Why the annual winter health crisis could be solved in homes, not hospitals

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Richard Morris, University of Bristol

As winter continues, so does the usual soul searching about the state of the UK’s National Health Service (NHS). Images of ambulances backing up outside emergency departments and patients lying on trolleys in corridors haunt politicians and the public alike.

Demand on the NHS, which is always high, increases over the coldest of seasons, when threats to health are greatest. Generally, more than 20,000 extra deaths occur from December to March than in any other four-month period in England and Wales. That number varies considerably, however – from 17,460 in 2013-4 to 43,850 in 2014-5 (which was not even a particularly cold winter). And there has been no evidence of a decreasing trend since the early 1990s, despite the national flu immunisation programme. Continue reading

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‘People like us just shouldn’t fall in love’: how British immigration rules are separating fathers from their families

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Melanie Griffiths, University of Bristol and Candice Morgan, University of Bristol

Couples are being subjected to painful separations, uncertainty about their future and financial hardship by the UK’s strict immigration rules, according to our new research.

Between 2014 and 2017, we followed nearly 30 couples where the man had irregular or insecure immigration status in the UK but his partner or children were citizens of Britain or the European Economic Area (EEA). Continue reading

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Putting algae and seaweed on the menu could help save our seafood

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If we have to feed 9.8 billion people by 2050, food from the ocean will have to play a major role. Ending hunger and malnutrition while meeting the demand for more meat and fish as the world grows richer will require 60% more food by the middle of the century.

But around 90% of the world’s fish stocks are already seriously depleted. Pollution and increasing levels of carbon dioxide (CO₂) in the atmosphere, which is making the oceans warmer and more acidic, are also a significant threat to marine life. Continue reading

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Why doctors need to improve the way we discuss assisted dying

Creator attribution: Nick Youngson – link to – http://nyphotographic.com/                Source: http://www.thebluediamondgallery.com/a/assisted-dying.html

Paul Teed, University of Bristol

Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.

At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad. Continue reading

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Evacuating a nuclear disaster areas is (usually) a waste of time and money, says study

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Over 110,000 people were moved from their homes following the Fukushima nuclear disaster in Japan in March 2011. Another 50,000 left of their own will, and 85,000 had still not returned four-and-a-half years later.

While this might seem like an obvious way of keeping people safe, my colleagues and I have just completed research that shows this kind of mass evacuation is unnecessary, and can even do more harm than good. We calculated that the Fukushima evacuation extended the population’s average life expectancy by less than three months.

To do this, we had to estimate how such a nuclear meltdown could affect the average remaining life expectancy of a population from the date of the event. The radiation would cause some people to get cancer and so die younger than they otherwise would have (other health effects are very unlikely because the radiation exposure is so limited). This brings down the average life expectancy of the whole group.

But the average radiation cancer victim will still live into their 60s or 70s. The loss of life expectancy from a radiation cancer will always be less than from an immediately fatal accident such as a train or car crash. These victims have their lives cut short by an average of 40 years, double the 20 years that the average sufferer of cancer caused by radiation exposure. So if you could choose your way of dying from the two, radiation exposure and cancer would on average leave you with a much longer lifespan. Continue reading

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The menopause: dreaded, derided and seldom discussed

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Sign of caution – or celebration?
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Author: Isabel de Salis, University of Bristol

Women experience the menopause between the ages of around 45 and 55, but their experiences of this significant stage of life are diverse. Each woman’s menopause is unique.

Common themes run through women’s stories, however. From our research talking with women in midlife, we found that they often talk about menopause as a normal, inevitable and natural process, which of course, it is. Seeing menopause in this way allows women to minimise symptoms and behave stoically. “It’s no big deal,” one woman told us. “You just get on with it.”

But this positive approach can also be a rebuttal of a common perception in society of the menopause as a negative event – a view which leads to denigrating women who react differently to the menopause. Continue reading

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Complex guidelines on eating fish when pregnant mean that mothers – and babies – are missing out

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Caroline Taylor, University of Bristol

As soon as women find out they’re pregnant, they are overwhelmed with information about what they can – or more likely can’t – eat and drink. Off the menu go soft cheeses, partially cooked eggs, raw meat, pâté, liver, caffeine, alcohol. It’s a lot to remember.

But the advice on eating fish when pregnant is the by far the most complex. Does it need to be so complicated? What is the actual evidence of the risks and benefits of eating fish for a mother-to-be? Continue reading

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Pregnancy, baby loss, and effective training for bereavement care in the UK

The 9th-15th October is Baby Loss Awareness Week, which provides a chance to raise awareness about the issues surrounding pregnancy and baby loss in the UK.  Our team has over 10 years of research experience in what makes effective training for staff involved in care for bereaved parents, and seven years working to end preventable harm related to stillbirth.

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Author: Dr Dimitrios SiassakosConsultant Senior Lecturer in Obstetrics, Department of Obstetrics and Gynaecology, The Chilterns, Southmead Hospital and Bristol Medical School

We welcome the House of Commons debate on Tuesday 10th October 2017 as part of Baby Loss Awareness Week, and have drawn on our recent research at the University of Bristol to contribute to this debate.

Our research has found that bereavement care is inconsistent across UK hospitals, and variable in quality. Bereaved parents are not always involved in decision-making, and parents may not be aware of the process when hospitals review their baby’s death. Healthcare staff may not be supported in caring for parents.

Our research on what makes training effective highlights that not all training is equal.

How we would like our MPs to help:

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How do we teach clinicians to talk about the end of life?

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Image credit: Doctor and patient – Government of Alberta. Creative Commons License 2.0 (Non-commercial No Derivatives). Source: Flickr

By Dr Lucy Selman Research Fellow (Qualitative Research in Randomised Trials) Centre for Academic Primary Care  University of Bristol

In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.

The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to expect when you’re dying, or a patient’s preferences for end of life care?

When this communication is done poorly, or not done at all, patients are confused and less satisfied with their care, experience inadequate symptom relief, and have worse quality of life. Staff who feel insufficiently trained in communication skills are more likely to provide depersonalised care and suffer from burnout.

While research in clinical communication has grown in recent years, there is little consensus on optimal training strategies and the most effective teaching methods. Continue reading

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Multimorbidity could cause a healthcare crisis – here’s what we can do about it

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Older patients often suffer from multiple conditions.
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Professor Chris Salisbury, Primary Health Care, University of Bristol

Multimorbidity is one of the biggest challenges facing healthcare. In recent years, a succession of research studies have shown that people with multiple health problems are more likely to have a worse quality of life, worse mental health and reduced life expectancy. The more health problems someone has, the more drugs they are likely to be prescribed and the more frequently they are likely to consult a GP or be admitted to hospital.

You might think this is all rather self-evident – it’s hardly a surprise that sick people get ill, take medicines and go to doctors more often than healthy people.

So why has multimorbidity become so prominent in discussions about healthcare over the last decade?

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