creative Commons BY 2.0 licence.


          Pharmacy service will save NHS £517.6m, finds study        

A scheme launched by the Department of Health in 2011 to help patients stick to their drug regimens has been so successful, that in its first five years, it will save NHS England £517.6m  in the long-term, a team of health economists has found


          Exclusive: 18 'high calibre' leads appointed to major NHS improvement programme        
Leading consultants have been appointed to lead 14 national reviews aimed at improving efficiency and reducing unwarranted variation in NHS, HSJ can reveal.
          First accountable care system managing director revealed        
An NHS England director has been appointed to the first managing director post of an “accountable care system”.
          NHS worker cleared of racism after being accused of 'wanting to poison Polish people'        
A MAN accused of wanting to “poison” Polish people has been cleared of a racism charge.
          NHS England and NHS Improvement reveal joint regional restructure        
NHS England and NHS Improvement have appointed two joint regional directors, in order to “test a more integrated approach” between the two organisations.
          Former SHA chief executive to be ACS 'strategic adviser'        
Portsmouth Hospitals NHS Trust
          Former Labour health secretary turns down top NHS roles to join estates firm         
Alan Johnson, the former Labour health secretary, has turned down national NHS roles to chair a local estates company, HSJ can reveal.
          Revealed: New national patient safety director        
Senior NHS England clinician Celia Ingham Clark has been appointed as interim national patient safety director for England in a joint appointment across NHS England and NHS Improvement, HSJ has learned.
          Exclusive: Regulator expands national mental health team        
NHS Improvement has recruited five new members to its mental health team.
          Exclusive: Former DH director returning to NHS to lead teaching trust        
A former senior manager at the Department of Health will be the new leader of one of England’s biggest trusts, HSJ can reveal.
          Trust chair steps in to lead STP        
NHS England has appointed a community trust chair as interim leader for the Staffordshire and Stoke on Trent sustainability and transformation partnership, following failure to recruit a permanent head since November.
          Two-thirds of London trusts lack own procurement director        
Only around a third of NHS trusts in London have their own permanent head of procurement or procurement director, HSJ research reveals.
          Healthcare PSPP Accreditation awarded to VideoCentric        
Leading Video Conferencing Integrator focused on improving Efficiency and Patient Care in Hospitals & the NHS with Cisco Video Collaboration Technology
          Manzanar NHS To Host Public Archeology Project September 1-5, 2017        
The following is a press release from the National Park Service. INDEPENDENCE, CA — Manzanar’s award-winning public archeology program provides exceptional opportunities to learn about the past and help preserve the site and its stories for the future. This year marks the 75th anniversary of Executive Order 9066 and the 25th anniversary of Manzanar National […]

          AUDIO: Interview with Manzanar NHS Interpretive Ranger Rose Masters        
We’re a little late with this, but on May 25, 2017, Gideon Culman, who publishes the K Street Coaching blog, interviewed Rose Masters, Park Ranger (interpretive staff), Manzanar National Historic Site, in a piece entitled, “Race Prejudice, War Hysteria, and a Failure of Political Leadership – Interview.” The interview runs the gamut of Manzanar history […]

          Manzanar NHS At 25 Years Old: More Relevant Now Than Ever Before        
The following is an expanded version of a story that will appear in the printed program for the 48th Annual Manzanar Pilgrimage, April 29, 2017. LOS ANGELES — A little over 25 years ago, after decades of hard work, Japanese American community activists, along with allies in California’s Owens Valley, celebrated a victory when the […]

          Manzanar NHS To Host Pilgrimage Weekend Events, April 28–30, 2017        
The following is a press release from the National Park Service. INDEPENDENCE, CA — Manzanar National Historic Site invites visitors to participate in a weekend of special events in conjunction with the Manzanar Committee’s 48th Annual Pilgrimage. All are welcome and the events are free. This year’s Pilgrimage coincides with the 75th Anniversary of President […]

          Manzanar NHS Seeks Candidates For “Teacher Ranger Teacher” Position        
The following is a press release from the National Park Service. This summer, Manzanar National Historic Site will participate in the Teacher Ranger Teacher program, offering a professional development opportunity for K-12 teachers to spend Summer 2017 acquiring new skills in experiential learning. The program is provided by a partnership between the National Park Service […]

          Manzanar Committee Mourns Loss of Former Manzanar NHS Superintendent Frank Hays        
LOS ANGELES — The Manzanar Committee extends its deepest sympathies to the family of former Manzanar National Historic Site Superintendent Frank Hays, who passed away due to a heart attack on March 3, which was, coincidentally, the 25th Anniversary of the establishment of the Manzanar NHS. A 58-year-old native of Philadelphia, Pennsylvania, Hays was the […]

          Training for a marathon, it's just like having a baby?        
I can't say that a marathon is something I've ever aspired to completing. Until recently.

The ballot for next year's London Marathon opened this week and my Facebook/Twitter/Instagram quickly became swamped with people declaring their entry.  Added to that, every weekend for the past month or more I've seen pictures of other people completing marathons of their own.  Ordinary people, just like me. Accomplishing something brilliant.

The feeling that I might want to do this myself, and soon, is becoming unshakable.

You see, when you take up running, distance and times all seem fairly irrelevant at first.  Then, as you start to improve you think, well, maybe I could.  I could run a marathon.  After all, last year I ran a half marathon and its just two of those.

Back to back. On the same day.  Just eight and a bit parkruns.

How hard could it be?

There is just one thing that worries me.  All that training.

Well, not so much the training as how much it takes over your life.  Rather like having children in fact (and I have plenty of experience of having children...).

Training for a long distance race for the very first time is a lot like having a baby.  A lot.

Maybe not exactly.  It's not as if you get a small human to take home when you run 13.1 or 26.2 miles, but bear with me here while I try to explain my thoughts.

1.  Fear and utter disbelief (aka submitting your race entry)

I can still remember the feeling I had when those two little lines appeared on the pregnancy test stick as if it were yesterday.  "What have I done?", "I don't think I can do this!"

Too late.

When I completed my first half marathon application, it took a week to be confirmed with my chosen charity and during this time I watched my emails with the same thoughts bubbling up inside my brain.

When the email finally came I realised that it really was too late to change my mind on that too.

2.  Buying all the things

When you are expecting a baby a whole world of retail opens up to you, as you discover shops that you previously had no interest in.  The latest baby monitor, moses basket, buggy and toys.  You decide you will need them all. In colours matching your nursery decor.

It's much the same when you start training for a race.  I'm afraid to say that the Nike outlet holds as much excitement for me now as Mothercare did back then.  What do you mean, I don't need another pair of running shoes? I don't have any that match my charity vest yet.

3.  Special underwear

You know the sort.  Sexless non underwired bras, reminiscent of something you imagine an elderly aunt to wear, coupled with Bridget Jones style knickers.  Sadly, while you may think I'm talking about maternity wear here, the same rules apply for comfortable running underwear. #chafefree

Oh, have you ever had those funny sock things in hospital after a c-section?  Well, runners have their own version of those too, specifically for after really long runs.  Luckily they come in funky colours (obviously this makes them loads better).

Fancy socks (its lucky for you that I didn't choose a picture of my underwear)


4.  The plan

What to eat, what to drink, how long to run for.  My running plan seemed OK to begin with.  Until I began getting emails telling me what phase I was in that week and how I should be progressing.  It's a bit like one of those baby development books that I bought when I was first pregnant, the sort that turn you into a complete obsessive over every detail.  What if I hadn't run the required number of miles?  What if I was 17% too fast? What if I didn't have any morning sickness?  What if my baby wasn't the size of a grapefruit?  FFS, it's all bonkers and none of it really matters anyway.  Except it did to me.  Both times.

5.  Two weeks before the big day

This is when most women start maternity leave, a blissful period of endless waiting and eating cake.

Runners have their own version of this called tapering, where they do very little milage, wait for an age for race day and then do something called "carb loading" which is basically eating lots of cake too.

6.  Labour and birth/Race day

I can confirm that for me both of these things started with a very early morning, nerves and excitement and intense self doubt.

Oh, and pain and exhaustion.  There was lots of that.

In pain, at least the photographer framed the shot nicely.


Also, some very unflattering photographs afterwards.

7.  Hanging out with your own kind

In pregnancy I had NHS Antenatal classes, in which we'd hang out at coffee shops and talk about stretch marks, piles and leaky nipples.  All morning.

Runners on the other hand have parkrun, where we hang out at the park and discuss appropriate training surfaces, running shoes and compare injuries (some of which include bleeding nipples and missing toenails *boak*).

There are genuinely no taboo subjects where both these groups of people are concerned.  Fact.

8.  Other people

From the moment that you announce that you are having a baby other people just love to pass on their helpful advice.  This ranges from how painful and difficult it's all going to be to how easy they found it to give birth themselves and how big their baby was/long their labour was.  People are obsessed with statistics I've found.

Runners are another good example of this.  So many people asked me what time I was hoping for in the lead up to my half marathon.  If not that then they told me how easy my target time would be to achieve.  Also, whenever you announce that you are planning to run a half or full marathon for the first time then there's always someone who replies that they've already run two (there's always one, eh?).  Or worse, the ones who ask you if you're going to stop running now, once you've completed it. Err, no.  I'm not.

9.  Post birth/race blues

You've had the baby and everyone's making a fuss of you both.  Things should be pretty great.  Except you can't stop crying or feeling sad that things maybe didn't go as planned or you are just overwhelmed with the whole experience and how exhausted you feel.  The three day weepy, as a friend of mine called it, is a very uncontrollable and real thing after you've had a baby.  But the good thing is that it passes pretty quickly.

Apparently feeling sad after your first race is also a real thing too.  Although you can't really attribute it to hormones, although I think all the post race adrenaline may have something to do with it.  From obsessing over the bad miles in your race where you know you could have improved, to wondering what to do with yourself now that it's all over and your charity has received their cash.  I even cried because I didn't get a photo of myself crossing the finish line.  I look like a state in all of my running pictures but I still wanted one *sulks*.  Thankfully this passed quickly too.

10.  I want to do it all again

When you suddenly realise that it's nowhere near as bad as you were told/thought and that maybe you are quite good at this and actually enjoy it.  In fact you wonder why you ever doubted yourself at all.  You've got this.  And, you feel an enormous sense of pride and achievement.  Your whole body may feel a wreck but you know you'd do it all again in a heartbeat.

Yes, on reflection, for me completing my first race was pretty similar to that too.




To marathon, or not to marathon?  The training may be as bad as pregnancy but I've survived that not once, but four times.

So, watch this space...


          Questions raised over CCG after 'inadequate' rating        
REDDITCH and Bromsgrove clinical commissioning group (CCG) has been rated ‘inadequate’ in NHS England’s annual review.
          Doctor by day, beauty queen by night: The medic who entered pageants to 'cure shyness' and is now competing in Miss Wales finals        
A woman doctor came up with a cure for her own shyness - by becoming a beauty queen.
Hospital medic Rhianne Robinson, 24, was always nervous about meeting new people despite newly-qualifying as a doctor.
So she came up with a diagnosis to beat her shyness by putting her name forward in a beauty contest.
Brunette Rhianne was stunned when her catwalk cure worked - and she won the beauty queen crown.
Cardiff Doctor Rhianne Robinson who is also a beauty queen
Cardiff Doctor Rhianne Robinson who is also a beauty queen
Self diagnosis: Rhianne Robinson is competiting in the Miss Wales finals for a chance to compete in Miss World

Now she has been given time off from her hospital rounds to compete in the Miss Wales finals - and the chance of a place in Miss World.
Rhianne reckons her beauty queen career has turned out to be just what the doctor ordered for her daily rounds at the University Hospital of Wales in Cardiff.
She said: 'I've always been really shy and never confident in my appearence.
'But I like challenging myself - and thought I might try something different to bring myself out a bit more.
'I was worried I wouldn't get through so I kept it quiet from my bosses and workmates.
'But after I won I've let them know everyone is being really supportive.'
Rhianne won the Miss Rhondda Cynon Taff title to qualify for the Miss Wales final next month.
Rhianne, of Miskin, near Cardiff, She said: 'Most people think contestants are a bit ditsy but I've studied really hard and have always been a bit of a bookworm.
'But every girl loves getting dressed up, and I don't have many opportunities to put my heels on when I'm on the wards.'
Rhianne, a red belt in karate, wants to deliver the knock out blow to her 49 fellow contestants and wow the judges at the final in Cardiff.
She said: 'If I was lucky enough to win it would be incredible, but I'd have to sort out the Miss Wales commitments with the NHS trust.
'The concept of the competition is charity and fundraising and I love helping people, I think I'm a caring person.'
If Rhianne wins she will compete in Miss World in November in London.
A spokeswoman for the Miss Wales organisers said: 'Rhianne has done very well just like the other girls in the final. She proves she's bright as well as beautiful.'

          Comment on Massive public spending cuts just around the corner? by Pump Head Bam        
[...] /* */ /* */ Our Honor DefendDefend the NHS [...]
          Comment on Labour may be toast – let’s make sure we’re not! by Barry Tebb        
To-days Guardian gives a page to publicising one Jeremy Taylor,head of New Voices,a lobbying group that claims to represent over 200 organisations and 15 million patients.Taylor believes fervently in hospital closures,polyclinics and in everything that's wrong and bad.He believes the nhs isn't about 'bricks and mortar'.Patients with illnesses need hospitals,patients with mental illnesses need day hospitals.Common sense and real knowledge have entirely passed this ex-treasury mandarin.Why is the Guardian pushing him?How did he get this job?He should be disowned and sacked,no-brainers with this level of clout need to be got out now.Barry Tebb
          Comment on A glimmer of hope for the NHS by chris        
We just had our health care vote yesterday in the usa. I hope all ends up well for us and the uk also. cheers
          London's Road to Gin Lane        


William Hogarth lived and worked as an engraver & painter in 18th century  London and cast a critical, satirical eye on London society as he observed it.


William Hogarth once said:
"I have generally found that persons who had studied painting least were the best judges of it."


Apply Hogarth's astute observation to UKIP's London Assembly team who are not professional politicians and you will find a team of talented Londoners who will actively support London businesses and who understand the  concerns of Londoners in relation to jobs, education, housing, NHS, taxation and the folly of local government waste which blights our lives. 


The road to ruin most aptly portrayed in Hogarth's engraving entitled "Gin Lane" (shown underneath) is being played out in parallel in today's capital city and can be amply illustrated by  increasing unemployment and social disorder as witnessed in last years London riots, lack of a meritocratic education system, housing crisis, NHS shortages and closure of hospital wings, incessant demands on Londoners by way of stealth taxes and London mayoral vanity projects such as Boris bicycles and imposition of the London emissions zone which will consign many small business people to an uncertain future.


  • UKIP London Assembly candidates, if elected, will speak up for Londoners and make sure that their voice is heard.
  • Ensure that appropriate training will be given to Londoners who are actively seeking employment.
  • Re-introduce Grammar schools to ensure a meritocratic educational system no matter what your background or circumstances.
  • Re-introduce matrons in hospital wards to ensure standards of cleanliness and respect for patients are assured.
  • Stop the London emission Zone in its tracks to ensure that Londoners with vans and small businesses are not driven off the roads.
  • Stand up for the people who work in the City. Not just the bankers but the cleaners, drivers, bar and restaurant staff along with the taxi drivers whose livelihood depends on a well regulated and functioning City.
  • Build more affordable housing through public and private partnership for working people and key workers such as policemen, firemen, nurses and teachers who cannot otherwise get on the housing ladder.

UKIP will not let you down.  Vote UKIP at the London Assembly Elections on 3rd May 2012.


Visit David Coburn's Twitter site for updates


https://twitter.com/#!/DavidCoburnUKip/followers




William Hogarth's engraving "Gin Lane" was published in London , 1751

          Hundreds of NHS Wales staff overpaid taxes while training        
HUNDREDS of Welsh NHS workers could have overpaid thousands of pounds worth of tax while studying on career progression schemes.  Doctors, nurses and midwives were mistakenly taxed while studying on ‘Widening Access Training Schemes’, despite being legally entitled to exemptions as they were not undertaking paid work. Figures revealed by the Welsh Conservatives showed over 600 staff are still waiting for rebates. One nurse from Cardiff and Vale University Health Board has issued a letter to Shadow Wales health minister Angela Burns to highlight the scale of the issue. “I estimate that I am now owed in excess of £3,000, and many others of my course mates are owed much more - one has even received a rebate of £7,000 with more to come,” she wrote. “Having submitted my own claim for a rebate more than a year ago, I am still yet to receive a penny. “My nurse’s salary is barely enough to satisfy my outgoings, and I often feel I am just about keeping my nose above the water.  “I work hard and often stay after my shift has officially finished because we are understaffed and because I care about my patients, but I am becoming increasingly frustrated with the lack of urgency by which the health board has treated my claim.” Conservative AM Ms Burns said: “The health boards really need to get their act together on this.  “Clear guidance should be issued to participants of this scheme over who is eligible to claim, how they can claim, and how long it will take for their claims to be processed. “Some NHS Wales employees are faced with serious financial challenges and to deny them the money they are rightfully owed sends a message of uncaring thanklessness.” The Widening Access Training scheme sees NHS workers – including nurses, midwives and doctors - undertake full-time training at colleges and universities in Wales.  A Freedom of Information request sent by the Welsh Conservatives revealed that ive of Wales’ seven health boards say they have workers still waiting for rebates under the scheme.  The highest number of workers still awaiting rebates was at Aneurin Bevan University Health Board, with 180 employees yet to receive money owed. Cardiff and Vale University Health Board currently has 125 staff who have not been refunded. Cardiff and Vale University Health Board have been contacted for comment.
          10 Tips of How to Buy a Car Without Getting Ripped Off        
Ten tips that can save you a lot of money when you buy your next car.
One of the smartest folks I know just wrote a terrific article giving you ten tips on how to buy a car that should be required reading for anyone who is even thinking about it. 

Its published over at the NHS Consumer Law Center blog, where you can find out much more about consumer rights, scams, and how to protect yourself.

One Smart Car Buyer Gives You 10 Tips
In the article, Nadine Ballard explains what she just did in buying a car that kept her in control of the process and avoiding some of the major pitfalls and dangers that lurk in the sales staff and paperwork car dealers use.

She also shows you how just saying "NO" can save you time and money and preserve your legal rights - and how car dealers will change even their form contract paperwork just to make a sale to you if they have to.

Nadine's advice is highly recommended to everyone!  Don't leave home (to go car shopping) without it -

Burdge Law Office
www.BurdgeLaw.com
Helping Consumers Protect Themselves, Everyday

          MD Medicine Dr. fined Rs.41 lakh for doing pleural tapping test without Sonography        

MD Medicine Dr. fined Rs.41 lakh for doing pleural tapping test without Sonography, that too in Causality section The Maharashtra State Consumer Disputes Redressal Commission, (MSCDRC) in its recent judgment dated 31/03/2017, gave the verdict against the Doctor, but absolved the Hospital.. Case details – Mr.Prashant Tamhane V/s. P.D. hinduja Hospital and anr. CC No.221 of 2003 Facts in short : 1. This is the case of 2002. The wife (since deceased) of the Complainant was admitted in the Hospital after the blood reports revealed symptoms of hepatitis. There she was examined by Dr.Ashit Hegde, the Opponent no.2 Doctor in the present case. At that time he after examining the patient he thought it fit for not admitting the patient. By taking medication she was improving. 2.However after about one month, she had Chest pain and difficulty in breathing. Initial X-ray was normal, but in later X-ray, she was diagnosed as suffering from pleural effusion. 3. On next day pleural tapping test was conducted by Dr. Hegde in the Casualty ward and the Doctor left. But as the patient complained of giddiness, Doctor was summoned again, but unfortunately she started sinking. 4.The Doctor tacitly admitted that it could have happened due to puncturing of the spleen by needle during tapping. 5. the CT scanning also revealed that the needle had punctured the spleen resulting in spleenic tear and profuse bleeding internally and she took her last breath in the next morning. 6. Thus the Complaint for medical negligence was filed by her Husband for claiming .Rs.87,50,000/-. Defense : 1. Dr. Hegde refuted all the charges of Negligence. The patient having complex condition with jaundice, alcoholic hepatitis, liver ailment etc..have lesser chances of surviving. the hospital also denied all the charges against it and submitted that as per Post Mortem report, There were multiple Abscesses in the Brain and the Kidneys and generalized septicemia this contributed to the death of the Patient. 2. It was also argued that the Dr. Hegde is well qualified M.D. (Internal Medicine) passed in 1984. Rather the patient was reluctant to get admitted herself. Held : 1. The Commission after hearing of parties and perusing the record and going through the various case laws on the point of Negligence of Apex Court, reduced the compensation from Rs.87,50,000/-.to Rs.41,00,000/-. 2.The Commission observed, The courts and the Consumer Fora are not experts in medical science, and must not substitute their own views over that of specialists. 3. It further observed, the entire medical fraternity cannot be blamed or branded as lacking in integrity or competence just because of some bad apples. 4.the Commission raised the query as to why the Process of injecting a needle or puncturing twice of space below chest for Pleural effusion was done casually in the casualty section of the Hinduja Hospital and not in ICU ? Why Sonography was not performed while passing or inserting the needle? 5. This omission on Dr.Hegde’s part is personally blameworthy and punctured Spleen of the Patient did hasten the dizziness, breathlessness and death of the Patient. These facts called for the attraction of well known principle of law i.e. res ipsa loquitur i.e. things speak for itself, and thus No expert opinion was required. 6. The Commission reiterated the “mistake” on part of the Doctor of performing the procedure in casualty section turned to be fatal. 7. Not using Sonography while inserting the needle twice in a case of pleural effusion resulted in puncturing of the spleen which hastened death of Patient. 8. The Commission, in my humble opinion rescued off the Hospital from any liability, as generally Hospitals are held vicariously liable for the Acts of its empanelled Doctors. How the compensation was ascertained 9. Calling claim of Rs.87,50,000/- as exaggerated & exorbitant, it was also observed that Compensation cannot be a lottery or jackpot for a Patient. As the patient when she died was only 35 years of age and her net annual income was computed to the tune of Rs.4 lakhs and applying the multiplier of 10 (this method is used in motor Accident cases, wherein the formula in simple words can be stated as lesser the age, higher the multiplier. The net annual income X multiplier = compensation. Apex Court in the landmark case of Sarla Verma V/s. Delhi Transport Cor. (2009) 6 SCC 121, has given the table of multiplier), the compensation was calculated at Rs.40,00,000/- and towards Hospital bill and litigation cost, Rs.1 lakh and Rs.25,000/- were awarded respectively, totaling to Rs.41,25,000/-. This judgment has released shock waves amongst the medical Fraternity. 2 principles which are usually followed, seems not to have been adhered to i.e. 1) Expert Opinion was not called for and, 2) The Hospital was not held liable much less vicariously liable. I am open to correction, but the Multiplier method was not followed by Hon. Apex Court in its landmark judgment of Dr. Kunal Saha’s case. This case is of 2002 and the technology prevailing at that time and as on today might be different and might also be flawless. Some of the medicos are of the Opinion that USG Guided Cannulations and procedures were mandated by NHS since 2006, so can it applied to the case of 2002 ? Henceforth, the Doctors will have to rethink as to what procedures are to be performed in Casualty section and what not ? and the question still remains, if the procedure is performed in ICU, whether it can lessen the chances of mortality or still it depend upon the facts of each case ? Adv. Rohit Erande Pune. ©

The post MD Medicine Dr. fined Rs.41 lakh for doing pleural tapping test without Sonography written by DesiMedicos Team appeared first on Desi Medicos.


          Energy Efficiency News on 25 June 2012        

Energy efficiency programs earn governments more tax revenue ...
Canada.com
A new report says provinces that promote energy efficiency may forfeit some tax revenue from lower sales.
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Energy savings reaped in NO
NOLA.com
A year after the launch of its $11 million citywide energy-efficiency program, New Orleans officials and executives at Entergy New Orleans say the program has ...
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PSE&G Lauded for Innovative Energy Efficiency Program for Hospitals
MarketWatch (press release)
PSE&G won in the innovation category for its $129 million hospital energy efficiency initiative, one of only four programs in the U.S. that specifically targets ...
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Denmark Pushes Through First-Ever EU Energy Efficiency Law
Forbes
With the clock running out on its EU presidency, Denmark achieved on June 13 one of the chief aims of its six months in control of the European agenda.
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Forbes

Food energy savings to reduce carbon footprint
ABC Online
One million dollars worth of refrigeration and lighting upgrades are about to start in regional NSW at the southern hemisphere's most modern dairying cut, pack ...
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ABC Online

Summer Energy Saving Tips From USA Insulation Include Adding ...
MarketWatch (press release)
A properly insulated and sealed home increases energy efficiency, comfort, and can reduce annual energy usage by as much as 30-50 percent. CLEVELAND ...
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Energy efficiency yields tax dollars: study
MetroNews Canada
OTTAWA – A new report says provinces that promote energy efficiency may forfeit some tax revenue from lower sales of fuel and electricity, but will make up for ...
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Saving energy
Chicago Tribune
In 2009, commercial buildings in the U.S. were found to be responsible for 18.9 percent of the total U.S. energy consumption and 19 percent of our nation's ...
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Siemens Systems Serve Up Energy Savings For Red Robin ...
MarketWatch (press release)
As a result of this successful implementation, energy consumption in EMS-controlled locations is down 9 to 15 percent, driving a significant energy savings for ...
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Aggressive Energy Efficiency Goals Are Transforming the Building ...
Business Wire (press release)
Aggressive energy efficiency goals within the building stock will drive revolutionary change in building automation systems and transform the building.
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Green energy saving environment, money
Middletown Journal
Home and business owners who have adopted solar power as an alternative energy source have found the devices are not only helping reduce their carbon footprints ...
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Nicor Gas Energy Efficiency Program Teams Up With Chicago Fire ...
MarketWatch (press release)
Nicor Gas Energy Efficiency Program provides rebates and incentives to help businesses and residents save energy and money. Eligible customers gain the ...
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Aggressive Energy Efficiency Goals Are Transforming the Building ...
MarketWatch (press release)
According to a recent report from Pike Research, aggressive energy efficiency goals within the building stock -- which is undergoing tremendous growth, ...
See all stories on this topic »

Ameresco to Implement $3.7 Million in Energy Efficiency ...
MarketWatch (press release)
As part of the ESPC, Ameresco will construct and implement $3.7 million in energy efficiency measures at 22 facilities town-wide. Once complete, the measures ...
See all stories on this topic »

LG Electronics Expands HVAC Training Series Across US To ...
MarketWatch (press release)
Widely adopted across Europe and Asia, VRF technology provides greater energy efficiency and cost savings compared with traditional HVAC systems.
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New efficiency standards for clothes washers, dishwashers
Sacramento Bee
New energy-efficiency standards for residential clothes washers and dishwashers were announced by the U.S. Energy Department.
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GSMA Green Manifesto Shows Network Efficiency Can Lead To ...
MarketWatch (press release)
The report used data and analysis from the GSMA's Mobile Energy Efficiency Benchmarking (MEE) service to calculate both the energy costs and the CO(2)e ...
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As Heat Wave Ushers In Summer, Energy Efficiency Can Cut Cost of ...
MarketWatch (press release)
"Simple energy efficiency steps can make your home more comfortable while also easing the strain on your budget," says Alliance President Kateri Callahan.
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Purdue students stress home's energy efficiency
Journal and Courier
Purdue students give tours of their Deep Energy Retrofit home.
See all stories on this topic »

Community News for June 21, 2012
Utica Observer Dispatch
UTICA. Energy efficiency workshop offered. UNHS NeighborWorks HomeOwnership Center will offer the final workshop in its first Conscious Communities ...
See all stories on this topic »

Reducing energy use in production agriculture
CattleNetwork.com
Running a farm takes a lot of energy—in more ways than one. In 2009, Minnesota's 81000 farms spent more than $700 million on transportation fuel and an ...
See all stories on this topic »

Cool your house in the summer with ceiling fans, energy-efficient ...
Fox News
While Americans can expect record hot weather this summer, according to the National Oceanic and Atmospheric Administration, there are ways to cool down ...
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Keeping your home energy efficient in hot weather
WXXA
With temperatures heading into the 90s, National Grid offers tips for summertime energy efficiency.
See all stories on this topic »

Freescale Debuts Kinetis L Series, World's Most Energy-Efficient ...
MarketWatch (press release)
"Kinetis L series MCUs are ideal for the new wave of connected applications, combining the required energy efficiency, low price, development ease and small ...
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Vigilent Sweeps Higher Education Energy Efficiency and ...
MarketWatch (press release)
EL CERRITO, Calif., Jun 19, 2012 (BUSINESS WIRE) -- Vigilent(R), the leader in intelligent energy management(TM) systems, today announced that both the ...
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National Grid offers summertime energy efficiency tips
Fall River Herald News
Summer is officially here, and temperatures are already rising. So will home energy usage in most households throughout the region. Whether you are spending ...
See all stories on this topic »

DOE Funds Energy Efficiency Training Centers
SustainableBusiness.com
Training programs will be created to give building operators the skills they need to optimize energy efficiency.
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Alfa Laval Wins SEK 60 Million Energy-Efficiency Order in South Korea
MarketWatch (press release)
"It proves our ability to meet the high demands for energy efficient products in the refinery business." Did you know... that one Alfa Laval Packinox heat ...
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Berkeley Co. school awarded gold star for energy efficiency
The Herald-Mail
Spring Mills Primary School - Berkeley County's first “green” school - was awarded gold certification through the Leadership in Energy and Environmental ...
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Google touts energy efficiency as another Google Apps benefit
ZDNet (blog)
In its official blog, the cloud service giant says it could reduce power consumption associated with running productivity apps by between 65 percent a.
See all stories on this topic »

ZDNet (blog)

Moving Beyond Energy Efficiency to Sustainability
nwitimes.com
A joint program of the EPA and DOE started in 1992, ENERGY STAR promotes energy efficient products and practices that help save money and protect the ...
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LG Electronics Expands HVAC Training Series Across U.S. To ...
PR Newswire (press release)
LG Electronics Expands HVAC Training Series Across U.S. To Support Energy-Efficient VRF Technology Education. In-market training events covering higher ...
See all stories on this topic »

East Lycoming approves energy savings project
Williamsport Sun-Gazette
HUGHESVILLE — The East Lycoming School Board approved a guaranteed energy savings program at Tuesday night's meeting to be implemented for the...
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Local lawmakers join utility to tout energy efficiency programs
Peoria Journal Star
The best way to conserve energy this summer is to use less of it. That's the simple advice state Sen. David Koehler, D-Peoria, espoused Wednesday as the ...
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Bay Wide Properties Manages Energy Efficiency with Vista Solar ...
Houston Chronicle
Bay Wide Properties partnered with Vista Solar to install a 54kW solar system on their Silicon Valley retail building, creating a more energy efficient building for ...
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Auto Dealer Association Studies Energy Use, Aims for Energy Star ...
Environmental Leader
The National Automobile Dealers Association has launched an online energy usage survey as part of a national effort to understand consumption trends, with an ...
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Environmental Leader

Make Pennsylvania more energy efficient
Pittsburgh Post Gazette
Pennsylvania lawmakers passed a measure in 2008 known as Act 129 that was aimed at curtailing energy demand, creating jobs and reducing pollution.
See all stories on this topic »

PSE Offering Discounts on Energy-Saving LED Bulbs
Patch.com
The utility company says the average household can save $150 a year by replacing the 25 most frequently used lights in the home with LED bulbs.
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Cutting energy use by adopting automation
Utility Products
FROM carmakers to textile plants, China's factories are introducing automation and advanced energy-saving devices into their production lines as rising wages ...
See all stories on this topic »

Imperial Irrigation District urges customers take it easy with energy ...
Imperial Valley Press
The Imperial Irrigation District is encouraging customers to take it easy this summer on their energy use to save money, stay cool and help promote electrical ...
See all stories on this topic »

Redwood Systems woos app developers for energy-efficiency platform
ZDNet (blog)
Occupancy data collected by Redwood's lighting management platform can now be used in broader space utilization or energy-reduction applications.
See all stories on this topic »

Intel: High-Performance and Energy-Efficient Server Deployments ...
X-bit Labs
Intel Reveals Atom "Avoton" for Micro-Servers Due Next Year.
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X-bit Labs

Energy Efficiency Project Launched to Assist SMEs
Government of Jamaica, Jamaica Information Service
The Development Bank of Jamaica (DBJ), in partnership with the Inter-American Development Bank (IDB), has launched an energy efficiency project targeted at ...
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Malloy touts energy efficiency
Westfair Online
Dannel P. Malloy sees it, Connecticut can soon recover the once-lofty reputation for energy efficiency it has since ceded to California and Massachusetts.
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          Comment on 5 Lessons Learned to Create Successful Teams by Paul Mendeika        
Hi Katie Really good blog. I'm a patient representative in the NHS and the main stumbling block is the style and practice of senior managers / leaders. Lead by title , power , hierarchy etc
          NHS Food Drive to benefit community        
National Honor Society members are sponsoring a food drive for the Greenwood community. They are starting a food drive to help families in need. The food drive means a lot to the school because we are helping people who are in need in our community. There are a lot of students and families in our community who […]
          National Honor Society gets involved        
The Trunk or Treat which the National Honor Society sponsored had more than a roaring 2,200 people with a line that never seemed to end, sponsor Rebecca Randolph said. “The members that plan and show up do a great job, especially everyone at Trunk or Treat,” she said. NHS members participated by providing 11 vehicles with each having […]
          Pizza profits NHS; delivery Jan. 28        
     With a minimum goal of $1,600, National Honor Society is planning to earn more for future events. They plan on earning most, if not all, on their current Little Caesar’s Pizza fundraiser.      “The fundraiser is going good so far, but we just started the other day,” NHS president sr. Aaron Campbell said.      […]
          NHS supports blood drive        
           National Honor Society is trying to get involved with the blood drive in order to support Mrs. Shelia Smith’s niece. They are partners with Student Council and are attempting to get people in each group to donate.         The members also plan to raise money for senior scholarships with a t-shirt fund raiser.         “Seor […]
          arçelik buzdolabı bi metal 4385620185        
 

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          Review of The Wasp at Jermyn Street Theatre        
I suppose I was very lucky at school. Although being short, wearing glasses and having ‘FA Cup’ ears, I don’t remember ever being bullied about theses things. Though I did get my ears fixed and once ‘lost’ a pair of NHS glasses as I hated them, so maybe things did get said after all. The […]
          Take the tablets − an HSJ supplement on innovation through technology        
Cutting edge technology can have huge benefits for the NHS and patients. HSJ’s innovation supplement examines how using new technology could save the service £3bn, and how new systems are improving end of life care
          An estate that works for you – an HSJ supplement        
This special supplement brings you the latest news and views on NHS estate and facilities managament
          Information Highways - an HSJ efficiency supplement        
This special supplement looks at some of the many ways NHS organisations can help meet their quality, innovation, productivity and prevention savings targerts.
          Mountain to climb - an HSJ QIPP supplement        
This QIPP supplement looks at medicines management, service improvement, innovation and commissioning to examine whether GP commissioners can deliver the savings the NHS needs.
          People of the future: an HSJ roundtable debate        
Encouraging the crew not to abandon the ship is critical for the NHS in these times. Ingrid Torjesen reports on an HSJ roundtable debate, in association with HCL Solutions, over the future of the healthcare workforce.
          Kicking habits: a special report on NHS drug services        
This special report on drug services, in association with Reckitt Benckiser, is a timely look at new and changing approaches to treating addiction and commissioning addiction treatments.
          HSJ and NHS Confederation supplement        
This exclusive supplement from HSJ and NHS Confederation includes an interview with Mike Farrar, insight for healthcare leaders on service provision and whistleblowing, data management and medical imaging case studies, plus a report from HSJ’s roundtable on partnerships.
          Accelerating innovation across the NHS: an HSJ supplement        
This week’s special supplement, in association with the Department of Health, focuses on Sir David Nicholson’s report Innovation, Health and Wealth, and includes interviews with Jim Easton and Sir Ian Carruthers, plus articles from key DH figures and NHS directors.
          Innovation through technology - an HSJ supplement        
The efficiency challenge means NHS organisations are having to find new ways of working. One area ripe for innovation is technology, and this valuable HSJ supplement looks at how trusts can utilise innovation in technology to full effect.
          The next big technology impact: an HSJ special supplement        
This week’s HSJ supplement reports from a technology in the NHS roundtable discussion, sponsored by O2 Health.
          HSJ roundtable: education and training        
Training in the NHS costs £5bn a year. Alison Moore reports from a lively HSJ roundtable discussion on the government’s plans to reform it.
          New Report Wants NHS To Prescribe Gardening        
Once again a report has been published linking the benefits of gardening with healthy minds and bodies. The King's Fund findings are outlined by Nathan James Dodd, and they include recommendations that gardening should be promoted as a way of improving health.
          Shock rise in violence against UK's children        
NHS figures show there are now 22,000 hospital cases a year of deliberate harm to youngsters

The scale of violence against children has been revealed in new figures which show that in England an average 58 youngsters a day are being admitted to hospital after being deliberately injured. The numbers, contained in National Health Service data, suggest that the incidence of intentional harm against children may be rising. Five years ago some 16,600 were counted as having suffered deliberate harm, but the figure rose to 21,859 last year.

These figures, which show the numbers admitted to English hospitals with a deliberate injury, do not include those who are taken to casualty departments but then sent home, or who die as a result of the harm. Most of the children diagnosed with injuries are babies and toddlers, who are particularly vulnerable to violence from parents or carers.

