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Published19 hours agoShareclose panelShare pageCopy linkAbout sharingBy Ewan Gawne & Kara O’NeillBBC NewsPatients who were filmed being mistreated at an NHS mental health unit were denied “basic dignity and their human rights”, a review has found. A BBC Panorama investigation found a “toxic culture of humiliation, verbal abuse and bullying” at the Edenfield Centre in Prestwich near Manchester.Some staff members were sacked or suspended following the 2022 broadcast.Greater Manchester Mental Health Trust (GMMH) said it was “truly sorry” and committed to a “much-improved future”.The independent report, led by Prof Oliver Shanley OBE, found the trust repeatedly missed opportunities to act on concerns, alongside a culture of “suppressing bad news”.It found the Panorama broadcast exposed the “most shocking abuse and poor care” of vulnerable patients, and that concerns raised by families were “not always taken seriously”. It added that in some services, patients had been denied “basic dignity and their human rights”.I went undercover to expose mental health hospital abuseRevealed: Mental health unit’s ‘toxic culture’ of abuseReview launched into abuse at mental health unitDuring the Panorama investigation, staff were filmed using restraint inappropriately and swearing at and slapping patients, while some of those being cared for endured long seclusions in small, bare rooms.More than 400 people shared their experiences with the review, which found a “striking level of distress among patients, families, and staff”.The report heard from a patient’s family member who tried to raise issues but was ignored.”The trust seem like they are firefighting and walking from room to room with fire, and petrol already in the room, smoking a cigarette,” they said. The report found several key reasons why the abuse and poor care of patients took place, including:Patient, family and carer concerns were ignored or not taken seriouslyStaff levels were unsafe, with a high use of temporary workersA poor leadership culture, low staff morale, and a lack of transparencySome staff described being treated unfairly because of a protected characteristic.A number of leaders at the trust were said to have “lacked compassion and empathy”, with senior managers fostering “a culture of fear and intimidation” among staff to “maintain performance standards”. The board of the trust had focused on “expansion, reputation and meeting operational targets” rather than the quality of care given to patients, the report found.But the review’s authors also said they spoke to “a great many members of staff who were passionate, evidently talented and highly committed to their patients”.Image source, Family pictureEighteen months before the Panorama investigation, Rowan Thompson, who identified as non-binary, died in the Gardener Unit on the same site as the Edenfield Centre, in October 2020. The inquest found observation records had been falsified and hospital blood test results had not been communicated back to the 18-year-old’s unit, because phone numbers and email addresses on the website were wrong.Rowan’s father Marc Thompson, who took part in the independent review into the trust, said: “I get angry.”Those are really basic, lack of detail, mistakes.”I get really angry that all they do is change the personnel. It doesn’t matter if you change the people. You have to change the systems.”He said staff “knew that they had signed stuff that they hadn’t done”.”There are other cases within three months where that was a key element to children having serious issues,” he said. “Eighteen months later the same thing is happening within the same trust at a unit on the same site. Where is the learning in that?” The trust’s chief executive, Jan Ditheridge, said: “We are truly sorry for the events described in the report. “We take the findings seriously and accept the recommendations. “We cannot change the past, but we are committed to a much-improved future – one in which all service users and carers feel safe and supported, and our people are able to do their best work.”She said an improvement plan would address the issues raised, with some actions already being completed. “Staff are more supported, leadership and governance is stronger and our culture is getting better,” she said, adding the trust had recruited more than 350 nurses in the last six months. The report outlines a series of recommendations for the trust, which include ensuring patient, family and staff voices are heard “at every level” and creating a culture where quality of care is the “utmost priority”.Other recommendations include a call to adapt to problems caused by staff shortages, to address the poor state of some building, and for a review into oversight to “prevent tragedies like those seen at Edenfield from reoccurring”.’Immediate action’The trust, which runs the centre, was downgraded from “requires improvement” to “inadequate” by the Care Quality Commission in July.Neil Thwaite who had been the trust’s chief executive since 2018 stepped down six months after the BBC’s investigation in September 2022.A spokesman for NHS England North West said “immediate action” was taken to improve patient safety at Edenfield after the mistreatment was exposed, including the commissioning of the independent review.”We now owe it to every patient cared for by the trust and the staff working for them and across the NHS, to ensure the review’s recommendations are implemented,” he added. Why not follow BBC North West on Facebook, X and Instagram? You can also send story ideas to northwest.newsonline@bbc.co.ukMore on this storyGreater Manchester health trust rated ‘inadequate’Published21 July 2023Health boss resigns after unit abuse investigationPublished14 April 2023Review launched into abuse at mental health unitPublished8 February 2023Staff sacked over abuse at mental health unitPublished14 October 2022Minister backs inquiry into abuse hospitalPublished13 October 2022Care watchdog praised bosses at abuse hospitalPublished4 October 2022Revealed: Mental health unit’s ‘toxic culture’ of abusePublished28 September 2022Years of scandal and promises as patients sufferPublished28 September 2022‘I’ve been treated like I’m an animal’Published28 September 2022I went undercover to expose abuse at mental health unitPublished29 September 2022Related Internet LinksNHS EnglandGreater Manchester Mental Health NHS FTThe BBC is not responsible for the content of external sites.

