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Newcastle robot surgery inquest: ‘Risk of further deaths’

There “remains a risk of further deaths” from robotic heart surgery, a coroner has warned during an ..

There "remains a risk of further deaths" from robotic heart surgery, a coroner has warned during an inquest into a man's death.

Stephen Pettitt, 69, died after an operation led by Sukumaran Nair at the Freeman Hospital, Newcastle, in 2015.

He was the first patient in the UK to undergo the pioneering treatment.

Recording a narrative verdict, coroner Karen Dilks said his death came as a "direct consequence of the operation and its complications".

"Mr Pettitt died due to complications of an operation to treat mitral valve disease and, in part, because the operation was undertaken with robotic assistance," she said.

Ms Dilks said Newcastle Hospitals NHS Trust should establish a policy covering the use of expert doctors, known as proctors, brought in to provide advice during new procedures.

Two proctors left during Mr Pettitt's operation and the inquest heard they could not have intervened in any case as they were not registered with the General Medical Council.

'Tragic outcome'

The coroner also said there was an "absence of any benchmark" for training on new intervention treatments.

The inquest heard Mr Nair had no one-to-one training on the Da Vinci device and had been "running before he could walk".

It was "more likely than not" that Mr Pettitt would have survived had conventional open heart surgery been used, with only a 1%-2% chance of him dying, it was told.

The trust's medical director, Dr Andy Welch, has apologised and said it had "failed to ensure the standard of care that would reasonably be expected of us with a tragic outcome".

The robotic heart programme was stopped after Mr Pettitt's death and "significant changes" had been made, he said.

Any outstanding recommendations by the coroner would be "implemented immediately", he added.

'Catalogue of errors'

Ms Dilks said she would also contact the Royal College of Surgeons and the Department of Health to ask them to consider whether national guidelines should be brought in.

In a statement after the inquest Mr Pettitt's family said an "investigation revealed a catalogue of errors including significant deficiencies in training and competence of the surgeon who had performed the procedure, who was subsequently dismissed".

"This was compounded by the fact that several observing clinicians left the theatre part way through the procedure, and were therefore unable to assist when difficulties arose," they said.

Mr Nair, who trained in India and London and previously worked at the Papworth Hospital in Cambridgeshire, now works in Scotland and no longer does robotic surgery.

Original Article

BBC

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Officials investigating 252 possible cases of polio-like illness AFM

Officials are now investigating 252 cases of possible acute flaccid myelitis (AFM), including 90 con..

Officials are now investigating 252 cases of possible acute flaccid myelitis (AFM), including 90 confirmed cases in 27 states, according to the Centers for Disease Control and Prevention.

The number of cases under investigation by the CDC is up 33 from last week, and the number of confirmed cases rose by 10, Dr. Nancy Messonnier, the director of CDCs National Center for Immunization and Respiratory Diseases, told reporters Tuesday.

Acute flaccid myelitis is a condition that has polio-like symptoms such as partial paralysis. The virus mostly affects children and young adults. The CDC said they do not know why the condition is impacting these individuals, but many believe it is caused by viruses. The CDC emphasized it remains a rare condition and said there have been no reported deaths from AFM so far in 2018.

The typical symptoms of AFM are similar to those of a severe respiratory illness, along with a fever, but then progress into neurological symptoms. Some patients with AFM feel weakness in their arms or legs, a loss of muscle tone or slower reflexes.

Some patients may also exhibit facial droop or weakness, difficulty moving their eyes and drooping eyelids or difficulty with swallowing or slurred speech. The most severe symptom is respiratory failure.

Messonnier said the CDC doesn't yet have enough information to definitively say what causes AFM and are casting a wide net for information. Part of that is studying the long-term health of AFM patients. Scientists are also looking for a pathogen in AFM patients' spinal fluid, but haven't yet found a pathogen that's a clear cause, she said.

The CDC said it sees an uptick in AFM cases every two years, and so far, the curve of the cases being investigated this year looks very similar to that of 2014 and 2016.

Officials don't expect many more cases in 2018 compared to 2016 and 2014, Messonnier said.

