Stroke patients admitted to hospital ‘out of hours’ wait twice as long to be assessed
Prompt treatment is particularly important in minimizing the damage of strokes
Stroke patients admitted to hospital ‘out of hours’ wait twice as long to be assessed and suffer delays in getting brain scans and a bed, according to a new report.
The study, covering NHS services in England and Northern Ireland, found ‘good evidence’ that people admitted on weekends, evenings and bank holidays suffer worse outcomes than those admitted during routine hours.
Researchers found these patients wait twice as long on average to be assessed by a member of a stroke team (typically 188 minutes compared to 87 minutes for those admitted in hours).
The delay in being given a dedicated stroke bed is also longer for patients admitted out of hours (234 minutes compared to 211 minutes) as is the delay to receiving a brain scan (170 minutes compared to 120 minutes).
Accessing prompt care and treatment is essential to reducing the risk of death and disability from stroke, which affects around 150,000 people in the UK each year and kills about 53,000.
The data further showed that patients who suffer a stroke while already in hospital experience the ‘worst delays’ in being assessed by a member of the stroke team and in getting a scan.
‘This suggests that hospital teams need to be educated about stroke symptoms and how to contact the stroke team,’ the study said.
Today’s report, the Stroke Improvement National Audit Programme (SINAP), covering 32,113 patients, found that one in three (34%) of all stroke victims are admitted to a ward that does not specialise in treating strokes.
This is despite the experts behind the study saying all patients ‘need immediate stroke unit care’.
While 94% of patients stay on a stroke bed at some stage during their hospital stay, a significant number do not arrive there quickly enough.
The report said: ‘There is no excuse for units admitting people with acute stroke not to admit them directly to a specialist bed and commissioners should be urgently reviewing services where patients do not routinely access stroke units as soon as possible following admission.’
Overall, there was an improvement in the proportion of patients receiving thrombolysis treatment within 4.5 hours.
Some 8% of patients received the clot-busting treatment following a stroke, up from 1% in the 2008 audit.
Not all patients are eligible for the treatment, which is suitable for those who have suffered acute ischaemic stroke.
Today’s audit found 7% of all patients were not given the treatment because thrombolysis was not available at the hospital, 5% of patients arrived “outside normal thrombolysis service hours” and 0.3% were not given it because they could not be scanned quickly enough.
Some 46% of patients arrived outside the timeframe when thrombolysis would work, while 12% were not given the drug because of their age.
It found an improvement in the percentage of patients overall who received a brain scan within 24 hours. In 2006, only 42% of patients were scanned within 24 hours of having symptoms, rising to 59% in 2008 and 70% in 2010.
But the report said: ‘The percentage of patients scanned within 24 hours of arrival remains suboptimal and commissioners should consider seriously whether they should be commissioning services in units that can only manage to scan 80% (or fewer) patients within 24 hours of arrival in hospital.’
Overall, 91% of patients are reviewed by a stroke consultant or associate specialist within 72 hours, although this should ideally take place within 24 hours.
‘Variation in the percentage of patients seen by a stroke specialist within 24 hours suggests that some services are not providing adequate senior clinical cover, particularly at weekends,’ the report said.
The study was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians’ (RCP) stroke programme.
Professor Tony Rudd, chairman of the Intercollegiate Stroke Working Party and director of the RCP stroke programme, said: “Acute stroke services are improving in England albeit from a low base.
‘Not all hospitals contributed to this national audit and one has to be concerned that the quality of care in the non-participating hospitals may be lagging behind those who have been willing to share their data.
‘We will be working hard to increase participation as I believe that publicly available data comparing each hospital against their peers is a very powerful tool to improve the quality of care.’
Health Secretary Andrew Lansley said: ‘Care of stroke patients in hospital has improved dramatically over recent years with the majority of patients now treated in specialist stroke units, but, as this audit shows, there is still more to do to improve outcomes from stroke.’
Want to hang bunting to celebrate the Queen’s Jubilee? You’ll need ladder training first
Organisers of a Diamond Jubilee street party who want to put up bunting have been told they must first go on a health and safety course – on how to climb a ladder. They will also be taught how to carry out the risk assessments required to put up tables for a street market.
The safety rules were described as ‘lunacy’ by those planning the party in Petersfield, Hampshire, in June.
The event will take place in the town centre and organisers need permission from a shopping centre to erect the bunting.
Committee member Vaughan Clarke, 71, said: ‘These ridiculous rules are making it more and more difficult to have some simple old-fashioned fun. ‘I’ve been using ladders all my life. All we want to do is mark the occasion by stringing up some bunting. It’s lunacy.
‘The centre management told me I needed public liability insurance, a risk assessment and a ladder certificate to put up the bunting.
‘We have taken it in good humour, but there is a serious side to this – we are a charity and £320 for a ladder course is an expense we could do without.’
The course, called Safety With Ladders, covers the Health and Safety Executive Work at Height Regulations 2005. Trainer Eric Goulding, who will run tomorrow’s course, said there would be a video and a PowerPoint presentation.