Published22 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Jennifer ClarkeBBC NewsFormer Scotland First Minister Nicola Sturgeon has been questioned about her handling of the pandemic by the Covid inquiry. Prime Minister Rishi Sunak and his predecessor Boris Johnson have already robustly defended their response. Their evidence was part of the second round of public hearings, which focused on the government’s handling of the crisis.What is a public inquiry? Public inquiries respond to “public concern” about events. Established and funded by government, they are led by an independent chair.Inquiries can demand evidence and compel witnesses to attend.No-one is found guilty or innocent, but conclusions are published. The government is not obliged to accept any recommendations.The Covid inquiry, originally announced by Mr Johnson, covers decision-making during the pandemic by the UK government and in Northern Ireland, Scotland and Wales.At the time, he said the government’s response would be “under the microscope”. Covid inquiry: The UK pandemic in numbersHow do Covid death rates compare across the UK?Who is leading the Covid inquiry and how does it work? The Covid inquiry began on 28 June 2022.It is chaired by former judge and crossbench peer Baroness Hallett, who previously led the inquests into the 7 July London bombings.Image source, Piranha PhotographyThe inquiry is split into different parts. Work in four areas has begun:resilience and preparednesscore UK decision-making and political governancethe impact of Covid on healthcare systemsvaccines, therapeutics and antiviral treatmentFuture strands will consider:the care sectorgovernment procurement and PPEtest-and-tracethe government’s businesses and financial responseshealth inequalitieseducation, children and young peopleother public servicesThere is no specific timescale for how long the inquiry will last but Lady Hallett does not expect the public hearings to run beyond summer 2026.The UK inquiry is holding public hearings on the question of government decision-making in Scotland, Wales and Northern Ireland in January, February and April 2024, respectively.Scotland is also holding a separate inquiry, which will take evidence from many of the same experts and politicians.Loss and suffering at heart of Covid inquiryA tale of two very different Covid inquiriesWho has given evidence during the hearings in Scotland?The inquiry has been looking at informal communications between Scottish government advisers and ministers.First Minister Humza Yousaf apologised unreservedly for the Scottish government’s failure to hand over relevant WhatsApp messages. Image source, Covid InquiryFormer First Minister Nicola Sturgeon admitted that she deleted messages from the period. But she insisted that she did not use these informal channels to reach decisions or to have substantial discussions, and that everything of relevance was available on the public record. Ms Sturgeon was emotional during some of her evidence, and appeared to fight back tears as she told the inquiry that “part of me wishes I hadn’t been [First Minister during the pandemic]”.The awkward Covid questions Nicola Sturgeon facedUK Covid inquiry in Scotland: Five things we learned What did PM Rishi Sunak say to the inquiry?The prime minister apologised to “all those who suffered… as a result of the actions that were taken”, but denied his Eat Out to Help Out Scheme had increased Covid infections and deaths.Image source, HM TreasuryHe also rejected earlier evidence from the government’s chief medical officer, Prof Sir Chris Whitty, and former chief scientific adviser Sir Patrick Vallance that they were not consulted about the policy.Did Sunak’s Eat Out scheme help to spread Covid?What did Boris Johnson say to the inquiry?The former prime minister gave evidence across two days. The inquiry had already heard from government officials and advisers, academic experts and representatives of bereaved families, many of whom were extremely critical of Mr Johnson.He began by apologising for the “pain and the loss and the suffering” experienced during the pandemic.His comments were interrupted by protesters, who were ordered to leave the room. Some members of bereaved families held up signs reading: “The dead can’t hear your apologies.”This video can not be playedTo play this video you need to enable JavaScript in your browser.Mr Johnson admitted mistakes were made, and that “there were unquestionably things we should have done differently”. He said he took “personal responsibility for all decisions made”, but insisted that ministers had done their “level best” in difficult circumstances.Contrite, shorn of theatrics – Johnson’s first day at inquiryFive takeaways from Johnson at the Covid inquiryWho else gave evidence during the second round of hearings?The inquiry heard from Former Health Secretary Matt Hancock – who