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May 5, 2020 • 28min

Diabetes & Covid-19; Southampton Critical Care; Antigen Tests; Cytokine Storm

Evidence from China, Italy, the USA and now the UK shows categorically that people with diabetes can get seriously ill if they're infected with the new coronavirus. Researchers are trying to untangle the risks for Type 1 and Type 2 but so far, diabetes isn't included in the government's high risk patient group. NHS England's National Specialty Advisor, Professor Partha Kar, tells Claudia Hammond that he believes an individual risk calculator which will enable people to work out their own risk, and so shield themselves accordingly, will be the best way forwards. In the meantime, Dr Kar says, glucose control is essential and people should check their ketone levels as soon as they start to feel unwell. BBC Radio Science Unit producer Beth and her husband Andy (who has Type 1 diabetes) describe to Claudia their experience of Andy getting very ill with Covid-19. They discovered ketone levels appeared at much lower blood glucose levels than normal, something that Dr Kar says appears to be a feature of Covid-19 infection.Erika Wright is back at University Hospital Southampton NHS Foundation Trust. Clinical lead and consultant in critical care, Dr Sanjay Gupta, talks about success giving critically ill patients oxygen using non-invasive ventilation: CPAP - continuous positive airway pressure. He also describes reorganising the hospital's critical care into four sections: patients positive for Covid, negative for Covid, those waiting for test results and those who test negative but are symptoms positive. Nationally, he tells Erika, those who falsely test negative, is between 5-10%.And Inside Health contributor Dr Margaret McCartney delves into the accuracy of antigen swab tests (the test that tells you whether you have the virus or not). False negatives, test results that report the person doesn't have the virus when in fact they do, have serious implications for health care professionals, who might return to work on the basis of a mistaken result. Caution is advised, Dr McCartney advises, when symptoms contradict the test result. A cytokine storm is a variant on a hyperactive immune reaction, where the body thinks its own tissues are invaders. Cytokines are small proteins that trigger more immune activity or less. In a cytokine storm the cytokines rage through the bloodstream, throwing our immune system out of balance and leading to severe illness and even death. This hyper inflammation has been seen in Covid-19 patients and Dr Jessica Manson, consultant rheumatologist at University College London Hospitals and co-chair of the national group of hyper inflammation doctors, tells Claudia what is and isn't known about how to treat cytokine storms in patients with coronavirus.Producer: Fiona Hill
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Apr 28, 2020 • 28min

Smoking vs Covid-19; non-urgent treatments; loneliness surveys; Southampton update, covid and the law.

It's well established that the best thing smokers can do for their health is to quit. Smoking contributes to many of the underlying conditions that undermine recovery from coronavirus and it is pretty clear that a coronavirus patient who smokes will likely have a worse outcome than one who doesn't. The FDA in the US recently went so far as to suggest smoking might increase the risk of contracting the virus at all. Nevertheless, existing data coming from various studies of patients around the world appear to show smaller numbers of smokers amongst the hospitalized cases than might be expected from local smoking populations. There are fewer smokers than there should be in the data. But why?As the University of Edinburgh and CRUK's Prof Linda Bauld tells Claudia, there may be several simple reasons for this, such as data gathering - that patients' smoking status is going unrecorded or unverified. But a study last week from France goes so far as to suggest that nicotine itself, know to disrupt some of the receptors viruses use to enter cells, may be conferring some kind of a protection. It is just a hypothesis, but while the dangers of smoking tobacco still stand, studies on Covid-19 patients using nicotine patches might be worthwhile. And if you are trying to quit, nicotine replacement therapy might be an even better idea just now than was thought.Inside Health's resident GP Dr Margaret McCartney talks of her concerns for NHS non-urgent treatments being side-lined under the current virus squeeze, and some of her hopes for the future. Professor Pamela Qualter and Dr Margarita Panayioutou describe why lockdown is an important time to do more psychological research into the effects of loneliness and other responses while we have the chance.And in this week's update from Southampton General, where Inside Science's Erika Wright has been speaking to frontline health workers every week, Mr Robert Wheeler, a surgeon and clinical law expert muses on some of the legal aspects of our coronavirus response.
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Apr 21, 2020 • 28min

Southampton update; health anxiety; death certifications; fast-track drug screening