Continue reading...
          Guardian Requests to Share Public Sector Volunteering Experiences        
According to sources, United Kingdom has almost three million volunteers in sectors such as disability, health, and welfare organizations. The figures tally with those who are employed in NHS and social care together. Few years back the pressure on all these volunteers had immensely grown because they tried to specify the demand which was caused by shortage in funds for public services and its benefits. From accident and emergency to food banks, these volunteers have been are delivering important services to people who are in desperate need of it in the United Kingdom. The debate regarding public sector funding is still continuing and the Guardian wants to check how these volunteers have been providing everyone with help. To present the contribution of the volunteers and the gaps they have been filling in terms of public services. The Guardian are also willing to see all the photos, videos, and listen to stories giving all the experiences while frontline volunteering. The Guardian asks all the readers if they have been involved in any kind of volunteering activities in any hospital, food bank or charity currently. They further ask if anyone is public service professional who is working with volunteers. The Guardian further requests to share all the experiences, even if it be positive or negative. This will be a great help in preparing interesting reports for them. In the official website, one can also add their photos by selecting contribute tab in it or can also use the new application that has been designed for the smart phones. Guardian is basically a great platform for all the readers. 

Original Post Guardian Requests to Share Public Sector Volunteering Experiences source Twease
          How is Connecting For Health Affecting You?        
Been to the doctors or hospital recently? Wondering how IT is being used in healthcare? Want to know if it's improving healthcare? Find out what you need to know about the NHS Connecting For Health programme.
          Much Vaunted National Health System© puts the hammer down        
Well, it was only a matter of time. After all, we noted exactly 3 months ago that:

"NHS bosses are planning a massive expansion of the controversial rationing that forces smokers and obese patients to wait months in pain before they can have surgery"

That's how government-run health "care" works, after all: limited resources controlled by unaccountable bureaucrats. And if the threat of such rationing isn't enough, well:

"NHS units impose surgery ban on obese and smokers ... including an end to the routine funding of hip and knee operations for patients with osteoarthritis"

Sorry (not sorry), grandma!

It gets squirrely from there, though:

"In one area of England obese patients must wait two years for hip and knee replacements while another area plans to deny surgery for smokers, including heart and brain operations."

Might pay to move, no?

But again, this is what happens when you put the DMV (or IRS) in charge of health care.

Worth noting, again, that this is the explicit end-goal of ObamaCare.

Sleep tight.

[Hat Tip: @Ʀєfùsєηíκ‏]

          Emergency Ambulance Services Market        
Ambulance Services in Healthcare Market Ambulance services play an important role in the healthcare sector. Due to emergency ambulances services many fatalities are prevented. Ambulance services help to rescue physically ill or injured patients by providing them transportation to the appropriate hospitals. The most common use of ambulance service is for emergency situations, for example when an individual is in a car accident or if the individual collapsed suddenly. In such cases, ambulance can quickly provide transportation to the individual to a health care facility where they can receive treatment. However, an ambulance service is also used for non-emergency services. An ambulance apart from providing transportation can also provide medical care to the patient during the transportation. An ambulance is equipped with medical equipment and staff which helps to maintain the condition of the patient stable, till the patient is transported to the appropriate medical facility. Types of Ambulance Services Ambulance service is available in three modes of transport which are ground ambulance service, air ambulance service, and water ambulance service. Ground ambulance service is the most common type of ambulance service used. The ground ambulance services market accounts for the largest share of revenue in the market.  Air ambulance service is used when a patient needs to be transported over a long distance quickly than ground ambulance service. This service is also known as medical airplane, emergency helicopter, medical helicopter, and life-flight. On the other hand, water ambulance service is a boat which is used for medical care in island locations. A water ambulance is equipped with a siren, two way radio, blue flashing lights, and radar. They also come with emergency medical care, and two first level emergency medical care providers. According to the equipment the ambulance services market [http://www.marketresearchreports.biz/analysis/194573] is divided into two major categories which are advanced life support (ALS) and Basic Life Support (BLS). ALS and BLS Ambulance Service Basic Life Support refers to ambulance service which offers transport to patients that do not need cardiac monitoring or extra support. Usually, the BLS ambulance has EMT level health care providers. A BLS ambulance service includes lower extremity fractures, medical and surgical patients that do not need cardiac monitoring, psychiatric patients, and discharge to sub-acute medical facilities or home. ALS ambulance provides transportation and the ambulance is equipped with medically necessary services and supplies and an advanced life support assessment by an ALS personnel. An ALS personnel refers to a person who is trained to the level of emergency medical technician which can be intermediate or paramedic. An ALS ambulance service includes a medical patient with a continuous supply of IV medicine, a patient on cardiac monitoring, patients from emergency care facilities, obstetrical patients, and any patient who has a potential complication during transportation. Ambulance Service Market Trends Healthcare sector is a booming sector and geographic zones such as North America and Europe have state-of-the-art medical facilities. However, due to the growing demand for better healthcare facilities the demand for advanced healthcare facilities is rising in developing countries such as China and India. There is rising demand for technologically advanced healthcare products and services. Ambulance service is one such service which plays a critical role, when it comes to patient care. Geography-wise the ambulance services market is divided into North America, Asia-Pacific, Europe, and Rest of the World. Some of the key players in the ambulance service industry are Acadian Ambulance Service, Dutch Health BV, Air Methods Corporation, Falck A/S, Envision Healthcare Corporation, Rural/Metro Corporation, and London Ambulance Service NHS Trust. The global market for ambulance services was estimated by a market intelligence agency to grow at a rate of 8.3% CAGR for the period of 2013 till 2019. The market for emergency ambulance service is accounted for the largest revenue share in the industry, and is forecasted to grow at the highest CAGR rate during the study period. About Us Marketresearchreports.biz is the most comprehensive collection of market research reports. Marketresearchreports.biz services are especially designed to save time and money of our clients. We are a one stop solution for all your research needs, our main offerings are syndicated research reports, custom research, subscription access and consulting services. We serve all sizes and types of companies spanning across various industries. For more information: http://www.marketresearchreports.biz/

Original Post Emergency Ambulance Services Market source Twease
          Aspirin not the ideal drug for prevention of common heart condition        
A new guideline stated by the National Institute of Health and Care Excellence proposes to the doctors to use newer medications other than aspirin for treatment of common heart problem. Blood thinning drugs such as warfarin are better for patients with atrial fibrillation as they tend to increase a patient’s risk of stroke, according to the NHS. Many doctors are already doing this. This advice will influence hundreds of thousands of patients. Atrial fibrillation (AF) results in an irregular heartbeat which is a common heart rhythm condition that affects up to 800,000 people approximately one in 100 in U.K. In this condition the heart doesn’t work as well it should be and blood clots are formed sometimes which increases the risk of a stroke. The drug aspirin has been used for many years to prevent patients from strokes. However, the new evidence indicates that the drug’s benefits are too small to compare with other type of treatments. The guidelines have acknowledged these studies and are currently being updated. They were last updated in the year 2006. Advice from NHS to switch from aspirin to a drug which helps in blood-thinning such as warfarin will help in prevention of thousands of strokes. Many experts claim that if the use of aspirin is to be stopped, then it should be done gradually under the prescription of a doctor. However, according to the medical director at the British Heart Foundation, it does not mean that aspirin is not effective in preventing strokes or heart attacks in other cases. Patients who are still unclear about the discontinuation of aspirin should consult their doctor.

Original Post Aspirin not the ideal drug for prevention of common heart condition source Twease
          8% Hip Replacements in the U.K. Found to be Lacking Proof of Safety or Effectiveness        
Even as an increasing number of people look toward hip replacements as a solution to their hip problems, Oxford University researchers have warned that one in 12 implants used in such replacements do not carry any evidence that proves their safety or effectiveness.  The team of researchers that studied hip replacement data collated from England and Wales found that nearly eight percent of the implants used in these procedures were not backed by safety-related information. Among the total hip implants that surgeons had access to, nearly 24% lacked evidence stating their effectiveness or safety. The team has said that the system that regulates hip implants in the U.K. comes across as being “entirely inadequate”. This comes two years after the occurrence of a widespread scandal that led to the NHS being issued an alert. In February 2012, the Medicines and Healthcare products Regulatory Agency (MHRA) had stated that nearly 50,000 patients that have undergone hip replacement surgery for ‘metal on metal’ parts would need to undergo health annual checks over fears that these replacement devices could be the cause of serious health issues including damage to bone and muscle and the neurological system. Experts are of the opinion that cobalt and chromium ions could potentially leak into the blood from the implants, affecting the health of patients.  The latest research that has been published in the British Medical Journal carries a comprehensive review of the collective hip implants that have been used in surgery in 2011. These records were obtained from the National Joint Registry for England and Wales. The team further stated that the eight percent figure could likely be an underestimation of the actual degree of the problem.

Original Post 8% Hip Replacements in the U.K. Found to be Lacking Proof of Safety or Effectiveness source Twease
          Death Rate of Patients in Britain's Hospitals 45% Higher Than the US        
Patients being treated in wards in Britain\'s Patients in English National Health Service (NHS) hospitals face a 45% higher risk of death as compared with US hospitals. These figures were tracked over a 10-year period by Sir Brian Jarman, credited for inventing the hospital standardized mortality rate. Jarman found that among the top seven countries, England had death rates that were 22.5% higher than the average. He noted that in 2012, patients face a 45% higher chance of death in the UK NHS hospitals as compared with hospitals in the US, which has the lowest death rates. Jarman said that though his studies have been showing similar indications since several years now, authorities have failed to act on warnings.  In view of these figures, the medical director of NHS, Sir Bruce Keogh has said that top-level discussions would be conducted to find the root cause of the comparatively high death rates, and reach a solution to address this problem. He also said that such data will play a vital role in improving the overall healthcare services in Britain, and that he wanted clinical experts to study the figures and provide solutions to reduce the death rates. 

Original Post Death Rate of Patients in Britain's Hospitals 45% Higher Than the US source Twease
          Comment on Everything You Need to Know: Science National Honor Society by Lauriann 450        
Yes, I am interested in creating a SNHS chapter at my middle school. We have students taking high school Physical Science and High school Biology. We also offer a STEM class, and have SECME club. Thank you.
          Comment on Everything You Need to Know: Science National Honor Society by Lourdes        
Is is possible to start a SNHS chapter in a middle school? Where could I get more information on this? Thank you in advance!
          It’s April Fools Day, citizen        

A magnificent range of April Fools Day japes for you this year.
1. Food banks. In the UK. And not organised by the Disasters Emergency Committee after an unexpected tsunami in Kent.
Organised by charities and churches and individuals who find themselves disturbed to live in a society in which so many of their fellow citizens are going hungry.
So hungry that they first have to swallow any residual pride they have somehow maintained – in the face of a media that’s hellbent on demonising anyone who’s sick or disabled or poor, and then go to beg for donated tinned goods and dried pasta.

2. A Bedroom tax… This sounds charmingly antique, like the window tax that existed from 1696 to 1851.
(You’d think the conservatives would have learned their lesson about the folly of reintroducing historical taxes after the Poll Tax but it appears not. )
The bedroom tax will mean an average £14 a week cut to people who are – by definition – so poor that they are already turning up at food banks in droves.

3. NHS reform reorganization carve-up. Pissup/brewery, enough said.

4. Many many more, ad nauseam. These are no longer funny.

5. Oh, yeah, a potential rerun of the Korean war with nukes.

Where is a bloody Atheist Rapture Index when you need it?


          Getting really cross        

“Sell everything you own and buy yellow precious metal, fashioned in the form of one vertical long stick crossed with a horizontal shorter stick. And wear it publicly at all times, as a sign of your devotion to me. Blessed are the jewellery wearers for they shall inherit media attention” Book of Ratner ch19.v4

(As Jesus directed his followers in a previously little-known apocryphal bible book covering the Jewellery Company Years)

Determined cross wearers Shirley Chaplin and Nadia Eweida (a former nurse and a former British Airways worker) have taken their case to the European Court of Human Rights

Shirley Chaplin and Nadia Eweida take cross fight to Europe.
Shirley Chaplin said “hiding” her cross was akin to denying her faith
(headlines on the BBC report)

I can’t see that it matters what styles of jewellery people wear. I think that their employers have behaved insanely (although I bet they were a real trial to employ). Although, if you know that a job has a uniform and you refuse to stick to the uniform rules, you shouldn’t really take that job.

The problem is that the cross ladies picked this fight on purpose. To bolster the picture of the UK’s imaginary condition of “discrimination against Christians”.

Christian Concern website (find it yourself, if you want, I’m not keen to post a link) is always willing to place itself at the centre of any case that it can use to promote the fantasy that we live in a parallel universe in which European Christians are beingpersecuted.

Increasing numbers of Christians have been penalised for their faith in the public sphere, often due to equalities legislation and the promotion of homosexual rights. Some Christians have been threatened with disciplinary action, suspended, and even sacked for refusing to act against their consciences. At Christian Concern we vigorously resist any restrictions on freedom of speech and expression for Christians.(from Christian Concern)

What? Equalities legislation and homosexual rights are a threat to Christians?

Passing blithely over the irony that people who feel threatened by human rights legislation are resorting to the European Court of Human Rights for redress, do they claim that they are being compelled to become homosexual in order to get human rights? No, I think I get it, maybe they claim the right to persecute gay people is the human right that they are in danger of losing?

Christians have been sacked for refusing to act against their consciences? I would have much sympathy – nay, admiration – if their consciences were telling them they had to resist the government’s ongoing programme to attack the poor and the NHS or if they were campaigning against wars or using their resources to feed the hungry and house the homeless…

But their Christian consciences aren’t stirred by such insignificant social issues. Their moral sense is roused by rules about wearing jewellery in work.

And their consciences can only be accommodated by following the Book of Ratner and wearing jewellery with malice aforethought.

Oh, and spending vast resources on getting their own way through the courts. What would Jesus Do? Well, the same, obviously. I believe he was working on his latest designer jewellery collection for Argos when he was crucified. He thought the cross shape would be really great for the brand.


          Does a baby's eye gaze really predict future autism?        


Note: Due to the considerable interest in this post, I've uploaded a PDF version at figshare.com. This can be cited as:
Brock, Jon (2013): Does a baby's eye gaze really predict future autism?. figshare. http://dx.doi.org/10.6084/m9.figshare.878085 

Baby's gaze may signal autism, study finds. That was the headline in the New York Times. The BBC declared that Autism signs present in first months of life. Turning the hype up to 11, a Canadian website boldly announced that Researchers prove that autism can be diagnosed right at the infant stage and that intervention is possible.

Nature, the journal that published the study, ran with Autism symptoms seen in babies, summarising the findings thus:
Children with autism make less eye contact than others of the same age, an indicator that is used to diagnose the developmental disorder after the age of two years. But a paper published today in Nature reports that infants as young as two months can display signs of this condition, the earliest detection of autism symptoms yet.
Certainly, being able to identify infants who were likely to develop autism would be a ground breaking advance, opening up the possibility of very early diagnosis and intervention. It would also allow researchers to study the very earliest stages of autism development.

But, as with many studies that receive the full media treatment, there are caveats a-plenty. In fact, it could be argued that the results show the exact opposite of what the authors and the media coverage has suggested.






The study was conducted by Warren Jones and Ami Klin from Emory University. Back in 2002, Klin and colleagues published a study showing that adolescents with autism spent less time looking at the eyes of people in a movie clip than did typically developing adolescents. Although, like all things autism, this seems to be true of some but not all people with a diagnosis.

Since then, Klin and Jones have reported similar results in two-year-old children with autism. Their new study was an attempt to push that all the way back to the very earliest months of life.

Jones and Klin began with a sample of 64 infant boys, 38 of whom had an older sibling with autism, putting them at increased risk of having autism themselves [1]. They also tested 46 girls but later excluded all of them from the analyses [2].

At various time points between the ages of 2 months and 2 years, the infants were eye-tracked as they viewed short video clips of a female caregiver’s face and upper body.

Sample scanpaths for a baby later diagnosed with autism (red) and a typically developing control (blue). Reprinted by permission from Macmillan Publishers Ltd: NATURE, doi:10.1038/nature12715, copyright 2013


Then, at 3 years of age, the by-now toddlers were assessed for autism [3]. 11 boys (10 from the high risk group) were identified as having an autism spectrum disorder (ASD). They were then compared with the remaining 25 typically developing (TD) boys from the low-risk group. 

The 64 boys were divided into 4 groups at their 3-year assessment: ASD; low risk typically developing (TD); high-risk with some autism symptoms (BAP); and high-risk with no autism symptoms (no-Dx). Forty-six girls were also tested but were not included in the reported analyses.

Jones and Klin began their analyses by building developmental trajectories for the two groups, similar to the growth charts that doctors use to tell, for example, whether a baby is putting on sufficient weight or not. Except here, what mattered was the percentage of time the babies were looking at the eyes in the video.

What they found was that the ASD boys showed a steady decline in eye gaze across time. However, there were no significant differences between the trajectories of the two groups until the final test session at 24 months [4].

Reprinted by permission from Macmillan Publishers Ltd: NATURE, doi:10.1038/nature12715, copyright 2013


The obvious interpretation of these data is that, in fact, eye gaze in infancy does not predict which infants will go on to develop autism (at least using Jones and Klin's set-up). Both from a practical and a theoretical point of view, that's an important finding. [5]

So how do we end up with "Baby's eye gaze signals autism"?

Having failed to find evidence for reduced eye gaze in ASD infants, Jones and Klin looked instead at the slopes of the developmental trajectories. In other words, not the amount of eye gaze at a particular time but the change in eye gaze relative to earlier and later time points. Here, they did find significant differences throughout the early months.

Reprinted by permission from
Macmillan Publishers Ltd: NATURE,
doi:10.1038/nature12715
copyright 2013
When the analyses were restricted to the data from 2 to 6 months, the boys who developed autism showed a negative slope (declining eye gaze) while the low-risk boys had a positive slope (increasing eye gaze).

This, in essence, is what all the excitement is about. The study suggests that if you measure a baby's eye gaze at multiple time points before the age of 6 months and notice a decline over time, then that baby is at heightened risk for developing autism. It doesn't matter how awkward the data collection process or convoluted the analysis, there's information about autism in a babies' eye gaze.

However, there was always something about this story that didn't quite add up for me - and it's taken a while to put my finger on it. But before I get to that, there are a few other more obvious points that need to be mentioned.

First of all, the final sample size is very small. This is understandable because, even with a high risk sample, you need to test a lot of babies just to get a dozen or so who develop ASD. But it doesn't change the fact that a study with only 11 participants in one group has to be considered preliminary at best. It wouldn't have taken much to get wildly different results and we really need a replication of this before we get excited.

Second, the most useful comparison would be between the high risk children who develop autism and the high risk children who don't. That's because, in practice, it's very unlikely that such an eye-tracking measure would be rolled out as a universal screening measure. Not only would that be extremely expensive and time-consuming (especially if babies had to be tested on multiple occasions under highly controlled conditions to work out the slope of their trajectory), it would also throw up a huge number of false positives - babies who the eye-tracking test said were likely to develop autism but were never really at risk. So, in reality, only babies with a family history of autism would be tested.  Unfortunately, Jones and Klin don't report this direct comparison [6].

But the biggest issue for me is this: The claim is that babies who develop ASD start off with typical eye gaze but it's the decline in eye gaze in the first 6 months that is the signal of impending autism. However, if the ASD babies start off at the same level as the TD babies then there should also be a significant difference in the amount of eye gaze at 6 months. In fact, the two groups are almost identical in terms of their eye gaze at 6 months. And the only reason there's a difference in slope is that the ASD babies actually start off with greater eye gaze than the TD babies [7]. 

It would be incredibly interesting if this were true - if boys who go on to develop autism make more eye contact at 2 months than is typical. However, we have to be very careful because, despite the media coverage focusing on the fact that the babies were tested from 2 months, there is in fact very little data from 2-month-olds in either group.

How do we know this?

Figure 1d in the paper includes the data from a single ASD baby. Each dot corresponds to the amount of time spent gazing at the caregiver's eyes in a single video clip. There are I think 16 data points for this baby at 2 months.

Matching this up with Supplementary Figure 2b, which combines the data from all the ASD babies, we can see that there are a total of 24 data points. This means that the remaining 10 babies provided just 8 data points between them at 2 months.  this one boy provides the majority of the data points at 2 months. This in turn suggests that there are only two, perhaps three boys with data at 2 months .

It could be that these 8 points all come from one baby. It could also be that they come from lots of babies all providing one data point but, given how much our first baby's eye gaze varies from video clip to video clip, this is going to be an extremely unreliable measure of eye gaze [8]

Adapted by permission from Macmillan Publishers Ltd: NATURE, doi:10.1038/nature12715 copyright 2013

Extended Data Figure 9 in the paper shows the trajectories excluding the data from the recording at 2 months. With the trajectories now beginning at 3 months, there is hardly any difference between the two groups before 6 months. In other words, everything hangs on the rather sketchy data from the babies at 2 months.

Here I've overlaid Extended Data Figure 9a (TD in blue) and 9b (ASD in red) and faded out the irrelevant data, leaving the trajectories for eye gaze based on data from 3 to 24 months (ie excluding data collected at 2 months). Adapted by permission from Macmillan Publishers Ltd: NATURE, doi:10.1038/nature12715 copyright 2013

So, to sum up, it's far too early to be declaring that baby's eye gaze predicts future autism.  Given that I've been pulling the paper apart, I probably haven't emphasised enough quite how ground-breaking and sophisticated Jones and Klin's study is. It's an extremely impressive effort to answer an important question. It suggests that, contrary to expectations, there is in fact very little difference between babies who do and don't develop autism in terms of their eye gaze (at least when the eyes are on a computer screen). This is something that appears to emerge very gradually over the first two years of life.

Future studies beginning even earlier and having even larger sample sizes may uncover evidence of atypical eye gaze in infancy - and there's a tantalising and intriguing suggestion that ASD babies may actually begin life with excessive eye gaze. [9]

However, not for the first time - and certainly not the last - the headlines obscure a far messier reality.


Reference:

Jones W, & Klin A (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature PMID: 24196715


Other coverage:


Discussion:

Some great comments below the line. See also the discussion thread on reddit started by Noah Gray, one of the Nature editors, and the comments on the Thinking Person's Guide to Autism Facebook page.


Footnotes:

1. It's usually the case in these studies that "low-risk" infants have older non-autistic siblings but this isn't explicitly stated.

2. It's not clear why the authors went to the trouble of testing 46 girls for 3 years only to exclude them later. The rationale given was that only 2 developed ASD, but this should have been expected given that autism is much less common in girls. My suspicion is that reviewers made them take the girls out of the analyses - but this is another reason why having an open peer review process is important.

Update 09/12/13: Ami Klin has informed me that more girls are being tested and their data will be analysed when the sample size is sufficiently large.

3. The ADOS was used as a severity measure in one analysis so was presumably included as part of the assessment. Beyond that, I can't find anywhere in the paper that actually says how the the authors determined which kids had autism.

Update 09/12/13: My mistake here. Although in my defence Nature doesn't make things easy by having three variations on the Methods section, each of increasing level of detail. Full details of diagnosis are buried in the Supplementary Information (which is separate from the Methods supplement, which is where I was searching for diagnostic information). In short, diagnosis was a clinical best estimate based on all available information, including ADI-R and ADOS scores (and direct or recorded observation of the ADOS session), language and cognitive assessments, history, and "any other relevant information". Diagnoses were made by independently by two experienced clinicians and positive diagnoses were reviewed by a third clinician.

4. This is based on the lower panel of Figure 2e

5. It's certainly possible that eye gaze discriminates between ASD and TD infants earlier than the 24 months reported and that the lack of statistical significant is just a reflection of the small sample sizes. With more babies tested, perhaps there would be a significant reduction much earlier. But that is speculation based on data that we currently don't have.

6. The high risk kids who didn't meet the ASD criteria were divided further into two subgroups - those who had no diagnosis (noDx) and those were had the "broader autism phenotype" (ie some autism symptoms) but didn't meet the full ASD criteria (BAP). The noDx group appear to resemble the TD group (at least in terms of their trajectory between 2 and 6 months) while the BAP group are intermediate between the TD and ASD groups. Unfortunately, nowhere does the paper say how the BAP was defined or whether the cut-offs were decided upon before the study started.

Update 09/12/13: Again, there were in fact details provided in the Supplementary Information. BAP infants were those for whom there were clinical concerns documented at any one of the clinical assessments. They differed significantly from the noDx group in terms of their ADOS Total scores. It would still have been useful to include a direct comparison between the high-risk babies who did develop ASD and those who didn't.

7. Based on the lower panel of Figure 2e this increase in eye gaze is statistically significant.

8. It seems as though one of the reviewers spotted this issue because the supplement to the paper includes a re-analysis looking at just the data from 3 to 6 months. This suggests that there was still a difference in the slope between the two groups , but this was barely significant. This is based on the Receive Operating Curves (ROCs) in Extended Data Figure 9d, where the 95% confidence intervals include chance at low levels of sensitivity (high specificity) but not a high levels (low specificity).

Update 09/12/13: I hadn't noticed that Extended Data Figure 9a has the trajectories based on data from 3 to 24 months. With the data from 2 months excluded, the early trajectories look very similar. For the ASD group, there's a drop from about 47.5% eye gaze at 3 months to 45% eye gaze at 6 months. The TD group are steady at about 45% throughout. If there is a real difference, it's very subtle.

9. By this I mean "more than is typical".

          Economics and education        
"Most of us have long lamented the general public's lack of understanding of economics", writes Chris Dillow - before linking to a study suggesting that it is the under-development of the average human brain that lies at the core of the problem. This is exacerbated by politicians who have a vested interest in reinforcing misconceptions, such as the the notion that a nation's finances are like a household budget. I really like Chris's writing but this isn't very helpful. If you want to assume people don't get economics because they aren't able, go ahead - but I'd suggest the reason is more straightforward: they don't get it because nobody bothers to explain it to them properly. Two points here:

 1) It isn't taught in schools very widely. In Scotland it is possible to do it as a certificate subject but not only is it not compulsory, hardly any schools do it at all. I'm not sure what the situation is in England except to say that I do know it doesn't form part of the core curriculum either. Given that this is unlikely to change, not least because there isn't really anyone demanding things be otherwise, any economics education would have to come from somewhere else. Chris probably rightly rules out politicians and the MSM here, which leaves only 'public economists'. But there's a significant problem here...

 2) 'Public economists' are a rather other-worldy bunch who really need to learn the humility of a good teacher. The bad teacher assumes that the reason the class hasn't followed what he or she is saying is because they're just plain stupid. Well, they may well be - but the good teacher at least allows for the possibility that perhaps the reason the class hasn't grasped the curriculum is because it hasn't been explained to them very well.  How many public economists are good teachers in this sense?  I'd suggest not many.  There are quite a few who I won't name but are the sort of people who spend an inordinate amount of time on social media complaining, or crowing, about how unbelievably thick people who disagree with them are.

Take, for example, the idea that the government's finances are like a household budget.  This is obviously wrong.  "When I find money is tight, I just print some more".  You can't because you don't have a currency-issuing central bank in your living room.  But economists, like good teachers, should use bad analogies, work with them - and then explain why they are wrong later when understanding has developed, rather than dismissing those who use them as thickos.  Why, for example, are there so few economists (are there any?) pointing out that many of those who claim to be "living within their means" have debt in the form of mortgages that are often easily in excess of two and a half times their annual income?  And why is there no 'anti-austerity' politician making the point that when Britain emerged from the Second World War with a national debt roughly around this proportion, the government built the NHS from the ground?  Why is there no-one to say that what this present government is effectively saying is that, "Sorry kids but Christmas is cancelled this year because we're making it a priority to pay off the mortgage earlier than we have to."?

More generally, why are there absolutely no anti-austerity politicians in the British Isles, even among those who say they are?  Corbyn isn't against austerity - he just want different people to do it.  The SNP aren't either.  They actually practice austerity in the form of budget under-spends while complaining that it's the rest of the UK that should be doing the more elastic fiscal policy.  The failure is pretty comprehensive and I blame the teachers - or rather the economists that should be teachers but have for whatever reasons failed in their responsibility.


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          Chi disprezza l'omeopatia non è figlio di maria.        
Se non mi piace qualcosa, posso disprezzarla?
Si disprezza anche un bellissimo fiore se, per i nostri gusti, fosse orribile. Diciamo, a volte, "i quadri di Picasso mi fanno schifo", oppure "la carne alla brace la odio!", "non sopporto la pasta alla carbonara". Dire una cosa del genere è grave? Irrispettoso perché in tanti amano Picasso o mangiare la carne?

Se qualcuno disprezzasse la medicina (e sappiamo che questo succede quotidianamente) si dovrebbero offendere i milioni di malati o i medici?
Io disprezzo il calcio, uno sport che una volta seguivo ma poi ho abbandonato per disgusto. Qualcuno si offende?

Se disprezzo l'omeopatia perché la ritengo una truffa al consumatore ed un esempio di falsa medicina, sto offendendo qualcuno?

Un po' come dire che i medici che prescrivono omeopatia offendono i milioni di colleghi che usano la scienza per fare il loro lavoro ed i milioni di pazienti che sanno cos'è l'omeopatia.
Beh, direi che stiamo perdendo tempo, si tratta di una suscettibilità infantile e stupida.

Raccontare le caratteristiche di un prodotto in vendita (ovviamente attenendosi ai fatti) non significa disprezzarlo ma spiegarlo a chi ne è vittima se questo prodotto è truffaldino e, anche se chi ne è vittima non accetta la spiegazione, il problema è suo non di chi spiega la realtà dei fatti, anche qui, ovviamente, dati in mano.
La disonestà sarebbe grave, se qualcuno, pur di disprezzare qualcosa, usasse argomenti fallaci, dati falsi o dicesse bugie, sarebbe scorretto ma, finché si usano argomenti veri, dati veri, spiegazioni scientifiche, c'è poco da lamentarsi. Quale legge fisica, quale esperimento scientifico, quale testo medico può smentire il fatto che un prodotto omeopatico (oltre la 12ma diluizione) sia semplicemente una caramella di zucchero? Questo "offende" chi lo usa?

Potremmo fare un paragone con l'astrologia: milioni di persone, ogni giorno, consultano gli oroscopi, ascoltano l'astrologo nelle TV nazionali nonostante si sappia che l'astrologia sia una pseudoscienza senza basi scientifiche né credibilità, una vera e propria superstizione.
Affermare che l'astrologia è una bufala e che bisognerebbe cancellarla dal servizio pubblico è un insulto? Significa mancare di rispetto a chi legge gli oroscopi la mattina? La seguono milioni di persone, in Italia esistono migliaia di operatori dell'occulto, che importa se si offendono? La scelta di seguire una pseudoscienza è loro e d'altronde il numero di seguaci non è il metro per decidere se e come valutare una disciplina.
In ogni caso, a prescindere dalla veridicità o meno di un'affermazione, non esiste la libertà di esprimere le proprie idee?
Sì. Fortunatamente sì.

Se quindi io spiego che l'omeopatia è una falsa medicina derivante da riti magici ottocenteschi. Se spiego (e sono un medico, quindi anche in dovere di farlo) che dal punto di vista scientifico non ha alcuna base né plausibilità, se ricordo che anche gli studi, tanti, hanno dimostrato che non ha efficacia in nessuna malattia e che le pillole di zucchero omeopatiche funzionano esattamente come...pillole di zucchero, sto disprezzando, sto insultando o sto semplicemente dicendo le cose come stanno?
Attenersi ai fatti, difendere il consumatore, avvertire la popolazione, è un'offesa o è informazione?
Perché è proibito farlo? Perché si grida all'offesa da vendicare?

Probabilmente perché, davanti ad una pratica fideistica come l'omeopatia, la spiegazione razionale e scientifica delle sue caratteristiche si scontra con le credenze personali, con le superstizioni.
Se qualcuno dicesse che un farmaco non cura nessuna malattia io, medico, non mi offenderei, giudicherei l'opinione, ne controllerei la veridicità (e quindi potrei essere d'accordo o meno) ma non sarebbe un problema, se proprio volessi far valere le mie ragioni proverei a discutere della mia versione dei fatti ma se qualcuno si sente in grado di "disprezzare" la medicina buon per lui, io la uso se lo ritengo opportuno, la offro e basta così.

L'omeopata o l'omeoseguace invece, esattamente come qualsiasi seguace di pseudoscienze, si sente toccato nel profondo, interpreta lo "svelare" il segreto della pallina omeopatica come un attacco personale, come togliere i vestiti lasciando nudo un credo non tanto moderno.

È lo stesso fenomeno che avviene nella religione.
Chi tocca uno qualsiasi dei dogmi religiosi (o addirittura arriva a disprezzare uno dei vari dei) si macchia del peccato di blasfemia che per secoli (ed ancora oggi) prevede addirittura la pena della morte.
Le fedi non si discutono, non si criticano.
Se qualcosa ci colpisce negativamente, se ne notiamo l'assurdità o addirittura la pericolosità, perché non dovremmo criticarla o disprezzarla? In passato ho chiamato "infame" un esperimento scientifico realizzato da istituzioni pubbliche che causò decine di vittime. Ho chiamato crudele l'uso di una sostanza per le radiografie che ne causò altrettante e frode una truffa compiuta da una "seria" azienda farmaceutica.

Perché questo si può fare con la medicina ma non con l'omeopatia?
Provate a discutere (più pacatamente possibile) con un fedele dell'omeopatia o dei fiori di Bach o dell'agopuntura. Provateci.
Nonostante i vostri sforzi, noterete che prima o poi la discussione diventerà un "uno contro l'altro", si sposterà sul personale: "l'omeopatia non ha base scientifica ed è una falsa scienza" (e questo è un dato di fatto), avrà come risposta, prima o poi "significa che io ed altri due milioni di persone siamo dei cretini". La discussione diventerà uno scontro tra persone e non tra fatti e così si può usare la (falsa) carta dell'offesa personale o recitare il ruolo dell'offeso che abbandona la discussione. Che l'omeopatia sia usata da tanti (e non è vero) non è una scusa, sono tante le sciocchezze usate da tanti.

Il numero di utilizzatori o di seguaci non ha nulla a che fare con la veridicità di una pratica, altrimenti faremmo diagnosi con i tarocchi e terapia con il pendolino. Eppure se un farmaco in vendita è in realtà una frode dimostrata, nessun paziente o nessun medico si sente chiamato in causa se non come vittima.
Se poi usare granuli di zucchero per curare le malattie ti fa sentire un cretino il problema è tuo, non mio. Il mio dovere morale e professionale si ferma alla spiegazione, sei tu che decidi per te.

Sapete che c'è gente che veramente condiziona le sue giornate in base a ciò che dicono gli astri?
Sapete che qualcuno dice che l'astrologia ha, in fondo, delle basi scientifiche?
Ebbene, un po' tutti consideriamo l'oroscopo come una sciocchezza inoffensiva. Quasi un gioco: ci riconosciamo nei vari segni zodiacali, curiosiamo tra le varie "previsioni" e, se capita, leggiamo ciò che dicono i vari giornali sul nostro segno. Nessuno però si offende se dico che l'astrologia è una sciocchezza senza basi scientifiche perché tutti, prima o poi, facciamo la figura degli stupidi credendo a qualche sciocchezza. Di certo io non giudico il prossimo dal fatto che segua gli oroscopi (o meglio, posso farmi un'opinione ma lo tratto come qualsiasi essere umano, non si discrimina in nessun caso) ma ho il diritto di definire la sua credenza una superstizione.

Ovvio infatti che non devi giudicare le persone in base alle loro scelte. Se discrimini una persona in base alle sue superstizioni lo stai offendendo ("credi all'omeopatia quindi non ti curerò con la medicina") ma quante volte accade la discriminazione? Non è forse l'omeopatia liberamente in vendita? Non sono gli omeopati persino negli ospedali pubblici? Di quale offesa si sta parlando dunque?

Così, pochi giorni fa, un tweet (Twitter è un social network che permette di rilanciare brevissimi messaggi dal proprio profilo) ha causato l'offesa di milioni di persone. O forse di una.
Già, perché ho pensato bene di mettere su Twitter una foto trovata su Facebook.
Nulla di particolare, solo un foglio nel quale erano indicati alcuni servizi ambulatoriali di omeopatia. Cosa nota, che sapevo ma per me da ribadire, che il servizio sanitario nazionale (anzi, regionale perché parliamo della regione Toscana) offra delle prestazioni in una struttura pubblica che non hanno alcuna base scientifica (l'omeopatia, oltre ad essere una pseudoscienza, non ha mai dimostrato di avere efficacia in alcuna patologia). La foto l'ho commentata con la frase "Questo in Toscana. 2017, ospedale pubblico. Poi parlano di sprechi.".

La foto rilanciata su Twitter.

Uno scandalo? Una denuncia forte? Una frase offensiva? Per me questo è un esempio di spreco di denaro pubblico, sfruttamento della credulità delle persone e danno al malato. Si può pure non pensarla come me ma per me è così.

L'immagine è stata rilanciata dal prof. Walter Ricciardi, presidente dell'Istituto superiore di sanità (ISS), che ha sempre preso posizione nei confronti delle pseudomedicine.
Ma qualcuno si è scandalizzato, tanto che il fatto è finito sui quotidiani ed è iniziato un botta e risposta in altri giornali.
Sempre con toni abbastanza composti.

Ma è apparso un altro "scandalizzato", fortemente turbato, che con la bava alla bocca grida vendetta e provvedimenti severi. Fregandosene della corretta informazione e della salute delle persone che potrebbero confondere la medicina con l'omeopatia.