previously told the inquiry the UK’s pandemic strategy had been completely wrong – denied he lied to colleagues during his period in office. But he admitted the UK should have locked down much sooner and criticised the “toxic culture” in government, for which he blamed Mr Johnson’s former adviser Dominic Cummings.Cabinet minister Michael Gove also apologised to “victims and families who endured so much loss”, but denied Mr Johnson could not take decisions.Sir Chris, his former deputy Prof Sir Jonathan Van-Tam and Sir Patrick revealed significant tensions between their advice to government and its political priorities, such as over Eat Out to Help Out.Image source, PA MediaSir Jonathan revealed he and his family had received death threats, while Sir Patrick said he had also considered resigning over abuse.Former deputy cabinet secretary Helen MacNamara told the inquiry that she struggled “to pick one day” when Covid rules were properly followed inside a “macho” and “toxic” No 10.Image source, EPAIn his evidence, Mr Cummings described a “dysfunctional” government with no plans to lock down the country or shield the vulnerable.The inquiry heard scathing text messages which he sent, many of which contained offensive descriptions of ministers and officials.He said he regretted the disastrous handling of his infamous trip to Barnard Castle during the first lockdown, but denied his actions had damaged public trust. Covid inquiry WhatsApps paint picture of chaosHow inquiry is exposing deep flaws in Covid decision-makingWho gave evidence during the first public hearings?The first public hearings, linked to the UK’s resilience and preparedness, took evidence from 69 independent experts and former and current government officials and ministers.This video can not be playedTo play this video you need to enable JavaScript in your browser.These included former health secretaries Jeremy Hunt and Matt Hancock, former prime minister David Cameron and former first minister of Scotland, Nicola Sturgeon.Sir Chris, his predecessor Prof Dame Sally Davies, and Sir Patrick also gave evidence during the first hearings. Covid Inquiry: What have we learnt so far? When will the inquiry publish conclusions?Baroness Hallett said she intends to publish the report for the first area of work “as soon as possible” – hopefully by early summer 2024.A report based on the second round of hearings is also due in 2024. Public hearings for the third area of examination – the impact of the pandemic on healthcare systems across the UK – are expected to run for 10 weeks from autumn 2024.But the inquiry will not take evidence in summer 2024 about the development of vaccines and other drugs, as planned. Witness hearings will be postponed, probably until after the next general election. Organisations needed more time to prepare for a separate investigation into the impact of Covid on the NHS, Lady Hallett said.How can the public get involved?Anyone can share their experience through the inquiry’s Every Story Matters project.The Covid-19 Bereaved Families for Justice campaign group – which criticised the government’s handling of the pandemic – urged the inquiry to ensure these voices are heard.Public hearings are streamed on the BBC News website and the inquiry’s YouTube channel, and witness transcripts are published on the inquiry website.Members of the public can also apply to attend in person.Related Internet LinksCovid-19 Public InquiryThe BBC is not responsible for the content of external sites.

The inquiry’s now finished for the day – but before it ended we heard questions from lawyer Kevin McCaffrey, acting on behalf of the Scottish Covid Bereaved group. Here’s a summary of what was said:Q: He asked Sturgeon why she thought releasing people from hospitals to care homes, but only testing those with symptoms, provided any protection at all.A: Sturgeon said there were concerns hospitals weren’t a safe place for vulnerable people who didn’t need to be there. The advice at that time, she said, was that isolation was the best way to protect people in care homes.Q: Sturgeon was asked to give more details about the situation in care homes.A: She said there were significant issues, including testing, and admitted that her government didn’t do everything right which she “deeply regrets”.Q: The former first minister was asked about visits to care homes during the pandemic. A: “That was an issue where we were always trying to strike a balance between opening up … and guarding against infection,” she said. “I don’t think we got that right … but it was not because we didn’t try.”Q: Sturgeon was asked what she would’ve done differently.A: Getting emotional again, she said she wishes she could “turn the clock back and do things that would have reduced the loss of life in care homes”, but added that it wouldn’t have changed the fact people in hospitals were still at risk.

