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.

Hands yellow flower

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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Statins and venous thromboembolism: should statins use extend beyond lowering cholesterol?

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Dr Setor Kunutsor, Research Fellow in Evidence Synthesis/ Epidemiologist, School of Clinical Sciences, University of Bristol

Statins are well known and established for their role in the prevention of cardiovascular disease (heart attack, strokes, or angina) and this is based on their ability to lower levels of cholesterol in the blood.

However, there is evidence to suggest that statins have multiple effects and these include potential beneficial impacts on other disease conditions.

Venous thromboembolism is a condition involving the formation of blood clots in the veins of the lungs and lower limbs. It affects millions of people globally and is a preventable cause of hospital-related deaths.

Standard techniques for the prevention of venous thromboembolism include the use of elastic stockings, compression devices, patient mobility and rehabilitation, and anticoagulant therapy (blood thinning medications).

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Deep Vein Thrombosis. Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010.  ISSN 2002-4436

Evidence now suggests that statins also have the ability to reduce inflammation in the body and prevent the formation of blood clots. Based on these properties, there have been suggestions that statins may prevent venous thromboembolism.

Several studies have investigated this, however the evidence has not been conclusive until now.

We decided it was time to bring all the evidence together and evaluate if statins really did have a protective effect on the risk of developing venous thromboembolism.

Altogether we analysed 36 studies (13 observational cohort designs and 23 randomised controlled trials) with data on more than 3.2 million participants.

Our results showed a clear link between the use of statins and a reduced risk of developing venous thromboembolism. Continue reading

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Global Health: Antibiotics and Superbugs

In 1928 Alexander Fleming discovered penicillin, thus bringing one of the greatest medical advances of our time: antibiotics.

Innocuous infections, operations and injuries were no longer a death sentence.

Since then, antibiotics have been developed to treat an array of diseases but this slowed, and then stopped in the 1980s. Although our arsenal of development ceased, the bacteria, viruses and fungi did not stop evolving.

This asymmetric development has resulted in an antimicrobial resistance problem: bacteria causing common infections and illnesses are now increasingly resistant to the drugs used to treat them.

By 2050, the death toll could be a staggering one person every three seconds if AMR is not tackled now. Infographic from the AMR review

Creative Commons Attribution 4.0 International Public License. Attribution notice: ‘Review on Antimicrobial Resistance.’ From the O’Neill Report in 2016.

Solving this issue is not straightforward.

It involves a complex landscape of policy makers, clinicians, vets, law makers, and many others.

As part of Bristol Doctoral College’s Research without Borders Festival 2017, a public discussion was held exploring the problem of superbugs and antibiotic resistance, in both the context of research happening at the university of Bristol, and from a wider perspective.

Discussions revolved around patent law, and how it may affect development of new drugs and solutions, the role of agriculture, in particular dairy farming, in reducing antimicrobial resistance, and what we can do as individuals to help address this problem.

Below is a brief snapshot of the research relating to antimicrobial resistance being undertaken across the University of Bristol by the postgraduate researchers who took part in the RWB discussion panel. Continue reading

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Scoping the impact of Brexit for NHS procurement

Dr Albert Sanchez Graells, Senior Lecturer in Law, University of Bristol Law School

Dr Albert Sanchez Graells, Senior Lecturer in Law, University of Bristol Law School

NHS England spends over £20 billion every year on goods and services. A significant part of the remainder of NHS non-salary budget involves the commissioning of health care services. This expenditure and commissioning is controlled by NHS procurement rules, which in part derive from EU law. NHS procurement rules are regularly criticised for imposing excessive red tape and compliance costs, and calls for NHS procurement reform to free it from such strictures are common.

In this context, Brexit could be seen as an opportunity to overhaul NHS procurement and to move away from the perceived excesses of EU law. This post concentrates on two issues. First, does EU law prevent significant reforms of NHS procurement and, if so, can Brexit suppress such constraints? Second, is the way Brexit is unfolding conducive to an improvement of NHS procurement? Continue reading

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Why healthcare services have a problem with gambling

Image of electronic gambling machines.

“I have a problem with gambling. There’s not enough of it.”

Dr  Sean Cowlishaw, Research Fellow at the Centre for Academic Primary Care, University of Bristol

That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.

The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling machines, called Fixed-Odds Betting Terminals (FOBTs), which now occupy the high street (within betting shops) and allow punters to wager up to £100 every 20 seconds.

Yet Britain doesn’t have much insight into its problem with gambling. Compared to most other addictive behaviours, involving drugs or alcohol for example, gambling is largely ignored by health services and public health agencies. This is partly because gambling is a hidden concern. It does not manifest with physical warning signs. Indicators are usually visible in extreme cases only, and generally following major life crises such as extreme debt or relationship breakdown. Continue reading

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We’ve created a new vibration-proof ‘metamaterial’ that could save premature babies’ lives

 

Fabrizio Scarpa, Professor of Smart Materials & Structures, University of Bristol

Andy Alderson
Professor of Smart Materials and Structures, Sheffield Hallam University

There are 16,000 transfers of premature babies to medical facilities each year in the UK alone. The babies are often transported over large distances from rural to city locations over significant periods of time, in some cases two hours or more. The ambulances, helicopters or aircraft used are miniaturised intensive care units, containing all the equipment required to keep the baby alive.

But mechanical vibrations and noise from the equipment and transfer vehicle can provide significant, even life-threatening stress to the most vulnerable and delicate human lives. As we discovered when speaking to clinicians, transfers are sometimes aborted as a result of the stress that develops in the baby. These vehicles need materials and structures to reduce the noise and vibrations to tolerable levels. Continue reading

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After 2016; how to achieve more inclusive food policy?

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Photographer: Ed Gregory

Dr Elizabeth Fortin, PolicyBristol Coordinator for Social Sciences, Law, Arts and Humanities,
E.Fortin@bristol.ac.uk

Having spent my British Academy Postdoctoral Fellowship researching forms of governance that aspire to achieve that nebulous concept of ‘sustainability’ in relation to certain parts of the global agro-food/fuel system, it seemed fitting that the last event I attend in this capacity should be City University’s annual Food Symposium.

This year’s Symposium enabled Prof. Tim Lang, who is passing the baton of running City’s influential Food Centre to Prof. Corinna Hawkes, and a number of his colleagues, to reflect on the past 25 years of food policy. But it also provided an unprecedented opportunity to 40 audience members from both academia and civil society to imagine a more utopian future – not difficult in our troubled present – to table their vision of ‘How to do food policy better‘. We heard from a headteacher, a producer, a proud ‘Colombian peasant’, a farmer’s daughter, a student, the BBC chef of the year, a former advertiser, a community food network coordinator.  We then went on to hear from a panel of those who have been working to enable such diverse voices to be heard both in relation to the research they have been undertaking or the programmes they have been endeavouring to implement. Continue reading

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