From the monthly archives:

January 2008

UK Health Care System In Need of Repair

by Brian Carty, MD, MSPH
01-26-2008

Inadequate facilities, poor quality medical and nursing care in several British hospitals cause deaths from intestinal infections.

Imagine that you are seriously, even critically ill. You are in a dirty, rundown, understaffed hospital. The nurses, doctors, and other employees are rude, inattentive, and incompetent, and you can’t get out. What could be more terrifying?

Such, apparently, was the nightmarish predicament of a number of patients with serious intestinal infections in a group of British hospitals between 2004 and 2006. An October 2007 report by the government’s Commission for Healthcare Audit and Inspection has exposed a number of deficiencies in the UK’s rickety government-run health care system, the National Health Service (NHS). The report showed that outbreaks of Clostridium difficile (C. diff.) intestinal infections in several NHS hospitals: Kent Hospital, Sussex Hospital, and Maidstone Hospital, directly caused at least 90 deaths between 2004 and 2006 and contributed to many more. C. diff. is a type of bacterium which can cause serious intestinal infections, often after the administration of antibiotics.

The report documented poor quality medical and nursing care and inadequate infection control measures. Doctors made mistakes in antibiotic prescribing, fluid and nutrition management, and in many other aspects of care.

Nurses frequently did not wash their hands, wear gloves and gowns, clean mattresses, empty and clean commodes, feed patients, or give patients their medications. Patients who asked for help in going to the toilet were often told to “go in the bed,” then left to lie in their own urine and stool for long periods. Patients and family members described the care as “despicable,” “sickening,” and “appalling,”

Drity sink in clean utility room in UK hospital

A sink in the "clean" utility room

The NHS hospitals involved were old, dirty, and rundown. Although patients with C. diff. infection should be put in single rooms to prevent transmission of the infection to other patients, this was usually impossible. Only 10% of the hospitals’ beds were in single rooms. Patients were usually put in beds jammed together in long rows in large rooms. One hospital had only one sink for every 6 beds, and the other two hospitals had one sink for every 12 beds.

Empty apologies, empty promises.

The public release of the report was followed by the usual cynical apologies and promises of reform and “zero tolerance.” In addition to the C. diff. outbreaks at Kent, Sussex, and Maidstone hospitals, a similar outbreak at another NHS hospital, Stoke Mandeville Hospital, caused 33 deaths between 2003 and 2005.

Beds jammed together in a UK hospital contributed to spread of infection

Patients were usually put in beds jammed together in long rows in large rooms

UK health care system needs a makeover.

How did the UK end up with such a dysfunctional health care system? The English are prosperous, intelligent, even brilliant people. One of my medical school professors, originally from the UK, published the first account of a carotid endarterectomy, the operation to clean out the arteries in the neck to prevent strokes. He was famous as a surgeon, professor, and writer and operated on Winston Churchill and the King of Kuwait.

Inadequate funding, poor management.

Although government mismanagement is without question part of the problem, the UK spends much less on health care than the US. Still, the British government nationalized the health care system in 1948 and has had over fifty years to work the kinks out of the system.

The British people deserve better.

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In the August 2007 Journal of Clinical Psychiatry, researchers reported the results of a study of a new appetite suppressant drug combination: bupropion, an antidepressant, taken along with zonisamide, an anti-seizure drug. A group of obese women taking both drugs lost about 16 pounds in 3 months. More weight loss might have been seen after a longer treatment period.

Although serious side effects were not seen in the study, there were too few patients, only 7 in the bupropion/zonisamide group, to evaluate the safety of the drug combination and the frequency of side effects.. Zonisamide can cause sedation, dizziness, potentially severe depression, and other adverse effects. Bupropion usually has fewer adverse effects than zonisamide.

If other appetite suppressants with an established safety record can’t be used and an appetite suppressant is needed, bupropion/zonisamide might be prescribed with careful monitoring for adverse effects. However, until there is more research, the bupropion/zonisamide combination can’t be considered an established, safe, effective obesity treatment. More research is needed.

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Medical Image of the Month - Harvey Cushing

by Brian Carty, MD, MSPH
01-01-2008

http://www.hotmedicalnews.com/images/cushing_800.jpg

Harvey Cushing (1869-1939) developed many of the basic techniques for operating on the brain and is often called "the father of modern neurosurgery". Photo Courtesy of Yale Whitney Medical Library

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