Guglielmo Pepe, giornalista che ha un blog su La Repubblica e che non ha mai nascosto le sue simpatie per l'omeopatia, le cure alternative come il "metodo Di Bella" e "Stamina", con un pizzico di antivaccinismo, tanto per non farsi mancare nulla. In passato ho cercato di commentare i suoi post, spesso a favore dell'una o l'altra cura alternativa ma sono stato sempre censurato, tranne una volta, quando il giornalista ebbe uno sfortunato problema di salute ed io gli augurai di risolverlo mostrandogli vicinanza. In quel caso non ci fu alcuna censura.

Pepe scrive tutto agitato che un esponente delle istituzioni (Ricciardi) non può "fare da spalla" ad un "sito privato".
In pratica la rabbia di Pepe non è tanto per il tweet o le parole di Ricciardi ma per il fatto che il presidente dell'ISS (che in ogni caso ha diffuso il tweet dal suo profilo privato) abbia dato spago ad un "privato" (chissà quale sarebbe lo scandalo) e ripete questa cosa ossessivamente. La cosa sembra dargli un'amarezza infinita.

Il "sito privato" sarebbe il mio: MedBunker. Pepe ce l'ha con me.

Il mio tweet non è quello di un "sito privato" ma è personale, mio ed io sono pure un medico (quindi, credo, titolato per dare pareri medici) ma Pepe è assolutamente arrabbiato, tanto da invocare provvedimenti da parte degli ordini dei medici e dei pazienti nei miei confronti. Fulmini e saette ma senza nemmeno avere il coraggio di nominarmi.

Una tale chiamata alla guerra santa non l'avevo mai vista nemmeno nei siti dei più odiosi e cattivi ciarlatani. Pepe si è arrabbiato probabilmente perché indispettito dal fatto che una mia opinione, con la quale lui non è d'accordo, sia stata rilanciata da altri, è questo che non gli da pace.
Il problema è ridicolo.
Secondo Pepe chi si permette di criticare o deridere l'omeopatia offenderebbe i "milioni di utilizzatori". Dicendo "l'omeopatia è una bufala" starei indirettamente disprezzando chi la usa, cosa assolutamente falsa e pretenziosa, solo che, sentirsi toccati nelle proprie convinzioni più profonde, è un motivo di frustrazione.
Esattamente come se dicessi "l'oroscopo è una truffa" starei disprezzando i milioni di utilizzatori, le riviste di astrologia, i maghi, i cartomanti e le trasmissioni TV (oltre che Paolo Fox, l'astrologo della RAI). Ma questo è un problema di chi si sente disprezzato, perché è normalissimo, permesso e comprensibile si possano manifestare le proprie perplessità su credenze e superstizioni.
L'omeopatia, esattamente come l'astrologia, non è una scienza e quindi quale sarebbe il problema?
Ma se anche criticassi o accusassi un farmaco vero e proprio contro l'ipertensione o contro l'ipercolesterolemia cosa succederebbe? Gli utilizzatori si sentirebbero "disprezzati"? O sarebbe un'occasione di discussione (ovviamente con i dati, attendibili, che lo permettono)?

Qui siamo praticamente al livello di lesa divinità, di reato di blasfemia e questo è punito con la pena di morte solo nei paesi fondamentalisti ed è (giustamente) considerato un segno di arretratezza.
I fondamentalisti si offendono (e reagiscono!) perché mentre le idee, le opinioni, le sentenze, persino le leggi, si discutono (e sono criticabilissime), le credenze, le superstizioni, le religioni no, sono dogmi inamovibili e per questo Pepe chiede il pubblico ludibrio e la fucilazione del sottoscritto, perché mi sarei permesso di offendere la sua superstizione personale del mese. Attaccami se dico falsità, accusami se scrivo dati manipolati ma non puoi attaccarmi nascondendoti dietro alle offese se offendo la tua religione.

Sentendomi chiamato in causa, mai nominato ho provato a rispondere e, come sempre faccio, ho provato ad unire ad ogni mia affermazione anche le basi sulle quali le faccio.
Ho sottolineato (perché ovviamente non lo scopro io) che l'omeopatia, non essendo una pratica scientifica è considerata pseudomedicina dovunque.
Anche istituzioni molto prestigiose come l'NHS confermano l'inconsistenza dell'omeopatia e quindi cosa ci sia di scandaloso nelle dichiarazioni (personali) di un medico non si capisce. La scienza non si cambia da un giorno all'altro e l'omeopatia non è riuscita a cambiarla in due secoli.

Ma Pepe a casa sua decide ed ha deciso di non pubblicare il mio commento, non concedendo nemmeno quel diritto di replica che andrebbe accordato per legge, per educazione e per onestà. Il diritto di replica io l'ho sempre concesso. Ho dato possibilità di replica a tutti, agli omeopati come agli agopuntori ma ognuno a casa sua agisce come vuole. Il problema è che Pepe ha insistentemente sostenuto che il mio commento fosse pieno di insultiHa detto (mi ha scritto anche in privato) che il commento sarebbe offensivo, giudicate voi, in un suo commento lo definisce "carico di ingiurie".


Pepe dice anche che questo blog sarebbe seguito da persone che "vorrebbero mettere al rogo tutti quelli che non si schierano e sputano veleno contro chi pensa diversamente".

Allora lo metto qui, non tanto per il contenuto (niente di nuovo) ma per mostrare cosa è stato rifiutato e considerato "insultante", quali sarebbero queste continue ingiurie. Può servire come metro per capire la mentalità di chi ha una credenza, di chi non si mette in discussione. Ma anche per mostrare la realtà, viste le scuse con le quali il giornalista ha censurato il mio commento.

Il mio commento (parte), in attesa di moderazione, poi non accettato

Eccolo qua:
Egregio sig. Pepe, abbia almeno il coraggio di dare un nome alle persone di cui parla. Il "sito privato" sarebbe il mio, almeno per rispondere a chi mi chiede "cosa gli hai fatto a Pepe?", il mio "blog privato" si chiama MedBunker ed io sono il dott. Salvo Di Grazia, un medico che cerca di spiegare la medicina al pubblico. Non capisco il suo rabbioso sfogo. Lei ce l'ha con me ma ha scelto l'argomento sbagliato per attaccarmi e l'uso di questi argomenti ("insulta milioni di persone") è umiliante, mi creda. Se fortunatamente esiste la libertà di opinione ed espressione, dovrà farsene una ragione quando qualcuno (se è un medico è addirittura un addetto ai lavori) ricorda al pubblico che l'omeopatia è una pseudoscienza senza alcuna base scientifica, queste non sono opinioni e lei lo sa benissimo. E non cerchi pacche sulle spalle dicendo che insulto i pazienti ed i medici, altrimenti io potrei dire che lei insulta nello stesso modo pazienti e medici (sicuramente molti di più) che non si rivolgono a questa pratica ottocentesca.
Sia maturo, per favore.
Mi pare che di fronte alla mia libertà di fare questa affermazione che ha suscitato le sue richieste di rogo pubblico e ricorso al linciaggio, c'è anche quella che consente, a chi lo vuole, di acquistare ed usare prodotti omeopatici, che consente agli omeopati di prescriverli ed alle farmacie e parafarmacie di venderli. Non si preoccupi dunque, nessuno proibisce l'uso di omeopatia, si critica la vendita di pseudomedicine ed il loro uso nel SSN. Io non dico lei sia un idiota, io dico e confermo che l'omeopatia è un'idiozia. La sua rabbia quindi è fine a se stessa. La libertà di parola è sacrosanta e lei non può impedire che si dica pubblicamente ciò che è la realtà e la libertà è di tutti, cittadini, istituzioni, consumatori, pazienti, medici. Esattamente la stessa libertà che hanno in tutte le nazioni civili, dove personaggi ed enti pubblici dicono semplicemente come stanno le cose. Come in UK dove l'omeopatia è rimborsata (ancora per poco) dal SSN: 
- La Royal Pharmaceutic Society (società inglese dei farmacisti): "Non c'è evidenza per supportare l'efficacia dei prodotti omeopatici, non vi è base scientifica per farlo".
- La British medical association (società inglese dei medici): "L'omeopatia è stregoneria, non dovrebbe essere usata come terapia".
- L'NHS (servizio sanitario nazionale inglese): "Non esiste nessuna condizione clinica per la quale l'uso dell'omeopatia abbia basi scientifiche di buona qualità".
Stupirsi davanti al fatto che un granulo di zucchero non sia una medicina è poco credibile, cerchi di capirlo. E come vede le "istituzioni" sanitarie straniere lo sanno, dicono le cose come stanno e non ci sarà nessuno, tranne gli omeopati ovviamente, a scandalizzarsi. Non diffonda poi dati pubblicitari, le vendite dell'omeopatia sono in costante calo e rappresentano un'inezia nel mercato dei farmaci (meno dell'1% del venduto, calo costante di vendite, dati Federfarma (pag.2).  I sondaggi li lasci fare alle agenzie di marketing delle multinazionali omeopatiche, l'omeopatia sta (fortunatamente) scomparendo. Per quanto mi riguarda posso solo consigliarle di lasciare che il prossimo abbia la libertà di dire ciò che pensa, anche se questo si scontra con le sue credenze, le farebbe onore. Mi dispiace lei usi questi argomenti scorretti e volgari per affermare le sue idee e sferrare attacchi personali nei confronti di chi lei non sopporta ma non fa altro che informare correttamente i consumatori, non otterrà nulla e semina odio ed antipatie.
Un saluto.
Dott. Salvo Di Grazia (proprietario del "sito privato")
PS: Visto che in passato mi ha censurato alcuni interventi, ho già pubblicato questa mia risposta su una mia pagina social, giusto per amore di verità.
Ditemi voi. Se avete letto ingiurie, se avete visto insulti. Non ho molte spiegazioni per questo attacco e cerco di giustificarlo pensando ad un periodo di poca lucidità del giornalista sfociato nell'attacco personale (anche nelle mail private ha tenuto un tono isterico con frasi del tipo "chi si crede di essere!"), in tanti trovano negli altri un obiettivo per sfogare le proprie frustrazioni e quindi spero che almeno tutto questo lo abbia reso più sereno.
Visto che Pepe fa finta di non saperlo aggiungo, all'elenco delle istituzioni che hanno preso posizione, quella recente dell'Accademia russa delle scienze, che auspica la cancellazione dell'omeopatia dal servizio sanitario pubblico perché è una "magia pericolosa". La tendenza è proprio questa, le autorità sanitarie dei paesi più moderni stanno prendendo coscienza del problema e lentamente, molto lentamente, si sta assistendo alla scomparsa (finalmente) di questa pratica ormai desueta, antica, falsa e pericolosa e si fa proprio per proteggere i consumatori ed i malati dalle speculazioni delle aziende farmaceutiche produttrici di zucchero miracoloso.

Per me, comunque, la discussione resta chiusa qui e non replicherò ulteriormente, una discussione si fa solo se gli interlocutori hanno l'onestà di accettare anche le idee diverse dalle proprie, inoltre è un discorso poco importante e non voglio regalare ulteriore pubblicità a chi la cerca, mi ritengo anzi fortunato perché ho la possibilità di diffondere le mie opinioni anche se me lo impediscono da altre parti, cosa che non tutti possono fare e quindi la uso per difendermi quando accusato di avere usato un linguaggio "ingiurioso" e con insulti, che non è nelle mie abitudini.
Ovviamente spero che Pepe abbia il buon gusto e la signorilità di evitare commenti (qui, a casa sua faccia ciò che vuole) dopo quello che ha fatto.
Di una cosa sono però certo. Questa è l'ulteriore conferma dell'atteggiamento fideistico ed ideologizzato dei seguaci dell'omeopatia. Una religione, né più né meno. Guai a criticarla, fulmini e saette ai miscredenti.

Per questo l'omeopatia è passato e non ha futuro e per questo sta scomparendo dal mondo. Basandosi solo su credenze, fede, atteggiamento di chiusura mentale, non sopravviverà in un modo che vede compiere i suoi progressi in maniera rapidissima e senza sosta. L'omeopatia ha inoltre una (brutta) caratteristica in più: prende in giro i pazienti e questo non può essere accettato da nessuno. Il desiderio di guadagno delle multinazionali omeopatiche deve avere un limite ed informare correttamente può essere un buon modo per proteggere pazienti e consumatori.

Il giornalista dunque se ne faccia una ragione, se vuole difendere l'industria e le multinazionali faccia pubblicità, non punti ad attaccare chi ne denuncia le furbizie. Perché a fermare la verità con la censura si ottiene proprio l'effetto opposto.
Ti piace l'omeopatia? Usala!
Sai cos'è e la usi lo stesso? Pazienza, fatti tuoi.

A prescindere dalle credenze personali quindi, che ognuno coltiva come preferisce, finché qualcuno continuerà ad andare contro gli interessi di consumatori, cittadini e pazienti pur di diffondere superstizioni e vecchie usanze, esisterà qualcun altro che lo farà presente.

Questo è anche un esempio di cosa un giornalista non dovrebbe fare, c'è sempre la consolazione che la correttezza non sarà cosa di tutti ma almeno è cosa dei migliori.

Alla prossima.

          Quelle cose mediche che i medici non farebbero.        

Questa è la traduzione dell'articolo comparso sul giornale "The Guardian" il 19/01/2013.

L'articolo è molto interessante e curioso, a tratti fa riflettere, i giornalisti del Guardian hanno sentito le opinioni di diversi medici, con estrazioni e specializzazioni diverse ed ad ognuno di loro hanno chiesto: "Cosa non faresti se fossi un paziente?". Le risposte sono interessanti.
Ovviamente si tratta di opinioni personali, alcune abbastanza attinenti alle attuali conoscenze scientifiche, altre molto discutibili ma sempre rientranti nella possibilità di scelta di ogni persona. L'articolo offre molti spunti ed è particolarmente curioso perché credo tante persone, al momento di una diagnosi o quando hanno problemi di salute, si siano chieste "ma se fossi un medico, cosa farei?" Oppure: "lei cosa farebbe al posto mio?". Ricordiamoci che spesso le scelte non dipendono solo dalla malattia ma anche da tanti altri fattori.
Ecco, sempre prendendo queste opinioni per quello che sono, con i loro limiti, leggiamo un po' cosa farebbero dei medici davanti a della scelte mediche.
Ci tengo a sottolineare che queste sono le opinioni dei singoli medici e che potrebbero non rispecchiare le attuali conoscenze mediche, quindi devono essere lette con curiosità ma non come consigli indiscutibili.

Ringrazio di cuore S.N. che ha segnalato e tradotto (io l'ho revisionato per i termini tecnici) l'articolo.

...:::...

COSE CHE I MEDICI NON FAREBBERO

Dagli steroidi ai sonniferi, dalla fecondazione artificiale ai vaccini antinfluenzali, alcuni medici rivelano i trattamenti che eviterebbero 


Fare uno screening completo (check up).
Non accetterei le offerte regolarmente pubblicizzate da strutture mediche private di fare un check up completo. Perché? Beh, se si hanno sintomi, è bene recarsi dal proprio medico di famiglia e lasciare che sia lui ad ascoltare la vostra storia, visitarvi, richiedere indagini e giungere a una decisione. Questo processo è noto come diagnosi. Un check-up completo, quando ci si sente completamente bene, non è una diagnosi. La procedura è nota come "screening ". Ci sono pochi test di "screening" in cui i vantaggi della diagnosi e del trattamento superano gli svantaggi ed è probabile che il vostro medico abbia già controllato per primo quando vi siete affidati a lui o successivamente per esempio nelle donne, tramite un pap test o una mammografia in età adeguata e per entrambi i sessi un controllo della pressione del sangue.
Uno dei test che si effettuano durante lo screening completo è un esame del sangue per il cancro alla prostata. Se si hanno sintomi alla prostata, la diagnosi può essere un aiuto per salvarti la vita. Se non hai sintomi e l'esame presenta valori elevati, potrebbe condurvi ad effettuare ulteriori indagini ed esami potenzialmente dannosi o addirittura un trattamento per il cancro di cui potreste non avere bisogno. Si sentono storie sui vantaggi dei controlli medici completi. Si sentono storie anche di persone che sono cadute dalla finestra del sesto piano e sono sopravvissute, ma io non lo proverei di persona.
Mike Smith , Medico Generico

Ricoverarmi in ospedale, affetto da demenza.
Vorrei evitare di andare in ospedale con una diagnosi di demenza. Le persone affette da demenza hanno difficoltà ad orientarsi all'interno degli ospedali. Anche il percorso dal vostro letto alla toilette e ritorno è irto di pericoli evitabili: pavimenti lucidi, cattiva segnaletica, rumori inquietanti e che distraggono, illuminazione pessima, scarso contrasto di colore tra pavimenti e pareti, corrimano invisibili che si fondono con l'arredamento, rubinetti che non sembrano rubinetti e lavandini senza tappi. Così ti bagni o cadi, o torni nel letto sbagliato o vieni rimproverato anche solo per esserti spostato. Perciò potresti venire trascurato nelle cure anti dolore come altri pazienti nella tua condizione e potrebbero dimenticare di farti mangiare o bere. Se mi dovessi ricoverare vorrei che la mia famiglia stesse con me il maggior tempo possibile. La settimana scorsa, ho saputo di una donna il cui marito malato di demenza era ricoverato, che è stata cacciata dal reparto all'ora di pranzo perché â€œl'orario dei pasti è protetto” e non ci devono essere visitatori perché i pazienti possano mangiare indisturbati. Desiderava rimanere proprio perché suo marito potesse mangiare. Che situazione perversa è questa?
Professor June Andrews, direttore Centro Sviluppo e Servizi malattie mentali presso l'Università di Stirling

Far nascere il mio primo figlio a casa.
Ho sperimentato molte situazioni in cui il primo parto di una donna non progredisce secondo i piani e, in alcuni casi, diventa un'emergenza. Per questo motivo, non vorrei mai il mio primo parto in un ambiente dove non vi sia la possibilità di un rapido accesso a una struttura di ostetricia e nemmeno in casa.
Moneli Golara, Ostetrica e Ginecologa

Eseguire un test per il cancro alla prostata.
Il PSA è un esame del sangue "semplice" per verificare la presenza di cancro alla prostata. Sapete cosa significa? PSA sta per "Prostate Specific Antigen". O meglio, come molti medici vi diranno "Persistente Stress e Ansia"! Il cancro della prostata è molto più comune e, di solito, meno grave di quanto non si pensi. Negli uomini anziani, è praticamente uno stato di normalità. La maggior parte di questi tumori della prostata rimane inerte e innocua, ed è una cosa con cui gli uomini muoiono, non a causa di...
Quindi effettuare un PSA può finire col darvi informazioni che sarebbe meglio non sapere. Questo se il risultato è affidabile: perché questo è noto per inaccuratezza, con falsi positivi, falsi negativi e per l'incapacità di distinguere tra tumori innocui alla prostata e quelli aggressivi. Motivo per cui quando un uomo chiede il test, è potenzialmente come aprire un vaso di Pandora. Noi cerchiamo di guidarli attraverso il labirinto dei “se”, “ma” e forse”. Certo, in teoria potrebbe salvarti la vita. Ma in pratica potrebbe condurti verso preoccupazioni, biopsie sgradevoli e interventi chirurgici inutili e traumatici.
Tony Copperfield, Medico Generico e autore di Sick Notes (note malate)

Non mi presenterei mai a un medico con un elenco di sintomi.
I pazienti spesso pensano che questo aiuti la loro causa, ma la vista di un elenco fa prendere un tuffo al cuore a un medico. Non sarà certo in grado di affrontare tutto in una sola seduta e, cosa più importante, fa pensare che non ci sia un problema particolare, ma una molteplicità di problemi, portando il medico a credere che sia un chiaro segno di un ipocondria. Inoltre, non andrei mai a prendere il sole o ad abbronzarmi su un lettino solare. Ho avuto il cancro della pelle. La gente sottovaluta il rischio. Pensano: "La mia pelle sembra integra, come può essere danneggiata?" Anche se la pelle non ha un aspetto invecchiato, si possono avere danni alla pelle che sono un potenziale futuro tumore. Prendere il sole nell'adolescenza e attorno ai 20 anni è un forte fattore di rischio. Ora stiamo assistendo al progredire di tumori come il carcinoma basocellulare (BCC), anche in persone sotto i 40 anni, che una volta si riscontrava soltanto sui volti di persone anziane esposte perennemente alle intemperie trascorrendo una vita all'aria aperta. Stiamo vedendo melanomi maligni, la forma più aggressiva di cancro della pelle, in diverse parti del corpo. Se fossi nato un medico, non avrei mai preso il sole. Andrei fuori al sole, ma non mi esporrei mai al sole allo scopo di abbronzarmi.
Carol Cooper, Medico Generico

L'uso non necessario di cortisone.
I medici trattano una vasta gamma di condizioni cliniche, ma spesso noi stessi non capiamo le terapie che stiamo offrendo e perché o come funzionano. Dodici anni fa ho avuto la colite. Uno dei trattamenti è a base di cortisone ma, come medico, sapevo che è uno di quei trattamenti applicabili a molte malattie, senza sapere bene perché funziona. Sappiamo che sono anti-infiammatori ma in realtà mascherano solo il problema e possono causare effetti collaterali a lungo termine.
Gli steroidi possono rendere la pelle più fragile, possono influenzare il tessuto connettivo e possono cambiare la forma del tuo viso. Una cosa è prendere qualcosa se si conosce il motivo per cui funziona ma non ero disposto a prendere quella strada. Fino a quel momento il mio stile di vita non era stato un granché. Sono stato molto occupato e non mangiavo bene. Ho cominciato a mangiare meno zucchero, meno carboidrati, ho smesso di mangiare cibi confezionati elaborati. Non solo mi sono sentito meglio ma da allora non mi prendo che qualche raffreddore. In termini di chirurgia plastica, non userei mai i filler di lunga durata. La gente non vuole la seccatura di venire ogni quattro mesi per le iniezioni, ma non vorresti qualcosa che restasse in circolo per troppo tempo, perché il corpo potrebbe eventualmente avere un fenomeno di rigetto. Potrebbe essere un inconveniente doverci andare più spesso,ma a lungo termine ti risparmierà qualche serio effetto collaterale.
Alex Karidis, chirurgo estetico


Fare una colonscopia virtuale.
Ho eseguito una colonscopia, ma mai una colonscopia virtuale, cioè una TAC dell'addome per trovare polipi e primi tumori nel colon. Questo perché è molto probabile che un radiologo inciampi su altre cose, tipo anomalie del fegato, reni e polmoni, che nulla hanno a che vedere col cancro al colon, cosa che risulterebbe da interminabili test, che spesso implicano l'uso di aghi nelle cavità del corpo, anche finendo sul tavolo chirurgico. Non prenderei mai farmaci per abbassare il mio zucchero nel sangue per un'emoglobina glicata del 7%. Uno studio a lungo termine di 50.000 diabetici nel Regno Unito ha scoperto che il tentativo di abbassare questo valore al di sotto del 7,5% aumenta il tasso di mortalità generale. Non sono nemmeno sicuro che dovremmo anche chiamare una glicata del 7% "diabete", ma sono abbastanza sicuro che non vorrei prendere farmaci per abbassarla.
Invece, vorrei cercare di perdere peso e fare più esercizio fisico, ma sarei disposto a considerare farmaci per abbassare la pressione sanguigna e colesterolo. Non farei mai esami di diagnostica per immagini (TAC, RMN, PET), quando mi sento bene. Studi di Tomografia Computerizzata (TC) di tutto il corpo hanno evidenziato che nell'85% delle persone sane di 50-60 anni di età hanno un dato qualche risultato anomalo e un paziente ha mediamente 2,8 anomalie. I numerosi conseguenti test e biopsie di controllo a qualcuno potrebbero recare qualche danno. Questo è diventato un grosso problema talmente comune che i medici gli hanno dato un nome: “incidentaloma”.
Mentre sarò contento di essere sottoposto a scansione se vittima di un incidente stradale o in caso di dolore addominale acuto con vomito, non desidero sottopormi a scansioni se sto bene.
H Gilbert Welch, professore di medicina alla Dartmouth Istituto per la politica sanitaria e pratica clinica, e autore di Overdiagnosed: Making People Sick in the Pursuit of Health (Sovradiagnosi: come gli sforzi per migliorare la salute possano far ammalare le persone)

Sottopormi a un intervento non necessario.
Avendo appena rimosso la cistifellea con la conseguente complicazione di perdita di bile, non farei alcun intervento o procedura senza prima leggere le linee guida per la malattia, guardando i tassi di complicazione e i rischio del non agire (per esempio quante probabilità ho che la mia condizioni comporti dei problemi).
Vorrei chiedere al chirurgo quante di queste procedure compia un anno e quale sia il loro tasso di complicanze, oltre a fare una ricerca su Google sul chirurgo e chiedere ad altri medici la loro opinione. Chiederei sempre che cosa stanno facendo su di me e perché. Se avessi dolore, vorrei chiedere cosa mi stanno prescrivendo e quanto e ogni quanto. Vorrei sempre leggere il mio foglio di dimissioni dall'ospedale perché Ã¨ spesso impreciso. Suggerirei di poter stare il più possibile fuori dall'ospedale, chiedendo solo esami che solo un medico può effettuare. E vorrei andare in un ospedale di eccellenza che darebbe una garanzia in più nel caso qualcosa andasse storto e che avrebbe più esperienza in termini di numero di pazienti e competenza del personale clinico.
Luisa Dillner, Medico Generico e editorialista del Guardian

Stripping delle vene varicose.
Non mi sottoporrei allo stripping delle vene per togliere le vene varicose e non lo farei mai comunque in anestesia totale. Non solo è molto doloroso, con grandi cicatrici che hanno una maggiore probabilità di infezione; un anno dopo, il 23% delle persone hanno la stessa vena ricresciuta. Dopo cinque anni l'83%. Perciò è doloroso e nemmeno funziona a lungo termine. Con i metodi laser pin-hole, abbiamo la chiusura completa della vena nel 97% delle persone ancora dopo 10 anni. Inoltre, l'anestesia generale immobilizza totalmente, aumentando il rischio di trombosi venosa profonda, oltre al fatto di non poter dire al medico quando fa male, col rischio di danneggiare qualche nervo, e il danno è riscontrabile solo al risveglio.
Se avessi metastasi al fegato non mi sottoporrei alla chemioterapia a meno che non fosse stato previsto da un chirurgo epatobiliare. Se le metastasi si trovano solo in una parte del fegato, è possibile rimuovere questa parte chirurgicamente. La sopravvivenza a cinque anni dopo la rimozione chirurgica di questi tumori è di gran lunga migliore rispetto alla chemioterapia.
Mark Whiteley, Chirurgo Vascolare

Prendere pillole per dormire.
Ho incontrato molti pazienti che hanno preso sonniferi per decenni. Queste pillole creano dipendenza e può essere molto difficile disintossicarsi; gli effetti collaterali possono includere cadute, stati confusionali, sonnolenza durante il giorno e la sensazione che siano necessarie dosi sempre più elevate per ottenere gli stessi effetti. Non riesco a immaginare una situazione in cui vorrei iniziare a utilizzarle.
Helen Drew Medico Generico

Seguire una dieta a basso contenuto di carboidrati.
Non farei mai una dieta a basso contenuto di carboidrati e alto contenuto proteico come la Atkins, Dukan o la Cambridge. Perché? Perché anche se probabilmente si perde peso, possono ucciderti. Non credete alle mie parole ma leggete delle 43.396 donne svedesi che ho seguito per una media di 15 anni. Quelle che hanno seguito una dieta a basso contenuto di carboidrati e alto contenuto proteico avevano un crescente rischio di morire di attacco cardiaco e ictus, in rapporto al rigore della dieta e per quanto tempo l'avevano seguita. C'era uno sconcertante 62% in più di rischio di tali malattie tra le donne che si attenevano più strettamente a quella dieta rispetto a quelle che mangiavano normalmente. Mangiare è un divertimento; queste diete trasformare il cibo in farmaci, ed è palesemente la medicina sbagliata - e spesso è letale.
Tom Smith, Medico Generico

Bere caffè o alcolici durante la gravidanza.
Io non berrei caffè se fossi incinta. Il caffè accelera il metabolismo e la frequenza cardiaca della madre e di conseguenza anche del bambino. Caffè e the inibiscono anche l'assorbimento del ferro. In gravidanza i livelli di ferro scendono sempre e bere del succo d'arancia fresco aiuta il suo assorbimento. Il caffè e il the danno invece l'effetto contrario. Le linee guida ufficiali dicono che si può bere un caffè, come si dice che si possono consumare alcolici, ma io personalmente lo eviterei. Il vostro bambino non ha bisogno di alcool come nutriente, non è qualcosa che va a beneficio del vostro bambino. So che ci sono le dosi raccomandate, ma consiglierei a tutte di non bere, specialmente nelle prime 12 settimane, quando il bambino si sta formando.
Nikki Khan, ostetrica

Usare terapie alternative.
Io non userei mai terapie alternative quali omeopatia o agopuntura, in base al fatto che non esiste prova evidente che funzionino. E spesso mi sono chiesto se i “valorosi” sforzi che facciamo per tenere in vita i nostri pazienti terminali abbiano alcun senso. Ma ho notato che spesso i colleghi dicono la stessa cosa finchè essi stessi o una delle persone a loro care non abbiano una prognosi di malattia terminale, in tal caso chiedono che gli sia fatto tutto. Victor Chua, Leader Sanitario

Vaccinarmi contro l'influenza.
Non mi vaccinerei contro l'influenza. I pazienti anziani o quelli con una condizione debilitante cronica come l'insufficienza cardiaca, farebbero meglio a vaccinarsi, ma non ci sono abbastanza prove che in un soggetto giovane e sano l'antinfluenzale sia di alcun beneficio. Inoltre le prove che l'inoculazione negli operatori sanitari protegga i pazienti, sono molto scarse ma, tuttavia, si fa molta pressione sugli operatori sanitari per farli vaccinare.
Stephen Leslie , cardiologo e professore onorario dell'Università di Stirling

Sottopormi a chirurgia estetica.
L'unica cosa che non farei è subire un intervento di chirurgia estetica. La ragione della mia riluttanza? Niente a che fare con l'anestesia (oggi una pratica molto sicura) ma tutto totalmente legato all'intervento in sé stesso che non dovrebbe essere mai eseguito per motivi “banali”. Non è che l'intervento chirurgico sia terribilmente pericoloso per la vita. Principalmente la mia preoccupazione sono le eventuali infezioni, che potrebbero risultare molto sgradevoli.
Mark Patrick, consulente Anestesista, University Hospital, South Manchester.

Rivolgermi a un counselor (esperto non qualificato di psicologia)
Non mi farei mai vedere da un counselor se avessi problemi di salute mentale. Chiunque si può professare“counselor”, è una zona non regolamentata. Come risultato c'è una terrificante variante nella qualità e ho visto troppi pazienti rivolgersi a dei counselor incompetenti, ritrovarsi ulteriormente danneggiati psicologicamente. Se soffrissi di depressione, starei molto attento ad assicurarmi che il terapista da me scelto abbia le corrette qualifiche e che sia riconosciuto da organizzazioni tipo BABCP (Associazione Britannica di Psicoterapia Cognitivo Comportamentale). Pagando privatamente, sceglierei unicamente un terapista che lavori anche nel NHS (Sistema Sanitario Nazionale), o che ci abbia lavorato in passato, uno psicologo qualificato, addestrato quindi ai più alti livelli qualitativi.
Max Pemberton, Psichiatra

Rifiutare le vaccinazioni.
Non rifiuterei mai le vaccinazioni ai miei bambini. Diversi anni fa, ero volontario nei Medici Senza Frontiere e ho passato sei mesi in Angola. Mi aspettavo la povertà, ma ciò che mi ha rattristato maggiormente, fu l'arrivo di bambini malati di diverse patologie che non avrebbero mai dovuto avere, malattie facilmente curate altrove, come morbillo o tetano. Quello, e la quieta umiltà con cui le famiglie si mettevano in coda per ore sotto il sole cocente a ricevere il loro vaccino.
Ora, praticando in occidente, incontro sempre più spesso genitori riluttanti a vaccinare i propri bambini, nonostante l'enormità delle prove della sicurezza dei vaccini. Molte di queste malattie sono di nuovo in aumento. E non riesco a fare a meno di domandarmi se i vaccini sono diventati la vittima del loro stesso successo; e se anche noi dovessimo stare in coda per ore, circondati da famiglie che sono state colpite da queste malattie che possono rendere disabili o anche uccidere, allora forse non daremmo per scontato il nostro benessere.
Damien Brown, Medico Generico e autore di Band-Aid for a Broken Leg: Being A Doctor With No Borders (Un cerotto per una gamba fratturata: Essere un Medico Senza Frontiere) 

Rifiutare la medicina alternativa.
Non rifiuterei una terapia alternativa senza prima capire come funziona. Mi ci sono voluti anni di esperienza medica per realizzare che solo perchè una terapia non ha prove di evidenza non significhi che non può aiutare qualcuno. Come medici siamo addestrati ,giustamente, a cercare le prove scientifiche dell'efficacia e sicurezza di una certa terapia. Ma la medicina convenzionale moderna non può aiutare tutti. A dispetto della mancanza di fondi per la ricerca, c'è un lento e crescente aumento di evidenze sull'efficacia di un certo numero di terapie alternative. Un esempio recente è che lo Yoga può aiutare a diminuire il dolore e aumentare la mobilità in persone con osteoartrite. La medicina moderna rimane nella sua area di competenza, ma ora comprendo altre forme di terapia, come la chiropratica e la ipnoterapia, che possono aiutare.
Ian W Campbel, Medico Generico

Curarmi con l'omeopatia.
Io non userei mai medicine omeopatiche. Sono basate su una pratica del 18mo secolo che consiste nel diluire particolari sostanze in acqua o alcool al punto in cui la soluzione è così debole da non contenere più alcuna traccia della sostanza originale. Gli omeopati credono che l'acqua preservi una “memoria” delle sostanze curative e perciò abbia un effetto benefico. Per me, la parola chiave è “credono”. I sostenitori dell'omeopatia credono nell'efficacia della medicina omeopatica nello stesso modo in cui potrebbero credere in una particolare religione. Il sistema dell'omeopatia è una medicina basata sulla “fede”, che, nelle menti dei fedeli, non necessita nessuna prova scientifica o di efficacia sui suoi benefici. Se l'omeopatia è efficace, allora la maggior parte di ciò che abbiamo imparato nel campo della medicina, chimica e fisica dal diciottesimo secolo dev'essere sbagliato. Non lo trovo plausibile, quindi preferisco sperperare i miei soldi in altro modo.
Eddie Chaloner, Chirurgo Vascolare

Ricorrere alla fecondazione assistita.
Non ricorrerei mai alla fecondazione convenzionale con stimolazione, che prevede prolungate assunzioni di ormoni per tre o quattro settimane, provocando inizialmente una menopausa nele ovaie, seguite da successive stimolazioni a dosi più alte. Questo metodo di stimolazione è associato al rischio più alto della sindrome da iperstimolazione ovarica (OHSS), che comporta seri rischi di salute per la donna. Possiamo evitare queste complicazioni grazie ai recenti sviluppi che hanno portato a una fecondazione artificiale più sicura, meno costosa, con più probabilità di successo e più accessibile. I progressi nel campo dell'endocrinologia, degli ultrasuoni e in embriologia hanno permesso di avere una fecondazione artificiale senza farmaci (IVF o IVM) con più probabilità di successo e permettendo allo sviluppo di una fecondazione assistita “leggera”, più sicura, i cui protocolli richiedono minori medicinali in un normale ciclo. Perché assumere tanti medicinali se puoi ottenere lo stesso effetto senza o con pochi farmaci?
Geeta Nargund, Capo Consulente per le Medicine Riproduttive al St. George's Hospital, Londra

Sottopormi a una mammografia.
Non mi farei fare una mammografia. Al microscopio i medici non possono dirti la differenza, tra “pericoloso” e “ok, lasciamolo stare”. Allora è possibile trovare qualcosa “troppo in anticipo” che non sia esattamente un pericolo di cancro. La pubblicazione indipendente di ricercatori sulla mammografia dell'anno scorso sulla rivista medica Lancet ha efficacemente distinto tra pregiudizi, incertezze e un po' di cattiva scienza. Recenti statistiche dicono che, per ogni 10.000 donne esaminate ogni tre anni dall'età di 50-70, circa 43 moriranno di cancro al seno. Circa 700 avranno diagnosi di cancro e molte di più saranno spaventate per essere richiamate per ulteriori esami.
Nonostante la maggior parte delle donne a cui si diagnostica il cancro con lo screening siano riconoscenti, non sono sicura se la mia vita sia realmente “salvata” o se sono diventata solo un nuovo paziente. Apparentemente ogni 15 donne che sono diagnosticate positive con lo screening, tre moriranno comunque di cancro al seno (quindi lo screening non ha salvato loro la vita), otto saranno sopravvissute (quindi lo screening ha portato a una diagnosi precoce, ma la cura sarebbe stata efficace ugualmente), una non morirà di cancro al seno (quindi lo screening previene la morte per questa causa), ma altre tre diventeranno vittime di cancro (quindi lo screening porta ad avere terapie e interventi chirurgici che non avrebbero mai fatto). Lo screening ha una sua validità confermata dalla donna che non muore di cancro al seno, ma tutte e 15 devono essere curate quando si trova qualcosa. E' abbastanza complicato da capire, e certe donne vorranno correre questo rischio. Ma sono felice di aspettare finché non avrò dei sintomi.
Susan Bewly, Professore del Complex Obstetrics, King's College London

Subire un intervento chirurgico alla fine della mia vita.
Non mi sottoporrei mai a un intervento di chirurgia addominale maggiore, se le probabilità di staccarmi dalle macchine che mi tengono in vita fossero scarse. Ho operato troppe persone in età molto avanzata per ragioni urgenti solo per vederle finire attaccate alle macchine, causando angoscia tra i familiari che devono decidere se staccare la spina. Personalmente eviterei interventi a tutti i costi e cercherei di trovare un altro modo per convivere con qualsiasi problema di cui sarei diagnosticato.
Paul Ruggieri, Chirurgo e autore del libro Confessioni di Un Chirurgo.

