Thursday, June 11, 2009

NHS Stroke patients facing unacceptable delays

Stroke patients are facing "unacceptable delays" in life-saving surgery, new research shows. Just one in five have operations to reduce their risk of another potential fatal attack within the two week target set by the National Institute for Health and Clinical Excellence.

A survey of 240 surgeons from 102 hospital trusts across Britain found of 5,513 patients who underwent surgery between December 2005 and December 2007, 83 per cent of whom had a history of stroke, three in 10 waited more than 12 weeks.

The common, procedure called carotid endarterectomy, is routinely used to remove the build up of fatty deposits in the main artery between the heart and brain. These deposits could cause blood clots that block the blood supply to the brain, leading to strokes.

The average delay from referral to surgery was 40 days. Twenty-nine patients (0.5 per cent) died while in hospital, while 48 (1 per cent) died 30 days after surgery, mainly from strokes.

Professor Alison Halliday, of St George's Hospital Medical School, University of London, and colleagues, called for major improvements in services to enable early surgery to prevent strokes in high risk patients. Prof Halliday, whose findings are published online in the British Medical Journal, said: "These findings show unacceptable delays between symptom and operation in the UK. "Such delays are associated with a high risk of disabling or fatal stroke before surgery, and the benefit of surgery consequently falls rapidly with increasing delay. "Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes."

Previous research has shown the sooner surgery was performed after patients had their first symptoms, the more beneficial it was in reducing the risk of subsequent, and more serious, strokes. Surgery was particularly effective if performed within two weeks after their initial symptoms.

Every year in the UK, about 120,000 people have a minor stroke, known as a transient ischaemic attack, and up to 30 per cent die within a month. Stroke is also the single largest cause of severe disability in adults and costs the economy £7bn a year.

Prof Halliday added: "This large survey of carotid endarterectomy practice in the UK shows that the operation is underused compared with other similar countries. "Surgeons abroad might be driven by 'fee for service' and certainly perform many more operations for asymptomatic disease. "It is possible, however, that of the 120,000 people who have a transient ischaemic attack or stroke every year in the UK at least 10,000 might be suitable candidates for carotid endarterectomy yet only 4,500 procedures are being performed each year."


Edu-babble is turning schoolchildren into ‘customers’

Performativity is forcing curriculum deliverers to focus on desired outputs among customers in managed learning environments.

If you struggled to understand that sentence, pity the poor teachers (curriculum deliverers) who are struggling to interpret jargon and management language rather than simply teaching their pupils (customers).

Edu-babble has become so common that it earns censure today in a review of education led by professors at the University of Oxford. Their report criticises the “Orwellian language seeping through government documents of performance management and control that has come to dominate educational deliberation and planning”.

Heads and teachers receive edicts on inputs and outputs, audits, targets, curriculum delivery, customers, deliverers, efficiency gains, performance indicators and bottom lines, it says.

This language of policymakers and their advisers hinders the enthusiasm of teachers and engagement of pupils, it adds. The Nuffield Review report is the biggest independent analysis of education for those aged 14 to 19 in fifty years, taking six years to complete. It was led by Professor Richard Pring and Dr Geoff Hayward, from Oxford, and professors from the Institute of Education and Cardiff University.

It claims that ministers’ micro-management of schools and colleges has resulted in a narrow curriculum, teaching to the test, and a high number of disaffected teenagers not in education, employment or training.

The report says: “The increased central control of education brings with it the need for a management perspective, and language of performance management — for example, levers and drivers of change, and public service agreements as a basis of funding. The consumer or client replaces the learner. The curriculum is delivered. Stakeholders shape the aims. Aims are spelt out in terms of targets. Audits measure success defined in terms of hitting targets. Cuts in resources are euphemistically called ‘efficiency gains’. Education becomes that package of activities (or inputs) largely determined by government.”

It adds: “As the language of performance and management has advanced, so we have lost a language of education which recognises the intrinsic value of pursuing certain sorts of questions, of trying to make sense of reality, of seeking understanding, of exploring through literature and the arts what it means to be human.”

Professor Pring told The Times that policy language was “leading to a narrowing of the curriculum and impoverishment of learning”. He added: “We are losing the tradition of teachers being curriculum directors and developers — instead they’re curriculum deliverers. It’s almost as though they have little robots in front of them and they have to fill their minds, rather than engage with them.”

Bill Rammell, a former education minister, recently told the House of Commons about the establishment of the Centre for Procurement Performance. This had worked “proactively with the schools sector” to “embed principles and secure commitment from the front line” by “working with and through key stakeholders” and “engaging with procurement experts” to “deliver efficiency gains”.

Mary Bousted, the general secretary of the Association of Teachers and Lecturers, said: “We call it edu-babble. It completely denudes education from being a human and social act.”


British judge attacked for using old-fashioned slang

We read:
"A judge has been accused of using a 'racial slur' against gipsies when sentencing a conman. Judge Christopher Elwen told the fraudster he had 'gypped' a student out of money on the eBay website. The slang verb 'to gyp' means to defraud or steal. Experts suggested there is 'scholarly consensus' that it is derived from the word gipsy.

Romany gipsies also claimed the word began life as 'gypsied' and is an insult. But the judge insisted there is 'no evidence to connect it to any racial group'.

Travellers Times editor Jake Bowers said: 'Gypped is an offensive word. 'It is derived from gipsy and it is being used in the same context as a person might once have said they "jewed" somebody if they did an underhand business transaction. 'Basically what Judge Elwen has done is ascribed thievery to an entire ethnic group.

A spokesman for the Judicial Communications Office defended the judge's choice of words, saying: 'Gyp is defined in the Oxford English Dictionary as an act of cheating, nothing more.


It's a word I have not heard used for a long time but it was once common. I always understood it to refer to the experiences of visitors to Egypt in the first half of the 20th century, who were often cheated in various ways.

NHS trust apologises after photo of nurse making v-sign during operation posted on Facebook

I am anything but a fan of Britain's dismal nationalized health system but I think this is a bit of a storm in a teacup. I have been on the operating table more times than I can count but mostly under local anesthetic. And there is always plenty of chatter between those present -- with laughter from time to time but absolutely NO detriment to my treatment. But I do go to a top private clinic for my procedures so perhaps I should not generalize too much:
"A hospital visitor visited Facebook to thank nurses for their treatment of a patient - and was stunned to find pictures of staff pulling 'v-signs' and pointing their backsides at the camera.

The picture of a nurse flicking a 'v-sign' while inside an operating theatre - with a patient apparently lying on the bed - was branded 'humiliating' by fellow patients and Tory MP Ann Widdecombe.

Bosses of the Maidstone and Tunbridge Wells NHS Trust today issued an apology, and had the pictures removed from the site while launching an investigation.


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