The best advice available is to wash your hands regularly, which lowers the chances of getting sick or spreading germs from many of the viruses linked to AFM, and protect against mosquito bites by using repellent, in addition to staying indoors at dusk and dawn.

The CDC said the vaccines your pediatrician suggests are very effective and children should continue to receive them on schedule even though there is no vaccine for AFM. (more…)

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‘Make-a-Wish’ wishes decrease trips to hospital for sick children: Study

A recent study from the Nationwide Childrens Hospital in Columbus, Ohio shows that participation in ..

A recent study from the Nationwide Childrens Hospital in Columbus, Ohio shows that participation in the Make-A-Wish program may give children better quality of life and reduce hospital visits and healthcare costs.

Patients who received a wish were 2.5 times more likely to have fewer unplanned hospital admissions and 1.9 times more likely to have fewer unplanned emergency department visits compared to patients of similar age, gender, disease category, and disease complexity who would also quality for a wish but did not receive one.

What is the Make-A-Wish Foundation?

The Make-A-Wish Foundation is a non-profit organization whose goal is to provide children aged three to 17-years-old who have progressive, life-limiting, or life-threatening medical conditions, with experiences known as “wishes.” These wishes include “I wish to…” “go,” “be (someone for a day),” “meet,” and “have” (i.e. receive gifts.) The foundation is funded by contributions from individual donors, corporations, and other organizations.

What are the goals and mission of the Make-A-Wish Foundation?

The Make-A-Wish Foundation “serves a unique, and vital, role in helping strengthen and empower children battling illnesses.” And, “wishes make life better for kids with critical illnesses.”

How many “wishes” does the foundation grant?

The Make-A-Wish Foundation was founded in November 1980 and the first wish was granted in the spring of 1981 to Frank “Bopsy” Salazar, a 7-year-old who had leukemia. Bopsy had three wishes: to be a fireman, go to Disneyland, and ride in a hot air balloon — all of which were granted to him. Since then, more than 285,000 children in the United States and its territories have benefited from experiencing their wishes. The foundation granted 15,300 wishes last year alone; which means on average, a wish is granted every 34 minutes.

What are the potential benefits of receiving a “wish?"

There is a long-held belief that receiving a wish improves a childs quality of life and potentially improves their familys quality of life, enhances family bonding, reduces stress, increases hope and serves as a distraction from illness. (more…)

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To curb STD rise, doctors treat patients’ partners without an office visit

This is a Kaiser Health News story.

If patients return to Dr. Crystal Bowe soon after taking medi..

This is a Kaiser Health News story.

If patients return to Dr. Crystal Bowe soon after taking medication for a sexually transmitted infection, she usually knows the reason: Their partners have re-infected them.

“While you tell people not to have sex until both folks are treated, they just dont wait,” she said. “So they are passing the infection back and forth.”

Thats when Bowe, who practices on both sides of the North and South Carolina border, does something doctors are often reluctant to do: She prescribes the partners antibiotics without meeting them.

Federal health officials have recommended this practice, known as expedited partner therapy, for chlamydia and gonorrhea since 2006. It allows doctors to prescribe medication to their patients partners without examining them. The idea is to prevent the kind of reinfections described by Bowe — and stop the transmission of STDs to others.

However, many physicians arent taking the federal governments advice because of entrenched ethical and legal concerns.

“Health care providers have a long tradition of being hesitant to prescribe to people they havent seen,” said Edward Hook, professor at the University of Alabamas medical school in Birmingham. “There is a certain skepticism.”

A nationwide surge of sexually transmitted diseases in recent years, however, has created a sense of urgency for doctors to embrace the practice. STD rates have hit an all-time high, according to the Centers for Diseases Control and Prevention. In 2017, the rate of reported gonorrhea cases increased nearly 19 percent from a year earlier to 555,608. The rate of chlamydia cases rose almost 7 percent to 1.7 million.

“STDs are everywhere,” said Dr. Cornelius Jamison, a lecturer at the University of Michigan Medical School. “We have to figure out how to … prevent the spread of these infections. And its necessary to be able to treat multiple people at once.”

A majority of states allow expedited partner therapy. Two states — South Carolina and Kentucky — prohibit it, and six others plus Puerto Rico lack clear guidance for physicians. (more…)

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