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The consumption of medications with anticholinergic activity has been suggested to result in the adverse effects of mental confusion, visual disturbance, and muscle weakness, which may lead to falls. Existing published evidence linking anticholinergic drugs with falls, however, remains weak. This study was conducted to evaluate the relationship between anticholinergic cognitive burden (ACB) and the long-term risk of hospitalization with falls and fractures in a large population study. The dataset comprised information from 25,639 men and women (aged 40–79 years) recruited from 1993 to 1997 from Norfolk, United Kingdom into the European Prospective Investigation into Cancer (EPIC)-Norfolk study. The time to first hospital admission with a fall with or without fracture was obtained from the National Health Service hospital information system. Cox-proportional hazards analyses were conducted to adjust for confounders and competing risks. The fall hospitalization rate was 5.8% over a median follow-up of ~ 19.4 years. The unadjusted incidence rate ratio for the use of any drugs with anticholinergic properties was 1.79 (95% CI 1.66–1.93). The hazard ratios (95% CI) for ACB scores of 1, 2–3, and ≥ 4 compared with ACB = 0 for fall hospitalization were 1.20 (1.09–1.33), 1.42 (1.25–1.60), and 1.39 (1.21–1.60) after adjustment for age, gender, medical conditions, physical activity, and blood pressure. Medications with anticholinergic activity are associated with an increased risk of subsequent hospitalization with a fall over a 19-year follow-up period. The biological mechanisms underlying the long-term risk of hospitalization with a fall or fracture following baseline ACB exposure remains unclear and requires further evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Systemic anti-cancer therapy (SACT) toxicity is a challenge for older adults with cancer. To date several tools have been developed to help predict this toxicity at baseline, thereby identifying patients in whom the risk of toxicity may outweigh the benefit of therapy.1 Our aim was to assess the incidence of hospitalisation due to SACT toxicity and to examine the proportion of these adverse drug events (ADE) that were potentially avoidable. Objective: Identify the incidence of hospitalisation due to SACT toxicity in older adults with cancer. Methods: Using inpatient management software (iPMS), we identified patients aged ≥ 70 years who attended the outpatient department (OPD) to attend a medical oncologist clinic in our institution, between 1 January and 31 March 2018. A retrospective medical chart review was conducted, and the following data were collected and pseudo-anonymised: age, gender, diagnosis, Cancer stage, performance status (ECOG),2 SACT treatment plan, hospitalisation within 6 months of a clinic visit (Y/N) chemotherapy toxicity if hospitalised, potentially avoidable/unavoidable hospitalisation. Microsoft Excel (IBM Corp.) was used for data input and analysis. Descriptive statistics were generated. All patients with a solid tumour diagnosis who attended their clinic appointment and were aged ≥ 70 years were included. Patients who did not attend their clinic appointment were excluded from the study population. Results: Of 133 patient records, 35 were excluded due to non-attendance at the clinic (n = 34) or duplication (n = 1). The median age was 75 years, range, of 70–94 and 61% (n = 60) were female. The most prevalent cancer diagnoses were breast cancer 40% (n = 39) and gastrointestinal cancers 37% (n = 36). Advanced disease (Stage III/IV was present) in 65% (n = 64) of patients. Performance status was good (0–1) in 58% (n = 56) of patients. A total of 62% (62) patients received SACT. Almost one-third (33%) of patients were hospitalised within 6 months of attendance. Of these hospitalisations 50% (n = 16) were due to SACT toxicity. Potentially avoidable hospitalisation was found in 19% (n = 3) of patients who experienced SACT toxicity. Discussion: SACT toxicity remains an important consideration for the oncology multidisciplinary team, accounting for half of all admissions in older adults with cancer.3 Despite the small sample size and single centre limitations, our results suggest the implementation of comprehensive geriatric medication review4 by pharmacists may identify patients at risk of SACT toxicity, leading to potentially improved patient outcomes in this cohort. [ABSTRACT FROM AUTHOR]

Abstract: This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n =72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of ‘chaos’ and ‘suffering’ emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient–clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety. [Copyright &y& Elsevier]

Purpose – This paper aims to develop a conceptual resilience-based model that takes account of the competing success factors of patient safety, finance, improvement targets and staff workload in NHS hospitals in the UK. Design/methodology/approach – A safe working envelope model was developed from the literature and adapted for use in the NHS. The proposition that finance and targets receive greater management attention was then tested by a pilot study using content analysis of risk management documents of four NHS hospitals. Findings – The need to succeed on finance and targets received greater attention in the risk management documents than patient safety and staff workload. Research limitations/implications – This is a pilot study only, using content analysis of risk management documents from four hospitals to see whether the model developed from the literature warrants further study. Practical implications – Using the proposed safe working model will allow the setting and monitoring of failure and marginal boundaries and make more explicit the pressures from the competing success factors in public sector hospitals in the UK. Originality/value – The development of the conceptual model using ideas from resilience engineering and applying them to NHS hospital management provides a policy and practical approach to improving patient safety. [ABSTRACT FROM AUTHOR]