Queste sono le personali opinioni di alcuni operatori nel settore medico. Consultate il vostro medico se siete preoccupati per la vostra salute

...:::...

Alla prossima.

          Increase in NHS Claims and Costs        

This month we see NHS claims, those brought against NHS Trusts and their staff for clinical or medical negligence, increasing 66% over the last four years.  The 2012/13 annual report of the NHS Litigation Authority also reveals that as a percentage of damages the total legal costs have risen from 45.9% to 54.9% over the same period.

If you are a claimant against the NHS, you want your claim closed quickly and to be dealt with sympathetically, responsively and fairly.  The NHS shares these aims and wants to ensure those they care for are dealt with fairly and supportively. 

Forcing a clinical negligence claimant to go through multiple layers of complaints and court process is slow, stressful and damaging.  It is beyond the means of most claimants.  NHS staff time is diverted into defending negligence claims through the adversarial complaints and legal process, consuming valuable resources that should be devoted to patient care.  Patients are prevented from seeking and obtaining redress and the support to secure their rehabilitation, causing prolonged or further ill-health, loss of earnings, and increasing the damages eventually payable by the NHS.

CfJ advocates a non-adversarial, constructive and speedy approach to resolve these claims for the benefit of both the patient and the NHS. 

CfJ has been in discussion with both the present and former heads of the NHSLA with a view to finding ways to bring about a greater use of these techniques.

If you would like to encourage greater use by the NHS of better claims handling and dispute resolution methods for the sake of both the NHS itself and its patients contact CfJ on info@centreforjustice.org.

If you wish to know more about how to use CfJ’s own non-adversarial arbitration and mediation scheme please explore our website.


          Full Circle Weekly News #61        
SHOW NOTES Canonical starts IPO path http://www.zdnet.com/article/canonical-starts-ipo-path/ World’s First Quantum Computer Made By China — 24,000 Times Faster Than International Counterparts https://fossbytes.com/worlds-first-quantum-computer-made-by-china/ NHS cyberattack is ‘biggest ransomware outbreak in history’ http://www.wired.co.uk/article/nhs-cyberattack-ransomware-security Debian GNU/Linux 8.8 Released With Tons Of Updates And Fixes https://fossbytes.com/debian-gnu-linux-8-8-released-features-download-upgrade/ Google’s “Fuchsia” smartphone OS dumps Linux, has a wild new UI https://arstechnica.com/gadgets/2017/05/googles-fuchsia-smartphone-os-dumps-linux-has-a-wild-new-ui/ Ubuntu,
          volunteer practices online get a UK charity in trouble - could it happen to your nonprofit?        

The U.K.'s Information Commission has served an enforcement notice on the U.K's Alzheimer’s Society and criticised the charity for displaying a "disappointing attitude" towards handling the sensitive personal data of its beneficiaries. An investigation launched by the ICO in November 2014 found that its volunteers were using personal email addresses to receive and share information about beneficiaries, storing unencrypted data on their home computers and failing to keep paper records locked away. The regulator also found that the volunteers had not been trained in data protection, that the charity’s policies and procedures had not been explained to them and that they received little supervision from staff. The failings identified by the ICO concerned a group of 15 volunteers who helped 1,920 dementia sufferers and their families or carers seek NHS healthcare funding between 2007 and 2014. The volunteers drafted reports that included sensitive information about the medical treatment, care needs and mental health of beneficiaries.

Stephen Eckersley, head of enforcement at the ICO, said in a statement: "In failing to ensure volunteers were properly supported, this charity showed a disappointing attitude towards looking after the very sensitive information that people trusted them with.

Here's the whole story.

What are your policies regarding volunteers - and staff - using personal emails for work? Or storing work-related materials on their home computers?


          Government to invest £21m in beefing up NHS data and cyber security        
Response to WannaCry attacks and National Data Guardian’s review includes £21m capital fund for major trauma centres and NHS contract change requiring organisations to adopt data security standards including contingency plans to respond to data security threats
          Vendors partner up as clock ticks louder towards GDPR debut        
With GDPR now just a year away, and NHS cyber-attacks fresh in the memory, suppliers of management consultancy, archiving and testing services are keen to highlight their expertise
          Papercraft Chimneys        
I got frustrated trying to saw a notch in some plastic HO scale chimneys, so I decided to make my own.


I started with the working drawings from the Great Northern Historical Society's Modelers' Pages (#392, "Section Houses and Facilities.")


I'd already enlarged the image to use as a template for making walls and roofs, so I just scanned my enlargement at 100% as a starting point. I opened The Gimp, and used one of Clever Models' excellent brick textures to make a simple box with a notch on the bottom. I used that scan of the enlargement to get the size and shape of the chimney correct. I inkjet printed the result on matte photo cardstock, along with a partial sheet of just the brick texture. I cut and assembled the chimneys, adding strips of heavy black cardstock to the interior as I folded, to give it a little thickness. I touched up the edges with gouache paint as I went along. I cut two strips from the brick texture -- one strip was three bricks wide, the other, one brick wide -- and I wrapped them around the chimneys near the top.

The first chimney must have taken about 45 minutes to make, and I messed it up badly and threw it out. By the time I'd made three, they all looked uniformly nice and my time dropped to about 15 minutes for each.

Here is one of the chimneys test-fitted to the roof I completed earlier.


 I opted to scratch-build these four models for my client rather than buy and assemble four GNHS kits, since it's actually a savings for him -- cutting the pieces myself and assembling them takes only slightly more time than merely assembling a kit. This also means the money I would have spent on the kits -- which are about $25 each -- goes directly in my pocket. Another advantage to me is: I only charge the client for the time spent on the buildings I make for him, and I track my time very carefully, so as I go along, I can make a fifth model on my own time and at my own expense, and sell it to another client later.
          deadlyhifi on "SUN...!"        

I'm not allowed to go anywhere. I coughed up a little bit of blood yesterday and NHS direct said to have a veeeeery relaxing weekend! I feel fine now. This isn't relaxing, this is annoying!


          Where there's a will... by Wiggia        

Two little gems emerged this week midst all the political shenanigans. 

The first was inevitable in one form or another. Anyone who believed purchasing an electric car was saving the planet and would be rewarded for it by not paying fuel duty and getting 100+ mpg to boot for threepence was being naive, to put it mildly.

In fact, it could end up costing you a whole lot more than the equivalent petrol-engined car at current prices. A study sponsored by government has emerged, suggesting ways to claw back the lost fuel duty when these cars finally sell in numbers. Anyone who thought the zero road tax and all the other goodies would go on into the sunset of motoring is now having their eyes peeled as suggestions emerge of toll roads in place of tax, or probably alongside ? Or mileage charges depending on when and where you drive, allied to city restrictions and zone charging. Running a car is going to be a lot more expensive than now. Add in the current disparity in prices for electric vehicles and many will not bother and maybe that is what they want regards cities.

There is no silver lining with this as you can’t strangle car use without having to make up the shortfall in revenue in another way. Going green has always been a con and whilst the spaghetti knitters will be cheering from the sidelines the man on the Clapham Omnibus, if he can get on one, will suffer the costs and inconvenience. Why do the hordes of gold plated civil servants that are put onto these schemes always come up with something that pleases a few and costs everyone else?

On a similar track is the announcement the supermarkets are starting to roll out “surge pricing.” This little wheeze involves electronic labelling that can  change the indicated price in twenty seconds. Ostensibly this is to reduce waste, yesss, and in their words……

“This would let them react to events and remove or introduce offers increasing the ice cream price during a heat wave for example.”

Needless to say “concerns” have been voiced from consumer groups that ultimately most shoppers will pay more. A 3% increase in profit margins is possible with this system, so once again those that work and have limited time to shop and have to do so in lunch hours and similar times will not only have to put up with the crush at those times but pay more for the privilege.

And just to round off the lightening of wallets by stealth - or diktat, in the government's case - the same supermarkets that now control the bulk of petrol retailing want to use the same surge pricing for their petrol forecourts. So the commuter who has to use his car will pay more for the privilege of using roads that as a taxpayer he has already paid for; will, if he uses a petrol station during the same commute periods, pay more for his petrol; and his wife, shopping during the lunch hour at work or on the way home, will pay more for their food.

A spokesman for Sainsbury’s said, “We always look at ways that technology can help us improve the shopping experience for our customers.”

And just to make you shuffle nearer to the cliff edge, the energy companies would also like to charge you according to demand with cheaper prices when nobody uses energy and the reverse when we do. Looking at all that, the only small chink of light is your very expensive electric car can be charged at night at a cheaper rate, though I am sure the government or energy company can fix that in no time at all.

Oh, and I just noticed the BMA want GPs to shut doors amid safety fears. Another spokesman said, “There has to be a limit on what you can do in a day, it is not about money it is about patient safety,” so shutting the doors when someone needs to see a doctor is a safety measure. That’s one way of looking at it, and of course there is only so much anyone can do in a day, but that day in the case of my surgery and most others is in effect a half day: the majority of GPs working there are only working part-time.

They want to able to declare a black alert as hospitals do when not capable of providing a safe and sustainable service and in order to protect patients (they are thinking of us, really) practices are enabled to self-declare a safety alert and direct patients to alternative service providers such as a "local hub", a walk-in centre or A&E. I have no idea what a local hub is but our one and only walk-in centre is overwhelmed, their doctors are working full-time and overtime; and the A&E department will be overjoyed that GPs  are wanting to direct even more patients their way than they do now.

This particular problem in the NHS is not about money. It is about someone somewhere insisting that the contracts that enable most GPs to go part time not work evenings and week ends are changed. The Blair government cock up , if that’s what it was, is costing us dearly - regardless of their independent business status GPs are paid by the taxpayer but you wouldn’t think so sometimes.

On my last visit to my surgery's web site they made great play of the fact ”they are a self care surgery.” Intrigued, I clicked the link and found they are advising everyone to help themselves in all ways possible: “Seek advice from your pharmacist, phone the NHS helpline, query whether your doctor's appointment is really necessary and try to treat yourself if you believe you only have a common ailment.”Do you get from that they perhaps are not wanting to have to deal with patients at all? Along with the fact that getting an appointment has reached the stage you have either cured yourself, self cared (!)or died waiting. 

Perhaps shutting the doors is the sensible thing to do. Not a lot of people would notice.

          Bulletin / v.15:no.1 (1985:Jan-Feb) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Bulletin / v.29:no.3(1999:Dec-Dec) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Bulletin / v.28:no.1(1998: Apr-Apr) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Bulletin / v.27:no.1(1997: Apr-Apr) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Bulletin / v.27:no.1/3(1997: Aug-Dec) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Bulletin / v.28:no.3(1998: Dec-Dec) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Bulletin / v.28:no.2(1998: Aug-Aug) (added: 08/06/2017)        
By:
East Africa Natural History Society.
Publication Info:
Nairobi, Kenya :East Africa Natural History Society,[1971]-1997.
Subjects:
Africa, East, Natural history, Periodicals
Related Titles:
Preceded by: Newsletter (East Africa Natural History Society)
Succeeded by: EANHS bulletin
Contributing Library:
Unknown
Sponsor:
BHL AFRICA
Copyright Status:
Public domain. The BHL considers that this work is no longer under copyright protection.

          Westminster Skeptics - Colin Leys on NHS Reform        
Colin Leys addresses the Westminster Skeptics to talk about the proposed NHS reforms. Recorded on the 23rd January 2012.
          East Surrey Hospital – HV Infrastructure Upgrade        
Metricab is proud to have been awarded this major project for Surrey and Sussex Healthcare NHS Trust.
          NHS shake up plans 'not cost cutting exercise' insist health chiefs        
THE decision to permanently downgrade maternity services at the Horton General Hospital is not a cost cutting exercise, insist health chiefs.
          Campaigners unite as one to stop NHS shake up plans in Oxfordshire        
CAMPAIGNERS, the clergy and politicians came together as one voice in their passionate plea to stop controversial healthcare plans.
          Have your say on the NHS in Oxfordshire        
PEOPLE interested in health issues and the running of the NHS in Oxfordshire have the chance to join a watchdog committee.
          Delivering a Patient Information Service (a CILIP Health Libraries Group and Patient Information Forum event)        

The aim of this event is to provide guidance to library staff who may be expanding their services to include patient information, in addition to the service they currently provide for staff.

 

10.00 - 10.30 Registration and coffee

10.30 - 10.45 Welcome and introduction

  • Sarah Hennessy - Co-Chair, CILIP Health Libraries Group

10.45 - 11.15 Making a difference - the benefits and value of providing high-quality health information

  • Nicole Naylor – Joint Head of Operations, Patient Information Forum

11.15 - 11.45 What are your concerns?

Discussion session

11.45 - 12.05 Refreshment break and speed networking

12.05 - 1.00 Learning from others - implementing innovative ways to give patients access to your information

  • Theresa Sullivan - Macmillan Patient Information Lead, Mount Vernon Cancer Centre and Lynda Jackson Macmillan Centre
  • Holly Case - Outreach Librarian, Surrey & Sussex Healthcare NHS Trust 

 

1.00 - 1.45 LUNCH

 

1.45 - 2.45 Managing challenging enquiries

  • Wendy Marchant - Macmillan Cancer Information & Support Specialist, Macmillan Mobile Cancer Information & Support Service
  • Deena Maggs - Head of Information and Knowledge Services, The King's Fund

2.45 - 3.15 What is high quality health information and where do you find it?

  • Nicole Naylor – Joint Head of Operations, Patient Information Forum

3.15-3.30 Sum up and close

  • Sarah Hennessy - Co-Chair, CILIP Health Libraries Group
Tue, 17th Oct 2017 - 10:00am to 3:30pm
Lesley Allen

Cost

  • The event is free to attend. But please note, as spaces are limited, for 'no-shows' or where cancellation is made with less than 72 hours notice, a £45+VAT fee will be payable. No fee will be payable if a colleague attends in your place.
Free Event: 

          Now Available: June issue of the HLG newsletter         

The June (latest) issue of the CILIP Health Libraries Group newsletter is now available online at:

http://www.cilip.org.uk/health-libraries-group/newsletter

Key items in this issue include:

  • Evidence into practice – case studies
    Jacqui Watkeys, Walsall Healthcare NHS Trust
  • NIHR Dissemination Centre Signals – evaluating the impact
  • Update-ing the Royal College of Surgeons of England’s Current Awareness Service
    Sarah Kennedy, Royal College of Surgeons
  • Connecting its workforce to corporate knowledge and best practice: how the Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) Library Service is utilising clinicalskills.net
    Angela Hall, Royal Liverpool & Broadgreen University Hospital NHS Trust
  • Meeting report – visit to the Dana Research Centre and Library
    Claire Jones, Princess Royal University Hospital

Internet sites of interest

This issue features useful information and sites related to transgender health.

Book reviews

  • Baker, D. and Evans, W. The end of wisdom? The future of libraries in the digital age. Chandos Publishing, 2017.

  • Foster, M. and Jewell, S. Assembling the pieces of a systematic review: a guide for librarians. Rowman & Littlefield 2017.

  • Gray, J. Becoming a powerhouse librarian: how to get things done right the first time. Rowman & Littlefield 2017.

Along with all our usual newsletter features. We welcome your contributions to the newsletter, such as original articles, meeting reports or book reviews. Let us know what you'd like to see!

For further information, please contact myself rachel.gledhill@phe.gov.uk or Joel Kerry, Editor joel.kerry@nhs.net.

The next copydate is 11 August; we look forward to hearing from you.

Rachel Gledhill

HLG Newsletter – Assistant Editor


          Safadas vagabas fodem com prazer        

Safadas vagabas fodem com prazer juntinhas, se acariciando e metendo o dedo na xoxota ate ficarem bem louquinhas de prazer na sacanagem, gemendo de praazer e ficando bem peladinhas provocando juntas o cara de safado.  Ele acaba pegando as galinhs da bunda empinada e vai fudendo demais com elas ficando bem arrombadinha e molhadinha de prazer na meteção perfeita sem pudor chegando ao orgasmo perfeito na pegação lesbica.


          Jeremy Hunt in climbdown over pledge to make newly-qualified doctors work for the NHS for four years        
Jeremy Hunt in climbdown over pledge to make newly-qualified doctors work for the NHS for four years
          The Santa Project        

The 30th Annual NHS Santa Project money drive starts on Monday December 8th.  The National Honor Society is hoping to raise $6,000.  All of the collected money goes to buy Christmas presents for needy local children whose names are on American Heritage Bank’s Spirit of Christmas tree.  Please encourage your students to contribute to this worthy cause.  Every penny helps.  


This is a competition between all first hour classes.  The top two classes with the highest dollar/student totals will be treated to breakfast on Friday, December 19th.  


The NHS Santa Project shopping trip is scheduled during the school day on Wednesday December 17th.  

Mannford FFA is selling raffle tickets to win this lap quilt. 100% of the proceeds of this raffle will go towards the 2014 Santa Project. Tickets are 1 for $5, 3 for $10, or 6 for $20. The drawing will be held Friday, December 12th. Look for an FFA Member to get your tickets and spread a little Christmas cheer!




I would like to thank you for your continued support of the NHS Annual Service Project. This marks the 30th year of the Santa Project, and so far a grand total of over $93,000 has been contributed by Mannford students and staff!

This year there are 274 Angels on the Tree at the Bank! Last checked, there were still 180 left! Other ways to help are to adopt an Angel from the tree yourself, or make a monetary donation at the high school towards the Santa Project.

There will be dress up days this week in honor of the NHS Santa Project!





          NHS Trust and Xerox team up in a bid to promote paperless communication with patients        

As of 21st November 2016, over 75,000 patients of Imperial College Healthcare trust now have access to email reminders and notifications for their medical appointments. This revolutionary progression in healthcare communication comes as the NHS Trust and Xerox partner up … Continue reading

The post NHS Trust and Xerox team up in a bid to promote paperless communication with patients appeared first on Printerbase.


          Fancy getting involved with your local NHS? Become a governor!        
NOMINATIONS to become a governor for the Black Country Partnership NHS Foundation Trust are now open.
          Chance to meet your new NHS governor        
Governors from the Black Country Partnership NHS Foundation Trust will be out and about over the next few weeks at a venue near you.
          Trust praises staff at awards ceremony        
Staff and volunteers were praised for their hard work and dedication at the Black Country Partnership NHS Foundation Trust awards ceremony hosted by the comedienne Mrs Barbara Nice of Phoenix Nights fame.
          Free NHS health checks for over-40s        
Everyone has some risk of developing heart disease, stroke, diabetes or kidney disease. The good news is that these conditions can often be prevented, even if there is a history of them in the family.
          More than skin deep        
NHS Dudley Public Health recently launched a new campaign to highlight the importance of cervical screening and encourage uptake of the free test in the borough.
           Dementia Awareness Starts in School – A Group of Pioneer Schools in England Pilot Intergenerational Exchange         
Bray, Jennifer and Atkinson, Teresa (2013) Dementia Awareness Starts in School – A Group of Pioneer Schools in England Pilot Intergenerational Exchange. In: NHS Healthcare Innovation Expo, 13th-14th March 2013, ExCel, London. (Unpublished)
          Escocia confirma su primer caso de ébola        
Por Josh Levs, CNN (CNN) - Autoridades de salud de Glasgow, Escocia, confirmaron un caso de ébola. "El paciente es un trabajador sanitario que ayudaba a combatir la enfermedad en África Occidental" y que regresó de Sierra Leona en la noche del domingo, dijo la agencia de salud escocesa NHS Scotland en un comunicado. El paciente voló vía Casablanca
          Why the left hates Blair        
Someone in prospect magazine wonders why the left hates blair more than some of his conservative predecessors. My thoughts are roughly:

Blair’s achievements are enormous: the huge improvement in the NHS and the funding and performance of schools to name just two. His constitutional changes (though conceived before he became PM) were also very significant. So too with peace in NI.

I think the virulent opposition to Blair from the left – more instense than against conservative leaders – owes something to a sense of betrayal. From the day of his controversial court backed electoral victory, Bush was loathed on the left. For Blair to align himself so closely with Bush, after 9/11 but even before the Iraq war, was always going to alienate Blair from large sections of left opinion. Blair allowed no distance between himself and Bush, not even a shade that might have made independence of mind and policy seem credible.

On Iraq, where Blair constructed a casus belli from intelligence that was plainly insufficient, if not patently exaggerated, he was always going to destroy his image on the left. In arguments about justifying Iraq, Blair keeps on saying that after 9/11 he knew islamic fundamentalism had to be confronted, yet everyone knows now, as they did then, that Al Queda and the 9/11 bombers were not spawned in Iraq but elsewhere. So despite Blair’s insistence that Saddam’s regime posed a threat, we know that it didn’t really, not after 1991 and all the years of sanctions. Saddam was a murderous dictator, but the time to intervene to save his victims was long past (incidentally the West backed him while he was at his most brutal).

On top of Iraq, there is Blair’s rightward lurch in matters concerning law and order, and issues like Freedom of Information (which he now says makes government impossible).

Blair was an immense politician, and I believe did have a genuine progressive intent, at least in the beginning. But more clearly than any prime minister in recent times, he let power go to his head. He became a megalomaniac, even evangelical in his zeal. He seemed not to have a healthy sceptism towards power itself. The way he deployed his power, and how he altered the office of prime minister, are troubling.

For Blair there was no such thing as a cabinet. He was right and his person decision was a diktat. It is probably on balance a good thing that there was another powerful figure next door whose presence was the ultimate limit on how far Blair wanted to stretch his office.

Blair’s term exposed how little real counterweight exists in the British system for a PM with a large majority and who is in command of the senior figures in his own party. In the end, he is hated on the left as much for how he deployed power as he is for any single policy (aside from Iraq).
          Swale Clinical Commissioning Group rated 'requires improvement' by NHS England        
A Clinical Commissioning Group requires improvement according to health bosses.
          Tooth Extractions Among Children Alarmingly High in the UK         
Dental care and hygiene is declining among young children in the UK, where the NHS reports that there were about 33,781 tooth extractions in children

          Ready, Steady, Go        
FFS - raining again!!
 It has been six weeks since we arrived back in the UK, it is amazing how the time rolls buy.  It has been a sociable time with plenty of walking and climbing with the usual suspects though the weather has been a bit of disappointment - I guess some things never change.
One of the reasons we came back was to try and get an old injury to my big toe sorted out. I have seen my GP, had X-Rays, seen a specialist and finally got a date for him to shave the bone back to something like its normal size. I guess six weeks for that from the NHS for something so trivial is pretty good going. I had the same operation done 30+ years ago, but the wear, tear and pressure of too many tight boots and shoes means it finally needs doing again.
Toe the line
Anyway a date towards the end of September means we can shoot off for a month, so Switzerland and Austria here we come. Possible venues include the Øtzal, where we have never been, and the Val di Mello, where we haven't been for about 15 years.
After that it is back home to get the 'procedure' done with the hope I will be fit enough to push off to Greece by mid October - about three weeks later. We have appointments with Kalymnos and the Peleponnes and they won't wait.

          Back to Blighty        
Yarncliffe Quarry - hot
After a great 10 days in Chamonix it really was time to get back on the road - a steady ride to Zeebrugge and then the ferry back to Hull - with the usual free upgrade to Club Class was as easy as it gets.
We arrived into heavy rain, thick spray on the motorway and traffic jams - oddly that was exactly the kind of welcome back to the UK that we had been expecting despite it being the end of June.
In the first week it was the usual round of visits to the Doctors (x3), the Dentists, the Hospital (x2), the Garage, the Opticians and a ride up North to visit our parents - never get a minute to yourself.
Colin - Horse Thief Wall, Stoney Middleton
Then Colin came to visit, he did some very useful work on the flat and we went out climbing several days on the trot which was very nice.
We mixed it up, alternating bolt clipping on the limestone with days on the Grit, and despite the rather oppressive heat it was novel to be back climbing in the Peak.
Already we are getting itchy feet - we will have to see develops. I am hoping (hopping?) to get a minor operation done on a bony lump on my big toe - but maybe we can fit in a slider whilst we wait for the NHS to sort me out.

          Value demand and failure demand        

My spirits lifted recently when I read the following as the opening of an article: “The Medical Protection Society has said that the NHS could be paying out £2.6bn a year in clinical negligence costs by 2022 and that urgent action is needed before the burden becomes unsustainable.” Brilliant, I thought, does this mean at long last the NHS is going to take this seriously and hone in on medical mistakes? Sadly not.

The post Value demand and failure demand appeared first on Litigation Futures.


          A&E waiting times target in England missed every month for last two years        
The NHS in England last met its target for A&E waiting times two years ago, new figures show.In July this year, 90.3% of patients spent four hours or less in A&E, missing NHS England's...
          Jeremy Corbyn to condemn Government for NHS failings during Cornwall visit        
Jeremy Corbyn is due to resume campaigning today with an attack on the Government's management of the NHS.The Labour leader is expected to use a visit to Cornwall to highlight new official data...
          Labour accuses government of secret hospital asset-strip        
The Government has been accused of secretly stripping hospitals of their assets to plug financial gaps as new analysis shows the amount of NHS land considered for sale has more than doubled in the...
          NHS has paid more than £17m to victims of breast surgeon Ian Paterson        
The NHS has paid more than £17 million in compensation for victims of rogue surgeon Ian Paterson. NHS Resolution said, as of July 31, it had received 277 claims involving Paterson's...
          NHS to see 'biggest ever' expansion as extra doctor training places confirmed        
The NHS is set to see the "biggest ever" expansion to the NHS medical workforce in England after health officials confirmed plans to increase training positions.Following a consultation,...
          Victoria and Treva Askey        
Trevor Askey met Victoria in high school and they were sweethearts for a short time. Then they left school. Trevor joined the British Army, and served for 23 years. They each had other relationships. Nonetheless, they kept in touch throughout.

In 2006, Trevor told Victoria his lifelong secret: that he should have been a woman. Victoria was not only supportive, she performed his first makeover, and even proposed marriage. They married as Victoria and Trevor, but Trevor is now Treva (say it Tree-Vah), and is undergoing full transition with Victoria's full support.

Victoria and Treva
They were kind enough to take the time to answer my interview questions. Victoria sent their replies in colour, which is an elegant way to keep their answers distinct. I have adopted Victoria's colours in their replies which follow.

Tell me a bit about what you remember about each other from meeting in school. Did you have a relationship then? How old were you when you first met each other?
 
Victoria: I remember seeing Trevor ride past me on his push bike and I couldn't keep my eye off him. It was like I knew him and wanted to seriously get to know this person. He was seen as a school bully because he wouldn't allow anyone to get close, including friends, but that wasn't going to put me off. I was nicknamed "Trevor's little stalker". It was in 1986 and I was 13. He was my first serious crush; I even remember being in my maths class and staring at him running in PE. He was a runner for the school and he was so gorgeous, I was totally smitten. We dated for about 4 weeks and I think I got too close so he finished it. I was devastated.
 
Treva: I was 15 and two years above Victoria. I remember her watching me all the time and various school mates telling me she liked me. I remember my first line to her was "your parka is not as good as mine", as I had an old M65 US-Army fishtail parka and she had one of those blue parkas with the orange inside.

I remember those parkas! I had a green one with the orange inside. Is it true you wouldn't let anyone get close to you in school? Can you explain why?
 
Treva: Yes it is true, I was unsure of what I was going through or what I was feeling and I didn't want anyone else to see who I really was, because they may have seen something I didn't want them to see.
Tinker, Tailor, Soldier: Trevor

What made you choose a career in the Army? Were you thinking of any other career?
 
Treva: I chose a career in the Army because being confused I didn't know what to do, so as I lived in a rural area I had little else to choose but the Army. On top of this I thought that going into the Army and choosing a masculine career (Engineer) would make me into a man. As for another career, there really wasn't anything else I could choose due to my location and the lack of opportunities available.

Did you join the Army knowing you had a feminine side, and expecting (or hoping) the Army to knock it out of you?
 
Treva: No. I joined the Army unsure of what I was going through. I just joined the Army to do the man thing, and with living in a rural area there was no other option in the job front. And on top of that I wanted to prove people wrong: various teachers had told me that I wouldn't be able to do it because of my disruptive nature.
 
What was it like serving as a soldier knowing there was a woman trapped inside you?
 
Treva: It was frustrating, difficult. I used my chosen career to keep my mind off things, keeping myself occupied to keep my mind off everything else.

You left the Army before announcing your transition. Did it ever cross your mind to consider remaining? Lieutenant Colonel Cate McGregor has remained in the Australian army and transitioned, with the support of her commanding officer.
 
Treva: No. I am a stubborn old fool, I signed on the dotted line as Trevor so I was going to complete my time as Trevor.
In civvies

How many other members of the armed forces do you think are affected by gender dysphoria?
 
Treva: I know of a few others that have gone through transition whilst still being in the forces.

You say your Army mates have been supportive. Does this differ from what seems to be a very homophobic and transphobic environment in the military?

Treva: As for the homophobic or transphobic, I personally believe that's more of a sheep following: one person says something negative, then the others follow. But some do stand up and won't follow and are accepting.

I have written about Jan Hamilton. To what extent do you think your story parallels hers? Is there anything you would say that is different between you?
 
Treva: We are two totally different people. Every trans story has some similarities, but are any two the same? And I was a Royal Engineer, not a Para.

What advice would you give to someone in the armed forces struggling with their gender identity?
 
Treva: There is a lot more in place within the forces now to assist you through your transition. Yeah, you may get a bit of hassle, but you have to be strong no matter what, to get through Transition. Don't wait and try later in life, say something and go for it.

I understand the British Army now allows serving soldiers to transition and remain in the Army. Is this right? Or am I misunderstanding?
 
Treva: No, that is correct. There was a lass at my last unit that was going through transition. They now help in any way that they can.

What are you doing for a living now?
 
Treva: I am retarded-- I mean retired! (laughs) But if you wanted to put a job title to my name, I would be the house wife. I look after my step kids, with packed lunches, take them to school, push them with homework, do all the cooking as my wife hates cooking, make sure my youngest step son has all his medication as he has health problems. Vicky spends most of her time typing for various book projects.

The press reports that you are taking hormones you have bought off the Internet. Please tell me this isn't true!
 
Treva: This is no longer true. I was getting my meds off the internet after months of research and seeing reports from a private GID [Gender Identity Disorder] doctor. I started self medicating on a very low dose and gradually worked my way up to a higher dose. But I wouldn't recommend this. After deciding to tell my GP and getting referred to a GIC [Gender Identity Clinic] I was then asked to stop my blockers, this was to get my hormone levels as close to my before-medication levels. This then shocked my system, making me lose weight, lose hair and lose all the other bits you get on hormones. After a few months on the NHS [National Health Service] I am finally getting the hormones on an even keel, I think!
Accepting: Victoria

Victoria, there was clearly a lifelong friendship (chemistry?) between you and Trevor. Looking back, did you see any hints of Trevor's gender dysphoria?
 
Victoria: I didn't see any hints as such, but when I looked into his eyes I thought there was a sadness I couldn't put my finger on. Every time I met up, I would ask what it was that he was keeping from me. At one point I was sent a random email from Trevor that had details of a Trans website. I was going to ask him outright but chickened out-- I mean how on earth do I ask someone that's a manly soldier if he is trans? We then lost contact for a little time.

How did Trevor first tell you about wanting to transition? What were your feelings at that time?
 
Victoria: We were emailing each other, something we did every now and then, touching base and seeing how each of us was doing. He said that he wanted to tell me something, so whilst on MSN instant messaging each other, about 2006-7 he just told me straight out. I can't remember exactly what was said and I didn't save the messages but it was along the lines of "I should have been a woman".

I cried like a baby, not because I was gutted that he was going to at some point be a she, but he could have told me years ago. I was at the time training to be a psychologist and wanted to help those who felt this way, I also worked for a photographic company that made people over to bring out their feminine side, and Trevor knew this but still didn't say anything.

Then it hit me that my sweetheart was suffering, and I desperately wanted to hold Trevor and tell him I will be there for him through this. I realised that this explained so much about how he was during his teenage years, why he always looked sad. I felt like I needed to be with Trevor even more from that point on.

You say you worked for a company doing trans makeovers. Can you tell me a bit more about that?
 
Victoria: It wasn't a company that just did trans makeovers, it was a photographic studio that was willing to do trans makeovers, so we had a few customers but not many as we didn't advertise this. The first makeover I did, it took the customer two attempts to go through with the full makeover and then they became very emotional when shown the end result. I think, along with my psychotherapy, that this has given me the opportunity to not fear what Treva is going through, but to empathise and want to understand more.

How did you first get introduced to Treva? How did you feel?
 
Victoria: Well Treva wasn't Treva to begin with: she was Clare, and I made her over. I really wanted to do this and it was an amazing moment. I was so nervous and so was Treva, mainly because I wanted her to feel special and she was showing me this side to her that she had never shown to another soul. She had never told anyone. I felt privileged. That same night I asked her to marry me with a big blue diamond ring. She said yes (smiles).  

Treva, being made up by the woman you love and then being proposed to must be close to heaven for some of us. Can you tell us a bit about your feelings at that point?
 
Treva: I was just full of nerves. Nobody had seen me dressed, never mind making me over. And when Victoria proposed I was overcome with joy and happiness and every other happy emotion that you could think of.

Victoria, you say you proposed to Treva. What made you take this decision? Didn't you think that marrying a trans person might create a heap of problems?
 
Victoria: Treva asked me to marry her in 1993, but due to other fears I said no. She told me that she would not ask me again and it was my turn to ask her. Many years later, she tells me about who she truly is and I didn't want to run a mile, I just wanted to be close to her so she wasn't alone. I had to wait years again to get any chance of asking her to marry me. As far as I am concerned, I love the person, and if Treva was born trans then so be it. I often wonder why a person wouldn't still love someone just because they are born this way. I don't totally understand why anyone would run a mile. I am not saying it isn't full of difficult situations but it has made us both very open and close to each other, a lot more so than most marriages.
 
Was getting used to the idea of Treva a quick thing, or did it take you a while to come around?
 
Victoria: Her transition has been so gradual that I don't feel like I had to get used to anything. We spoke about what she wanted at length before we moved in together, so there was no real "getting used to". For me it was more like getting used to living with a woman, having never had to live with a woman before and being a bit of a tomboy myself, I do get a little annoyed with her beautifying herself. But then I look at her and want to thank her for allowing me to be part of her life, she is so beautiful.
Treva

Is Treva a different person from Trevor?

Victoria: Hell yes! She is totally different, because Trevor acted the big man and yet she is shy and reserved and sweet. Trevor is more football and scooters (1960's Lambretta scooters) and Treva still likes her football and scooters but just a milder version. It's difficult to explain really.

Question to both of you. You got married as a man and a woman. Did you contemplate getting married while both wearing dresses?
 
Victoria: I wanted her to but no one knew about her.
 
Treva: We even thought about doing it as a joke (according to others) but we decided not to in the end. Victoria is currently pestering me to marry her again and I have to wear a "heavy, can't breathe, need at least two people to take me to the loo", full-on dress. I am trying to convince her otherwise.
 
Victoria: She will wear a wedding dress. I am a very determined person.

Victoria, tell me about your book.
 
Victoria: I wrote a book about what it has been like so far living with Treva as she transitions. It's my diary. You can find it on Amazon, in either paperback or for the Kindle. It's called Too Deep.

I also have a website. You can find a link to my book via my website. I currently have a survey on my website that I am looking for people who are going through and have been through Transition to fill in for me. It's about 18 questions long and I need as many different accounts as possible.

I am currently writing my next two books. One is Too Deep Two; this is the next part as we enter the NHS, and the other is a book about other people's experiences. I have found that trawling through the internet when Treva was first starting her transition, there was no single place for honest accounts of other experiences, and we had read so much negative stuff it was depressing. I would like to show people that it's not all bad; doom and gloom.

I also have two children's books: My Special Step-mum Angelina, about a step-daddy who becomes step-mummy, and My Two Daddies, about a young boy adopted by a same-sex couple. I will be writing more children's books in the future.

What's the most difficult thing about having a transgender husband?
 
Victoria: The lack of testosterone causes a lack of libido. I find her so attractive and that's difficult. Having to think about what we are doing, who we will see and were we are going, and having to look for suitable toilets. And not being able to be spontaneous, due to the fact she still has to shave (we can't afford electrolysis and laser doesn't work on blond hair), we have to make sure her hair is good, etc. etc. Some days I do wish it was all done and we didn't have to think this way.

What's the best thing about having a transgender husband?
 
Victoria: Although it's bad for our purse, I do enjoy clothes shopping. At the moment it's getting a little difficult seeing the good things but hopefully it will get easier-- then perhaps I could answer this question a little better.

"It's getting a little difficult seeing the good things". What do you mean by that?

Victoria: It's not that Treva and I are unhappy together. It's more the fact that we have to go through so much. I hate the fact that she has to go through years of "real life experience" just to get to the point of surgery referral; getting hormones wrong and things going pear shaped because of this; the fear of going to new places; the wondering which toilets she can use without causing problems.

I mean, use the men's and get beaten up, use the women's and get some female complaining, use the disabled and get someone complaining, and this can all be in front of my children. Some people don't seem to think before reacting. I hate the fact we are stared at. What happens if we go some place and she needs to use the toilet but there is no option to her? Then we have to come home just so she can pee.

We have to think about whether we can stay out before facial hair starts showing through. We have to think about how the children are at school: are they being picked on? Does anyone make comments to them at school? Are they happy? We have few friends and worry about what other parents say to their children if asked about Treva.