Participants are shown how to set up a barrier around a ladder to stop people bumping into it, and how to position someone at the bottom of it to warn others the ladder is there.
Mr Goulding said: ‘It is about trying to find the right balance between being a killjoy or having people hurt themselves.’
Shopping centre spokesman Michael Knowles said: ‘The committee informed us that their team was to have ladder training and would supply an appropriate risk assessment.’
Church of England schools ‘to expand to combat secularism’
Hundreds of new Church of England schools are to be opened to spread Christianity and combat “aggressive secularism”, it emerged today.
At least 200 Anglican primaries and secondaries could be established within the next five years as part of a major expansion plan outlined by the Church.
A report – to be published later this week – will also recommend rebranding existing Anglican schools to “reinvigorate” them in the face of competition from new academies and free schools.
The Church will also propose a more structured programme of advice to secular schools on improving their religious education and boosting exam results.
The Bishop of Oxford, the Rt Rev John Pritchard, chairman of the Church’s board of education, said major reform was needed to tackle “the level of religious illiteracy in our society”.
He also said the changes – to be formally outlined in a report released on Friday – would allow faith leaders to confront the growing influence of secularism.
It follows comments last month by Baroness Warsi, the Conservative Party chairman, that British society was under threat from a rising tide of “militant secularisation”.
Bishop Pritchard said: “The whole national context is one in which secularist debates, whether it be on equality, gay marriage, employment in schools, a whole range of things, are bringing up the issues of secularist versus [religious] approaches to society’s life.”
Currently, the CofE runs 4,800 out of 23,000 state schools in England.
But the Church is keen to expand its influence on the back of the academies and free schools programme, which takes schools out of direct local authority control and places them in the hands of charities, entrepreneurs and faith groups.
Speaking before the publication of the report, Bishop Pritchard told the Sunday Times that around 200 new schools could be opened under the reforms in just five years.
The report will also suggest joining with other religions to open a new wave of multi-faith schools.
A group of Church officials is also to be created to design a re-branding strategy for existing Anglican schools, which could result in a new name or logo, internal reorganisation and a campaign advertising the benefits of a faith-based schooling.
Bishop Pritchard, who has led the review, accused the Government of failing to prioritise religious education.
“Successive secretaries of state have discovered that [religion] is such a contentious area and because the level of religious illiteracy in out society is so high, that we don’t know how to handle religious diversity,” he said.
Hilarious! The new British climate record (HadCRUT4) reinforces how FLAT average temperatures have been in the last 12 years
The differences between years are only in hundredths of one degree! How trivial can you get?
The media have almost unanimously said that HadCRUT4 now makes 2010 the hottest year. But what HadCRUT4 actually shows is that 2010 ties with 2005 for the hottest year and a trivial 0.01 deg C above 1998. Given the errors (0.1 deg C or ten times the difference being quoted) the only scientifically respectable way to describe the warmest years would be to say that 1998, 2005 and 2010 all tied, but that would have perhaps been a little to inconvenient. I note that NasaGiss, and here, faced a similar problem but chose to follow the respectable route in not calling a record if a year has a temperature difference of only 0.01 deg C.
In fact a better way to summarise HadCRUT4 is that one cannot rank with confidence the top eight years (ranging from 0.53 to 0.48 deg C) so they should all be declared statistically indistinguishable.
It is regrettable, and in my view poor form, to release the HadCRUT4 top ten years and not simultaneously release the complete dataset so that a more detailed look can be made at the time the media are compiling their stories based on the Met Office press release. Not releasing the full dataset could lead to accusations of ‘spinning’ the data. The HadCRUT4 complete data is said to be available in a few days. There is no reason why the Met Office’s press release of the 19th March could not have been held for a few days to coincide with the full data. In most other scientific disciplines this is standard practice.
Some parts of the media are claiming that HadCRUT4 shows an increased warming since 1998 of 0.11 deg C (said to be 0.04 deg C more). However, until the full data is available it will not be possible to look at this figure in more detail though looking at the data that is available I don’t think that figure will stand up.
Also mentioned in the Met Office press release is the global warming ‘signal’ seen since 1900, which they say is 0.75 deg C. Of course that ‘signal’ is not homogenous as we have discussed because it includes the periods not influenced by mankind and those said to be under his influence.
Overall the new HadCRUT4 dataset does not seem to change anything. It even seems to emphasise the lack of warming in the past 10-15 years more than HadCRUT3 did. Although we do not yet have HadCRUT4 data for 2008 it is obvious that HadCRUT4 has less variance in this short period. HadCRUT3 had a range of 0.12 between the top ten warmest years with a fairly even spread. HadCRUT4 has the top three years separated by 0.01 and years 4 -8 also separated by 0.01 deg C, in fact years 4,5,6,7 are identical numerically.
More HERE (See the original for links, graphics etc.)