Published46 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Jasmine HooleBy Charlotte McDonaldBusiness reporter, BBC NewsA record one in five drinkers gave up alcohol for Dry January, a British Beer and Pub Association survey suggests.Charity Alcohol Change UK said those using its app to track a month of not drinking saved on average £118.But pubs have reported a drop in drinks sales, while the prices of no and low-alcohol drinks are rising faster than their boozy counterparts.Jasmine Hoole tried Dry January for the first time and said it boosted her bank balance as well as her energy levels.”I have managed to save myself £200 for my holiday fund which I am super happy about as I normally find it quite hard to save for these kind of things,” she said.The young people saving money by going soberThe 23-year-old is one of an estimated 8.5m people who planned to ditch drinking in January, according to Alcohol Change UK.She is also one of more than 100,000 people who downloaded the charity’s official Try Dry app which tracks days without alcohol and the financial savings of a booze-free month.UK users of the app saved on average £118 this Dry January, compared with £117 last year, Alcohol Change UK said.Impact on pubsHowever, all this extra cash in punters pockets is hitting the hospitality industry hard. CGA consultancy which works with the alcohol industry said drink sales at UK bars were down by seven per cent in January.Sasha Lord, chairman of the Night Time Industries Association, told BBC Breakfast pubs and bars in the UK had noticed “a slight downward fall off due to the cost of living”.He said: “I think we now need to start breaking away from this mould that to go to a pub you have to have a pint.”We know times are hard but if you are in the fortunate position that you can go out, maybe for a bite to eat, or come to the pub and have a pint, non-alcoholic pint, please do it.”Spend Dry January with us, say pubs and barsEmma McClarkin, chief executive of the British Beer and Pub Association said: “Over the last 15 years, alcohol consumption in the UK has fallen by 15% and this January has been the driest yet with 1 in 5 giving up alcohol.”Meanwhile, the no and low alcohol drinks market is growing, she said.”85% of pubs now serve alcohol-free beers, up from 78% in 2020 and our survey also showed that 30% of consumers enjoyed no or low alcohol products in their pub over the past month when partaking in Dry January – half plan to integrate these drinks into their life moving forward,” she added.As the popularity of alcohol alternatives has been rising – so have the prices. The cost of no and low alcohol beer and cider has been going up faster than the boozy versions, according to data by Associa, and analysed by The Grocer magazine.The research suggests a surge of 13.3% in the prices of non-alcoholic alternatives since the beginning of last year. In comparison, full-strength beer and cider experienced a milder increase of 10.4% Price risesAssocia compared display prices on 1 January 2024 to those in the same week of 2023 in the UK’s major supermarkets Sainsbury’s, Morrison’s, Tesco’s, Asda and Waitrose.One of the biggest price changes was found in Waitrose where a 500ml bottle of Erdinger Alkoholfrei Wheat Beer rose 75% from £1 to £1.75.Waitrose said the price increase was down to the drinks returning to their regular prices in January 2024, having been on offer previously.Meanwhile in Sainsbury’s 12 packs of Heineken 0.0 Alcohol-Free Lager jumped from £7 to £11.50.Sainsbury’s said the conclusions in the report were “misleading” because it compared mostly promotional prices in 2023 with base prices in 2024. “Prices can go up and down for a range of reasons but we’re committed to offering our customers great value,” a spokesperson said.James Beeson, drinks editor at The Grocer, said: “Even if we discount the impacts of promotional activity, we’re still seeing low and no alcohol beer and cider prices on the rise.”The British Retail Consortium said one reason for this could be that many alcohol-free and low alcohol drinks do not yet benefit from the same economies of scale in production as traditional alcoholic drinks. “Nonetheless, retailers are focused on value for every product they sell including low alcohol drinks, and will continue to deliver the best choice and prices for their customers,” a spokesperson said.One of the UK’s first alcohol free bars hosted a pop up in London in January. It’s called Torstig, which means ‘thirsty’ in Danish. The concept was launched by husband and wife duo Luke and Emmi Cousins who were inspired by Denmark’s thriving alcohol-free drinks scene. With the bar’s cocktails priced up to £9 per drink, many are as expensive or more than their alcoholic counterparts. Mrs Cousins said: “We say you’re paying to not have a hangover but also you’re paying to appreciate what’s gone into making that drink.”Most of the drinks start their process at 40 per cent spirit, and then the alcohol is taken away and the drink is rebalanced with lots of flavours, botanicals, minerals and herbs,” she explained.Mr Cousins said the ingredients for their mocktails were pricey and that it would be cheaper to make them with alcohol. Included in the price are the mood altering effects customers can gain with some drinks making you more relaxed while others can give you a buzz or help you feel more focused and sociable. We caught up with Dry January first-timer Miss Hoole at an event at Torstig hosted by The Sober Girls Society, a community for women looking to change their relationship with alcohol.She said: “I’ve had two drinks so I guess I’ve spent £15 or £16 but if I’d been drinking [alcohol] it probably would have turned into a whole afternoon of drinking so I’ve definitely saved money.”Miss Hoole said the benefits of Dry January were more than financial.”