Then Treva is so down about how she looks and that is difficult to watch. It does take some strength to stay positive. It is by no means easy and you have to have a very strong and open relationship. You have to be able to talk to each other. I must admit I find it difficult to talk to Treva about how I am feeling because I keep thinking that it's nothing in comparison to how she must be feeling. Treva tells me off for this. But, after all that we are both close, we hold on to each other through each step and hoop-jump Treva has to do, and we always tell each other how much we love each other every single day. So, given time, it will get better-- I hope.

We both have our fears of the future but we try not to dwell on that as we don't know what's around the corner. At the moment we are struggling a little due to hormones not being right, but we take each day as it comes. And yes: everything Treva goes through is referred to as a "we" thing.    
 
What advice would you give to another woman who finds out her husband has a feminine side?
 
Victoria: To take into account that it's taken a lot for your husband to have told you this. There could be various reasons he didn't tell you, from not wanting to admit it himself to the fear of losing everything.

Telling someone you love is difficult. Take a deep breath and listen to your husband; and talk: don't blame and don't shout. Don't reply with anger. I get that it can be difficult to understand why your husband hasn't told you before, but please listen first before making any decisions, and don't be swayed by any negativity, You may find that you will become far closer than you could have ever imagined if you talk. And if you decide that you love your husband enough to stay, then hold on: it's gonna be one hell of a rollercoaster ride. You will cry, you will grieve, but to see the happiness can be equally overwhelming.

Question to both of you. What famous person would you most like to meet, and why?
 
Victoria: Angelina Jolie, because she has done exactly what I would do if I had her money: I would adopt. I find her fascinating and she comes across like a person you could really sit down and have a chat to. Either that or Tom Hanks, so I can tell him that he is the single best actor ever to grace this planet.
Dishy: Gino D'Acampo
 
Treva: Gino D'Acampo. Not sure you know who he is! He is an Italian chef and I would love to have cooking lessons with him.

===

This has been one of my longer interviews, but I thought it was worth including all of Victoria's and Treva's replies because I thought they were interesting and revealing.

There are two things about this couple which are especially worthy of interest. First, Victoria is a woman who not only accepted Treva's transition, she completely embraced it. This is no everyday occurrence. It seems to me that Victoria's acceptance of Treva was immediate and complete: no period of hesitation, of negotiating boundaries, of coming to terms with it. Nonetheless, by her own admission, it hasn't been easy by any means, and Victoria has faced (indeed, they both continue to face) some very difficult situations in their daily lives.

But Treva is fortunate indeed: few relationships seem to survive transition unscathed, and finding someone special post-transition seems to be a difficult road for many. This, at least, is one obstacle Treva doesn't have to face.

Second, Treva survived two decades in the Army, an environment which has a reputation for being profoundly transphobic and homophobic. Jan Hamilton spoke of joining the Army as a means to "prove" her masculinity. I think there are quite a lot of transgender people in careers such as the military, the police, and other "masculine" professions, and I think the reason for this is that some, at least, deliberately sign up for those careers in the hope that it will "make a man out of them".

For Treva, this seems not to be the case. From this interview, it seems Trevor was a troubled youth, and was seen to be such by his peers and teachers. I wonder if this was because Trevor knew at that age he felt he carried a secret he could not bear to share with others. In any case, it seems that Trevor joined the Army because he felt he had few other options open.

I do wonder about the armed forces. There has been a spate of transgender soldiers telling their stories lately: Jan Hamilton, Cate McGregor, Kristin Beck (and I am aware of some transgender stories from much older people who served in conflicts long finished). I suspect that this is the small tip of a very large iceberg, and I wonder both about how many military people are already transgender, and what the armed forces (of any country) would do if they all came out at once! I have collected material for another blog post about this topic.

Meanwhile, my thanks to Victoria and Treva for their patience with my questions, and for providing photographs from their personal collection to illustrate this blog post. Victoria promises to let me know if they renew their vows in wedding dresses. I close with a reminder to check out Victoria's book or to read her blog.

For my exclusive interview with Jan Hamilton, now Abigail Austen, click here.
 

          The Late Lunch Briefing        
I will be taking a couple of weeks out after today, so my postings will become far less frequent, though I do hope to get the odd thing up – not least the PMQs Battle on Wednesdays. Today’s Late Lunch Briefing is just a quickie...

The Latest Poll – Bad News for the Tories

ICM has released its latest polling figures – the first pollster to do so in light of the nationalisation of Northern Rock – and it makes miserable reading for the Tories. They are unchanged on 37%, but Labour are actually up two points on 34%. ICM, it should be noted, have been the harshest on the Tory share of late, but the fact Labour has gone up post NR is a telling story in itself. All this ties in with the growing perception that the government have handled this latest episode of the Northern Rock debacle fairly well; and that their decision making has been far more sensible than the option that the Tories want to pursue.

To Cut or Not to Cut

The same poll has said that a significant number of people want to see some sort of tax cuts or sustained spending. The obvious thing for the Tories to do is promise tax cuts therefore you might think. But it is an absolute minefield for them and really sums up the difficulties the Tories face if they are ever to get a serious, general election winning lead over Labour. As soon as they start to promise tax cuts the first thing everyone thinks about is the NHS. Get the Tories on the NHS and they become the nasty party again. In fact, get them on tax cuts and they are easily painted as the nasty party again because everyone assumes cuts in key public services.

However, unless the Tories do something they are simply unelectable – as poll after poll, month after month has shown. They are going to have to be very clever in how they position any public spending policies or they will be taken to the cleaners. But Cameron and Osborne will sooner or later have to take a risk – when they do this very much depends on when an election is going to be called and how itchy the right of the party get about the Cameron leadership. If the right start to sense that they are on to another hiding with Cameron in charge, expect them to become more and more vocal and the Tories to become more and more un-electable. But, a 3% lead in the polls is simply not good enough for the Tories.

Dangerous times ahead

Forget Labour being “in between a Rock and a hard place” with their banking issues, long term it is the Tories who are firmly wedged between the rock and hard place – they are damned if do and they are damned if they don’t. I will be very interested to see what effect NR nationalisation has had on the other pollsters’ polls.


          The Poliblogs 13 February 2008        

Darling getting it wrong again

Under Blair, Labour was never so foolish as to come into direct conflict with the City. The government tiptoed around it in an effort to nurture the powerhouse of the British economy. But led by Brown, with Darling as Chancellor, they are now clumsily treading on the collective toes of many in the business community.

Adam Smith

Time to go on the offensive on Europe?

It’s pretty much a given in the Liberal Democrats that the party doesn’t talk about Europe in its leaflets. It’s with good cause too. Firstly, it isn’t actually one of the top concerns of voters when they are asked in opinion polls what their biggest issues are. Just like electoral reform, it comes well down the list after all the big ones like health, education, crime, transport and so on. But also, there is an understandable reluctance for Lib Dems to talk about an issue on which it is perceived that the party is out of touch with the voters.

Anders Hanson

Spreading democracy...

Foreign Secretary David Miliband today makes the argument for military intervention to 'spread democracy'. So, according to The Guardian (although it is less than clear in the text) Britain and its partners have a 'moral imperitive' to use force to 'spread democracy'. Gone is the requirement for some sort of facade, no more humanitarian intervention to defeat tyrants terrorising their own people, not even a 'sexed-up' excuse to wipe out fantasy weapons of mass destruction... no, the moral argument for spreading democracy will be sufficient for us to send our forces off to die, and to kill.

Bob Piper

They really don't want you to have a referendum

Labour is clearly rattled by the row over it reneging on its promise of a referendum on the EU Constitution. Not content with threatening to withdraw the whip from Labour MPs who support honouring this manifesto commitment, Labour is engaged in a desperate attempt to discredit the cross-party ‘I want a referendum campaign’.

Coffee House

Should we subsidise the arts?

Should there really be tax breaks for donations to the arts, as Paul Myners and Nicholas Serota demand here? The Pigovian case for such tax breaks is well-known; without them, there’d be an under-supply of such public goods. However, the egalitarian case for such breaks is very shaky, as this recent paper discusses. It argues that donations to the arts can actually increase inequalities of well-being in two ways - even leaving aside the possibility that such donations are really intended to boost the ego of the donor.

Liberal Conspiracy

Frank Field: Right theory, Wrong practice

Labour MP Frank Field has had to put up with a lot over the years - not least being ousted from Blair's first government for being too radical and since then being treated by his own side as if he's about to defect to the Conservatives. Well, today Frank launched rather interested reform plans that would charge people who earn over £150,000 a year an extra 10% tax which could be offset totally through donations to charity. You can read the BBC report here.

Little’s Log

Foul emission in London

Up in London the Livingstone beast is at it again. He is going to charge the owners of Chelsea Tractors £25 a day for taking their gas guzzlers into “town”. It will not affect me. I have only driven in London twice in the last six months and the Crippen Toyota Previa (four children, Ken, what else can we do?) has relatively modest emissions. As Iain Dale vehemently points out, the charge will not apply in some of the most congested parts of London, such as Crouch End and Willesdon. The people most affected will be voting for Boris anyway.

NHS Blog Doctor

Prime Minister Balls?

In a fascinating post, Robert shows how the Tories are doing Alistair Darling harm by sympathising with him. The Chancellor may be replaced by Ed Balls so they present Darling as a decent man treated awfully by bossy Brown. They want to spread discord and paranoia because it suits their own ends. But at the root of the Balls for Chancellor movement, is a prospect even more worrying for the nation: it is that Ed Balls appears convinced he is the natural next Labour leader. Can I be alone in finding this idea preposterous?

Three Line Whip

Voodoo polling corner

A sudden outbreak of voodoo polling this morning, or more to the point a sudden outbreak of serious newspapers reporting a voodoo poll as being meaningful. What’s a voodoo poll? It’s what Bob Worcester calls the little “press the red button to vote” polls on Sky News, or the little readers’ votes things on the BBC website. They are entertaining enough, but they mean nothing whatsoever, they don’t measure the opinion of a representative group of people, they only measure the opinions of people who wander past that particular website (or are directed to said website by people trying to influence the poll) and care enough about the issue to vote…often several times if they know how to delete cookies from their computer.

Polling Report


          Comment on Harga HP BlackBerry Curve 9360 by Jayanta        
Counting how many I've used sin. Not including 天地線 :p, I've used 11 cell peonhs in 11 years...6 Ericsson/SE, 2 Nokia, 2 寒jai, 1 panasonic. Notwithstanding the number, I just found good 'basic' functions come before anything - communication. no eager to be online given short commune time to office. Camera... not using that before; though having used that more frequently recently, likely have to resume non-use mode. But I care for walkman function ga... the sound quality of sony walkman works well for me.Anyways, your 7 years 1 cell phone are really amazing.
          Actuar con rapidez ante un ataque de ácido es fundamental para reducir las secuelas        
Las personas que involuntariamente asisten a un ataque con ácido pueden marcar una diferencia importante en las consecuencias, ya que si actúan con rapidez pueden reducir las secuelas en la población atacada, según un estudio realizado por médicos de Barts Health NHS Trust y el Real Colegio de Medicina de Emergencia.
          Let us be grateful for our wonderful NHS staff        
I WISH to express my thanks to the Royal Worcestershire Hospital for an urgent appointment in five days with the acute stroke unit as a day patient.
          The Turnout 2 - On Homeopathy, with Michael Marshall        
For the 2nd episode of The Turnout I spoke with journalist Michael Marshall of The Good Thinking Society (as well as the Be Reasonable podcast and others). Michael was the man behind the 10:23 campaign which was a ... mass overdose of homeopathy outside branches of Boots UK in several major cities throughout the country, to publicly demonstrate the inefficacy of homeopathic products and protest against their sale. I asked Michael about the history of homeopathy and what it actually is, or indeed isn't. I also asked him about it's availability on the NHS in various parts of the country and what should be done about it. We also got on to some of the wider dangers of "medicines" that are not based on any solid science. Hope you enjoy LINKS https://twitter.com/MrMMarsh http://www.merseysideskeptics.org.uk/category/podcast/be-reasonable-podcast/ http://www.merseysideskeptics.org.uk/category/podcast/inkredulous-podcast/ http://goodthinkingsociety.org/ http://michaelgreenwell.wordpress.com/ https://twitter.com/mgreenwell
          ScotIndyPod 94 - Philippa Whitford        
For the 94th episode of the Scottish Independence Podcast I spoke to Philippa Whitford. Philippa is an NHS doctor and has been making some of the best speeches of the entire Independence Campaign. Specifically she has been outlining why the Scottish NHS is more than just under threat if there is a No vote, it is in fact in serious trouble. In the podcast we talked about why that is the case but we also talked about the broader independence campaign and what we thought Yes activists can do to push us over the line. Finally, as ever, I asked my guest their personal reasons for supporting Scottish Independence. Hope you enjoy…
          ScotIndyPod 82 - Out And About 1        
There are so many Independence and Yes events going on around the country now that it is very hard to keep track of them. MP3s and youtube videos are going up all the time. With that in mind, this is the first in a series of podcasts I'll be putting together using some of the best ones to give you the chance to hear them without searching too far. Each one will have different speakers from independent independents, people in the different parties and/or groups at these events. In this first episode the contributions come from a wide variety of sources. The first is a contribution from John Ainslie of Scottish CND who lays the facts out pretty succinctly on trident. Next up is a contribution from poet Rachel McCrum who talks about her journey from Northern Ireland to living in Scotland and supporting a Yes vote. The penultimate is our mystery man, that's all I'm saying. The final speaker in this episode is Dr Philippa Whitford, who is a consultant breast surgeon in Kilmarnock, on what is going to happen to the NHS in Scotland if there is a No vote, and it won't be pretty. Hope You Enjoy, and tell your friends...
          PKU funding battle: Family wins High Court challenge over drug – BBC News        
‘The family of a seven-year-old boy whose condition could cause brain damage have won a High Court challenge over an NHS decision not to fund a life-changing drug.’ Full StoryBBC News, 8th August 2017Source: www.bbc.co.uk
          Connor Sparrowhawk death: NHS clinician admits string of failings – The Guardian        
‘A consultant psychiatrist has admitted a string of failings over the death of a vulnerable teenager who drowned in a bath at an NHS care unit.’ Full StoryThe Guardian, 7th August 2017Source: www.theguardian.com
          Mother's Day        
Beautiful!

Despite a freezing cold wind and grey skies for some of the week, this weekend has been absolutely beautiful: clear blue skies setting a vibrant backdrop to the daffodils, primroses, forget-me-nots and whatever other flowers it is that grace our garden. Even Nana's camellia is flowering pinkly (which has not happened since it was savoured by deer in its early years).

I have been trying to get exercise every day, which is a great excuse for a walk to the bluebell woods as they sprout. This week I surprised a number of deer, pheasants and a squirrel as I ambled past, which somehow makes me very happy.
Rosie has been unwell with a very sore chest this week, leading to a pleasing encounter with the apothecary but a much less appealing visit to a walk-in clinic at A&E. How can the NHS get it so right, and yet so wrong?

Nevertheless she managed to perform at another Museum Showoff event, with support from friends including her sister. Vicki was delighted to report that Rosie was very funny and really good, taking a quick snap which I hope neither will mind me sharing for posterity.
Both were kind enough to let family know quickly that they were safe when a madman caused mayhem on Westminster Bridge. Thank heavens for WhatsApp.

On Friday night I was out for dinner, staying up until gone 3am chatting, which meant that I inadvertently drank waaay too much wine. That bright sunlight on Saturday morning was for once not the most welcome sight, and did not lead to a pleasant drive home. Fortunately, however, Max was just leaving for rugby (a really good game against an unbeaten side that they lost in the last ten minutes and in which Max played well) and Martin had taken himself off for a solo sail, so I was able to take to my bed and sit au soleil to recover.

And then my lovely Mother's Day started! Max brought Vicki home from Winchester, and they tricked me into thinking they were going out for a takeaway... and brought home Ben! So a jolly evening was had by all.
Enjoying the sun on bacon hill
Then this morning Max cooked us all breakfast, I received some great books and fascinating 'modular chocolates' (Complements), then sat in the garden reading the paper whilst there was some business in the kitchen. Then it was off to visit Sandham Memorial Chapel and a walk up Beacon Hill, where Vicki produced an amazing picnic with bubbly, delicious homemade crackers and dips, followed by coffee and fresh brownies!
Yay, bubbly at the beacon!
The dregs!
So now I am sipping a G&T as Ben cooks our evening meal, before Max drops Vicki back to her train. Rosie sent me some beautiful tulips, Martin is checking whether our camping gear is in any fit state to lend to lil' brother, and we are planning where to go on our first proper sail of the year next Sunday. May the weather oblige.




          The Monday Musing - The best iPhone games to play outside        

Look, it's Monday. The sun's out, the birds are chirping, the bees are looking at the birds lasciviously. It's beautiful and we're all probably stuck doing our jobs so we can pay rent and do boring things like make sure we don't die.

But if you're lucky enough to have today off, and don't want to spend your time cooped up, what's a mobile gamer to do? Well, that's the question we're going to try and answer in this here Monday Musing. Yup, this was all heading somewhere.

These are mobile games that get you outside in the real world. You can download them by clicking the emboldened links below. And if there's anything you want to recommend then make sure you do just that in the comments at the bottom of the article.

Pokemon GO

This is the big one. It's an AR adventure that lets you go into the real world and nab as many of the pocket monsters as you can. Walk about and you can hatch Poke-eggs as well. Different Pokemon pop up in different places, so you're going to need to spread your wings if you want to catch them all.

Read the Pocket Gamer review here

The Walk


A mystery game created in conjunction with the NHS in the UK. It's all ab…

Click here to read more.


          NHS Left With Unpaid Bill Worth £350,000 After Nigerian Woman Flew To UK To Give Birth To Twins        

The NHS was left with an unpaid bill totaling nearly £350,000 after a woman from Nigeria flew to the UK before giving birth to twins. In 2015, the unidentified woman delivered twins at Luton and Dunstable University Hospital via Caesarean section. The infants were admitted to the intensive care ward after their birth. Altogether, the woman’s [...]

The post NHS Left With Unpaid Bill Worth £350,000 After Nigerian Woman Flew To UK To Give Birth To Twins appeared first on Knights Templar International.


          Super Bug MRSA, in for a Dressing Down        
The spread of MRSA has baffled experts and in a new move to contain the spread, NHS trust has brought about a ruling tha
          Comment on Number of children getting enough physical activity drops by 40% by Elaine        
Maybe the role of competition in primary schools needs to be examined, in driving out any enjoyment of being active.. and the role of play - more play time in which children can be active, more space and more outdoor learning to encourage active learning over learning at desks... maybe the impending obesoty epidemic and associated NHS bill will get the government thinking differently ..... there is always hope!...
          Buy Cheap Designer Glasses In UK - Oakes Opticians        
Oakes Opticians is a family owned business providing value and care since 2010 serving the local Huddersfield community and beyond. They offer wide selection of frame choice at reasonably competitive prices and more importantly bespoke eye examinations prioritising the patient at the forefront. They have over 20 years of combined optical staff experience. They have invested in the latest technology and often provide a longer eye test appointments compared to your average high street opticians. Their opticians have regularly diagnosed and referred patients with conditions such as Glaucoma, Diabetes and Cataracts. They are the only opticians within the area to offer a late evening appointment which is a big advantage to the 9 to 5 workers and school children.NHS Eye Care Our Services :1. cheap designer glasses UK2. cheapest contact lenses UK, 3.eye test Huddersfield,4. Huddersfield opticians5. sight test Huddersfield6. eye test in Huddersfield7.contact lenses Huddersfield,8. designer glasses Huddersfield,9. designer prescription glasses UK,10. eye specialist in Huddersfield,11. eye test Huddersfield,12. eye test in Huddersfield,13. free eye test Huddersfield,14. glasses Huddersfield,15. Huddersfield opticians,16. optician Huddersfield17. opticians Huddersfield18. opticians in Huddersfield,19. prescription glasses online UK 20. prescription glasses UK Visit: http://www.oakesopticians.co.uk/ call : 01484652670
          'We were both shocked – you don’t expect to have a stroke at such a young age' - Couple raise money for stroke victim        
TWO big-hearted residents have raised hundreds of pounds to thank NHS staff who helped a close friend recover following a serious illness.
          Communicating success: Peterborough Regional PR and Media Awards        

Winners on the night included the YMCA Cambridgeshire & Peterborough, for their Sleep Easy campaign; Peterborough & Stamford NHS Foundation Trust’s communications team, Speed Agency, Shine Charity, Opportunity Peterborough and Peterborough City Council. Peterborough Telegraph reporter Joel Lamy was named  the Journalist of the Year, in recognition of  covering Peterborough’s political landscape,  its politicians and […]

The post Communicating success: Peterborough Regional PR and Media Awards appeared first on The Moment Magazine.


          Helping to support affordable warmth in Peterborough          

Fuel poverty doesn’t often come up as a topic of conversation, but paying for energy bills can be a real area of concern for families across Peterborough. The basic definition of fuel poverty is when someone cannot afford to heat their home to an adequate temperature to maintain health and wellbeing – the NHS recommends […]

The post Helping to support affordable warmth in Peterborough   appeared first on The Moment Magazine.


          Call the midwife!         

FOR A WHILE IT HAS BEEN CONSIDERED THE NORM FOR BABIES TO BE BORN IN HOSPITAL, BUT WE’VE SEEN THAT CHANGE IN RECENT YEARS. WHY IS THAT? Prior to the 70s it was very much the norm to be born at home, but various things changed – the NHS grew, district hospitals were built, and […]

The post Call the midwife!  appeared first on The Moment Magazine.


          The main aim of Miliband’s speech today: expose the extent of Osborne’s planned spending cuts        
If the general election in May 2015 is fought on who is best placed to deal with the deficit, then the Labour party will lose. Both Labour and the Tories know this. Miliband will focus on living standards, the NHS and inequality. So why a major speech on the deficit today, six months before an election? And why a pledge to cut spending and the debt? Both the politics of what's going on, and the numbers that underline it, are important. The Labour leadership feel, quite rightly, that George Osborne wants to push public services off a cliff with unprecedented cuts. They lost the first fight on austerity, for reasons I outline here. But they recognise that if they don't fight Osborne back this time, he will once away get away with having the media debate on his own terms. Which is why Miliband's speech is important today.
          NHS trust launches HIV online chat support service        
IT IS the online service that aims to support those affected by HIV.
          Hospital staff celebrated at awards night        
THE fantastic care provided by nurses, midwives, healthcare assistants and allied health professionals across Hampshire Hospitals NHS Foundation Trust was celebrated at the annual Director of Nursing Awards.
          PICTURES: NHS campaigners march through Southampton        
Around 100 campaigners who are calling for the NHS to be saved marched through Southampton today
          Hampshire doctor handed national sepsis role        
A HAMPSHIRE Hospitals NHS Foundation Trust doctor will play a key role in improving how sepsis is managed across the country after being appointed as the National Clinical Sepsis Advisor.
          Hampshire expert set to play key role in managing sepsis        
A HAMPSHIRE Hospitals NHS Foundation Trust doctor will play a key role in improving how sepsis is managed across the country after being appointed as the national clinical sepsis advisor.
          NHS team takes on the Wolf challenge        
A TEAM of doctors and mammographers who work across Hampshire and the rest of the NHS Wessex Region are putting their own bodies on the line this weekend in The Wolf Run.
          Occupational health future workforce crisis: is the NHS the solution?        
A recent paper published in the British Medical Journal argues that to solve the occupational health future workforce crisis, OH...

The post Occupational health future workforce crisis: is the NHS the solution? appeared first on Personnel Today.


          Doctors call for occupational health service for all NHS staff        
The British Medical Association’s (BMA) annual representative meeting in June warned of “stress, fatigue, burnout, substance abuse and low morale”...

The post Doctors call for occupational health service for all NHS staff appeared first on Personnel Today.


          Le réseau NHS peaufine NHSbuntu, un dérivé d'Ubuntu destiné à remplacer l'offre Windows sur ses systèmes touchés par le ransomware WannaCry        
Le réseau NHS peaufine NHSbuntu, un dérivé d'Ubuntu
Destiné à remplacer l'offre Windows sur ses systèmes touchés par le ransomware WannaCry

Le réseau NHS en Angleterre fait partie des institutions qui ont le plus été atteintes par le ransomware WannaCry qui a commencé à sévir en mai dernier. On sait aujourd'hui que cela s'est produit à cause d'une forte adoption du système d'exploitation Windows XP en son sein. Des médecins de la structure ont décidé de modifier cette donne avec l'initiative « NHSbuntu Â»,...
          Social Marketing in Healthcare        
The NHS is struggling to keep up with rising demand. But what of preventive healthcare and how can this help the NHS respond to the challenges it’s facing? Perfect Circle believes in the power of social marketing to make change happen. Working with healthcare advertising agencies, the NHS and health trusts, they specialise in marketing health services, creating health marketing strategies and promoting life-changing NHS Marketing awareness schemes, leading to lifestyle change and health benefits.
                  
The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms used to describe the same condition. A type of eczema may be described by location (e.g., hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema and the term for the most common type of eczema (atopic eczema) interchangeably.
The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001 which simplifies the nomenclature of allergy-related diseases including atopic and allergic contact eczemas. Non-allergic eczemas are not affected by this proposal.

The classification below is ordered by incidence frequency.
Types of common eczemas
Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is an allergic disease believed to have a hereditary component and often runs in families whose members also have asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising. (L20)
Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate, for example). Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from one’s environment. (L23; L24; L56.1; L56.0)
Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder. (L30.8A; L85.0)


Seborrhoeic dermatitis or Seborrheic dermatitis ("cradle cap" in infants) is a condition sometimes classified as a form of eczema that is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless except in severe cases of cradle cap. In newborns it causes a thick, yellow crusty scalp rash called cradle cap, which seems related to lack of biotin and is often curable. (L21; L21.0)
Less common eczemas
Dyshidrosis (aka dyshidrotic e., pompholyx, vesicular palmoplantar dermatitis, housewife’s eczema) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching, which gets worse at night. A common type of hand eczema, it worsens in warm weather. (L30.1)
Discoid eczema (aka nummular e., exudative e., microbial e.) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go. (L30.0)
Venous eczema (aka gravitational e., stasis dermatitis, varicose e.) occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin and itching. The disorder predisposes to leg ulcers. (I83.1)
Dermatitis herpetiformis (aka Duhring’s Disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease, can often be put into remission with appropriate diet, and tends to get worse at night. (L13.0)
Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps. (L28.0; L28.1)
Autoeczematization (aka id reaction, autosensitization) is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection. (L30.2)
There are also eczemas overlaid by viral infections (e. herpeticum, e. vaccinatum), and eczemas resulting from underlying disease (e.g. lymphoma). Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.

Medications
[edit]Corticosteroids
Dermatitis is often treated with corticosteroids. They do not cure eczema, but are highly effective in controlling or suppressing symptoms in most cases.[5] For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone or desonide), whilst more severe cases require a higher-potency steroid (e.g. clobetasol propionate, fluocinonide). Medium-potency corticosteroids such as clobetasone butyrate (Eumovate), Betamethasone Valerate (Betnovate) or triamcinolone are also available. Generally medical practitioners will prescribe the less potent ones first before trying the more potent ones. In many countries, weak steroids can be purchased 'over the counter' (e.g., hydrocortisone in UK, United States, Germany, Czech Republic, Australia, Iceland), while the more potent ones require a prescription.
[edit]Side effects
Prolonged use of topical corticosteroids is thought to increase the risk of possible side effects, the most common of which is the skin becoming thin and fragile (atrophy).[6] Because of this, if used on the face or other delicate skin, only a low-strength steroid should be used. Additionally, high-strength steroids used over large areas, or under occlusion, may be significantly absorbed into the body, causing hypothalamic-pituitary-adrenal axis suppression (HPA axis suppression) Finally by their immunosuppressive action they can, if used without antibiotics or antifungal drugs, lead to some skin infections (fungal or bacterial). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma [8] or cataracts.
Because of the risks associated with this type of drug, a steroid of an appropriate strength should be sparingly applied only to control an episode of eczema. Once the desired response has been achieved, it should be discontinued and replaced with emollients as maintenance therapy. Corticosteroids are generally considered safe to use in the short- to medium-term for controlling eczema, with no significant side effects differing from treatment with non-steroidal ointment.
However, recent research has shown that topically applied corticosteroids did not significantly increase the risk of skin thinning, stretch marks or HPA axis suppression (and where such suppression did occur, it was mild and reversible where the corticosteroids were used for limited periods of time). Further, skin conditions are often under-treated because of fears of side effects. This has led some researchers to suggest that the usual dosage instructions should be changed from "Use sparingly" to "Apply enough to cover affected areas," and that specific dosage directions using "fingertip units" or FTU's be provided, along with photos to illustrate FTU's.
[edit]Other forms
In severe cases, oral cortisosteroids such as prednisolone or injections such as triamcinolone injections may also be prescribed. While these usually bring about rapid improvements, they should not be taken for any length of time and the eczema often returns to its previous level of severity once the medication is stopped. In the case of triamcinolone injections, a waiting period between treatments may be required.
[edit]Immunomodulators
Topical immunomodulators like pimecrolimus (Elidel and Douglan) and tacrolimus (Protopic) were developed after corticosteroid treatments, effectively suppressing the immune system in the affected area, and appear to yield better results in some populations. The U.S. Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products,[11] but many professional medical organizations disagree with the FDA's findings;
The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen's disease).
Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHS resources, when they are most appropriate to use.
In addition to cancer risk, there are other potential side effects with this class of drugs. Adverse reactions including severe flushing,headaches, flu-like syndrome, photosensitive reactivity and possible drug interactions with a variety of medications, alcohol and grapefruit.
Antibiotics
When the normal protective barrier of the skin is disrupted (dry and cracked), it allows easy entry for bacteria. Scratching by the patient both introduces infection and spreads it from one area to another. Any skin infection further irritates the skin and a rapid deterioration in the condition may ensue; the appropriate antibiotic should be given.
Immunosuppressants

When eczema is severe and does not respond to other forms of treatment, immunosuppressant drugs are sometimes prescribed. These dampen the immune system and can result in dramatic improvements to the patient's eczema. However, immunosuppressants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. In the UK, the most commonly used immunosuppressants for eczema are ciclosporin(Cyclosporine), azathioprine and methotrexate. These drugs were generally designed for other medical conditions but have been found to be effective against eczema. Commonly prescribed as an immunosuppressant in the United States for Eczema is the steroid Prednisone.
Itch relief

Anti-itch drugs, often antihistamine, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the Itch cycle).[citation needed], however,in eczema, the itch relief is often due to the sedative side effects of these drugs, rather than their specific antihistamine effect. Hence, sedating antihistamines such as promethazine (Phenergan) or diphenhydramine (Benadryl) are more effective at relieving itch than the newer, nonsedating antihistamines.
Capsaicin applied to the skin acts as a counter irritant (see: Gate control theory of nerve signal transmission).
Hydrocortisone applied to the skin aids in temporary itch relief.
Avoiding dry skin
Moisturizing
Eczema can be exacerbated by dryness of the skin. Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms.
Soaps and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. Instead, the use of moisturizing body wash, or an emollient like aqueous cream, will maintain natural skin oils and may reduce some of the need to moisturize the skin. Another option is to try bathing using colloidal oatmeal bath treatments. In addition to avoiding soap, other products that may dry the skin such as powders or perfume should also be avoided.
Moistening agents are called 'emollients'. In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients like aqueous cream may not have any effect on severely dry skin. Some common emollients for the relief of eczema include Oilatum, Balneum, Medi Oil, Diprobase, bath oils and aqueous cream. Sebexol, Epaderm ointment, Exederm and Eucerin lotion or cream may also be helpful with itching. Lotions or creams may be applied directly to the skin after bathing to lock in moisture. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. While creams are easy to apply, they are quickly absorbed into the skin, and therefore need frequent reapplication. Ointments, with less water content, stay on the skin for longer and need fewer applications, but they can be greasy and inconvenient. Steroids may also be mixed in with ointments.
For unbroken skin, direct application of waterproof tape with or without an emollient or prescription ointment can improve moisture levels and skin integrity which allows the skin to heal. This treatment regimen can also help prevent the skin from cracking, as well as put a stop to the itch cycle. The end result is reduced lichenification (the roughening of skin from repeated scratching). Taping works best on skin away from joints.
There is a disagreement whether baths are desirable or a necessary evil. For example, the Mayo Clinic advises against daily baths to avoid skin drying. On the other hand, the American Academy of Dermatology claims "it is a common misconception that bathing dries the skin and should be kept to a bare minimum" and recommends bathing to hydrate skin. They even suggest up to 3 short baths a day for people with severe eczema. According to them, a moisturizer should be applied within 3 minutes to trap the moisture from bath in the skin. U.S. National Eczema Association and the Eczema Society of Canada make similar recommendations.
Regardless of more or less frequent bathing, the hardness of the bathing water is a major factor. Soft water can have therapeutic effects for people with eczema currently using hard water. An ion exchange water softener can be installed (plumbing required) to reduce the hardness of the water supply.
Recently, ceramides, which are the major lipid constituent of the stratum corneum, have been used in the treatment of eczema. They are often one of the ingredients of modern moisturizers. These lipids were also successfully produced synthetically in the laboratory.
However, detergents are so ubiquitous in modern environments in items like tissues, and so persistent on surfaces, "safe" soaps are necessary to remove them from the skin in order to control eczema. Although most eczema recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, detergents and soaps are not the same and are not equally problematic to eczema sufferers. Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration").
Unfortunately there is no one agreed-upon best kind of skin cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin-friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms "hypoallergenic" and "doctor tested" are not regulated,[26] and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others. It may be best to avoid soaps and detergent cleansers all together, except for the armpits, groin and perianal areas, and use cheap bland emolients in the bath or shower, for example aqueous cream.
Dermatological recommendations in choosing a soap generally include:[citation needed]
Avoid harsh detergents or drying soaps
Choose a soap that has an oil or fat base
Use an unscented soap
Patch test your soap choice, by using it only on a small area until you are sure of its results
Use a non-soap based cleanser
Instructions for using soap:
Use soap sparingly
Avoid using washcloths, sponges, or loofahs, or anything that will abrade the skin
Use soap only on areas where it is necessary
Soap up only at the very end of your bath
Use a fragrance-free barrier-type moisturizer such as petroleum jelly before drying off
Use care when selecting lotion, soap, or perfumes to avoid suspected allergens; ask your doctor for recommendations
Never rub your skin dry, or else your skin's oil/moisture will be on the towel and not your body; pat dry instead
source from : wikipedia

          10 year-old quizzes NHS bosses        
Engaging use of the video interview format to make NHS strategy changes accessible to a wide audience:

As we enter the next phase of consultation on the Sustainability and Transformation Plan for our local NHS offer in mid and south Essex, Healthwatch Essex have asked a 10 year old girl ‘Healthwatch Harriet’ to quiz NHS bosses on what STP means and what is involved.

Mandy Ansell, Accountable Officer at Thurrock CCG said:

“All of us are guilty of talking about things in ways that make it hard for the person on the street to understand. Well done Healthwatch Essex, we thought this was a great way to explain things simply. We will be holding a public engagement event with Healthwatch Thurrock in March to talk about the re-organising of hospital services in mid and south Essex. Keep following our site for future updates and to book on to our workshops.”


           Online Course Benefits Newly Qualified Nurses        
Newly qualified nurses, midwives reported that Flying Start NHS - an online course had been useful in terms of clinical skills development and confidence.