Even the recently released new and improved temperature record disproves the IPCC models
This post compares the new and improved CRUTEM4 land surface temperature anomaly data to the same CMIP3 multi-model mean. CRUTEM4 data was documented by the 2012 Jones et al paper Hemispheric and large-scale land surface air temperature variations: An extensive revision and an update to 2010. I’ve used the annual time-series data, specifically the data in the second column here, changing the base years for anomalies to 1901 to 1950 to be consistent with Figure 9.5 of the IPCC’s AR4.
And, as I had with the other 20th Century Model-Observations comparisons, the two datasets are broken down into the 4 periods that are acknowledged by the IPCC in AR4. These include the early “flat temperature” period from 1901 to 1917, the early warming period from 1917 to 1938, the mid-20th Century ‘flat temperature” period from 1938 to 1976, and the late warming period. For the late warming period comparisons in this post, I’ve extended the model and CRUTEM4 data to 2010.
As shown in Figure 1, and as one would expect, the models do a good job of simulating the rate at which the CRUTEM4-based global land surface temperatures rose during the late warming period of 1976 to 2010.
But like CRUTEM3 data, that’s the only period when the IPCC’s climate models came close to matching the CRUTEM4-based observed linear trends.
According to the CMIP3 multi-model mean, land surface temperatures should have warmed at a rate of 0.043 deg C per decade from 1938 to 1976, but according to the CRUTEM4 data, global land surface temperature anomalies cooled at a rate of -0.05 deg C per decade, as shown in Figure 2.
Figure 3 compares the models to the global CRUTEM4 data during the early warming period of 1917 to 1938. The observed rate at which global land surface temperatures warmed is almost 5 times faster than simulated by the IPCC’s climate models. 5 times faster.
The models show no skill at being able to simulate the rates at which global land surface temperatures warmed and cooled over the period of 1901 to 2010. Why should we have any confidence in their being able to project global land surface temperatures into the future?
More HERE (See the original for links, graphics etc.)
Is carbon cutting a waste of time? Figures show Britain’s ‘footprint’ has increased by 20 per cent despite green taxes
Ministers were accused of saddling consumers with pointless green taxes last night – as new figures revealed surging imports from developing countries that rely on ‘dirty’ power.
Successive governments have boasted that a cocktail of green taxes and expensive wind farms has helped to curb carbon dioxide emissions blamed for global warming.
But new official figures reveal that Britain’s so-called ‘carbon footprint’ has increased by 20 per cent in the last two decades as we import ever more from developing countries like China that rely on dirty coal-fired power stations.
The revelation will fuel criticism that imposing huge costs on British industry to ‘go green’ has simply shifted emissions – and jobs – overseas.
The figures will also pile pressure on George Osborne to use this week’s Budget to roll back the costly green measures imposed on consumers and industry in recent years.
Tory MP Dominic Raab said the figures raised serious questions about the value of punitive taxes aimed at curbing carbon emissions in this country.
Mr Raab said: ‘The toxic mix of green tariffs and subsidies inherited from Labour is punishing the squeezed middle by hiking electricity bills, but doing little to combat global carbon emissions.
‘We are consuming more carbon than ever, while countries like China and India are laughing at the economic price British consumers are paying. We need an environmental policy that makes wider economic sense.’
A new study by the Department for the Environment, Food and Rural Affairs (Defra) reveals that carbon dioxide emissions relating to imported goods have doubled in the last 20 years as Britain’s manufacturing industry has declined.
Imports now account for almost half of the UK’s total carbon footprint. The surge in imports is so great that Britain’s overall carbon footprint has increased by 20 per cent.
A large proportion of the imports come from developing countries, particularly China, which have refused to sign up to binding targets to cut carbon emissions.
The figures will provide ammunition to the Chancellor who has vowed to tone down the Government’s obsession with the green agenda.
Mr Osborne sparked a furious backlash from green groups and the Liberal Democrats last year when he pledged that in future Britain would cut carbon emissions ‘no slower, but also no faster’ than other European countries.
In a speech to the Conservative Party conference he said: ‘We’re not going to save the planet by putting our country out of business.’
Green policies have become increasingly controversial in recent years. Electricity prices are already 15 per cent higher than they would be as a result of the push to use costly new renewable sources, such as wind farms.
The Government’s own figures suggest green measures will have pushed up electricity costs by 27 per cent by 2020.
Matthew Sinclair, of the Taxpayers’ Alliance, said the figures underlined the folly of imposing unilateral national measures to tackle a global issue.
Mr Sinclair said: ‘The rise in the emissions produced supplying the British market shows why politicians proud of the draconian regulations and expensive taxes they have put in place, thinking that they have led to a fall in our emissions, are fooling themselves.
‘Not only is the tiny share of global emissions produced in Britain – less than two per cent of the total – almost irrelevant to overall global emissions, but as our targets are all framed in terms of emissions produced here, they can be satisfied without cutting total emissions at all if industry is simply relocated to other countries.’
A Defra study suggests that Britain’s carbon footprint surged by 35 per cent between 1995 and 2005, mostly because of the increase in imports. It fell back by nine per cent between 2008 and 2009 as the recession forced consumers to cut back spending and brought the construction industry to a halt.