[Alcohol] does give you a bit of extra social courage so I’m learning to pick that up on my own which I think is great for my own mental health and confidence to improve those skills.”It’s been quite a game-changer for me and probably something I’ll be sticking with past January,” she said.Tips for saving money on alcoholBefore you go out, set a limit for how much you’re going to drink and a budget for your spending on alcohol.Tell your friends and family that you’re trying to cut down.Take it steady – try cutting back a little more every time you drink.Mix up your habits, order a small glass or a half-pint instead and alternate alcoholic drinks with soft ones.Source: NHSMore on this storyGoing sober in your 20s to ease the cost of livingPublished16 January 2023

Published48 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Aurelia Foster and Hugh PymHealth reporter and health editor Treatments for seven conditions such as sore throats and earaches are now available directly from pharmacists, without the need to visit a doctor.The Pharmacy First scheme will allow most chemists in England to issue prescriptions to patients without appointments or referrals.It will save GP surgeries an estimated 10 million appointments a year (3.3%).Pharmacy groups welcome the move but there is concern about funding and recent chemist closures.The conditions are:sore throatearachesinusitisimpetigoshinglesinfected insect bitesuncomplicated urinary tract infections in womenPatients needing more specialist or follow-up care will be referred onward.More than 90% of community chemists had registered to deliver the new service, NHS England said.They have been paid £2,000 each and will receive £15 per consultation plus £1,000 a month if they see a set minimum number of patients.Similar services are already offered in Scotland, Wales and Northern Ireland.NHS England’s chief executive Amanda Pritchard called it “great news for patients”.”GPs are already treating millions more people every month than before the pandemic – but with an ageing population and growing demand, we know the NHS needs to give people more choice and make accessing care as easy as possible,” she said.The Royal Pharmaceutical Society called it a “leap forward” in patient care.Working parentsAde Williams, who trialled the scheme at Bedminster Pharmacy, in Bristol, told the BBC News: “One of the frustrations you have as a pharmacist is that you have patients coming in and then you want to help them – but then you are then not able to. It’s a really big deal for us.”You feel a greater sense of satisfaction and it’s lovely when the patient comes back and says, ‘I am better now – that worked.'”Ali McKerrow, whose young son was prescribed an impetigo cream at the pharmacy, says the scheme will help working parents. “It can be really challenging getting a GP appointment,” she said.”I am about to do the school run and just popped in here on the way – that’s infinitely easier than staying on the phone on hold.”Nearly half the pharmacies in England have also recently started prescribing the oral contraceptive pill.They will also increase the number of blood-pressure checks.But there are concerns about pharmacy closures. Last year, BBC News analysis showed the number of chemists in England had fallen to its lowest level since 2015.And the Association of Independent Multiple Pharmacies has warned community pharmacies in England are “severely underfunded”.Chief executive Dr Leyla Hannbeck welcome the scheme but said that without greater funding, “more pharmacies will shut their doors for good and more workload will be transferred to remaining pharmacies”.NHS England said £645m was being invested over two years in expanding services offered by community pharmacies.More on this storyUniversities team up to tackle lack of pharmacistsPublished1 JanuaryMore women to get contraceptive pill from chemistsPublished16 November 2023Pharmacies to prescribe antibiotics instead of GPsPublished9 May 2023Are there 2,000 more GPs than before the pandemic?Published9 May 2023Scores of local pharmacies closing across EnglandPublished8 May 2023Related Internet LinksNHS EnglandThe BBC is not responsible for the content of external sites.

A new study co-led by Associate Professor Kristin Cleverley of the Lawrence Bloomberg Faculty of Nursing has found evidence that Psychosis Spectrum Symptoms (PSS) are often present in youth accessing mental health services.
From a profile of the initial 417 youth aged 11-24 participating in the study, 50 per cent were shown to meet the threshold for Psychosis Spectrum Symptoms, a number Cleverley says was higher than expected, meaning there is a large number of children with these symptoms accessing mental health services.
Cleverley, who is also the CAMH Chair in Mental Health Nursing Research, says that what is novel about this study is that researchers are assessing early indicators that might predict whether someone is more at risk of developing Psychosis Spectrum Disorder, and examine whether there is a point at which earlier intervention for that youth could be more effective.
“Traditionally, early psychosis care starts when there is a serious presentation of psychotic symptoms, which usually occurs in the late teen years,” says Cleverley. “The current approach to identifying children at risk of developing a psychotic disorder is only about 5 per cent effective, but with this study we can start to assess certain patterns or changes in function that can signal if an earlier intervention may be beneficial.”