          A tour for the Congresswoman        
U.S. Congresswoman Lynn Jenkins, right, shares a story with Holly Baker, chief of interpretation and resource management at the Fort Scott National Historic Site, and FSNHS Superintendent Betty Boyko...
          How to avoid Residential Care Costs in UK?        
Thousands of people have secured NHS Continuing Healthcare funding for themselves or their relatives. This package of care, funded solely by the NHS is awarded when a person’s primary need is a health need. if you are an UK Resident and paying for residential care costs in uk, then you should know How to avoid residential care costs in uk for you or loved ones. Continuing healthcare assessment can be carried out with the help of the Professional team of continuing healthcare experts by calling on 0844 248 3254
          Ransomware hackers have stolen hospitals and doctors' offices across the UK, using a leaked NSA cyberweapon        

25 NHS trusts and multiple doctors' practices in England and Scotland (but so far, not Northern Ireland or Wales) report that they have had to effectively shut down due to a massive Wcry ransomware infection that has stolen whole swathes of the English healthcare system in one go. The infection appears to exploit a bug that the NSA discovered and deliberately kept secret, only to have it revealed by the Shadow Brokers. (more…)


          Staff Nurse Jobs in Manchester – NHS Professional        
cmuh_september-2017-nhsp-flyer-min  Full-time, Permanent NHS Professional Staff Nurse Positions at Central Manchester NHS Foundation   *** Ongoing Skype Interviews Available for New Qualified and Experienced Nurses with current NMC registration ***     ** £1,000 ACCOMMODATION ALLOWANCE **     ABOUT THE TRUST The Trust comprises of Manchester Royal Infirmary, Saint Mary’s Hospital, Royal Manchester Children’s […]
          NHS Staff Nurse Jobs Close to London – Dartford & Gravesham NHS Trust        
dartford-and-gravesham-nhs-trust_skype-16th-august  The Kate Cowhig International Healthcare Recruitment team are seeking newly qualified and experienced Staff Nurses for full-time, permanent positions at Dartford and Gravesham NHS Trust   *** Skype interviews for vacancies across all areas will be conducted via Skype on 16th August 2017 ***   Dartford and Gravesham NHS Trust is a vibrant, friendly, forward thinking […]
          NHSP Staff Nurse Jobs in Nottingham, England        
nottingham-nhsp-flyer-ongoing-skype_no-dateNottingham University Hospitals NHS Trust in partnership with NHS Professionals is seeking applications for full-time positions in Medicine and Surgery.   *** Ongoing Skype Interviews Are Available Now for Newly Qualified & Experienced Nurses with  their NMC Pin or IELTS Certificate ***   Salary & Benefits  Salary £23,517 plus shift differential and over-time (depending on experience) Full-time […]
          Oxford University Hospitals NHS Foundation Trust – Staff Nurse Positions        
oxford-university-hospital_-general-skype-flyer-ongoing  Kate Cowhig International Healthcare Recruitment (KCR) is looking for excellent, compassionate and innovative registered general nurses to work at Oxford University Hospitals NHS Foundation Trust. The Trust has permanent full time positions in the following specialties:   Medicine, Cardiology, Respiratory, Stroke, Rehabilitation, Gastroenterology, Neurosciences, Surgery, Orthopaedics, Vascular, Urology, Cardiac, Operating Theatres, Recovery, and ICU   *** Newly […]
          September Interviews for NHS Staff Nurse Jobs in the South of England        
uhs-flyer_skype-1-sept_v2-min  Newly qualified and experienced nurses required for permanent Band 5 Staff Nurse positions at the University Hospital Southampton NHS foundation Trust, England.   *** Interviews in Portugal & Via Skype in September 2017 *** *** IELTS Support & Training Included for Successful Applicants ***   About the Trust:  University Hospital Southampton NHS Foundation Trust […]
          Comment on Two more consultations from the NHS white paper by Current consultations | ROLE network        
[...] Choice and control – 14 January 2011 [...]
          Pfizer fined record £84.2m for overcharging NHS – BBC News        
‘Drugs giant Pfizer has been fined a record £84.2m by the UK’s competition watchdog for overcharging the NHS for an anti-epilepsy drug.’ Full story BBC News, 7th December 2016 Source: www.bbc.co.uk
          Training in Healthcare, Personal Development, Sales and Marketing        
Maguire Training is well-known for providing different trainings management, marketing and NHS healthcare professionals. Their well-designed courses include personal development courses, non-clinical training in the NHS, sales and management courses and others. These courses are available in both online and offline method so one can do them at their own pace. Contact to know about their courses and applying through CESR- Certificate of Eligibility for Specialist Registration.
          Locksmiths Manchester        
Lodksmiths Manchester provide a fast and reliable service 24/7 for all of your lock, key and personal security needs. Guaranteed best prices and fastest response in the Manchester area. Always offering first class customer service that centres around your personal home security needs in the best way that suits you. Most locks can be accessed within minutes if you ever find yourself locked out of your home or business address and need fast entry. Use of non-destructive methods that cause little to no damage and can save you money and time. Prices from £38 and no hidden costs such as call out fees or VAT- just simple and fair prices. Locksmiths Manchester will always go the extra mile to ensure you are fully satisifed with the job that the team carries out and offers unlimited discounts of 50% to students, OAP's, NHS staff and the armed forces. Everyone should be entitled to a good standard of home security which is why Locksmiths Manchester only use the best and most current products on the market but for the most affordable and competitive prices. Rest assured that the team carry out a second to none service and have years of experience within the trade which allows them to use their skill to find a solution to suit you. Call Locksmiths Manchester on 0161 3123557 and speak to a friendly and helpful adviser or visit the website for more information at http://manchesterslocksmiths.co.uk/
          WHY THIS NHS PAY DISPUTE MATTERS TO US ALL        
The forthcoming NHS pay dispute is likely to involve up to 10 TUC and non-TUC affiliated unions taking some form of strike action, with all unions with members in the NHS involved in the wider campaign. At the time of writing, Unison, Unite, GMB and, significantly the Royal College of Midwives have already announced overwhelming [...]
          West Suffolk NHS Foundation Trust Helps Save Lives with the Implementation of Extreme’s Solutions        
Introduction As one of the leading hospitals in the United Kingdom, West Suffolk NHS Foundation Trust (West Suffolk Hospital) is...

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          First weigh in        
I went to the NHS weight loss group today, it was good, the talk was about fluids which was very informative. My w eight was 11st 12lbs.
          Computer working        
Well I found out that there was no problem with my computer, I usually leave such things to Michael but decided last night that something must be done, this morning after my brekkie I switched it on to find that there was never a problem(touch wood) don't know why it locked up but at least it is OK now.
The non holiday I had earlier this year still bothers me so again I have taken action and contacted something called Lets Talk Wellbeing, it is run by the NHS but it is self referral, I ...
          Boris Johnson should be jailed over Brexit claims, says ex-David Davis aide        

In series of tweets, James Chapman asks ministers hard questions about leaving EU and calls for new party to avoid ‘catastrophe’

The former chief of staff to David Davis has said Brexit is a catastrophe, and suggested that Boris Johnson and other leading Brexit campaigners should be jailed for claiming there would be an extra £350m a week for the NHS after the UK left the European Union.

James Chapman, a former special adviser who now works for a public relations firm, expressed his real views about leaving the EU in an online tirade after working for the Brexit secretary for a year at the Department for Exiting the European Union.

Related: The three ‘whats’ of leaving the EU – Brexit Means podcast

Past time for sensible MPs in all parties to admit Brexit is a catastrophe, come together In new party if need be, and reverse it #euref19

Hello @chrisgraylingmp - can you confirm airlines won't be able to sell 80% of flights from next March? How are bilateral deals coming?

Has govt yet corrected ministers' claims Brexit will not limit cancer treatments, now condemned as false by every expert body in the land?

There won't just be one punishment budget if Brexit proceeds GBH. A decade of them as businesses flee and revenues collapse #brexitbonus https://t.co/DiHknLpPwm

It's nice to know there are a few fellow Tories who share my deepest concerns about Brexit & in particular HardB. policy of HMG & Labour opp https://t.co/rPQjkEY3XI

Continue reading...
           Do NHS libraries have a role in providing information to patients, carers and the public?         
Brettle, A and Ormandy, P 2008, Do NHS libraries have a role in providing information to patients, carers and the public? , North West Health Care Libraries Unit.
           Do NHS libraries have a role in providing information for patient care?         
Brettle, A and Ormandy, P 2008, Do NHS libraries have a role in providing information for patient care? , Project Report, University of Salford, Salford.
          Experience: I am a professional mermaid        

I ordered my tail online. Custom-made from silicone and neoprene, it weighs two stone and cost me £800

I grew up in St Ives, on the Cornish coast, so as a child I spent a lot of time in the water. The sea has always fascinated me. The film Splash was a huge part of my childhood and people even called me a mermaid because I spent so much time underwater. But then I grew up.

In 2015 I was in a relationship with someone who lived in London. I was in my mid-20s and thought the big city lifestyle was what I wanted, so I decided to move to the capital to be with her. I found a job with the NHS but unfortunately my relationship soon fell apart. I didn’t have a support network in London and it was lonely. The anxiety I’d always suffered from became extreme, and I developed symptoms of post-traumatic stress disorder. I couldn’t eat or sleep, had night sweats and all-day tremors. After five months in London I decided to hand in my notice and drive home to Cornwall. It was a life-saving decision.

Continue reading...
          "who does the wolf love?"        
posted by k

In my brief and ineffectual period of political involvement – back in the 1970s - I learnt some of the rules about elections. I saw how counts were conducted and scrutinised, I discovered that there were limits on party spending in any constituency – and that they started the moment a candidate stopped being called the “prospective party candidate” after his official adoption for the seat, and I learnt the rules on treating.


“Treating” is regarded in electoral law as a form of bribing the electorate. I learnt that the rules were so strict that if I was working in a committee room on election day, I'd have to pay for any coffee and biscuits I consumed, even though the committee room was in the house of a personal friend. If I didn't pay for my mid-morning snack, that could either be regarded as a bribe to vote for the candidate I supported or as payment for my services, in which case it could topple the allowed expenses for the constituency over the permitted maximum.


Things seem to have changed, according to Craig Murray's account of Jack Straw's campaign in Blackburn. Jack Straw, the Secretary of State for Justice, seems happy to invite 700 people for free, sit-down dinners. It sounds like the sort of practice that led to laws against treating. He's been getting away with it for years so, unless the rules have changed, I suppose he's found some way round the law. I wonder what it is.

All politicians offer bribes to voters. The party manifestos are full of them. There are promises to help you if you're poor, rich, old, young, married, officially partnered. There are even bribes for the dead – the Conservative Party's rhetoric talks of a “death tax,” as though people would rather pay more in taxes when still alive. (Nobody seems to have noticed the way the conservatives' proposed marriage allowance deprives the widows and abandoned, whose taxes will rise by £150 a year, as if to punish them for the loss of a partner.)

There's something disturbing about this focus on bribing the electorate. Media stories repeatedly tell voters that it's fine – even praiseworthy – to vote entirely out of self-interest. Self-interest is bound to play a part. I know the world most vividly from my own experience and that is bound to influence my decisions. But there's more to it than that. As citizens in a democracy, we should also be asked to consider the good of the whole. I want to vote for more than “bread and circuses.”

There's nothing indecent in caring for the well-being of others – even people I haven't met. Most people are more generous and unselfish than they realise. If I look around, I see daily acts of kindness and courtesy – cruelty and selfishness are still unusual enough to be shocking. People who can barely afford it give money to charitable appeals. Marathon runners ask for sponsorship – often to help people they don't know – and their friends are happy to sponsor them. People who express hatred or mistrust for a minority group (Muslims, asylum seekers, gay people) rarely live out that hatred in their daily lives but make ever more exceptions for the likeable individuals they encounter.


Away from elections, citizens also care about big political questions and international responsibility. At the lowest estimate, 1 in 50 members of the entire British population made their way to one of the big anti-war demonstrations on 15th February, 2003. They were supported by millions more. This wasn't a selfish impulse but a real political concern which the government chose to attack, misrepresent and finally ignore. Huge numbers of people are concerned about poverty overseas and pollution of the environment. Beside the concerns of the people, the scope of the leaders' debates and media reporting seems rather narrow, as though voters are being encouraged to vote only from self-interest.

Even if we were all to vote from self-interest, we don't have the information we need. The three candidates for chancellor agreed in their debate that cuts would be brutal – harsher than under Thatcher – but none of the leaders is prepared to turn to the voters and explain precisely what they plan for us. The Financial Times on 26th April laid out the kind of cuts we might expect; according to their simulator, using government figures, cuts of £30 – 40 billion, which all parties agree we need, would require the following cuts or their equivalent:

" a 5 per cent cut in public sector pay; freezing benefits for a year; means-testing child benefit; abolishing winter fuel payments and free television licences; reducing prison numbers by a quarter; axing the two planned aircraft carriers; withdrawing free bus passes for pensioners; delaying Crossrail for three years; halving roads maintenance; stopping school building; halving the spending on teaching assistants and NHS dentistry; and cutting funding to Scotland and Wales by 10 per cent."

None of the parties is talking about cuts on this scale – and no-one seems to be addressing the knock-on effect such cuts would have. If large groups of people have less money to spend, a large number of businesses will collapse – and that will lead to more unemployment and, presumably, higher spending on benefits. It's a nasty cycle and no-one is talking about how we shall ever get out of it – or whether we need to adjust our way of life.


This election should have been an opportunity to discuss questions of equality and the distribution of wealth. These are vital questions in a democracy. Wealth buys influence – and that may be the strongest political argument for its more equal distribution. There are also important ways in which the poor are not free.

During this election, the media have encouraged us to see the political parties as purveyors of treats and promises. What they offer sounds more alluring than a cup of instant coffee and a biscuit – or even a plate of curry. But the rewards we're offered may prove insubstantial – and they're a pretty poor substitute for a grown-up and thoughtful political debate.


          Liberté, Egalité, Fraternité        
posted by k

The Liberal Democrats are conferring this weekend. A long time ago I used to attend Liberal Assemblies - they weren't conferences then but altogether unwieldier bodies where debates were taken seriously as the means of changing party policy and, through that, the country and the world.

I left the Liberals on a point of policy in the early 1980s. Since then, the Liberals have merged with the Social Democrats although there are still liberals within the new party. There seem to be other changes too. There's concern with security. When I joined, in my late teens, Assemblies were a place where I might find myself sitting next to a Member of Parliament, a peer or - even in those days - a celebrity supporter. It was remarkably easy to take part in eager discussions of policy though hard to get called to speak - there were so many keen to debate.

If I couldn't get called to speak at the main debates, I had a chance to express my views at a range of smaller fringe meetings. And I'd wander round the stalls run by a range of organisations and have conversations with the stall-holders. I remember some of the organisations who ran stalls and fringe meetings. The Campaign for Homosexual Equality was there. So were the National Council for Civil Liberties and the Child Poverty Action Group. I remember these in particular because they challenged some of my assumptions and told me facts I hadn't previously known. The Liberal Assembly was a place where people actually changed their minds.

These days there are still stalls and fringe meetings. But it's all much glossier. As the Conference Directory says, "The Liberal Democrat Conferences have become increasingly professional as the party has become increasingly professional." I'm suspicious of the term "professional." It can be used to mean simply that someone has particular qualifications or behaves in a responsible manner. But it can also be used to urge that loyalty to an employer is more important than telling the truth or questioning the principles of a business or institution.

In the case of the Liberal Democrat Conference, one of the things professional seems to mean is sponsorship. The conference is marketed at potential sponsors as "
a fantastic opportunity for companies, societies and organisations to meet thousands of conference attendees face-to-face and increase their brand awareness." I don't know what they pay for these opportunities but I am anxious at some of the organisations paying for access to delegates during debates about national policy.

All fringe meetings to do with health are in an area sponsored by Humana, a profit-making company which works on "NHS commissioning" in the United Kingdom and in the lucrative field of health insurance in the United States. A meeting on "Culture: Today and Tomorrow" is sponsored by Camelot, who are also represented on the panel. Similarly, a fringe panel on "The Future for Home Ownership" is sponsored by Lloyds who have a place on the panel. The National Landlords Association, which includes "promoting ... members' interests to national and local government" among its aims is also represented.

Obviously organisations should be able to stimulate debates and talk to people who are politically active. I may feel doubts about The British Association for Shooting and Conservation who, with The Angling Trust, are sponsoring "The Rural Reception" at which senior MPs are speaking (and for which drinks and canapés are provided). However, campaigning organisations have engaged in dialogue with party politicians for a long time. It seems reasonable that unions and even newspapers should sponsor events or advertise in the conference programme. Politically active people are likely to join unions and read newspapers.
I'm surprised that publicly-funded organisations and charities find money for sponsorship or think it a worthwhile cost - what do they get in return?

But as I look through the list of sponsors, I find some names that puzzle me: Dr Foster Intelligence, Ernst & Young, Bloomberg, Tesco, The Nuclear Industry Association. And why is Asda, wholly owned by the U.S. company Wal-Mart, sponsoring a fringe meeting on "Imagining New Britain: Forging a New National Identity"?

The current Liberal Democrats - just like Labour and the Conservatives - are taking money from big business. They are even advertising privileged access to Members of the British and European Parliament. Monday at the Conference is "Corporate Day" when "senior business leaders" can "meet and engage with "senior parliamentarians". Party leader Nick Clegg and Shadow Chancellor Vince Cable will be there - and there will be a reception at the end of the day. I don't suppose places are free. It sounds like cash for access to me.

Parties may need to sell advertising and access in order to be taken seriously. And it's important to be taken seriously in politics - small parties and independents don't get the same publicity or access to public debates, as ex-Ambassador Craig Murray discovered in the recent Norwich North by-election. But all this sponsorship seems a long way from what I remember of Liberal Assemblies.

Liberalism has been defined in many ways recently. Some commentators in the United States equate it with Marxism. In Europe it's often seen as a right-wing force in politics. For me it is neither.

Back in 1978, I heard Gerard Mulholland define the principles of Liberalism. He spoke as follows:

“The first principle of Liberalism … is freedom to live one’s life free from legal restraints, except those which stop your freedom from interfering with somebody else’s.

“The next principle is equality before the law and social and economic opportunity to enjoy life, liberty and the pursuit of happiness without discrimination against caste, creed, politics, race or sex.

“The third principle is the brotherhood of all people everywhere, with tolerance for the things we dislike, forbearance for the things we don’t understand and joyful celebration of the things we share.

“It all adds up to progress towards a fair and just society for the only race that matters – the human race.”


The principles he stated were rooted in 17th and 18th century debates on individual liberty. They were passed on like the copy of Milton's Areopagitica which was handed to every new president of the Liberal Party. The interpretation has developed over time but they still seem like good principles to me.

Parties which are dependent on the sponsorship and goodwill of wealthy organisations and big business are a long way from the ideals of liberalism. It doesn't sound much like democracy either.


          Stopping Smoking        
Stopping smoking is the single most helpful thing you can do to improve your health and the health of the people around you.  Every year more and more people quit smoking, and enjoy the better health, wealth, lifestyle and life expectancy this can bring. Getting NHS support really works – it can be four times [&hellip
          Security message on recent Ransomware attacks (WannaCry worm)        
(In case it helps, here is an email I sent today to all of PhotoBox Group Technology team)

Hi all Tech (TL;DR: high risk of Ransomware, see list of recommendations below)

As you probably have seen in the news, there has been a wide spread Ransomware attack which affected large number of companies worldwide, and is bound to cause more damage next week.

The attack is called Ransomware (a play on Ransom + Software) and has the business model of encrypting all files the affected computer has access to, and then asking for a ransom (i.e. payment) to decrypt the files.

What makes this attack dangerous, is that it's also a self-propagating worm. Once it runs on a machine, it will scan the local network and compromise computers not patched with the MS17-010 - Critical security update released by Microsoft in March (and yesterday for XP) . Once in the new infected computer, it will continue scanning (if connected to other networks) and eventually start encrypting all files. See Troy Hunt's post for a really nice technical explanation of this issue.

As far as we can tell, we have not been impacted with this WannaCry attack (although we have add Ransomware incidents in the past). This is more down to luck and maybe the fact that this security researcher managed to hit a 'kill switch' by accident (which btw, could have a way to re-enable itself).

It is important to note that this attack is severely limited by the criminal's simple business model (pay $300 per affected computer). This would had been much, much worse, if the attackers corrupted/disclosed the data, and had a much higher ransom price. So when the NHS says that no patient data has been compromised this is more to do with the limited attackers business model vs the NHS ability to protect that data  (i.e. the malicious code had access to patient data, but chose to 'only' encrypt it'). The analogy here is "Imagine that the criminals broke into a bank, had access to all customer records + the money stored in the vault, and the only thing they did, was to change the locks of the font doors and vault").


Note that this kind of attack is also moving to the cloud. See "Look out for the Google Docs phishing worm" and "Why the Google Docs worm was so convincing".


In terms of our ability to detect and mitigate against these type of attacks, we are not in a good shape, and really depend on your help. 

Here are some recommendations that we would like you to follow:

As a user:

  • Install latest Security Updates (vs 'install it later tomorrow')
  • Be careful when clicking on links, and only download apps/executables from known/trusted sources
  • If you think you have been compromised:
    • Communicate to the Group Security Team as soon as possible (#security on slack)
    • unplug device from network and shut it down as soon as possible
  • Avoid at maximum to plug in non-company laptops/devices to our network (and if you have to, ask local IT support to take a look at that laptop's security)
  • Double check that your data is backed-up regularly (daily or hourly) so that when you/we are hit with RansomWare (which would encrypt those files), the amount of data lost would be minimal
  • Reduce the amount of data (and file shares) that you have access to (namely internal or customer's PII (Personally Identifiable Information))
  • Ask for your laptop/desktop to be rebuilt regularly (helps to understand the 'what is not currently backed')
  • Use 2FA (two factor-authentication) for your most important accounts
  • Use a Password Manager
  • Encrypt sensitive data (when not in use)
If you run as an admin (or manage your IT infrastructure):
  • Ensure Security Patches are automatically installed
  • Enable your Firewall and set it to block incoming connections (apart from some white-listed ports)
  • Ensure anti-virus are installed and automatically updated
  • Don't use old Operating Systems (if we have OSes that we can't patch, there are a couple mitigations we can do, like "disabling SMB")
  • Don't run as admin, ideally creating low privilege accounts to browse the Internet + read emails, or even better, create VMs dedicated for Internet Browsing and email handling
  • Use git as an backup strategy since it will give you version-control and easy re-install (assuming you push it to GitHub)
  • Review the current 3rd party VPN connections to our network from 3rd party companies
  • Help to identify current Risks so that we can proactively find solutions for them (to be involved please see the OwaspSAMM and JIRA Risk mapping activities currently under way)
From a detection point of view, at the moment our best bet is the Dark Trace service that we manage. This is a passive monitoring service which 'should' give us an alert if worms like WannaCry are set lose in our network. In the medium term I would like us to have a more proactive solution in place, where the damage is minimised when (not if) an malicious link was clicked or when (not if) malicious code is running in our network. 


For now we really depend on you to keep our data and our customers magical moments safe.

Finally, to give you an idea on who to talk about any of this issues, here is a brief intro to our current PBX Group Security team:
  • Clare and Dilek are our Risk management and policies rock stars and the ones that proactively are help us to manage our risk
  • Naushad is our resident hacker (on the good/light side of the Force) which helps us to hack ourselves first and is currently helping to setup a SOC (Security Operations Centre) so that we can have a much better view on what is going on, and are able to effectively (and pragmatically) react to events
  • XYZ and Antoine are part of our NIS (Network Information Security) team, and are also very actively (50% of their time) in the setup of the SOC (which will be a service made available to all teams, and will leverage existing investments in log management and visualisation systems)
  • Anders is the one managing all Security Activities and helping to create the FY18 Security strategy (you know him from his previous TechOps role)
Note that we are still quite a bit far off from the team, infrastructure and services that we need to have in place to protect all PBX Group brands and customers (which is why we really need your help in securing our world).

Don't hesitate to contact any of the team members if you have any questions, concerns or ideas.

Thanks for you help

Dinis Cruz
CISO PhotoBox Group

          Bio Identicals        
It is fantastic to see that more attention is being paid to the importance of the menopause, estrogen deficiency and its consequences, both in respect to symptoms and later health.

Since publication of the NICE guideline on diagnosis and management of the menopause in November 2015, more clarity has been provided about treatment options, although the information has not yet reached everyone with many women and some healthcare professionals still expressing confusion around benefits and risks of Hormone Replacement Therapy (HRT) in particular.

Sensationalist headlines do little to dispel myths, and indeed are more likely to add to the confusion. However, I do strongly believe that enough evidence has now been provided and thoroughly analysed such that the time has come to view HRT as a very useful option for controlling menopausal symptoms and providing later health benefits with little risk for the majority of women.

HRT is an obvious option to consider when treating menopausal symptoms which are caused by estrogen deficiency, since its aim is to replace estrogen. In women who have not had a hysterectomy, progestogen or progesterone is added to the estrogen to prevent the estrogen stimulating and causing a thickening of the womb lining (the endometrium).

Different types and routes of both estrogen and progestogen are available and the type and route chosen are determined by each woman’s preference, as well as the type of symptoms that she is experiencing, her medical and family history and any other current medication.

Individualisation is essential.

This may appear straight forward so far. However, an increasing concern is the development of practitioners prescribing “compounded bio identical hormones” which are promoted as being natural and individually prepared to best suit the hormonal needs of individual women. The term “Bio identicals” refers to hormones that very closely resemble estradiol, estriol, estrone (all types of naturally occurring estrogen), progesterone, dehydroepiandrosterone (DHEA), and testosterone as produced by the human ovary and adrenal gland. While the message of replacing hormones which are very like the hormones that we produce ourselves until the menopause seems sensible, hormones are being provided by compounding pharmacies which are not standardised or government approved in terms of content, dose and balance between estrogen and progesterone.

Compounding bio identical pharmacies have been practicing in USA for a number of years and have recently appeared in the UK. Investigations in the USA are being reported. In 2001 the Food and Drug Administration (FDA) collected and analysed 29 compounded drugs. Two of the compounded hormone drugs failed analytical tests because of contamination risks.

In 2012 “More” magazine commissioned laboratory tests of bio identical hormones produced by 12 compounding pharmacies. It was found that these hormones were of unreliable potency and would not meet the standards for the FDA requirements for commercially manufactured drugs and in fact because of the variable hormone levels, concern was expressed that endometrial cancer risk could be increased.

When considering the use of HRT, emphasis on risk has been widely publicised over recent years and it is understandable that women may wish to take hormones which are seen to be as natural as possible and closely resemble women’s own hormones.

What is often not realised is that both estrogen and progesterone can be prescribed as standardised, regulated, government approved HRT in ways that very closely mimic our own hormones. These preparations which are available with NHS prescriptions could also be described as “bio identical” and are prescribed in approved forms.

The difference between hormones prescribed in compounding pharmacies and those prescribed in approved forms is that while some of the basic hormones used in both settings may be the same, ie estroegn and progesterone, the amounts and balance between estrogen and progesterone are not provided in regulated, approved forms in compounding pharmacies such that the stimulating effect of the estroegn on the endometrium may not be adequately balanced by the progesterone provided.

This has raised concerns about these compounded combinations leading to increased risk of endometrial cancer, and cases have been reported. In approved regulated forms of HRT, the appropriate dose and balance has been thoroughly investigated. Use of the term “bioidenticals” is in itself confusing and misleading and better would be to adopt the terms—government approved, or non-government approved hormone therapy.

Another concern is that compounding pharmacies may recommend blood tests or saliva tests to supposedly determine hormone requirements and to assess response to treatment, all at a cost to the woman. While there are some situations when measuring hormone levels by blood test may be useful, saliva levels are of no benefit and blood tests are rarely helpful or required. Better is to start treatment in standardised doses and measure response by effect on symptoms and presence or not of side effects.

Finally, it should be noted that individualisation is indeed the key and that even the use of natural type estrogen and progesterone in government regulated and approved form may not suit the woman. It is always necessary to be prepared that often changes in type and/or route of hormone therapy may be required to provide treatment which provides benefit while minimising side effects, but at all times regulated, government approved hormones should be used rather than compounded, non-government approved hormones.

Recently published national and international guidelines support this advice with NICE guideline on Diagnosis and Management of Menopause stating “..bio identical formulations that are compounded for an individual woman according to a healthcare provider’s prescription are not subject to government regulations or tested for safety or quality and purity of constituents, therefore their efficacy and safety are unknown”.

The recently updated International Menopause Society recommendations on women’s midlife health and menopause hormone therapy state that “Prescribing of compounded BHT is not recommended due to the lack of quality control and regulatory oversight associated with these products, together with lack of evidence of safety and efficacy.”
--




          Award winning Menopause Magazine, what is it all about?        
The Menopause affects ALL women and is a phase of significant hormonal, physical and psychological change. While all women are affected very differently, they should all have access to accurate, non-biased information to empower them to make informed choices about the management of their menopause. At Menopause Matters, our mission is to provide such information and support. To achieve this aim,Menopause Matters Ltd was founded in 2001, and in January 2002 launched what is now the leading UK based, award winning menopause website www.menopausematters.co.uk attracting an average of 4,500 visitors per day.
To provide essential information and support in a complementary, glossy format, reach a wider audience, and satisfy an evident need for a hard copy resource, Menopause Matters magazine was launched in summer 2005. Menopause Matters magazine is currently the only magazine of its kind, written specifically for women approaching and experiencing the menopause. Menopause Matters combines medical facts with glamour in an upbeat, readable style. Menopause Matters magazines are posted out to individual subscribers, GP's surgeries and menopause clinics and to gyms and yoga studios. While our print run has increased, so too has the use of our website where the online magazine can be viewed, the two mediums complementing and promoting each other, achieving our aim of a continued increase in the use of both.
With the medical background and knowledge of Dr Heather Currie, a national expert in Women’s Health and the menopause, the editorial skills and extensive publishing experience of Mr Andrew MacKay, the website expertise of Mr Rik Moncur and the advertising expertise of Mrs Annie Preuss, this innovative team cross public and private sector, medical and non-medical boundaries to provide accessible, accurate, readable, attractive information and support which is essential for all women.
Surveys of both women and health professionals showed:
  • 90% considered Menopause Matters to be very useful
  • 96% found Menopause Matters content good or very good
  • 91% found the advertisements useful
  • 90% said that the magazines were received well or very well by patients
  • 97% wish to keep receiving the magazines
  • 99% felt that the magazines should be available in all GP’s surgeries and menopause clinics
  • 98% felt that Menopause Matters helped women be better informed
While providing general menopause information, Menopause Matters magazine also sensitively tackles embarrassing menopause related topics, enabling women to understand, seek help when necessary and go on to lead as healthy, full lives as possible. With current NHS constraints, Menopause Matters goes a long way in empowering women to cope with an inevitable health process, without necessarily needing to use NHS resources.
 
Testimonials
I have just picked up a copy of 'Menopause Matters' at the GP surgery and I found it really refreshing and confidence boosting - the fact that somebody out there believes that we 55+ women are not on the sexual decline was heartening and in particular, that vaginal atrophy is treatable. I want to thank you sincerely for producing this magazine which offers such a ray of light in the apparent gloaming. You have given me such great hope.
I am sure there must be many colleagues who equally find balancing careers with the menopause a real challenge.............I cannot thank you enough for putting me back in the driver’s seat.
 
ALL females should have access to the magazine young & old!
 
Fabulous magazine. Really helpful tool and good for staff too
 
Brilliant. Magazines go like hot cakes
 
Excellent up to date glossy mag for ladies. I give copies to all my menopausal patients
 
Read by staff and patients alike – excellent
 
Please can we have some more magazines for the surgery- they go like hot cakes!
 
I just LOVE Menopause Matters magazine!  Thank you for sending to the United States.
 
My patients have found the magazines very useful, especially when they realised that other women had similar symptoms of the menopause to them and they were not alone.
 
Was just reading the articles in your last edition about STD issues in my age pocket, awesome piece!!! Glad to see someone getting the info out there!
 
Magazine extremely useful and allows women to look information for themselves and educates and builds confidence
 
Excellent resource for profession and public

          Comment on Press release – NICE and NHS England’s decision to deny access to new medicines is no April Fool’s Joke by An end to hope? - A Hunter's Life - Learning to Live with MPS II        
[…] MPS Society press release […]
          Ill-informed politicians and journalists kicking NHS PR professionals – again        
 The Telegraph has an incredibly ill-informed article on ‘NHS ‘spin bill’ soars as crisis grows’. Oh the irony of a journalist falling for a politician’s spin about spin. What galls is that I know that most of these politicians don’t really believe what… Continue Reading
           Public policy, power and time: a case study of community-based midwives in the NHS         
Bryson, Valerie and Deery, Ruth (2008) Public policy, power and time: a case study of community-based midwives in the NHS. In: University of Huddersfield Research Festival 2008, 25 Feb-13 March 2008, Huddersfield. (Unpublished)
          The Spending Plan policy 38: reform patient list auditing to cut NHS "ghost patients"        

Each day we are publishing a blog on one of the policies from our Spending Plan.
Click here to read them all.

In response to a written question from Valerie Vaz MP in 2013, health minister Norman Lamb revealed that in 2012 there were more than 55.7 million general practitioner registered patients in England, 104.2 per cent of the population. 


          The Spending Plan policy 37: raise the efficiency of NHS estates to match the top 25 per cent        

Each day we are publishing a blog on one of the policies from our Spending Plan.
Click here to read them all.

The amount of unused floor space on the entire NHS estate is equivalent to that used by nearly 14 trusts, according to the building consultancy EC Harris. They calculate that the NHS could save £3 billion a year by making better use of its vast estates and facilities, matching the efficiency of the top 25 per cent of trusts.

Savings that big would offer significant relief to trusts struggling with the increasing cost of delivering healthcare, and must surely factor as a key strand of meeting the £20 billion efficiency savings highlighted by the Nicholson challenge. NHS management must, as a matter of urgency, start to make better use of their existing property to save money and boost productivity. Staff within NHS trusts should be involved in this process, as they will no doubt have the best idea of what works and what doesn’t.

We have estimated that £3.6 billion could be saved by 2019–20 after adjusting for growth in the overall budget


          The Spending Plan policy 36: increase the extent of charges in the NHS        

Each day we are publishing a blog on one of the policies from our Spending Plan.
Click here to read them all.

The current model for funding the NHS is unsustainable in the long-term. As countries become better off, they spend more on healthcare as people live longer and technology improves. As outlined later, the NHS itself must undergo substantial reform to make it affordable in the long-term, but more immediately we must look at ways of paying for the growing costs of healthcare outside of general taxation. The think tank Reform proposed a comprehensive set of proposals to introduce charges for certain NHS services, such as prescriptions and GP appointments, from which those on low incomes could be exempt.

In France, for instance, GP appointments are charged for and then those on benefits can claim back the costs later. Introducing a price mechanism, even if the money is refunded, will help people to realise that healthcare is expensive and that nothing is "free".


          The Spending Plan policy 33: scrap national pay bargaining         

Each day we are publishing a blog on one of the policies from our Spending Plan.
Click here to read them all.

Moving towards greater regional differentiation of public sector pay would save money in two key ways:

  • In low-cost regions, staff wouldn’t have to be paid excessive salaries. Public sector staff in London are paid a small premium but given the much lower living costs, many staff outside London are often significantly better off than those doing the same job in London.
  • In high-cost regions, organisations wouldn’t have to hire expensive agency staff unnecessarily. In the NHS in particular they are often used because in richer areas with higher costs of living, trusts struggle to recruit the staff they need while offering national pay rates. So they hire agency staff where pay isn’t restricted. But that can have other adverse effects beyond the additional expense of hiring agency staff instead of permanent employees.

Introducing local or individual pay bargaining would also have two important beneficial side effects:

  • It would reduce the crowding out of the private sector in poorer regions.

  • It would improve standards and even save lives in richer areas of the country. With the cost of living much higher in the South East but pay for healthcare staff, for example, not sufficiently different to that in regions where the cost of living is lower, standards are compromised. A study for the London School of Economics found that centralised pay bargaining was having a significant effect on heart attack death rates. For a 10 per cent rise in wages outside the health service (a 10 per cent richer area), the heart attack death rate went up by between 4 and 8 per cent.

In 2012, Policy Exchange estimated the saving available at £6.3 billion. After adjusting for the Office for Budget Responsibility’s forecast for decline in the public sector pay bill, we estimate that this saving would fall to around £5.8 billion by 2020. Big public sector unions are extremely attached to centralised pay bargaining for obvious monopsonistic reasons. It also gives national trade union leaders prestige and importance. But tackling this problem has to be part of a package of reform to make public sector pay and pensions more affordable for taxpayers.


          Hire a Taxis in Southampton        
We are here with taxi services to make you tension free of travelling from one place to another from luggage as our drivers won’t let you allow to carry luggage and offers with smooth ride. We formed our company in 2010, with primary objective to help travelers with Southampton Taxis and we provide special discounts to NHS staff, Students and to the emergency services. We run with using latest technology of GPS/GPRS and are vehicles are well maintained and drivers are experienced and are holding with license so it’s safe to hire us.
          By: Simon@NHS CB        
Hi Mike Thank you for your comment. You can find the information on the <a href="https://www.england.nhs.uk/ourwork/d-com/spec-serv/crg/" rel="nofollow">clinical reference groups membership page</a>, along with a link to the application form. Kind regards Simon Digital Communications Officer NHS Commissioning Board
          By: Simon@NHS CB        
Hi Jayne Thank you for your comment. You can find details of which which clinical reference group (CRG) Chair posts are vacant on the <a href="https://www.england.nhs.uk/ourwork/d-com/spec-serv/crg/" rel="nofollow">CRG memberships page</a>, in the <a href="https://www.england.nhs.uk/wp-content/uploads/2013/01/crg-chairs.pdf" rel="nofollow">list of filled and vacant positions</a> document. The current Chairs were asked if they would like to continue in their role and Burns CRG was one of these. Kind regards Simon Digital Communications Officer NHS Commissioning Board
          By: Simon@NHS CB        
Hi Thank you for your comment. Craniofacial surgery will be in the Paediatric Surgery clinical reference group and skin cancer is in Specialised Cancer. Kind regards Simon Digital Communications Officer NHS Commissioning Board
          By: Simon@NHS CB        
Hi Dr Mohanty Thank you for your comment. Here is the direct link to the<a href="https://www.engage.england.nhs.uk/consultation/crg-member" rel="nofollow"> Clinical Members application form</a>. You can also find more information on the <a href="https://www.england.nhs.uk/ourwork/d-com/spec-serv/crg/" rel="nofollow">Clinical Reference Groups membership page</a>. Kind regards Simon Simon Dixon Digital Communications Officer NHS Commissioning Board
          How To Relieve Back Pain        
Perhaps the most important fact to know about disc surgery is that you probably don't need it. In a recent survey of people suffering with various forms of back pain, for every survey participant who had disc surgery, three others were told they probably had disc problems requiring surgery but found successful alternatives.

This widespread use of 'ruptured disc' as a diagnosis isn't surprising for two reasons. First, participants with severe, chronic back pain were typically referred by a doctor to an orthopedic surgeon or a neurosurgeon, either of whom was more likely than any other practitioner to suspect a ruptured disc or suggest surgery. Second, most survey participants who were told they needed surgery received a tentative diagnosis that was not borne out by diagnostic procedures.

This was the experience of Julia, a UK survey respondent: "I suffered acute back pain after about thirty years of on-and-off lower back pain and sciatica. I had an MRI scan which showed two discs blocking nerve paths. I had sciatica in both legs and was on
a morphine-based strong painkiller. My husband had to carry me to the toilet and I couldn't walk for a week. I had to attend the appointment with the surgeon on crutches and was put on the list for a "discectomy".

