recovering from surgery at home
In an experimental move designed to reduce waiting times and the risk of infection, patients having colostomy reversals in Somerset are being sent home on the day of their surgery. Thanks to technology that measures blood pressure, oxygen levels and heart rate, post-operative monitoring can be done remotely by a nurse acting as an intermediate care clinician while the patient is able to enjoy home comforts. This strategy also frees up hospital beds and it is hoped that it can be extended to other procedures where the risk of complications is low.
The greatest benefit, however, is to the patients themselves who no longer have to wait up to two years for an ileostomy closure, which could now take place as quickly as several weeks after bowel cancer surgery. Dubbed the 'Hospital at Home Scheme', it is to be hoped that other NHS trusts will follow Somerset's example, with benefits to patients and the wider health service.
1. Bowel cancer patients allowed home on same day as stoma surgery. BBC News, 8 November 2023. bbc.in/3O4kLcM
reducing the incidence of breast cancer
Around 47,000 people per year in England develop breast cancer, and women on average have a 15 per cent chance of contracting the disease during their lifetimes. The risk is higher in post-menopausal women and those carrying the BRCA gene mutation.
A drug previously used post-operatively to prevent breast cancer from recurring has now been approved for use as a prophylactic in women at elevated risk of developing the disease for the first time. Anastrozole is off-patent and can therefore be produced cheaply to provide a daily dose for the 289,000 women estimated to be eligible for the drug, with a potential saving to the NHS of £15m in treatment costs.
As with all medication, there are possible side effects (though less serious than those associated with tamoxifen), many of which mimic menopausal symptoms as the drug targets oestrogen. But for women at high risk, the benefits outweigh the inconvenience.
1. Anastrozole: Thousands to be offered drug to prevent breast cancer in England. BBC News, 7 November 2023 bbc.in/3O64QdQ
the high cost of industrial action
Industrial action is estimated to have cost the health service £1bn this year.'1 But the cost of this year's strikes by healthcare workers cannot be measured only in monetary terms. Waiting lists have lengthened (to 7.8 million) and there is a real concern that the NHS will struggle to cope with the extra demand for beds this winter.
Staff shortages contribute to this crisis with one in ten posts unfilled. The vicious cycle of overwork and stress imposed on those who remain in the NHS is likely to result in more doctors, nurses, and midwives leaving either to work in other countries or less demanding careers in the private sector.
1. NHS struggling to open extra winter beds and fill staffing gaps. BBC News, 14 November 2023 bbc.in/3U5IjBN
nitrous oxide now a Class C drug
Whatever the wisdom of turning a widely-used drug with minimal deleterious health effects into an illegal substance, possession of 'laughing gas' is now officially a criminal offence.
As any medical student will know, nitrous oxide or 'gas and air' is the drug of choice for relieving the pain of childbirth (not very effective in my experience!). Used recreationally, and inhaled from balloons into which the high-pressure gas has been released, it causes short-lived euphoria. Although prolonged and frequent use can lead to neurological damage, mainly due to vitamin B12 depletion, occasional light use has fewer negative effects than alcohol or cannabis, and the Advisory Council on The Misuse of Drugs advised against a ban because of the possibility of unintended consequences.
Besides the health risks that come with heavy and prolonged use, discarded gas containers have a significant environmental impact, with the small silver capsules littering many urban streets now increasingly replaced by large and heavy canisters that contain much more of the gas and make excessive use much more likely. Time will tell whether the ban will lead to a reduction in the health and social consequences of this drug.
1. Nitrous oxide: Laughing gas possession becomes illegal. BBC News, 8 November 2023 bbc.in/424Devt
an assessment of the current global crisis
The opening paragraph of a report[1] by the 'Lancet Commission on peaceful societies through health equity and gender equality' makes disturbing reading and is worth quoting in full:
'The multiple and overlapping crises faced by countries, regions, and the world appear unprecedented in their magnitude and complexity. Protracted conflicts continue and new ones emerge, fuelled by geopolitics and social, political, and economic pressures. The legacy of the COVID-19 pandemic, economic uncertainty, climatic events ranging from droughts to fires to cyclones, and rising food insecurity add to these pressures. These crises have exposed the inadequacy of national and global leadership and governance structures. The world is experiencing a polycrisis—ie, an interaction of multiple crises that dramatically intensifies suffering, harm, and turmoil, and overwhelms societies' ability to develop effective policy responses.'
This is the world that you, as a student, are inheriting and it is easy to feel overwhelmed by the enormity of the situation. But as a follower of Christ, you have an eternal hope that you can hold out to those who are in despair, whether healthy or sick. The Saline Solution course[2] is one tool to help to show you how.
1 . The Lancet Commission on peaceful societies through health equity and gender equality - The Lancet, 4 November 2023 bit.ly/3Sk7qzy
addressing the UK's shortage of doctors
Despite plans to boost the recruitment of doctors within the UK, the BBC reports that the NHS will continue to rely on doctors from overseas for the foreseeable future. Currently, NHS England is short of nearly 11,000 doctors. Last year, 63 per cent of those serving in the NHS were trained in other countries, while 2,000 UK doctors left to practise overseas.
The government plans to pour a very substantial amount of money into additional training places for healthcare workers. But will young people be attracted to a career that requires five years of intensive study followed by work in an often-stressful environment? Strike action by junior doctors has highlighted the fact that, for the first few years at least, pay is not considered to be commensurate with the demands and responsibilities of a career in medicine.
NHS England acknowledges that education reform is needed if the needs of patients are to be adequately met both now and in the future- Overseas doctors will remain 'crucial' despite recruitment drive — regulator. BBC News, 13 November 2023. bbc.in/3O3Z38Q