Psychosis Spectrum Disorder can be extremely disabling, and is linked to cognitive impairment, long-term disability, and higher rates of death by suicide than other mental illnesses. Even without a diagnosis of psychosis, Psychosis Spectrum Symptoms can severely affect youth.
This study is one of three projects being led as part of the Toronto Adolescent and Youth (TAY) Cohort Study that is set to follow 1500 youth over the course of five years. The goal of the cohort study is to better understand the populations of youth seeking mental health treatment, how their mental health symptoms and functioning change over time, and whether early predictors of psychosis spectrum disorder can be determined.
This study was co-designed with patient and caregivers in addition to involving extensive engagement from clinicians. A novel aspect of the TAY Cohort Study is youth are given access to a patient-facing dashboard of their research results that is also integrated into their clinical record.
“We wanted to ensure that the study was embedded in the clinical program so that research assessments could be immediately utilized within clinical practice, including supporting decisions about interventions or services,” says Cleverley.
This longitudinal study will include a follow-up every six months, and will provide researchers access to information about whether symptoms in these youth become chronic or episodic, and whether these changes are related to developmental milestones or environmental stressors, or changes to mental health services.
“Our goal with this research is really to characterize this population better so that we can identify new strategies that will complement existing strategies for early identification of youth at risk of psychosis,” says Cleverley. “It also creates an important opportunity for graduate students and researchers to develop sub-studies for this sample that will enable further research to improve youth mental health outcomes.”

A recent study co-authored by Dr. Matthew Segar, a third-year cardiovascular disease fellow at The Texas Heart Institute and led by his research and residency mentor, University of Texas Southwestern Medical Center’s Dr. Ambarish Pandey, utilized a machine learning-based approach to identify, understand, and predict diuretic responsiveness in patients with acute decompensated heart failure (ADHF).
The study “A Phenomapping Tool and Clinical Score to Identify Low Diuretic Efficiency in Acute Decompensated Heart Failure,” published in the prestigious Journal of American College Cardiology Heart Failure (JACC Heart Failure), leverages decades of clinical and registry datasets funded by the National Institutes of Health and American Heart Association.
The researchers leveraged machine-learning-based approaches to develop a prediction tool called the BAN-ADHF score, which showed promising results in accurately predicting diuretic response. After validation in other clinical populations, implementing this tool could potentially lead to personalized strategies for effectively managing the congestion of patients hospitalized with ADHF.
There remains a lack of agreement among experts regarding the most effective approach to address diuretic resistance in patients with heart failure who are stable hemodynamically and have an excess volume of fluid. It is generally recommended to optimize the dosage of loop diuretics before considering combination therapy; however, there is no consensus on how much the dosage should be increased before introducing another diuretic.
“Inefficient diuretic response in hospitalized patients can hinder treatment progress and increase the risk of post-discharge rehospitalization and mortality. It’s crucial to identify individuals with low diuretic efficiency early on to tailor decongestion strategies and improve clinical outcomes,” according to Dr. Segar.
ADHF is a public health issue that is becoming increasingly concerning. The disease results in emergency room visits, hospital admissions, and associated high healthcare costs. ADHF is characterized by the body having too much fluid, which often requires hospitalization or changing a patient’s current treatment plan.
“Today, a primary goal of treating ADHF is to relieve congestion using loop diuretic drugs. However, there is still uncertainty about the best dose of these agents to administer. Additionally, because of the heterogeneity of ADHF patients, a more personalized approach to predicting optimal dosing strategies is needed,” said Dr. Joseph G. Rogers, President and CEO of The Texas Heart Institute.

In the study, researchers from institutions across the United States utilized machine learning (ML) algorithms to identify subgroups of patients with acute heart failure based on their responsiveness to diuretic therapy. Specifically, the researchers developed a diuretic efficiency phenomapping approach for patients with ADHF by using publicly available and deidentified data from several clinical trials and registries, including DOSE, ROSE-AHF, CARRESS-HF, ATHENA-HF, ESCAPE, and the American Heart Association Precision Medicine Platform Get with the Guidelines-HF (GWTG-HF) registry. This participant-level pooled data enabled the investigators to develop a phenomapping approach and diuretic efficiency score. The patients within each subgroup shared similar characteristics but were clinically distinct from other subgroups, particularly in their response to diuretic therapy. In addition to differences in their diuretic response, the patient subgroups also had meaningfully different clinical outcomes, highlighting the prognostic utility of the phenogrouping approach. The investigators subsequently developed and validated the BAN-ADHF score to predict the probability of being in the phenogroup with the least diuretic response.