In the eight months that I waited my doctor referred me to the NHS physio and he gave me Pilates type exercises to do. It took a long time but I am now completely pain-free, having strengthened my "inner-core" muscles.'

There is a growing consensus among medical authorities that no more than 5 per cent of back sufferers require surgery. But the president of the American Holistic Medical Association is even more optimistic. He believes that fewer than 1 per cent of back sufferers have disc problems requiring surgery.

If surgery has been advised for you, survey participants' experience can help you choose a surgeon and avoid post-operative complications. The absence of skilled physiotherapy is one major reason for a poor outcome from surgery; scarring is another reason, Survey participants who didn't fare well after surgery tended to be abandoned - in spirit if not in fact - by doctors. You may also be interested to read about helpful alternatives to surgery that some of them tried.
To discover how to relieve back pain you first need to understand how your back works, and what make sit hurt. When you know that, getting rid of chronic back pain is not that hard to do if you can follow a few simple steps and maybe some exercises. Head over to helprelievebackpain.org to get the solutions.
          Stoptober        

It's the first of October. There are three charity things happening this month which have all appropriated an otherwise innocent chunk of autumn.

The first is Stoptober, an NHS attempt to make us give up smoking.
The second is Go Sober for October, a MacMillan Cancer Nurses initiative which speaks for itself.
The third is Octobeardfest, which comes from the Prostate Project, and is "inspired" by Movember.

All are worthy causes. All can be achieved (for men, anyway) with minimal effort.

As I don't smoke, haven't had a drink since December, and will be filming a TV series throughout this month, I can't take part in any of the above October-related fun.

But that doesn't mean you can't. So join me in feeling better about yourself and raising money for good causes by doing nothing in October.

It's easy.

Right now I am not really thinking about not drinking at all, which is a deliberate ploy. Partly because there's no point and partly because the urge to have a drink simply does not exist any longer, almost to the extent that I am feeling a little daunted about starting again. This will change in December as I start hassling people for sponsorship and planning some exploratory visits to pubs with friends in January.

So making it three-quarters of the way through the year has been unremarkable save for one unexpected exception. The dawning realisation that I am going to watch an entire season of Strictly Come Dancing sober.

After Saturday night, that might be more of a struggle than I anticipated.

.
          The Southern General....        
We are in the throws of the undignified name calling and ludicrous argument that passes for political debate over here. It will go on until May 7th when various reprobates will think they run the country. And hopefully keep out the way of those that actually do.

                                  
                                   The hospital is being transferred  from this  to this..

                                                                 The Death Star

Some things are  too important to be in the hands of politicians. I think Gordon Brown thought that  about interest rates and  handed  them over to the Bank of England.

The NHS is a popular football for the various political parties to kick around while most of us believe that it is too valuable to be in the hands of  any political party.

                                      
                                              The helicopter landing pad

I have always suffered from migraine but since February they have changed character. From the 'go away and leave me alone while my head feels like it is being skewered so I want to lie still and watch the kaleidoscope on my eyelids' type of migraine, to something much. much worse. Rolling on the floor, banging my head off the tiles, pulling hair out type of pain. Short lived, but brutal.
Even I reckoned this was not normal.

                                
                                                   new meets old or vice versa

Went to Gp and got stuff to stick up my nose as soon as the headache starts. This medicine works very well but gave no clue as to what was causing  the pain. He diagnosed cluster headache, often called the suicide headache because it is that painful. I am lucky that, with me, the pain is there and gone within thirty minutes and (so far) it is always in the small hours of the morning. But I can’t imagine living with that pain four or five times a day. If a patient does, the current treatment of choice is a having a brain stimulator surgically placed in the deep part in the brain to derail the signals.

                                   
                                          Fancy car park. With no spaces.


The only problem was my cluster headache is not in the part of the head that gives cluster headache. So the GP referred me for a neurological appointment at the Southern General Hospital, known by locals as the Suffering General. He said it was not urgent, the appointment may take a while to come through. The subtext of that ( and what the political debate is always about) is that the waiting list is a bit long at the moment. But just to make it clear, if you really need it, it will get done and the NHS will do it quickly. But if you can wait – you wait.  Neurology is always busy as for some of their patients, waiting is a matter of life and death. Mine wasn’t, Mine was just sore. So a routine appointment was requested and came through within two weeks. On a Sunday. Subtext,  so busy they were doing Sunday clearance clinics. I had a thorough consultation with a neurologist  who was very nice and very engaging. What did I think? What did she think? What did I think of what she thought? Why can I not have cluster headache in the same place as everybody else? Because it might not be cluster headache.

                                        
She recommended two MRI scans - brain  and neck. Not urgent. The appointment for the scan came through  two days later.  Eight o’clock in the morning.

                                          
                                                      Nice quiet surroundings for the patients


And that was this morning.

By now, the neurologist and I had been thinking about Arnold Chiari malformation which means the bone at the top of the spine is a bit wonky so bits of the brain start to slid down the spinal canal.  As you can imagine, that is a wee tad sore.

                                       
                                                   This hurts!

But I am consoled that it only happens to folk with big brains. That is not really true but it’s my blog so I can say what I like.


It used to be thought of as a fatal condition but as scanning gets better it has been realised that a few folk are walking about with various versions in various degrees of malformation with no symptoms what so ever.  Until something else annoys it. Like an old spinal fracture. Like mine.

                                        
                                                      Where exactly  do we walk?

And when the neurologist read about that, her little face lit up in a true light bulb moment.  That is now coming back to haunt you, she said with something approaching glee.  I was still with the theory of big brain in a wee head.

The Southern General is a big Glasgow Hospital, right on the side of the Clyde at Govan. It is slowly being rebuilt into a super hospital called the ‘death star’.  It has become a local talking point as it has been built with very little regard to patients.
And the fact that patients need transport.
And maybe need somewhere to park their car.

                                      

Driving around the Southern General building site for an hour and a half to get a parking place is common. Locals now need permits which they have to pay for, to park their own cars in the streets outside their own house. Promises of free buses, and patient transport have not yet come to fruition.  The radiologist who dealt with me parks in the garden centre a mile and a half away and walks it from there.

The hospital/ building site is about fifteen  minutes drive from my house so I left at six thirty am for my eight am scan and got the last parking space available on the first drive round. I sat in the car waiting and writing the next book while the builders in front of me kept taking their clothes on and off like some geriatric Coca Cola advert. I don’t know what they were wearing underneath their t shirts, but it needed ironing. The old jokes are the best.
                                  
The old hospital  was based in a Victorian Workhouse. If there was a fire,  patients had to be strapped  to their mattresses  and bounced down the stairs. The hospital then had big wards, a stern matron, no MRSA,  no talking back and stank of Dettol and boiled sprouts.
                                       
Now the whole scene is weird; builders everywhere, trucks, diggers, cement mixers, people walking around confused and lost, taxis doing u-turns, wheelchair users bumping up curbs, patients running from A to B, then B to A, posters telling folk where to go ( the posters have been drawn over as a new building was added or opened or closed ). There are over head tunnels temporarily connecting bits X to Z as Y has not been built yet.  To get to the scanner, I had to walk for about twenty minutes from my car, into a reception, upstairs, along a corridor, through a kitchen ( so it seemed), passed a few disused lift shafts,  all the time following a series of printed out signs sellotaped on the wall,  over tunnels, under ground until I bounced almost by accident into the MRI scanning reception. After the scan , the nurse took me by the hand,  across the hall, into an office, over some boxes and out a side door, and lo and behold, there was my car.

Once the superhospital is finished, there will  be rest stops, sherpas and Sat Navs.
                                      
So the scanner has not been moved to the new  bit yet so the waiting area was well worn, battle scarred and depressing. But it was spotlessly clean and the service was second to none. So what  if the gowns looked as though they have been washed to within an inch of their existence, the bit of the service that actually saves lives was running like a well oiled machine.

I was aware of the comedic drama the other patient  - some old guy who had been hauled in off the street outside for his scan  as he was having a last minute fag, and wouldn’t come in until he had finished.  I bet he was having a scan for a growth in his lung. He was round; five feet five in every direction and too breathless to undress himself.  And the nurses were great with him, humorous and cajoling but taking no nonsense.
                                       
                                             Fried egg roll, black coffee and notebook!


After a hour of being zapped and blasted, I climbed into the small Fiat and drove round  (and round and round) to the garden  centre…. Just to chill before going back home on the motorway.
                                       
                                                  goodies at the garden centre....

                                         
                                                These are the size of one of small asteroid.

                                         


                                        


                                            


And did some more writing...
                                                               The view out my writing room window!



Caro Ramsay  17 04 2015

          Î ÏÎ¿Î²Î»Î®Î¼Î±Ï„α στα νοσοκομεία στη Βρετανία μετά από κυβερνοεπίθεση        
Η Υπηρεσία Εθνικής Υγείας της Βρετανίας ανακοίνωσε σήμερα ότι αποκρίνεται σε επίθεση στον κυβερνοχώρο, η οποία όπως ανέφεραν νοσοκομεία στη χώρα τα ανάγκασε να αναβάλουν ραντεβού και να παραπέμψουν αλλού ασθενείς. «Είμαστε ενήμεροι για ένα περιστατικό ασφάλειας στον κυβερνοχώρο και εργαζόμαστε σε μια απόκριση», δήλωσε εκπρόσωπος του NHS Digital, μιας διεύθυνσης του NHS [Εθνικού Συστήματος ...
          Information sheets for the Year 9 options        
Originally posted on SNHS Science:
General details about the options available to Year 9 students can be seen by clicking on the following and then openning the pdf on the next page. IGCSE IN BIOLOGY IGCSE IN CHEMISTRY IGCSE IN COORDINATED SCIENCE 2015 IGCSE IN PHYSICS 2015 On the options form you should indicate your choices…
           Evidence-based commissioning in the English NHS : who uses which sources of evidence? A survey 2010/2011         
Clarke, Aileen, Taylor-Phillips, Sian, Swan, Jacky, Gkeredakis, Emmanouil, Mills, Penny, Nicolini, Davide, Powell, John, Roginski, Claudia, Scarbrough, Harry and Grove, Amy L.. (2013) Evidence-based commissioning in the English NHS : who uses which sources of evidence? A survey 2010/2011. BMJ Open, Volume 3 (Number 5). Article number e002714. ISSN 2044-6055
           Reducing attendances and waits in emergency departments : a systematic review of present innovations         
Cooke, Matthew, Fisher, Joanne, Dale, Jeremy, McLeod, Eileen, Szczepura, Ala, Walley, Paul and Wilson, Sue (2004) Reducing attendances and waits in emergency departments : a systematic review of present innovations. [London]: [National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)]. ( ).
           A stakeholder derived framework for safety assessment in the NHS case management programme         
Jones, Sarahjane (2014) A stakeholder derived framework for safety assessment in the NHS case management programme. PhD thesis, University of Warwick.
           Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008 : ecological study         
Keown, Patrick, Weich, Scott, Bhui, Kamaldeep and Scott, Jan. (2011) Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008 : ecological study. BMJ, Vol.343 . d3736. ISSN 0959-8138
           Facilitating technology adoption in the NHS : negotiating the organisational and policy context : a qualitative study         
Llewellyn, Sue, Procter, Rob, Harvey, Gill, Maniatopoulos, Gregory and Boyd, Alan. (2014) Facilitating technology adoption in the NHS : negotiating the organisational and policy context : a qualitative study. Health Services and Delivery Research, Volume 2 (Number 23). ISSN 2050-4349
           In defence of the NHS : why writing to the House of Lords was necessary         
McKee, Martin, Pollock, Allyson M., Clarke, Aileen, McCoy, David, Middleton, John, Raine, Rosalind and Scott-Samuel, Alex. (2011) In defence of the NHS : why writing to the House of Lords was necessary. BMJ, Vol.343 . d6535. ISSN 0959-535X
           NHS research ethics committees : still need more common sense and less bureaucracy         
Robinson, Louise E., Murdoch-Eaton, Deborah and Carter, Yvonne. (2007) NHS research ethics committees : still need more common sense and less bureaucracy. BMJ, Vol.335 (No.7609). p. 6. ISSN 0959-535X
           Short stay emergency admissions to a West Midlands NHS Trust : a longitudinal descriptive study, 2002–2005         
Sibly, E., Wiskin, C. M., Holder, Roger L. and Cooke, Matthew (Professor of clinical systems design). (2007) Short stay emergency admissions to a West Midlands NHS Trust : a longitudinal descriptive study, 2002–2005. Emergency Medicine Journal, Vol.24 (No.8). pp. 553-557. ISSN 1472-0205
          Does this mean I wouldn't be allowed to wear my Port Power Tie?        
From

BBC News
Thanks Arbroath.


Novelty sock

Novelty socks ban plan for medics


Doctors, nurses and health visitors in Lancashire could be banned from wearing novelty socks to work.
The proposed ban is part of a uniform policy which would also stop staff from having tight clothes, unusual hairstyles or excessive tattoos.

The East Lancashire Hospitals NHS Trust said it wanted a "corporate image which presents a professional and business-like approach".

But a Conservative MP has labelled the policy "completely daft".

Lynn Wissett, director of clinical care, said: "Many of our staff work with very sick or dying patients and the policy is intended to make sure that our staff present a professional image at all times.

"Our staff and members of the public have told us is that we need to spell out clearly what is and isn't acceptable in relation to personal appearance, dress, grooming and hygiene."

'Silly socks'

Ms Wissett added that the trust would adopt a "common sense" approach to such issues.

The board met to discuss the issue on Wednesday but Nigel Evans, Conservative MP for the Ribble Valley, said the policy "should not be a priority for the NHS".

"I would have said that in children's wards it would be compulsory to wear silly socks," he said.

"I think people would prefer to see happy doctors and nurses - it's dictatorial and it's over the top.

"It's completely daft, this cannot be a priority for the NHS."
          Boato: PL que cancela CNH após 30 dias de vencimento não existe        

Uma notícia falsa, publicada hoje, assustou muitos condutores. De acordo com o falso texto, o Senado teria aprovado um PLS que cancela CNHs com mais de 30 dias de vencimento.

O post Boato: PL que cancela CNH após 30 dias de vencimento não existe apareceu primeiro em Portal do Trânsito.


          Will the British Working Class Stand Up and Fight Back?        
I spent my teenage years in 1980s Thatcher’s Britain. Working-class people struggled in a grim environment. Three million people were unemployed, local services and the NHS were underfunded, and attacks were launched against unions (as a result of the miners’ … Continue reading
          Eastipedia: NHS        
NHS  is a national program that recognizes students for excellence in scholarship, service, leadership and character. Its chapter at East is looked upon favorably by colleges and shows the high-achieving qualities of each of the candidates. To be considered for National Honors Society, students must have 3.5 or higher unweighted GPA. Invitations are mailed to […]
          Parceiros e Fornecedores da Casa Verde Cozinha Ética no EARTH FEST        
O blog do EARTH FEST  :)




Promete ser um grande evento!

Vão até lá e provem o que vos estamos a preparar.

A cafetaria está entregue à COZINHA ÉTICA - uma parceria inédita entre:

Lucie Rousset (cozinheira) ligada à Escolinha da Aldeia das Amoreiras (Alentejo)  lucie.rousset@yahoo.fr

Monte Mimo (Rita Magalhães - cozinheira) https://montemimo.wordpress.com/

Souto Queimado (Joana Gil Nave - cozinheira) http://soutoqueimado.blogspot.pt/


A Casa Verde e a Reco, escolheram criteriosamente para fornecedores:



Herdade do Carvalhoso http://www.herdadedecarvalhoso.pt/




Conservas de atum Santa Catarina http://www.atumsantacatarina.com/

Casa do Sal da Figueira da Foz http://www.casadosal.pt/

A Milene do Monte Vale de Água (Alentejo)

Amoraterra* Bacelos (Silvia Henriques, Alentejo) amoraterra.bacelos@gmail.com 

e outra vez o Souto Queimado, a Lucie Rousset, a Casa Verde e o Monte Mimo.


Estes fornecedores dão-nos garantias de termos alimentos produzidos sem envenenar a terra, pessoas e animais.

Para saber mais detalhes sobre os critérios dos produtos que escolhemos, apareçam por lá, degustem e conversem connosco.


Bjnhs p`ra aguçar o apetite



Mónica


          Transforming Community Care through Technology        
With the NHS continuing to reduce the burden of in-house treatment, the introduction of community care services enables those who...

Read More


          My thoughts on Oracle Open World 2013 – part 2        
Right then, now I have got most of the ranting out of my system it’s time to reflect upon my own session experiences from this year’s conference. I was co-presenting a session covering the HR Analytics implementation we had completed for the NHS ESR project.  Along with all the other HCM offerings, we were decamped[...]
          FBI arrests hacker Marcus Hutchins who stopped NHS cyberattack        

The FBI has arrested a cybersecurity researcher widely credited with helping to neutralise the global WannaCry ransomware attack.

Marcus Hutchins was detained by FBI officials in Nevada.

The British-based malware researcher gained attention for detecting a "kill switch" that effectively disabled the WannaCry worm in May.

We'll update this as we get more information.


http://news.sky.com/story/fbi-arrests-hacker-who-stopped-nhs-cyberattack-10972693

          Notes on Nursing; What It Is, and What It Is Not        
Notes on Nursing; What It Is, and What It Is Not
author: Florence Nightingale
name: Jennifer
average rating: 5.00
book published: 1858
rating: 5
read at: 2017/03/07
date added: 2017/04/17
shelves: library-loan, read-2017, non-fiction
review:
Read for the library book café's 'women who changed the world' theme... and also for a trip down Memory Lane, as I read and used Nightingale as an undergraduate nurse many years ago. I found her refreshing then, but reading this book now even more impressed.

Yes, the tone is openly didactic and there are dated elements but far fewer than might be supposed, and some are perhaps merely translated: for example, she asserts (very briefly) that a good nurse is religious, when we now require an espousal of NHS values in recruitment. Perhaps our ever increasing uncomfortable awareness that there are limits to antibiotics in particular, and the importance of environmental factors in ill health and recovery leads us to look once more to the fundamentals she insists upon.

She is very practical but that does not mean she pays no attention to psychology - only that she is not constantly on the lookout for ways to blame the patient or explain away the patient's experience. She is all about not getting in nature's way.

          Moving Overseas Guide – What You Need To Know        

By Alison Steed Moving abroad whether for retirement or work is an exciting but slightly daunting time, and you need to consider every area of your life that will be affected – everything from your day-to-day lifestyle right through to your financial affairs can change. Adjusting to the culture in your new home is something you can do at your leisure, but even before you go there are plenty of things that you need to consider before moving, and you will have some work to do in advance of going. How much work will depend on where you are choosing to move to. So here is a simple guide to the things you should be looking at before you go:   Spend time in your new country It is unlikely that many people will decide they want to move to a new country – unless it is for work purposes – before they have spent any time there. But to be sure it is somewhere you are keen to be, you really should spend time in your prospective home before you go to live there long term. Having a holiday in a place is extremely different to living there, so you should try to spend some time living and, if applicable, working in the country you are planning to move to. If your employer is sending you overseas on secondment, then you may have little choice in the matter. But even in this instance you should ask for a chance to spend time in the country and your new working environment. One of the biggest changes – especially if you are moving out of Europe – could be the change in culture. Within the EU the culture may change slightly, such as a slower pace of life compared to the UK, but for countries further afield such as the United Arab Emirates or Saudi Arabia you may find a real culture shock as you are unable to do certain things we take for granted in the UK, such as drinking alcohol. The Foreign and Commonwealth Office website is a useful source of information on a variety of countries and what is expected of you in them. Its website is at https://www.gov.uk/government/organisations/foreign-commonwealth-office   Visas People emigrating to the USA, Australia, New Zealand, or a number of other countries – whether they are working or retiring – may need to get a visa. Speaking to the relevant embassy in the UK is the most sensible course of action to find out what you might need, as they can tell you the type of visa you will need to get and any details on the latest fees you would need to pay to get one. Many applications are now processed online, and it should be possible to click through to the relevant country’s immigration department and fill in the relevant forms. However, you may not be able to do this for every country, so be prepared for some paperwork if this is the case for you. It is important to be wary when you are searching the internet for information, as there are a number of companies that offer ‘visa services’ which could cost you more than going direct to the embassy and dealing with the application alone. For some people these services are worthwhile, but it is important to understand the costs involved before you sign up, especially as this will help you to determine whether the service is worth paying for. Make sure you are getting the right visa for your needs, because getting the wrong one could prevent you from achieving your aims when you arrive in your new home. If you need a work visa, get a work visa – not a visitor or student visa – as you may be turned away at the border if you have the wrong one. It should be simple to see what type of visa you need, but the embassy staff should help you if you cannot establish exactly what you need.   Employment Working abroad can mean a different set of paperwork, depending on how you are employed. For example, if you are employed in a country by a multinational company, a local employer, or you are going to try to find work when you get there, you may still require a visa. Checking the details for the country you are travelling to is essential to make sure you do not fall foul of the rules. For British nationals travelling and working in Europe, there are no visa requirements as you have the right to live and work freely within the EU. If you are a non-EU national, different rules apply so you would need to check the requirements of each country. Some jobs are forbidden to some people in certain countries, so it is vital to check in advance. For example, Saudi Arabia restricts the roles that women can take, and has previously passed a law which reserves 10% of all jobs for Saudi nationals to cut unemployment within the population. So make sure you do your research before you make any financial outlay towards starting a new life abroad.   Health Certain countries will ask for health checks to be undertaken as part of your visa application to live there, and if you are found to have a condition which is listed as a particular concern, then the outcome will depend on the reason and length of your stay, and the type of job you were intending to do. For example, Australia asks that you are tested for tuberculosis, HIV and hepatitis. If you have either HIV or hepatitis B or C you would be considered a “threat to public health” if you were working in the medical or dental profession, or your viral load was above a certain level, or there was a risk that your blood could come into contact with an open wound on a patient. In other countries such as the United Arab Emirates, you would have to have a blood test when you apply for a residence visa, and you would be deported if found to have HIV, hepatitis B or C. Again, the rules vary dramatically so you should check thoroughly with the country you intend to live in before you go.   Healthcare Britons love to moan about the state of the NHS in the UK, but one thing is for sure – if you live in a country with no free-at-the-point-of-access care, it becomes clear just how good the NHS is for us. When you move abroad, you may not have access to a State-funded care system, so it is worth considering private medical insurance before you leave the UK, which may need to cover you and your family depending on your circumstances. If you are likely to travel with your work through more than one country, it would be best to get a policy that is ‘global’ – so no matter where you are, you know your medical bills will be taken care of. This is vital, as being taken ill in America – one of the most expensive places to become poorly – could literally bankrupt you. Insurers that can help with these needs are companies such as Allianz Worldwide Care, Bupa International, Aetna International, Aviva, and Healthcare International. It is vital to check the details of any policy carefully to check for any exclusions for pre-existing conditions, and to make sure the things that matter most to you are covered. If you have had a condition within a period of time – often five years but this can vary depending on the insurer – that particular condition may be excluded from cover until you have been clear for the required period. Employers who are sending their employees overseas will often take care of your healthcare need for you as part of a relocation package, but do not assume this is the case. You should check that you and your family are covered on any policy, and negotiate a deal with them if this is not happening already. Remember though, this could have an impact on the amount of tax you pay.   Getting a home Buying a property – and being intent on buying property – is a very British thing to do, but to ensure you do not make a mistake when you buy your property overseas, it is probably worth renting a property for a period of time when you first arrive. This gives you the freedom to check out the area that you think you want to live in permanently, and to spend time as a local understanding all of the good and bad points of the local area. For example, you may have not realised when spending time there on holiday that the crime rate is higher than you would like it to be, or that it can be very noisy at certain times of the year. Renting gives you the freedom to move in the short term if you find that your dream destination is more of a nightmare. For some, renting might be a better long-term option than buying too, especially if you intend to spend five or six months of the year overseas, and the remainder back in the UK. If you think about renting somewhere for, say, €1,000 a month and you were considering spending £100,000 buying a property, you could rent at that amount for 20 years for the same money as buying. Of course, this would mean that you would not have a property at the end of the process to show for it, and if you were renting out the property as well you could generate an income for yourself while you were not living there. But you would not have to worry about getting an agent to take care of the property while you were not there, and you would also not be tied to the area. If you fancied going elsewhere for a change, you could. For some people, this would not even be a consideration, so it is best to go with what you feel most comfortable doing. Spending time searching for properties to see before you leave the UK will save time when you get there, and if you can set up meetings with local estate agents in advance as well, that will help to speed things up. Just like in the UK, first impressions count, so make sure you are presentable when you turn up for your first appointment and any viewings. Also, it would be wise to rent out your property in the UK, if you have one, at least initially. No-one likes to think that something will go wrong, but you can never tell how you will feel about emigrating until you get there. If it is not for you, then by not selling your home in the UK you have a familiar place to return to.   Moving Dealing with an international move yourself is possible, but is likely to be fraught, so it is probably worth getting international moving specialists in to help you get your worldly goods overseas. Many people will sell as much as they can before they go, which cuts down on transport costs and can free up money to use to replace items while you are settling in abroad. Taking pets abroad can be tricky – and costly – so make sure you check out any pet passport requirements your chosen country may have to ensure Fido does not spend longer than necessary in quarantine.   Transferring your funds overseas Once you have sold any items you do not want, such as your car, furniture and perhaps even your home in the UK, you will have a significant amount of money to start your new life with. To ensure you keep as much of it as possible, you should think carefully about the best way to transfer that money overseas. Some banks will allow you to move money between accounts at no cost – it will depend on the type of account you have in most cases – but generally the banks will charge you very high fees to move money from one country to another. So you will need to do some research before moving your money. Currency brokers can typically offer you better rates than you will get from the bank, and the costs are often much lower too. When you consider that a 4% boost to exchange rates – which is a typical amount compared to the bank exchange rates – on a £100,000 transfer is £4,000, the amount of money you could save is considerable. A currency specialist can offer you services that you would find it hard to get at a bank, such as the ability to fix an exchange rate in advance so you are not at the mercy of currency fluctuations that could eat into your life savings. Check the rates you would get with a number of specialists, such as HiFX, Caxton FX, Moneycorp and FairFX, and also with the banks to see where you will get the best exchange rate. Of course, you need to take the fees into account too, so be sure you identify all of the costs you face.   Taking your pension If you are moving abroad to retire, you will need to consider what to do with your pension to make sure you keep as much of your income as possible. The rules on how you can take your pension changed enormously in the UK in April this year, and pension freedom now means you can take as much or as little of your pension as you like at any time. The one caveat is that the first 25% of the pension amount you take is tax free, the remainder is taxed at your marginal tax rate. So if you are a 40% taxpayer, you would be taxed at 40%. Bear in mind though, that if you took enough money from your pension to tip you into the 40% bracket for this year – as the taxman will consider the money you take is income – you will lose 40% rather than, say, the 20% you were expecting. This could prove costly, and you should take advice before you do this. Moving your pension overseas via what is known as a Qualifying Recognised Overseas Pension Scheme (QROPS) used to be a very appealing prospect. But now the UK rules have changed, the need to use a QROPS has been reduced significantly, and HM Revenue & Customs is constantly changing the rules under which these work, which can make it very difficult for someone to meet the criteria. That is not to say they do not have their place – one particular benefit is that they allow you to have your pension paid in the same currency as you are paying your bills in – but again, you should take expert advice before you move your pension abroad. Making a mistake with this can result in an extremely hefty tax charge, so do not take this decision lightly. Some pension schemes will not allow you to move your pension overseas, including the unfunded public sector schemes used by teachers, nurses and Armed Forces personnel. Other schemes may be reluctant to allow you to move your pension because of their scheme rules. So this is also something to bear in mind. Also, just because you have the freedom to move your pension does not necessarily mean it is the best thing for you. The main risk to your income is currency risk when you are transferring money from one denomination to another, but again the currency brokers can help you reduce the risk you are taking with these transfers. Your State pension will be paid to you when you are overseas, and that is impossible to move in any case, so you would need to deal with those payments separately to any other pension. One important consideration is that if you move to countries such as Canada, Australia or South Africa – among others – your State pension is frozen at the level it was when you left the UK. So it will not rise in line with inflation or earnings and will ultimately be worth less and less in real terms as the cost of living rises in your new home.   Tax and liabilities in the UK Once you have finally decided to make the move, you should let HM Revenue & Customs know that you are moving overseas, and also let the Department for Work and Pensions know too, as they will need to arrange to have your State pension paid to you when you are overseas. You should also try to clear as many of your debts as possible in the UK, as it helps to make a clean financial break. Tax is one of the most complicated elements of moving abroad, so to ensure you set up your affairs in the most tax-efficient way, you should speak to a tax specialist before you leave. Taking advice on how to deal with your investments, pensions or general financial position could result in you saving a lot of money. Leaving these elements to chance could be extremely damaging financially, especially as there are some countries that will impose a tax charge on the money you take into the country with you. There are some things to be aware of that could benefit you considerably. For example, if you are in a PAYE job in the UK, and you leave part way through the tax year, then the chances are you will be due a rebate. Your UK tax liability in this case is split equally into 12 parts that you pay each month, and is based on being paid a full year’s salary. If you only work six months, then you will have overpaid in each of those months, and the taxman should give you a rebate.   Enjoy it! There is plenty to think about when you emigrate, but it is a great adventure and you should most definitely enjoy yourself. Sorting out your affairs before you go as far as you can will give you and your family the best chance of a bright future.

The post Moving Overseas Guide – What You Need To Know appeared first on MyMoneyDiva.


          CHM Recruit: Care Services Nurse - Children        
NHS pay scale Band 5 or Band 6 (£11.20 - £16.00 per hour) depending upon experience: CHM Recruit: Are you an experienced registered nurse who is looking to make a real difference to the lives of disabled and terminally ill children in the UK? Do... Cannock, Staffordshire
          NHS shake up plans 'not cost cutting exercise' insist health chiefs        
THE decision to permanently downgrade maternity services at the Horton General Hospital is not a cost cutting exercise, insist health chiefs.
           Readiness for work of newly qualified nurses in London         
Harris, R., Marshall-Lucette, S., Chu, C., Ooms, A., Grant, R., Sayer, J., Christian, S. and Burke, L. (2011) Readiness for work of newly qualified nurses in London. In: NHS London Modernising Nursing Careers Conference, 14 Mar 2011, London, UK. (Unpublished)
          Susan Forbes        
Susan Forbes, M.Sc., is a psychotherapist with many years experience of working privately and within the NHS in GP surgeries. She studied clinical hypnosis in the Faculty of Psychology at University College London and cognitive behavioural therapy at Canterbury Christ Church University, where she gained the Postgraduate Diploma in Psychological Therapies: Cognitive Behaviour Therapy (High [...]
          NHS shake up plans 'not cost cutting exercise' insist health chiefs        
THE decision to permanently downgrade maternity services at the Horton General Hospital is not a cost cutting exercise, insist health chiefs.
          Campaigners unite as one to stop NHS shake up plans in Oxfordshire        
CAMPAIGNERS, the clergy and politicians came together as one voice in their passionate plea to stop controversial healthcare plans.
          Comment on AUDIO: Interview with Manzanar NHS Interpretive Ranger Rose Masters by Rose Masters        
Dear Tadashi, Many thanks for your informative comment. I completely agree with you that I will never fully understand the impact of the "Loyalty Questionnaire." In fact, I think it's difficult -- if not impossible -- for most people who did not live through it to understand just how damaging that questionnaire was. This is why I'm so grateful to those who have been willing to share their first-hand stories of unjust incarceration. Your description of the "Loyalty Questionnaire" is what I hope every visitor to Manzanar National Historic Site comes away understanding. Thank you. If you'd ever like to get in touch, my email address is Rose_Masters@nps.gov. All my best, Rose Masters
          Comment on AUDIO: Interview with Manzanar NHS Interpretive Ranger Rose Masters by Tadashi Kishi        
It was an interesting and informative overview of the Executive Order 9066. For those of us who were of draft age, Question 27, 28 was the two question that cut deep into the Japanese family upbringing: the mores, the loyalty, and respect for our ancestors. The questionnaire was undeniably ill conceived; tore families apart, left loyal Americans with the choice of deserting their parents, or answering "No No" to save the family, the most precious thing in the life of Japanese. While she mentioned the Loyalty Questionnaire, I do not believe she can fully understand the tremendous mental and emotional impact it had on young Japanese American of draft age. For the US Government to use those two answers as a loyalty question was unforgivable, demeaning, and devastating to both Citizen and non-citizen. They said that the Watchtower and the barbed wire would protect us from harm. But why were the searchlight and machine gun pointed inwards to the camp? But at night, the searchlight would sweep the camp to remind us that we were not free!
          Comment on Manzanar NHS At 25 Years Old: More Relevant Now Than Ever Before by New At Manzanar NHS: You’ve Got To See The Historic Women’s Latrine | Manzanar Committee        
[…] CA — With the 25th Anniversary of Manzanar becoming a National Historic Site (March 3, 2017) being commemorated this year, and with the much more significant milestone, the […]
          Mid Cheshire Hospitals Trust wins top award        
AN NHS trust that manages services in Northwich and Winsford has been given a prestigious honour in the Royal Society for the Prevention of Accidents (RoPSA) health and safety awards.
          Literary Festival 2015: Perceptions of Madness: understanding mental illness through art, literature and drama [Video]        
Speaker(s): Dr Sarah Carr, Paul Farmer, Nathan Filer, Dr John McGowan | How mental illness is portrayed in art, literature and on TV can have a positive or negative effect on how the public perceives mental ill health. Representations of people with mental health problems can range from the mad psychotic criminal to people within their daily lives dealing with depression, schizophrenia or bipolar disorder. This panel discussion explores how such presentations of mental illness can affect public understanding of mental ill health with insights from research and personal experiences. Sarah Carr (@SchrebersSister) has a background as a senior research and policy analyst in mental health and social care, with a focus on service user participation, personalisation and equality issues. She runs her own independent mental health and social care knowledge consultancy. Most recently she worked for the Social Care Institute of Excellence (SCIE) as a Senior Research Analyst and was seconded to the role of Joint Head of Participation. She is an Honorary Senior Lecturer, Institute for Applied Social Science, School of Social Policy, University of Birmingham; a Visiting Fellow, Social Policy and Social Work, University of York and a Fellow of the Royal Society of Arts. As Co Vice-Chair of the National Survivor and User Network (NSUN) and a member of the editorial board of the journal Disability and Society, Sarah has a particular interest in mental health issues and is a long term user of services. Paul Farmer (@paulfarmermind) has been Chief Executive of Mind, the leading mental health charity working in England and Wales, since May 2006. Paul is Chair of the Association of Chief Executives of Voluntary Organisations (ACEVO), the leading voice of the UK’s charity and social enterprise sector. Paul is also a trustee at Lloyds Bank Foundation which invests in charities supporting people to break out of disadvantage at critical points in their lives. He is also Chair of the NHS England Mental Health Patient Safety Board. Paul received an honorary Doctorate of Science from the University of East London and was chosen as most admired charity Chief Executive in the Third Sector Most Admired Charities Awards 2013. Nathan Filer (@nathanfiler) is the author of The Shock of the Fall, winner of the Costa Book of the Year (2013), the Betty Trask Prize (2014), and Popular Fiction Book of the Year at the National Book Awards (2014). It has been translated into twenty-seven languages. He worked as a mental health nurse for many years and in 2014 was named as a Nursing Times’ Nursing Leader for “influencing the way the public thinks about mental illness”. He lectures in Creative Writing at Bath Spa University. John McGowan (@cccuapppsy) is Clinical Psychologist. Following many years working in acute mental health wards in the NHS, he is now works on the Clinical Psychology Training scheme at the Salomons Centre for Applied Psychology in Kent. As well as conducting research into self-harm and suicide, he is currently editing a new British Psychological Society Report on Depression. He has written for The Guardian, the Health Service Journal and blogs regularly at Discursive of Tunbridge Wells. He will be speaking on 'Psychos, Cuckoo's Nests and Silver Linings: Madness in the Movies'. Martin Knapp is Director of PSSRU and a Professor of Social Policy at LSE. He is also Director of the NIHR School for Social Care Research. The Personal Social Services Research Unit (PSSRU) is one of the leading social care research groups, not just in the UK, but internationally. The LSE branch of PSSRU sits within LSE Health and Social Care (@LSEHSC) in the Department of Social Policy (@LSESocialPolicy). This event forms part of the LSE Space for Thought Literary Festival 2015, taking place from Monday 23 - Saturday 28 February 2015, with the theme 'Foundations'.
          Literary Festival 2014: "Who is it who can tell me who I am?" Understanding Dementia through Art and Literature [Video]        
Speaker(s): Melvyn Bragg, Dr Andrea Capstick, Professor Justine Schneider | Dementia “continues to be surrounded by fear and stigma … Nearly half of UK adults acknowledge that public understanding of dementia is limited, and 73 percent of them do not believe society is geared up to deal with the condition” according to the Department of Health, who also say a key step involves “raising public understanding and challenging attitudes which may inhibit people with dementia living life to the full”. This panel discussion will explore ways of understanding dementia and dementia care through art and literature, including theatre, participatory videos and the novel with insights from research and personal experiences. The quotation in our title is taken from Shakespeare's King Lear. Melvyn Bragg is an award-winning author and broadcaster. His latest novel is Grace and Mary. His first novel, For Want of a Nail, was published in 1965 and since then his novels have included The Hired Man, for which he won the Time/Life Silver Pen Award, Without A City Wall, winner of the John Llewellyn Rhys Prize, Credo, The Maid of Buttermere and The Soldier's Return, which was published to huge critical acclaim in 1999 and won the WHSmith Literary Award. He has also written several works of non-fiction including Speak for England, an oral history of the twentieth century, Rich, a biography of Richard Burton, On Giants' Shoulders, a history of science based on his BBC radio series, The Adventure of English, 12 Books that Changed the World, In Our Time and The Southbank Show: Final Cut. He is president of the National Campaign for the Arts, and in 1998 he was made a life peer. He won an Academy Fellowship at the BAFTA Television Awards in 2010. Andrea Capstick is lecturer in dementia studies at the University of Bradford. She has been a member of Bradford Dementia Group (BDG) since 1994, and became the inaugural leader of the UK’s first BSc (Hons) in Dementia Studies.She holds a Doctorate in Education (EdD) for her work on the use of film and narrative biography in teaching dementia studies, and has published on a variety of subjects including service user involvement in dementia care education; arts based approaches to teaching and learning, and the ethics of visual research. In 2009 she conducted a pilot of the use of Participatory Video (PV) with people with dementia, and has recently been awarded funding by the National Institute for Health Research’s School for Social Care Research to extend the use of PV to people living in long-term social care. Justine Schneider is professor of mental health and social care at the University of Nottingham. Before moving to Nottingham in 2004, Justine was a senior lecturer in the Centre for Applied Social Studies at the University of Durham and a non-executive director, County Durham and Darlington Priority Services NHS Trust. Justine has extensive experience in many aspects of applied health research using a wide range of methodologies and approaches. She has particular expertise in mental health service evaluation, carers, care homes, costs and supported employment. Her current work focuses primarily on dementia and staff development, and she is exploring innovative approaches to knowledge exchange in dementia care. Martin Knapp is professor of Social Policy at LSE and director of the Personal Social Services Research Unit (PSSRU). This event forms part of the LSE Space for Thought Literary Festival 2014, taking place from Monday 24 February - Saturday 1 March 2014, with the theme 'Reflections'.
          Ð¡Ð¿Ñ€Ð°Ð²ÐºÐ° Аналитического центра ГК InfoWatch о «краже личности»         

Цифровая трансформация государства, бизнеса и общества несет новые риски и угрозы информационной безопасности. Корпоративные базы данных, содержащие имена, даты рождения, номера удостоверений личности и другую чувствительную информацию о сотрудниках или клиентах, все чаще становятся мишенью киберпреступников. Обычным делом становится так называемая «кража личности». На безопасность персональных данных граждан не влияет ни политический режим в стране, ни уровень ее экономического развития.

