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  1. Front-line doctor talks about Ebola care

    A brave British doctor has been talking about the experience of working in the Ebola outbreak in Sierra Leone.

    Oxfordshire emergency doctor Chris Bulstrode is setting up an Ebola Management Centre in Sierra Leone that he will run for the next nine months.

    Dr Bulstrode, who has extensive experience in disaster relief, is working under the auspices of Médecins du Monde Spain to set up the centre, which is currently under construction in the village of Moyamba.

    Dr Bulstrode is writing a daily journal entitled ‘Ebola Diary’ for, in which he shares his daily experiences. He has recounted what it’s like to wear a protective suit that consists of surgical boots and scrubs, a whole body waterproof suit, a thick apron, a hood, two face masks, goggles or a visor, and double gloves.

    “Within five minutes of putting on the suit you are pouring sweat and mist is forming inside the goggles and on your glasses. Within ten minutes you can see nothing but a blur in front of you. In 30 minutes you are soaked and your boots are literally filling up with sweat,” he writes.

    Aside from the strict decontamination code, he talks about how the suits mean that “Caring comes a long second after ‘Being Careful’.”

    Recruiting staff is one of his key tasks within the next week, while the centre is under construction.

    “We will open with ten beds then rise to 100. My primary job will be to make sure that not one member of staff gets Ebola. If they do, it will be because a mistake has been made and I will hold myself to blame.”

    He will have a large number of staff to protect. “Opening 50 beds requires recruiting more than 200 staff,” he explains, adding “How do you interview someone to discover whether they will obey the rules that protect us all?”

    Dr Bulstrode, who has been a member of since 1998, has previously worked in the Sudan, Haiti, Afghanistan, and Gaza, so is no stranger to putting himself in the frontline. However he himself admits that his latest mission is extremely dangerous.

    When asked why he’s doing it, he has no obvious answer other than "It’s a new challenge".

    “Few people know much about Ebola and even fewer about caring for patients who have it,” he writes. It is hoped that his daily eyewitness entries in the Ebola Diary for a membership of more than 200,000 UK doctors will go some way towards making a difference.

    Read the Ebola Diary

  2. Psychosis not an illness - study

    A major study published today challenges the idea of psychosis as a physical illness.

    People who hear voices or believe strange things may be suffering from psychological rather than neurological problems, according to the study by senior psychologists.

    The findings, from the British Psychological Society, will be seen as challenging the growing links between psychiatry and neurology - and reinforcing the drive to use talking therapies.

    The psychologists say that hearing voices may be as much a psychological problem as anxiety or shyness - and may be a reaction to trauma or adversity of some kind.

    They say that psychotic symptoms rarely lead to violence - and there can be no handbook for defining the causes of the symptoms. Nor should schizophrenia be seen as a "frightening brain disease," it says.

    According to the report, services should not seek to tell people who suffer psychosis that they are ill.

    And it calls for increased emphasis on prevention by tackling child poverty and mistreatment.

    It says: "Some prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without."

    The findings were welcomed by the NHS England clinical director for mental health Dr Geraldine Strathdee.

    She said: “I am a passionate advocate of supporting people to develop an understanding of the events and difficulties that led them to mental health services. That is the first step to getting back in control, and this important report will be a vital resource both for them and for those of us who design and deliver services."

    There was also backing from care minister Norman Lamb, who confirmed the government backing for psychological therapies.

    Beth Murphy, from the charity MIND, said: "People describe and relate to their own experiences in very different ways and it’s important that services can accommodate the complex and varied range of experiences that people have.

    "This can only be done by offering the widest possible range of treatments and therapies and by treating the person as whole, rather than as a set of symptoms.”

    The report was compiled by senior psychologists from eight universities and six NHS trusts.

    Researcher Anne Cooke, from Canterbury Christ Church University, Kent, said: "In the past we have often seen drugs as the most important form of treatment. Whilst they have a place, we now need to concentrate on helping each person to make sense of their experiences and find the support that works for them."

  3. Surgery backed for obese with diabetes

    Thousands of obese people may need rapid weight loss surgery if they are diagnosed with diabetes, according to new guidelines published today.

    Early treatment can limit the impact of the type 2 form of the disease and help prevent side-effects, according to the National Institute for Health and Care Excellence.

    The guidance means that surgery will no longer be the last resort for these obese patients.

    NICE said surgery can make a "real difference."

    The latest guidance also warns against trying to use very low-calorie diets for people who are obese. It says they should only be used in some circumstances.

    Professor John Wilding, a diabetes specialist in Liverpool, said: "Weight loss surgery is not a quick fix or easy option, and although effective, it isn’t the answer for everyone. At the moment only 1% of people eligible for surgery actually have it; most people should try diet and exercise first.

    "However, if someone is obese and they are diagnosed with type 2 diabetes it is really important that their doctor talks to them about the benefits undergoing surgery could provide for them.

    “The new guideline also looked at very-low-calorie diets – after considering how well they work and if the weight loss can be sustained, we have recommended that they should not be used routinely for people who are obese. But we are not ruling them out entirely, they may be considered for people who have a clinical need to lose weight quickly, such as before joint replacement surgery.”

    Dr Rachel Batterham, head of obesity and bariatric services at University College London Hospital NHS Trust, added: “Bariatric surgery is not an easy option. It cannot be used alone. It must be accompanied with changes to diet, activity levels and lifestyle.

    “There is an initial cost of around £6,000 in the short term, but preventing the long-term complications of diabetes is great for the individual and will save the NHS money.”

    The guidance was welcomed by the Royal College of Physicians.

    Professor John Wass, from the college, said: "In our 2013 report, Action on Obesity, we highlighted that medical care for obese people is patchy, with some local areas offering no clinical services at all.

    "It is disappointing that this situation hasn’t improved much in the two years since we produced the report, because it is vital that people are able to access joined-up, patient-centred care, particularly tier 3 services."


  4. Welcome for learning disability shake-up call

    Senior psychiatrists have welcomed the findings of an inquiry into the care of people with learning disabilities and autism.

    The Bubb inquiry was launched following the scandal at the Winterbourne View home near Bristol and the unearthing of similar problems elsewhere in the country.

    The report yesterday called for the closure of institutional homes for these people and more community facilities.

    And it criticised patchy arrangements for commissioning services in the NHS, calling for a charter of rights for people with learning disabilities.

    Dr Ashok Roy, from the Royal College of Psychiatrists, said: "Given the scale of the task in improving services for people with learning disabilities and autism, there are still a number of obstacles that need to be overcome, including inadequate funding sources, deficient information systems, poor organisational structures and work practices, and ineffective local commissioning arrangements and relationship with NHS England.

    "The Government and NHS bodies must make this a priority if they are to ensure that people with learning disabilities and autism get the support and treatment they both need and deserve.”

    He added: "The Royal College of Psychiatrists has been trying - with limited success - to influence improved commissioning standards. We have tried to get commissioner support for local and latterly national guidelines, but this has not been acted on as far as we can tell.

    "It is therefore encouraging to see clear support for a mandatory commissioning framework and a single accountable commissioner."

    Sir Stephen Bubb, who led the inquiry, said: "We need a new charter of rights to empower people with learning disabilities and their families, and give them the right to challenge the system.

    "We need that system to have the courage to act on these recommendations, and not to promise another false dawn.”


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