“We know the BAN-ADHF score can accurately identify, characterize, and predict diuretic resistance among individuals with ADHF mathematically. Now we must take this medical knowledge and conduct a clinical study to evaluate whether implementing the BAN-ADHF score in our care protocols improves outcomes for patients hospitalized with acute decompensated heart failure,” shared Dr. Segar.
Notably, the work described in this study received recognition from the National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) as a winning solution to the NHLBI Big Data Analysis Challenge: Creating New Paradigms for Heart Failure Research. The challenge encouraged the development of novel, open-source disease models to define subgroups of heart failure and support further advancements in managing the disease. Additionally, Dr. Segar received the American Heart Association’s Samuel A. Levine Early Career Clinical Investigator Award for his role in developing the phenomapping tool and the diuretic resistance clinical risk score. As part of the honor, he presented his research on “Development and Validation of a Phenomapping Tool To Identify Patients With Diuretic Resistance in Acute Decompensated Heart Failure: A Multi-Cohort Analysis” at the American Heart Association’s 2022 Scientific Sessions.
Study collaborators included investigators from The Texas Heart Institute, Duke University School of Medicine, Cleveland Clinic, Houston Methodist DeBakey Heart and Vascular Center, University of Mississippi Medical Center, Baylor Scott and White Research Institute, St. Vincent Heart Center, The University of Texas Southwestern Medical Center, Ronald Reagan UCLA Medical Center, Institute for Precision Cardiovascular Medicine at the American Heart Association, Stony Brook University School of Medicine, Northwestern University School of Medicine, and University of Colorado.
Segar MW, Khan MS, Patel KV, Butler J, Ravichandran AK, Walsh MN, Willett D, Fonarow GC, Drazner MH, Mentz RJ, Hall J, Farr MA, Hedayati SS, Yancy C, Allen LA, Tang WHW, Pandey A. A Phenomapping Tool and Clinical Score to Identify Low Diuretic Efficiency in Acute Decompensated Heart Failure. JACC Heart Fail. 2023 Dec 13:S2213-1779(23)00688-1. doi: 10.1016/j.jchf.2023.09.029. Online ahead of print.
About The Texas Heart Institute
The Texas Heart Institute is an independent, nonprofit organization that is improving cardiovascular health through trailblazing research, thought leadership, education and patient care. Located within the Texas Medical Center in Houston, Texas, and founded in 1962 by renowned cardiac surgeon Dr. Denton Cooley, The Texas Heart Institute performed the first successful heart transplant and total artificial heart implant in the United States. Since then, our physicians and surgeons have remained recognized as worldwide leaders in diagnosing and treating even the most complex cardiovascular conditions. Research programs at The Texas Heart Institute continue to push the boundaries of cardiovascular science by translating laboratory discovery into patient care. The Texas Heart Institute has been ranked among the top cardiovascular centers in the United States by U.S. News & World Report for more than 30 years. http://www.texasheart.org/ @texasheartinstitute

There is some lead in the sealing material used in the cup, the company says. But experts say it’s inaccessible to people drinking from one, and caution that at-home lead tests are unreliable.You might have heard of the Stanley tumbler, the hip, trendy water bottle that has people camping outside stores or getting into fights to get their hands on one.They’ve become a fashion accessory, especially since the company that makes the cups, Stanley 1913, has made use of influencer culture to target women and make the tumbler’s sales skyrocket. The reach of the bottles has been amplified by social media users.But social media giveth and social media taketh away. In recent weeks, several widely shared posts on TikTok, Instagram, Reddit and X have amplified concerns Stanley cups may contain lead, with one X user calling it “The Leadening.” YouTubers have also jumped into the fray. One TikTok video on the topic was viewed nearly seven million times.Some Stanley owners, hoping to check the claims, started to use home lead-testing kits, which experts say are not reliable. A sendup of the Stanley cup phenomenon on “Saturday Night Live” over the weekend — a sketch called “Big Dumb Cups” — even mentioned the lead in passing.The lead discussion has popped up on Facebook comment sections, as in one group with more than 61,0000 members called “Stanley Cup Hunters + Drops” — for “passionate Stanley Cup fanatics.”One person wrote, “If we want to dress up our lead cups with a flower straw cover and a glitter boot and show them off, lets us be!! We know they have lead, you have told us. We don’t care!”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

More than half of the world’s population — 4.4 billion people — lives in cities, and that proportion will grow to two-thirds by the year 2050, according to the United Nations.
As the world’s population expands, and becomes increasingly urbanized, many have raised concerns about the impact of waste — from house trash to wastewater to greenhouse gas emissions — on the planet.
“We as a society tend to ignore the unpleasant side of our production,” says Mingzhen Lu, an assistant professor at New York University’s Department of Environmental Studies.