Кража личности (англ. Identity theft — термин впервые появился в 1964 году) — преступление, при котором незаконно используются персональные данные человека для получения материальной выгоды.

Согласно опросам, кража личности является одним из основных опасений граждан США. В Соединенных Штатах в качестве удостоверения личности используют SSN (Social Security Number). Его номер запрашивают большое количество организаций для подтверждения личности граждан. Похитив номер SNN, злоумышленники способны, например, испортить кредитную историю своей жертвы. В Великобритании для осуществления «кражи личности» используются страховые идентификаторы NINO (National Insurance number) и NHS (National Health Service Number).

В России нет статистики, какие из электронных идентификаторов подвержены наибольшему риску компрометации, однако стремительно растет сама вовлеченность граждан в процессы электронного взаимодействия, в том числе и на корпоративном и государственном уровне.

Так, по данным Минкомсвязи России, уже более 50% граждан используют государственные услуги в электронном виде, а число пользователей Единого портала госуслуг достигло 40 млн человек, более 18 млн из которых зарегистрировались на портале в 2016 году.

Утечки

В конце февраля 2017 года правоохранительным органам КНР удалось предотвратить шесть крупномасштабных операций по краже персональных данных, полиция арестовала 138 подозреваемых в 14 точках города Гуанчжоу. По данным следствия, было украдено более ста миллионов единиц личных данных: от почтовых адресов до истории телефонных звонков. Преступники приобретали данные потерпевших у сотрудников банков, крупнейших телекоммуникационных и логистических компаний. Полученную информацию они перепродавали.

В феврале 2017 года восемь человек в штате Юта, США были приговорены к тюремному заключению за мошенничество с персональными данными. Имея в распоряжении ПДн и банковскую информацию 143 тыс. американцев, злоумышленники, по версии обвинения, создавали фальшивые документы, удостоверяющие личность. Подделки использовались для открытия кредитных счетов в магазинах и совершения покупок.

В Индии под угрозой оказались биометрические данные 1 млрд человек: анкетные данные, отпечатки пальцев и фотографий радужной оболочки глаза. В системе идентификации граждан и резидентов Индии UIDAI обнаружились сотни транзакций, совершенных с применением одних и тех же отпечатков пальцев. По мнению местного чиновника, это не было бы возможным без незаконного использования и хранения биометрических данных из системы UIDAI. Происшествие породило опасения за сохранение конфиденциальности личной информации граждан Индии.

В декабре 2016 года стало известно о краже базы данных, содержащих имена, даты рождения, адреса, телефонные номера, сведения о семейном положении, финансовую информацию и прочие данные 203 млн клиентов компании Experian. Хакеры намеревались продать украденную информацию за 600 долларов США.

В организации еще одной «мега-утечки», целью которой были сбор и продажа персональных данных 24 млн клиентов компании, обвиняются руководитель и несколько высокопоставленных сотрудников корейской фирмы Homeplus (подразделение британской Tesco PLC). Фигурантам дела удалось продать собранную информацию страховым компаниям. Объем выручки от незаконной сделки составил 21,14 млн долларов США.

В марте 2017 года в распоряжении специалиста по безопасности из США оказались данные 33,6 млн американских пользователей, в том числе военнослужащих. База содержит адреса и телефоны, места работы и должности, а также данные об уровне доходов граждан США. Среди мест работы — AT&T и WalMart, банки Citigroup и Wells Fargo, почта США и Университет штата Огайо. Владельцем базы оказалась организация, которая собирает и продает различные корпоративные данные для проведения «маркетинговых кампаний».

Пояснения Аналитического центра ГК InfoWatch

На примере стран с более развитым цифровым обществом хорошо видно, что по мере цифровизации происходит и значительно больше утечек ПДн, масштаб которых ограничен разве что размером базы данных компании или организации. Основную угрозу несут атаки на крупные сервисы, которые хранят огромные массивы информации.

В 2016 году в мире было зафиксировано 44 «мега-утечки» (против 21 в 2015 году), в результате каждой из которых «утекло» не менее 10 млн персональных данных, совокупно на «мега-утечки» пришлось 94,6% всех скомпрометированных записей.

Долгое время в России не утихают дискуссии о возможности введения единого идентификационного документа, приравненного к паспорту гражданина страны. Напомним, что концепция единого универсального электронного документа гражданина уже была опробована в рамках проекта «Универсальная электронная карта» (УЭК). Кроме того, во время проведения Кубка конфедераций FIFA 2017 и Чемпионата мира FIFA 2018 по футболу в России будут использоваться электронные паспорта болельщиков, которые позволят гостям турниров не только получить доступ к спортивным объектам, но и осуществить безвизовый въезд на территорию Российской Федерации.

Так или иначе, с большой долей вероятности можно утверждать, что введение электронных паспортов, удостоверяющих личность граждан, является лишь делом времени. А это означает, что Россия встанет в один ряд с теми прогрессивными странами, где такие системы уже действуют, и где мы видим значительный отрыв по количеству совершаемых «краж личности», а также по масштабам компрометируемых данных граждан.

Если до сих пор российским разработчикам удается своевременно адаптировать свои ИТ-решения для защиты данных даже по наиболее уязвимым каналам передачи информации, то по мере роста вовлеченности персональных данных граждан в работу корпоративных и государственных электронных систем, для обеспечения их безопасности потребуется координированная работа государства и бизнес-сообщества.

При этом проблема безопасности персональных данных не сводится только к одной их защите, а существует как минимум еще один аспект, на который следует обратить особое внимание — это возможность извлечения информации из сверхбольших объемов данных.

Представим, что у вас есть 3 млрд записей с персональными данными, в том числе реквизиты банковских карт, адреса электронной почты, номера телефонов, сведения о финансовых транзакциях и другой критичной информацией. Также представим, что у вас получилось нормализовать этот объем данных и составить алгоритм анализа, благодаря которому вы научились видеть неявные связи между пользователями и находить ответы даже на вопросы, которые прямо не задавали.

Допустим, вы точно узнали, что без всякой кооперации жители конкретной страны забрали из ее банков часть своих сбережений и этого оттока недостаточно, чтоб вызвать массовую панику, но тенденция уже видна.

Конкретное развитие ситуации после этого может быть любым, причем в той или иной степени управляемым. Важно, что подобный прогноз на основе анализа на первый взгляд никак не связанных данных возможен в принципе. Причем в ближайшем будущем.

Те способы применения украденных персональных данных, о которых принято говорить сегодня, не идут ни в какое сравнение с теми возможностями, которые открывают технологии машинного обучения, выявления неявных связей. Кто сказал, что эти технологии завтра не станут так же доступны злоумышленникам, как сами персональные компьютеры?

Политика в области защиты персональных данных должна строиться с учетом этой перспективы, начиная с определения субъектов права использования персональных данных, выработки определения больших пользовательских данных и заканчивая правилами их оборота и надзора.

Проблема «кражи личности», точнее, огромных объемов персональных данных имеет еще несколько важных аспектов. Сухая статистика говорит о том, что в 2016 году скомпрометировано более 3 млрд персональных данных. Однако к этому факту следует относиться с осторожностью. Даже если предположить, что данные почти половины жителей планеты украдены, всё равно остается ряд неочевидных на первый взгляд моментов.

К счастью, в руках злоумышленников пока нет инструмента для извлечения из этого объема данных действительно ценной информации. Действия людей, стоящих за «кражей личности», в большинстве случаев примитивны. Число сценариев использования персональных данных ограничено — получить налоговый вычет, оформить покупку в интернете на чужие платежные данные и так далее. Поэтому компрометация 3 млрд записей персональных данных — проблема серьезная, но, скажем так, решаемая.

Интереснее другое — «кража личности», как мы уже сказали, преступление довольно примитивное. В последнее время четко прослеживается тенденция, когда «кража личности» становится основным источником дохода дл

          Growing the Productivity of Government Services [Video]        
Speaker(s): Leandro Carrera, Professor Patrick Dunleavy, Joe Grice, Edwin Lau, Barry Quirk | For many decades there has been little effective analysis and guidance on how to improve the organizational productivity of government bodies consistently over time. Yet unless this can be achieved, the relative price of public services is doomed to rise ineluctably (the 'Baumol disease' problem). Leandro Carrera and Patrick Dunleavy's new book Growing the Productivity of Government Services (published by Edward Elgar) provides the first in-depth empirical treatment of the organizational productivity of unique national government agencies, focusing on UK taxation, social security and regulatory agencies. In addition, they also show how productivity analysis for decentralized services can include salient and managerially useful variables, looking at how IT and management modernization help shape the productivity of NHS hospitals. The first rule of productivity growth in public services is to focus hard on consistently measuring and improving productivity performance. The second rule is to embrace IT modernization carried out in tandem with genuinely effective and well-considered business process reorganization. This lecture will discuss ideas for the improvement of public sector productivity from a local, national and international government perspective. Leandro Carrera is a senior researcher at the Pensions Policy Institute. Patrick Dunleavy is professor of political science and public policy at LSE. Joe Grice is chief economist at the Office for National Statistics. Edwin Lau is head of the Reform of the Public Sector Division in the OECD Public Governance and Territorial Development Directorate. Barry Quirk is chief executive at the London Borough of Lewisham. Diane Coyle OBE is a freelance economist, and is a member of the UK Competition Commission and Vice Chairman of the BBC Trust. Previously she was an advisor to the UK Treasury and the Economics Editor of the Independent. LSE Public Policy Group (PPG) is an independent consultancy and research organisation. PPG provides thorough analysis and recommendations for a variety of clients; providing an interface between academia, the private, public and 'third' sector. LSE Works is a series of public lectures, that will showcase some of the latest research by LSE's Research Centres. In each session, LSE academics will present key research findings, demonstrating where appropriate the implications of their studies for public policy. A list of all the LSE Works lectures can be viewed online.
          Quality in Health and Social Care [Video]        
Speaker(s): Dr Zack Cooper, Professor Julien Forder, Professor Mireia Jofre-Bonet, Dr Irini Papanicolas | In this lecture, organised by LSE Health and Social Care, and supported by LSE HEIF 4 Bid Fund, LSE academics will discuss quality and competition in the field of health and social care. Welcome from Chair - Professor Alistair McGuire (LSE Health and Social Care). Does Hospital Competition Save Lives? Evidence from the English National Health Service - Dr Zack Cooper (LSE Health). Payment by Results and Quality in the English NHS - Dr Irini Papanicolas (LSE Health). Measuring Quality and Outcomes in Social Care - Professor Julien Forder (PSSRU Kent and LSE). Discussant: Professor Mireia Jofre-Bonet (City University).
          Sounding out social investment: Chime’s story        

Network, network, network – managing director of Chime Social Enterprise Jonathan Parsons shares the lessons he’s learnt whilst at the helm of the only audiology NHS spin out on track to be considered social investment ready. 10 million people in the UK suffer from hearing loss, of which just under four million are of working […]

The post Sounding out social investment: Chime’s story appeared first on Make it happen.


          Patients can nominate NHS staff who go 'extra mile' for Healthcare Hero Award        
Lewisham and Greenwich NHS Trust is asking patients to nominate staff who have provided "outstanding care".
          @richardjgodwin latest column in the ES:        
Music to my ears, as national Transport Spokesperson for the Green Party; this is what we've been saying for months/years:

"Our railways are now owned by companies that cost us more in public subsidy than British Rail ever did, inflict annual fare rises on us and then reward their shareholders with record profits. All Britain gets is the bill. Last week the ailing Network Rail was quietly renationalised along with its £34billion (34,000,000) debt. Just as perversely, the East Coast Mainline, which has been publicly owned since 2009 and just made a profit of £235 million, will be re-privatised again next year. 
 "Which is not to say that national interests are not being served - they're just other countries national interests...
  "David Cameron refuses to exempt the NHS from the Transatlantic Trade and Investment Partnership, which critics warn will make it impossible for future governments ever to reverse these decisions. That would amount to a huge loss of sovereign power, and I am not hearing many battle cries from MPs..."
 
...Except of course from Caroline Lucas.
 
#VoteGreen!

          Peers from across political spectrum unite to support our CHD service        
Peers from around the country voiced their opposition to NHS England's plans to close congenital heart services at Royal Brompton Hospital on 20 July in a debate tabled by Baroness Boothroyd, former speaker in the House of Commons.
          Councillors tear into NHS England's plans for congenital heart disease        
"If you want to close something that's going to have such a serious effect as this is going to have, I think it warrants some serious evidence."
          Simon Friend appointed non-executive director        
Simon Friend joins the Board of Royal Brompton & Harefield NHS Foundation Trust today, as non-executive director.
          Our world class allergy team        
Royal Brompton & Harefield NHS Foundation Trust boasts a cutting-edge research allergy team led by Professor Stephen Durham, clinical lead for allergy services at the Trust and head of allergy and clinical immunology at Imperial College's National Heart and Lung Institute.
          Trust forges new research links with industry        
Researchers from the Royal Brompton & Harefield NHS Foundation Trust recently took part in a major networking event aimed at fostering future collaborations between industry and leading academic institutions in London and the South East.
          Latest update on congenital heart disease services review        
Latest news (22 November 2016): NHS England has announced that the public consultation on its congenital heart disease (CHD) proposals will not take place until the New Year.
          Trust research celebrated by visitors and researchers at open day        
Royal Brompton & Harefield NHS Foundation Trust opened its doors to visitors for its sixth annual heart and lung research open day on 15 July.
          Professor Andrew Bush, awarded second term as NIHR Senior Investigator        
Professor Andy Bush, consultant in paediatric respirology at Royal Brompton & Harefield NHS Foundation Trust and head of paediatrics at Imperial College London, has been awarded a prestigious second four-year term as NIHR Senior Investigator. Only 200 clinical academics nationally have been successfully granted this position; eight of whom work at the Trust.
          Trust and NHLI researchers hail discovery of important Wars 2 gene        
Investigators from Royal Brompton & Harefield NHS Foundation Trust and the National Heart and Lung Institute (NHLI) recently worked on an international research collaboration which could lead to better treatments for both heart disease and certain cancers.
          Pioneering research to be showcased at Royal Brompton & Harefield open day        
Members of the public can hear about groundbreaking studies and meet leading researchers at Royal Brompton & Harefield NHS Foundation Trust's fifth annual heart and lung research open day on July 15.
          Dr Richard Grocott-Mason appointed medical director at the Trust        
Dr Richard Grocott-Mason has been appointed medical director of Royal Brompton & Harefield NHS Foundation Trust with immediate effect. Dr Grocott-Mason was appointed acting medical director in December 2015.
          3D imaging and printing: technology of the future at the Trust        
Specialists at Royal Brompton & Harefield NHS Foundation Trust are using 3D imaging and printing to create exact replicas of patients' hearts to help them plan and carry out surgery.
          Press releases        
Read and download press releases about the pioneering work of Royal Brompton & Harefield NHS Foundation Trust in the diagnosis and treatment of heart and lung disease.
          New pacemaker is trialled at Royal Brompton & Harefield NHS Foundation Trust        
A novel pacemaker that connects to multiple locations in the heart could provide a new treatment option for thousands of patients with abnormal heart rhythms.
          Academic Health Science Centre welcomes Royal Brompton and Harefield expertise        
The Trust, along with the Royal Marsden NHS Foundation Trust, has joined the Imperial College Academic Health Science Centre (AHSC),
          Trust scores highly in inpatient survey        
Inpatients rated the overall experience of care at Royal Brompton & Harefield NHS Foundation Trust as 8.8 out of 10, according to results from the Care Quality Commission (CQC) national adult inpatient survey.
          Royal Brompton and Harefield staff rate Trust as good employer        
Staff at Royal Brompton & Harefield NHS Foundation Trust are among the most likely in the NHS to recommend the trust they work for, both for its clinical care and as an employer.
          Health minister visits Royal Brompton Hospital        
Parliamentary Under Secretary of State for NHS Productivity, Lord Prior of Brampton, visited Royal Brompton Hospital on Tuesday 12 April, where he enjoyed a tour of the hospital's new state-of-the-art hybrid theatre and Fulham Wing.
          Trust experts visit Iran and Russia to share expertise        
Experts from the respiratory division at Royal Brompton & Harefield NHS Foundation Trust have recently collaborated with international clinical teams in Iran and Russia to share knowledge and improve health outcomes for patients in the regions.
          Royal Brompton & Harefield NHS Foundation Trust gets high score for patient care        
95 per cent of patients at the Trust rated their experience seven or above out of 10, significantly above the national average of 84 per cent, in the 12th annual CQC inpatient survey.
          Royal Brompton consultant wins national NHS Award        
A Royal Brompton & Harefield NHS Foundation Trust consultant was last night awarded the title National Innovator of the Year at the National NHS Leadership Recognition Awards.
          Lib Dems’ NHS pledge would mean an extra £42 million for Haringey Health Services        
The Liberal Democrats are the only major party to have pledged £8 billion additional funding for our NHS, in accordance with advice from Simon Stevens, the Chief Executive of NHS England. Once implemented, the extra cash would mean at least … Continue reading
          Haringey GPs and patients to benefit from funding boost        
An extra £550 million of NHS funding has been announced by the Government to improve access to GPs, modernise GP surgeries, and improve out-of-hospital care. Seven practices in Haringey – including the Vale Practice, Crouch Hall Road Surgery and Evergreen … Continue reading
          Olympic South HATS and Trapeze Combine for Efficient Patient Transport Services        
Trapeze Group’s Transport scheduling system (NOVUS for Demand Response) has been installed at Olympic (South) Ltd t/a Healthcare and Transport Services (HATS), a London-based provider of specialist transport to Local Authorities and NHS Trusts.
          Mid-Staffordshire : Response of Royal College of Physicians Edinburgh        
Time to refocus the NHS on quality and dignity of patient care: RCPE response to Mid Staffordshire SENIOR CARE AND REVIEW Many of the detailed recommendations also offer potential for improving standards, including the recommendation that ‘hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a […]
          Government Response to NHS Future Forum        
GOVERNMENT RESPONSE TO NHS FUTURE FORUM “The Government has announced that it accepts the core recommendations of the NHS Future Forum report and will make changes to its plans for modernisation of health and social care. The key changes include: Reaffirming that Ministers are accountable overall. The original duty to promote a comprehensive health service […]
          Liberating the NHS        
LIBERATING THE NHS: DEVELOPING THE HEALTHCARE WORKFORCE “More than 1.4 million people work for the NHS in England and they are supported by many more people working in community care, in social care, and in public health services. They are the heart of healthcare in this country. Their skills, commitment, professionalism and dedication are key […]
          A Ten-Minute Talk on “Practicing Lean” [Transcript] – And an Update on the Book        
A Ten-Minute Talk on “Practicing Lean” [Transcript] – And an Update on the Book

I was invited to give a talk at a gathering of improvement teams and Kaizen Promotion Offices within the NHS in England. It wasn’t feasible for me to attend in person… and presenting live over the internet would have meant waking up at 4 am, so we decided that I would record a ten-minute talk for their event.

The video is below… and a transcript and some of their tweets follow.

Updates on “Practicing Lean” – the Book

The idea of “practicing Lean” is, of course, explored in the book I edited (with 15 other contributors) called Practicing Lean.

Continue reading A Ten-Minute Talk on “Practicing Lean” [Transcript] – And an Update on the Book at Lean Blog.


          Your invitation to join Comms Unplugged        
Imagine a weekend with no devices, surrounded by professional communicators in tents. Sound good? You’re in for a treat… Today I have a guest post by Sally Northeast, @salzasal, Deputy Director of OD, Participation and Communications at Dorset HealthCare University NHS Foundation Trust here in the UK. She is co-creator of Comms Unplugged in her spare […]
          NHS DIGITAL: Digital Delivery Director        
£100,000 - £113,625 per annum, Benefits: From £100,000: NHS DIGITAL: We are looking for an experienced dynamic Digital Delivery Director to lead one of the most complex patient facing programmes in health & social care. Leeds
          Doctors Forced to Become State Snitches to Spot “Radical” Patients        
NHS demands GPs monitor potential extremists
          Please, please, please 'Vote Remain' in the referendum this week.        

The European Union may need many improvements but we have no say if we decide to leave.

Leaving the EU will risk jobs and trade and could cause a major economic crisis, with the value of the pound falling and major investment quickly moving away. 

Leaving the EU is bound to add to domestic and international instability and insecurity. 

And leaving the EU could threaten not just the unity of the UK but the unity of the rest of Europe, which has been peaceful and collaborative for 70 years.

At home it could lead to an even more right-wing Conservative government led by someone like Boris Johnson which would be even less willing to support the NHS and other public services and even less willing to support the poor and the less well off.

But worse even than all these things, leaving the EU means that we would for the first time since 1945 turn away from international leadership towards international isolation. At the moment we have the benefit of leadership in the UN, and the Commonwealth, and NATO and the EU. Leave and we will lose much of our influence in international development and diplomacy in all of these places.

We have never given away control of our country to unelected people in Brussels; what we have done is decide that our elected representatives will share decisions with other democratically elected government ministers, who very rarely take decisions we do not agree with. 

The last thing I want is a new form of nationalistic Independence Day to mark the beginning of the UK moving away from collaboration with our nearest neighbours, reducing the European nature of Britain and which will give big problems to all of us and especially to Northern Ireland and Gibraltar. 

Vote Remain on Thursday 23rd June!

Please, please, please vote remain. Let us lead in the world and in our continent and not retreat from them. 

Each and every vote could make the difference. Please vote for a sane and civilised future this week, and don't be misled by some of the most dishonest claims in the recent history of British politics. 

Simon Hughes


          Why Do Children Fidget and Should We Embrace It?        
Over the years, scientists have come up with numerous explanations as to why children fidget. Fidgeting very often occurs when a child is involved in carrying out a task that is not interesting enough to sustain their focus.

It is believed that the additional motor-sensory input gained through fidgeting can stimulate a child’s brain, satisfy the brain’s need for stimulation and allow the child to focus on the task at hand.

Fidgeting is a common symptom of some neurological and developmental disorders such as Attention Deficit Hyperactivity Disorder and some sensory processing disorders and Asperger’s Syndrome.

Another train of thought is that children are not getting enough exercise. They are not getting outside and moving around enough, which is why they lack concentrate when in school and learning in the classroom.

Children are spending too much time sitting down. It has been raised as an issue for many reasons right across the UK in recent years, particularly in terms of childhood obesity, the risks of overuse of screens, parental fears and liability issues about children being left free to play outdoors without constant supervision, and increasing pressure from busy time schedules and educational demands.


A recent study by the British Journal of Sports Medicine revealed that sitting down is replacing physical activity from the time children start school, from as early as seven years old. Seven years old! It is no wonder that our children are so fidgety.

How Fidgeting Helps Children with ADHD to Focus

In the UK, it is thought that ADHD affects between 2-5% of school-aged children. The NHS cites common symptoms as a short attention span, restlessness and impulsive behaviour.

A recent study into how children with ADHD process information, revealed that they could perform much better in school if they could fidget. Their fidgeting and restless movements are an important part of how they remember things and work out complex tasks.

The study, carried out at the University of Central Florida, discovered that children with ADHD performed much better if they could move, for example by riding an exercise bike or playing with an activity ball, whilst performing work related tasks and tests.


It also found that movement serves a purpose and is only apparent when a child needs to use their brain’s executive functions.

It suggested that rather than trying to reduce hyperactivity in children with ADHD, parents and teachers should be doing exactly the opposite. While letting them run riot is not the idea, their “movement should be facilitated” in constructive ways so that they can “maintain the level of alertness necessary for cognitive activities”.

How to Manage Fidgeting

Fidgeting is a double-edged sword. It can help some children to learn, but if not properly managed, it can interfere with a child’s performance at school and even disrupt the rest of the class.

The trick is knowing what to look for and how to manage it. It sometimes requires us as adults to change our own perspectives and comfort zone boundaries to embrace movement rather than challenge it. By implementing some simple strategies, this can certainly be done.

The problem now is that children are going into school with their bodies less prepared for learning than ever before. This is happening as early as EYFS, as the recent studies have shown.

Children are too sedentary in their lifestyles, their sensory systems are not developing fully, but they are asked to sit still and pay attention. It’s a vicious circle! They start fidgeting to try and get the movement their bodies are craving to be able to focus, so they are told to sit still.

This makes their brains just want to go back to sleep! If they don’t get enough movement at appropriate times throughout the day, they cannot pay attention when they must. And if they cannot pay attention then they cannot learn. It’s as simple as that.

The best approach is to try and reduce excess fidgeting and restless behaviour by providing suitable outlets for movement.


It’s a case of activating the brain enough to hold and maintain a child’s interest, without conflicting with the main task of learning. It sounds much more complicated than it is! Here are some great ways to go about it:

There are things that can be done inside to help displace or channel movement. Small “fidget toys”, are small enough for a child to hold in one hand and manipulate with small movements while they are listening or reading i.e. putty or a squeezy foam ball.

Half an hour of movement and playtime each day is not enough! They need to be moving, running, jumping, climbing, stretching their muscles and breathing in the fresh air for an hour at the very least every day!


Children with ADHD and other sensory processing disorders have particularly short attention spans.

Given the opportunity for shorter, more manageable activities throughout the day, with ample time for regular breaks and bursts of playtime in between, may help reduce a child’s fidgeting during school and at home.

Author bio

Emma Homan is an educational copywriter for Pentagon Play and a mother of two who enjoys sharing information on parenting and education at school. Pentagon Play are one of the leading providers of school playground equipment in the UK. You can visit their website here – www.pentagonplay.co.uk

          Bokong Besar itu Sehat..!!         
Ghiboo.com - Memiliki pantat langsing namun padat berisi selalu menjadi dambaan banyak wanita. Namun, bagi yang berbokong besar, Anda boleh bangga memilikinya. Penelitian menunjukkan walaupun bentuknya kurang diinginkan banyak wanita namun bokong besar baik bagi kesehatan Anda.
Para ilmuwan di Oxford University telah menemukan bahwa lemak yang banyak tersimpan di bokong itu jauh lebih baik dibandingkan lemak di perut. Lemak ini dipercaya dapat menurunkan tingkat kolesterol jahat (LDL) dan menaikkan tingkat kolesterol baik (HDL), sehingga mencegah pengerasan pembuluh darah.
Temuan yang diterbitkan International Journal of Obesity ini juga menunjukkan ukuran bokong yang lebih besar dapat mengurangi risiko diabetes.
Professor Jimmy Bell, pimpinan dari metabolic and molecular imaging di Hammersmith Hospitals NHS Trust menjelaskan lemak terbagi menjadi dua bentuk -sama seperti kolesterol-, yaitu lemak baik dan buruk. Sel-sel lemak di bagian tubuh bawah mempunyai cara kerja yang berbeda dengan sel-sel lemak tubuh bagian atas.
Lemak gluteofemoral, yang banyak tersimpan di sekitar bokong akan bertindak sebagai penyangga dan membersihkan semua peradangan lemak yang bisa membahayakan jika berada di bagian tubuh lainnya.
"Lemak di bokong Anda dihancurkan dengan cara yang lebih lama dibandingkan lemak perut. Sehingga, lemak ini akan lebih sedikit memproduksi inflammatory cytokines, zat kimia yang telah lama dikaitkan dengan diabetes, penyakit jantung dan obesitas," papar Prof. Bell, dilansir melalui Dailymail, Selasa (7/2).
          NHS support        
I joined the Dudley Group of Hospitals Foundation Trust as a Foundation Trust member approximately 2 years ago as I am a very staunch supporter of the NHS. I wanted to play a part, no matter how small, in trying to maintain and improve the NHS services in Dudley and saw this as a way of becoming involved.
          The same great NHS         
On this, the 60th anniversary year of the NHS, I would like to express some positive views rather than the usual negative ones we are used to reading about.
          By: Phoebe        
Heyya Jane, *hugs* Not a lot else to say. First hand experience of the sort of disempowerment those bastards can get up to is hard. Sorry you've had such a hard day. It would be nice if someone could get an informed-consent model through the NHS one day. It'd be so much cheaper just liberalising cheap drugs than public funding £300 every appointment for some gatekeeper to drag the assessment process out.
          Therapist/Substance Abuse Counselor - Utah Navajo Health System - Monument Valley, UT        
Substance Abuse counseling is preferred, or extensive addiction and substance abuse background. UNHS is looking for a therapist to serve our patients in...
From Utah Navajo Health System - Mon, 07 Aug 2017 23:22:08 GMT - View all Monument Valley, UT jobs
          Therapist - Utah Navajo Health System - Monument Valley, UT        
Substance Abuse counseling is preferred, or extensive addiction and substance abuse background. UNHS is looking for a therapist to serve our patients in...
From Utah Navajo Health System - Mon, 07 Aug 2017 23:22:07 GMT - View all Monument Valley, UT jobs
          A chance to question NHS Wirral Primary Care Trust on homeopathy        
Well, this could be an interesting event. At rather short notice, the NHS Wirral Primary Care Trust are to hold a public meeting this Wednesday March 6th at 6:30pm in the Old Market House on Hamilton Street, Birkenhead. There they will discuss a recommendation made by their Professional Executive Committee (PEC) to discontinue Homeopathic Services ...
          Friends of Rosedale Library hosting Fall Anniversary Celebration tomorrow 1 - 4 pm        
FRIENDS OF THE ROSEDALE LIBRARY

Fall Anniversary Celebration


“REVERSE BOOK SALE”

Donate books in good condition to support FORL’s programs at the Rosedale Library.  Questions?  Contact info is below.

We'll use the books to raise funds for FORL programs and events at the Library.

*Reverse Book Sale
*Bake Sale and Cider
*Halloween Crafts for Kids
*Film Screening at 2 p.m.  “Mama C: Urban Warrior”
*DCPL and FORL info and give-aways.


Sunday, October 25th â€“ 1 p.m. to 4 p.m.


Friends of the Rosedale Library
c/o Rosedale Library – 1701 Gales Street NE,  DC 20002
571-213-1630 | Friendsoftherosedalelibrary@gmail.com         | 


Rosedale Library - 1701 Gales Street NE


Join us in celebrating the 3rd Anniversary of the Rosedale Library.
 We’re doing things in a different way – a Reverse Book Sale.  Drop off your gently used books and make a donation.




          HR and social media in the NHS.        
Guidance prepared by NHS Employers for HR and other strategic leadership teams about the role of social media in a … Read more » - HR and social media in the NHS.
          NHS local        
Award winning site which uses rich media to deliver information on local services while collecting patient opinion. Site uses blogs … Read more » - NHS local
          Victory against 'the biggest single NHS privatisation'         
Plans to privatise "all cancer and end-of-life treatment for children and adults across Staffordshire and Stoke on Trent" have been scrapped
          But We Are Told Not To Encourage Vermin...        
...and if that goes for rats, pigeons & urban foxes, why does it not go for beggars too?
Southend could become the first place in Britain to install lockers for rough sleepers to store their belongings.
You have got to be kidding me!
The project, headed by Quiller Hawkins of Solidarity Lockers UK, has taken inspiration from a similar scheme in Lisbon.
ACA Portugal, which is behind the yellow metal cabinets, is now working in partnership with Mr Hawkins. He came up with the idea after speaking to a homeless person who had their guitar stolen. The lockers, which could soon be installed in Southend town centre, will allow people who are homeless to store their belongings safely - reducing the risk of them being robbed and allowing them to own more clothes than they can carry.
Southend is already far too attractive to beggars and homeless drug addicts, thanks to the proximity to London & the antics of group like Harp, which exist solely to ensure that shopkeepers have to shoo beggars away when they open up in the morning.
The lockers will also have an address, as they come equipped with a letter box - meaning that the person using it can register with the NHS and get allocated a National Insurance number.
Not necessarily their own, either!
Mr Hawkins is drawing up plans for the project alongside Mark Flewitt, Tory councillor for housing, planning and sustainability. Mr Flewitt said: “I am optimistic that any measure, soft or otherwise, if it starts giving people some dignity it will encourage people to try harder and, more importantly, the authorities to try harder.
“If we help one or two people then it could make a huge difference to their lives, as they will feel like they are being paid attention to.”
The only people that should be 'paying attention to them' is the police. Begging should be dealt with like any other crime, zero tolerance.
Mr Flewitt told the Echo he has not yet formally taken the idea to Southend Council as he and Mr Hawkins believe it is best to publicise the idea first and gauge reaction from the community.
Of course, the only 'community' that'll actually be listened to will be the tiny minority of SJWs and charities employing people to ensure these people are carefully farmed like sheep...
          If big business is to thrive, it needs a strong welfare state | Phil McDuff        

The entrepreneurial spirit cannot flourish if people don’t feel valued, rewarded and, above all, sheltered from severe economic turbulence

Unleash the power of markets and the private sector will deliver returns that raise everyone’s living standards: that’s the market liberalism argument. However, for a decade now we have been living in a world where the opposite is true. GDP rises but wages shrink. The financial crisis was 10 years ago but austerity looks set to continue into the middle of the next decade, as we endlessly wait for the recovery that’s always round the corner.

The chancellor, Philip Hammond, berated Labour during his budget speech for wanting to “saddle our children and burden our future”, but young people who entered the jobs market in 2010 will be in their mid-to-late 30s before austerity is projected to end. It’s not “protecting our children’s future” to keep them in low-waged, precarious work from 18 to 38. The UK government is issuing 40-year bonds at 1.87% and, in a fit of perversity, we’re “protecting” our children from those interest payments by forcing them to take payday loans at 1,500%.

The NHS saves British business thousands on health insurance, compared with in the supposedly more flexible US

Related: Hammond's NICs U-turn is a political disaster for the government | Larry Elliott

Continue reading...
          Muslims in Hospitals Don't Have to Follow Rules of Cleanliness        
MORE POWERFUL in the long run than bombs and terror, waging jihad by gaining concessions is designed to gradually establish Sharia law everywhere on earth. Here's yet another concession Islam has won from non-Muslims: As of two months ago, female Muslim staff in British hospitals are now allowed to cover their arms to preserve their modesty despite earlier guidance that all staff should be "bare below the elbow."

This change has come about because "female Muslims objected to being required to expose their arms below the elbow."

The purpose of the original rules was to "reduce the number of patients who were falling ill, and even dying, from superbugs such as MRSA and Clostridium difficile." Oh well, people may get sick and die, but at least the Muslims are happy. It will be mostly infidels getting sick anyway.

Read the story: Muslim staff escape NHS hygiene rule.

          A Permanent Placement        
For the past year, I've been working in a "fixed-term" position. What that means is that I have a contract for exactly 11 months. The post is not guaranteed to run past the end of October. Fortunately, a position became available in the same NHS Trust...(read more)
          â€˜Can You Back That Up?'        
I was asked that question last week by a board member of the NHS Trust in which I work. Rather a few members are making the rounds of different services to see how things are working (or not) and to assess if they are getting monetary value for those...(read more)
          delisha turn to 6 months..:)        



alhamdulillah
sekejap je masa berlalu
teringat2 detik2 cemas saat melahirkan dulu
(cemas ke??)
cemas laaaaa...saat2 nyawa dihujung tanduk tu!!

anak dara kesayangan aku dah pon 6 bulan
demam c.pox dah pon baik
tinggal pulak batuk2
maybe disebabkab jerebu kot
tapi....

alhmdlh..tinggal sikit2 je lagi
bile dah ade anak ni
berhabisan duit pon x pe