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michael stone

michael stone

Recent activity

Comments (3167)

  • Comment on: NICE abandons plan to publish A&E safe staffing guidance

    michael stone's comment 30-Jul-2015 2:12 pm

    Pressure combined with cowardice, or what ? 'Dr Clifford Mann, president of the Royal College of Emergency Medicine, said not publishing the information this month was a “retrograde step”, which would “allow unacceptable variation in staff to patient ratios to continue and will inevitably have consequences for patient care”. “It is difficult to justify why a process that is as methodologically sound as the NICE process can’t be shared with the wider public,” he said.' I'm with him !!!

  • Comment on: NICE sets out draft guidelines for end of life care

    michael stone's comment 30-Jul-2015 2:09 pm

    Anonymous | 30-Jul-2015 12:14 pm Everyone isn't 'tarred with the same brush'. I think the point is that these days, as opposed to 'rather a long time ago', bad stories spread faster because of 'social media', and that leads to 'headlines'. And even if only a few deaths go very badly, the bereaved are extremely upset. However, there is an issue with 'Communication is vital with both patients and relatives' - there is very unclear and ambiguous guidance around the combination of patient confidentiality and end-of-life patients who have lost mental capacity. This does need to be sorted out, as I have pointed out more than once, for example at: http://www.bmj.com/content/348/bmj.g4094/rr/703333 It isn't good mouth care, which is fundamentally problematic, anyway: it is the general issue of 'who makes the decisions'. For example, the NICE guidance addresses drinking in this section: 22. Support the dying person to drink if they wish to and are able to. Check for any difficulties, for example, swallowing problems or risk of aspiration. Discuss the risks and benefits of drinking with the dying person, the multiprofessional team and others involved in the care of the dying person. That first sentence has got an issue of interpretation, with the words 'able to' - and the third sentence talks about a discussion, but it does not make clear what happens if discussion leads to disagreement. Last year the LACDP included the following two sections about drinking, on page 89 of 'Once Chance To get It Right': 10. The dying person must be supported to eat and drink as long as they wish to do so and there is no serious risk of harm (for example through choking). However if there is likely to be a delay in assessing their ability to swallow safely, alternative forms of hydration must be considered and discussed with the person. Nursing and medical records on the assessment of intake must be kept. 11. If a dying person makes an informed choice to eat or drink, even if they are deemed to be at risk of aspiration, this must be respected. The LACDP's section 11, seems to be 'missing' from the NICE draft (from my 'first very-partial glance') but the LACDP are legally correct - 'clinicians describe risks, mentally-capable patients decide which risks to take' is the correct legal situation to start from. Ditto the NICE section 28, which is not clear who is doing the decision-making: it is the patient, if mentally-capable, who 'does the considering'. There are some issues which need sorting out, not ignoring, or setting aside 'as being too difficult to deal with' - including the issues I pointed at in a comment on Marie Curie: http://blog.mariecurie.org.uk/2015/04/08/new-conversation-terminal-illness/#comment-65442 The 'common sense' seems to have moved to Radio 4's 'Today' programme.

  • Comment on: NICE sets out draft guidelines for end of life care

    michael stone's comment 30-Jul-2015 9:29 am

    I am still working my way through this guidance - it doesn't seem to be quite the same as what Mark baker from NICE was saying about it on BBB Radio 4 yesterday morning, when he said among other things that: “…decisions about the end of life need to be taken in conjunction with the person concerned if they are able to and with those close to them rather than these decisions made by doctors on their behalf, and there is a widespread belief within the profession that do not resuscitate orders are a clinical decision but they are a decision to be made in conjunction with the patient and their families” You can use the BBC 'listen again' for a few weeks - he was speaking about 2hrs 15 minutes in, and the link is at: http://www.bbc.co.uk/programmes/b0639wwr

  • Comment on: CQC finds over-use of agency workers at Stafford Hospital

    michael stone's comment 28-Jul-2015 3:07 pm

    There is currently a lot of stuff in the media, about nurses: mainly about permanent NHS staff versus agency nurses. Three points seem a good place to start: one is that the nurses who work permanently on-staff in a hospital, will 'get to understand it as a working enviroment'; the second, is that agency nurses are in a way 'potentially less useful' because sometimes they do not properly understand the hospital; the third, is that there is a view that some nurses find agency work easier to fit into their life, because permanent NHS staffing rotas/etc 'are too inflexible'. Almost everyone agrees at the moment, that the NHS needs to get to a position of having more on-staff nurses and less agency nurses: and there is work on staffing ratios under way. How about this, for a wild idea: why not 'nudge' hospitals towards employing more on-staff nurses where that is possible, by under-weighting an agency nurse, relative to an on-staff nurse, when 'counting the nursing ratios' ? Perhaps when working out long-term staffing ratios, hospitals could be told to count an hour worked by an on-staff nurse with a value of 1, but an hour worked by an agency nurse with a value of, for example, 0.9 ? Probably another of my barmy ideas.

  • Comment on: Amyloid therapies show promise for slowing dementia

    michael stone's comment 26-Jul-2015 12:38 pm

    Anonymous | 25-Jul-2015 0:48 am Margaret McCartney has been writing about this one on BMJ - she claims, there isn't any convincing evidence that it even works: http://www.bmj.com/content/351/bmj.h4064

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