However, while both waste and urbanization increase each year, less certain is the magnitude of waste generated by cities and the nature of its growth.
To address these matters, Lu and Chris Kempes, a professor at the Sante Fe Institute, and their colleagues examined waste production in urban systems. Specifically, the authors used scaling theory to analyze waste products — municipal solid waste, wastewater, and greenhouse gas emissions — from more than 1,000 cities around the world. Scaling theory, which describes how changes in the size of systems impact a range of system properties, has been used to elucidate phenomena in urban systems — such as the accelerating wealth creation as cities get bigger — so is a suitable means for understanding how waste production scales with the growth of a city.
“The key question is whether waste is produced more or less efficiently as systems scale up, and how big a recycling burden there is as a consequence,” says Kempes.
Their findings, which appear in the journal Nature Cities, showed distinct differences in waste production as cities grow.

Specifically, their analysis revealed that solid waste scales linearly; because it is tied to individual consumption, it increases at the same rate as population growth. By contrast, wastewater production scales superlinearly — at a faster than linear rate — while emissions scale sub-linearly, or at a slower than linear rate. So, when cities double in size, the generation of their greenhouse gas emissions increase at less than double the rate of their population growth, suggesting bigger cities, on average, are more energy efficient but less water efficient.
Their analysis also showed that cities with a higher per-capita GDP generate more waste, which underscores the strong bond between waste generation and economic growth.
The researchers conclude that, overall, more waste generation seems to be a natural consequence of economic growth. To address this, the authors argue for a “break up” of economic growth and waste generation, an unavoidable path to urban sustainability but one already adopted by some cities.
For instance, two decades ago, San Francisco implemented a long-term goal of zero waste and has sought to achieve it through increased recycling and composting — sustainable methods of waste that would otherwise go to landfills. Seoul has adopted a similar approach and now recycles nearly all of its food waste.
Moving forward, Lu expressed his inspiration to contribute to this endeavor of urban sustainability by learning from nature.
“Examining how cities generate waste is only the first step,” he says. “We eventually need to figure out a way to close the material loop. Natural ecosystems and the organisms within, being the early multicellular life or the ancient wood-decaying fungi, have figured out how to deal with nature’s waste for millions of years. We can too.”

The two most common obesity surgeries — gastric bypass and gastric sleeve — have few short-term complications and are equivalent in that sense. These are the findings of a study conducted at the University of Gothenburg.
Every year, around 5,000 obesity surgeries are performed in Sweden. The person undergoing surgery will normally have a BMI of at least 40, or 35 if they also have other serious medical conditions related to obesity.
The most common procedures are gastric bypass, where a large part of the stomach and part of the small intestine are bypassed, and gastric sleeve, where a large part of the stomach is surgically removed. The aim of the current study was to compare the short-term risks of the different procedures.
The study is the largest of its kind. 1,735 adult patients planned for surgery between 2015 and 2022 agreed to participate, and they were randomly assigned to either gastric bypass or gastric sleeve. The surgeries were performed in university hospitals and other hospitals, public and private, 20 in Sweden and 3 in Norway.
Relatively few complications
The results now presented in the journal JAMA Network Open show no significant differences between the methods. Surgical time was longer for gastric bypass, averaging 68 minutes compared to 47 minutes for gastric sleeve, but hospitalization after surgery was one day regardless of method.
The follow-ups also gave equivalent results for the two methods. At 30 days after surgery, both groups had relatively few complications such as hemorrhage, leakage, blood clots and infections. No deaths occurred during the follow-up period of a total of 90 days.

“For both surgical procedures, the risk of complications is very low, especially from an international perspective, and there is no statistically significant or clinically relevant difference between the groups,” says Suzanne Hedberg, first author of the study.
Many stakeholders and many opinions
“Many people have had surgery, or are on waiting lists for surgery, and there are lots of discussions and opinions about the different methods. What the study shows is that patients and doctors can now choose their surgical method without considering short-term surgical risks,” she says.
Suzanne Hedberg defended her thesis in surgery at Sahlgrenska Academy, University of Gothenburg in April 2023, and is a consultant at Sahlgrenska University Hospital. The study, included in her thesis, is the first publication with results from BEST (Bypass Equipoise Sleeve Trial), a Scandinavian registry-based randomized controlled multicenter study comparing the two methods of obesity surgery. The main outcome of the trial which analyzes the risk of complications and weight progression over 5 years, is expected to be completed in 2028.
“For the ongoing studies, we are off to a good start with equivalent groups, laying a good foundation for further comparisons of more long-term results,” concludes Suzanne Hedberg.