Objective To assess the validity of case mix adjustment methods used to derive standardised mortality ratios for hospitals, by examining the consistency of relations between risk factors and mortality across hospitals. Design Retrospective analysis of routinely collected hospital data comparing observed deaths with deaths predicted by the Dr Foster Unit case mix method. Setting Four acute National Health Service hospitals in the West Midlands (England) with case mix adjusted standardised, mortality ratios ranging from 88 to 140. Participants 96 948 (April 2005 to March 2006), 126 695 (April 2006 to March 2007), and 62 639 (April to October 2007) admissions to the four hospitals. Main outcome measures Presence of large interaction effects between case mix variable and hospital in a logistic regression model indicating non-constant risk relations, and plausible mechanisms that could give rise to these effects. Results Large significant (PS0.0001) interaction effects were seen with several case mix adjustment variables. For two of these variables--the Charlson (comorbidity) index and emergency admission--interaction effects could be explained credibly by differences in clinical coding and admission practices across hospitals. Conclusions The Dr Foster Unit hospital standardised mortality ratio is derived from an internationally adopted/ adapted method, which uses at least two variables (the Charlson comorbidity index and emergency admission) that are unsafe for case mix adjustment because their inclusion may actually increase the very bias that case mix adjustment is intended to reduce. Claims that variations in hospital standardised mortality ratios from Dr Foster Unit reflect differences in quality of care are less than credible. [ABSTRACT FROM AUTHOR]

The article discusses the annual performance rating system used for Great Britain's National Health Service trusts and whether targets have improved due to its administration. Reported performance shows improvement on key targets though it is suggested that manipulation of data was practiced to achieve some of these targets. Measures to prevent gaming are considered. INSET: Summary points.

Aim: The aim of this study was to understand how people evaluate and make sense of their experience of hospital care. Method: Narrative interviews were conducted with 18 patients between 4-6 weeks after an episode of inpatient care or day surgery. Participants were deliberately sampled from a population who participated in a hospital-wide audit which took place during 1 week in June 1995. Sampling criteria ensured a mix of age, gender, type of, and reason for, admission. The interviews were audiotaped, transcribed and analysed using grounded theory. Findings: Three categories: 'feeling informed', 'valued as an individual', and 'at home' contributed to a core category: 'building confidence, faith and trust'. Notably, confidence and trust were determined as much by observations of the care given to other people, as the care the participants themselves had received. Conclusions: More attention needs to be given to understanding the complex social and reflective process which underpin patient judgements about quality of care. [ABSTRACT FROM AUTHOR]

Examines the use of a guideline based questionnaire to audit hospital care of acute asthma in Great Britain. Comparison of the care given by chest physicians and general physicians; Occurrence of deviations from the guidelines; Proof on the use of questionnaire for both doctor and audit physicians.

Focuses the necessity of measurement of clinical results for monitoring the quality and achievement of cost effectiveness of health services in Great Britain. Debate on the system of measurement; Advantages of measurement system on patients; Requirement of establishment of effective relationship between general practitioners and hospital consultants.

The article discusses issues related to the misuse of alcohol in Great Britain. It has been stated that more than a million admissions a year occur in hospitals of the National Health Service (NHS) in England because of consumption of alcohol. It has been stated that the Office for National Statistics show that drinking levels have not increased in the past decade, but alcohol induced hospital admission is still too high and there is need for greater efforts to reduce hazardous drinking. It has been stated that the Scottish government has increased price of alcohol to cut its sale across the board and David Cameron, prime minister of Great Britain should also do something same to prevent alcohol related hazards.

The article reports on the demand for the British government and the Care Quality Commission to review the standards of hospital care by the Patients Association (PA). The PA released a publication of 16 accounts of hospital care considered as bad. Aside from the standards review, the association also seeks for more stringent supervision and regulation of care. PA president Claire Rayner noted that cruel nurses need to be identified and punished.

In this article the author discusses a wide variation in lung cancer treatments in hospitals in Great Britain and a low survival rate for cancer patients in the country. She is critical of an unwillingness of clinical teams in hospitals to review their practices and patient outcomes. Also discussed is a report from the National Lung Cancer Audit which evaluated cancer treatment at several British hospitals.

The author reports that the Great Britain National Health Service watchdog body, the Healthcare Commission, has found that medical patients at some England hospitals are waiting too long for medical services. Services included routine diagnostics, such as scans and blood tests. The projected target had been a maximum wait of 18 weeks from referral to treatment.

The article discusses the author's father's death and the health care he received. The author recalls the excellent National Health Service care her father received in Great Britain from nurses and ambulance care assistants. When she arrived at the hospital her father's paperwork was already processed, he had a drip in each arm, blood tests were on their way to the laboratory, and an ECG was being printed. She comments on this efficiency.

Looks at the treatment of hospital-acquired infections in Great Britain's National Health Service (NHS). Details of a critical report by the Great Britain's House of Commons, which suggest that hospitals have not taken sufficient actions to prevent hospital-acquired infections; View of legislators that too much effort has been given to treating methicillin resistant Staphylococcus aureus (MRSA), with insufficient attention given to other infections; Critique of current infection-control policies and practices.

Reports that children and teenagers are unhappy with the lack of communication they receive when they are treated by in the British National Health Service. Report published by the Commission for Health Improvement; Claim by young patients that they have the right to participate in decisions about their treatment; Dislike of the hospital environment.

Editorial. Offers a look at how personal feelings affect an individual's reading of a medical journal. Discussion of a paper by Jack Wennberg in the March 13, 2004 issue regarding death in highly respected American hospitals; Use of healthcare resources in the best hospitals in America; Reference to a paper in the same issue by Chibuzo Odigwe that claims children in Great Britain often feel ignored by the British National Health Service; Communication between children patients and physicians.

Reports on improvement of the management of coronary heart disease by the British National Health Service. Lack of improvement in preventing the disease; Evaluation of services by the Commission for Health Improvement and the Audit Commission; Progress related to clinical care of patients.