Every week we’re heading to Southampton General Hospital, where we’ve heard a lot about the doctors and nurses doing amazing work. But this week Erika Wright has been talking to Gemma Blanchett who does a job you might not even associate with the virus or with intensive care – and that’s physiotherapy. Gemma is a respiratory physiotherapist who has the joy of watching some recover with her extraordinary help.Recovery is going to be a long haul for some and can even take time for those who’ve had the virus with mild symptoms at home. So what do we know about how long a complete recovery takes? James Gill GP and Honorary Clinical Lecturer at Warwick Medical School discusses the latest insights.For people who have already found themselves worrying excessively about their health or who have an obsessive compulsive disorder related to hand washing, this is a particularly difficult time. With all of us now on the look-out for symptoms, Claudia Hammond speaks to Jo Daniels, a Senior Lecturer in Clinical Psychology at Bath University who specialises in health anxiety, and David Adam, author of the Man Who Couldn’t Stop – an intimate account of the power of obsessional thoughts.There’s been a lot of discussion about how to get accurate numbers for the people who have died from the virus outside hospital and one issue that’s been raised is whether doctors are wary of putting Covid-19 on a death certificate, when there’s been so little testing in the community. GP Margaret McCartney examines the current dilemmas.Amidst a host of trials to find effective treatments against Covid19, are there existing drugs which no one has thought of yet? We hear from Dr Lindsay Broadbent whose team at Queens University are testing more than a thousand drugs on human lung cells infected with Covid19 in the lab, to see what might work for both mild and more severe infection.Producer Adrian Washbourne
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Apr 14, 2020 • 28min

Covid-19 drug trial; Mental health alone; Southampton update; Antarctica's lockdown lessons

A range of potential treatments have been suggested for Covid-19 but nobody knows if any of them will turn out to be more effective in helping people recover than the usual standard hospital care which all patients will receive. Inside Health regular Dr Margaret McCartney talks to Claudia about how the first randomised trials are now setting out to test some of these suggested treatments with unprecedented speed and adaptability as potential new drug candidates emerge.During lockdown some find their mental health is put at higher risk. Katie Connebear is a mental health campaigner and blogger who was diagnosed with bipolar disorder eight years ago. She has experienced psychotic episodes and has coping strategies in place for when she feels her mental health deteriorating. She offers her thoughts on how to make small progressive steps in the absence of family and friends who she normally relies on when times are difficult.We’ve the latest in Inside Health’s regular visits to test the temperature at Southampton General Hospital. During the current pandemic maternity wards have to make sure that the birth of babies happens in a way that keeps expectant mothers, their birth partners and staff safe from the virus. Government advice includes pregnant women in the “vulnerable group" who need to take extra steps to socially distance, with extra attention after 28 weeks. Consultant obstetrician Jo Mountfield is keen to allay pregnant women’s concerns.And with isolation set to continue, we can also learn from people who have lived in a different kind of lockdown – and one that was in many ways more extreme. Beth Healey is an intensive care doctor currently working in Switzerland who spent 14 months at Concordia research station in the Antarctic, investigating how the team coped with living in such an isolated environment She reveals the similarities in life there and life under lockdown here.Producer Adrian Washbourne
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Apr 7, 2020 • 28min

Covid-19 and moral injury; Asthma; Southampton update; Mental health services

Claudia Hammond reports on Covid-19 and "moral injury" - when the virus peaks, some healthcare staff will find themselves in a situation never faced before, forced to make decisions they would never normally have to make. This puts them at risk of a so-called “moral injury” which might harm their mental health. It’s more often associated with life in the armed services and Neil Greenberg, Professor of Defence Mental Health at Kings College London, explains how he's applying lessons from research in the military to support staff starting work at the new Nightingale Hospital in London. And some of the million recipients of letters saying they should shield themselves by not going out at all for 12 weeks are people who have asthma. Margaret McCartney examines the evidence for how those with asthma receiving letters were selected. Plus the latest dispatch from University Hospital Southampton: consultant Chris Hill explains that the emergency department has been split into Red and Blue areas based on the probability of arrivals having Covid-19. And what’s happening to mental health services during this time of crisis when seeing someone face-to-face needs to be avoided as much as possible? Claudia finds out from psychiatrist Dr Sri Kalidindi. Producer: Erika Wright
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Mar 31, 2020 • 28min

Dispatches from University Hospital Southampton; Covid-19 and loss of smell; intensive care access; coronavirus home care

When hospitals are full of patients, they're said to be "hot". The coronavirus crisis will push up the temperature of hospitals across the UK and in the first in a special series of weekly dispatches from the medical front line, producer Erika Wright will be taking the temperature of University Hospital Southampton - or The General - in Hampshire (which services almost two million people in the south of England) as they cope with the influx of Covid-19 patients. In this first dispatch, Erika talks to the Divisional Director for Medicine, Dr Trevor Smith, who says as patients have been moved out of this large teaching hospital to make space for coronavirus patients, the hospital's current temperature reading is "cold", but all staff know that this will soon change.This virus is deeply frightening for everybody, but often for older people and those with underlying health conditions it is even worse. The fear is that if hospitals are overflowing, then crude cut-offs by, for example, age, might determine who does or doesn't, get a a bed in intensive care. But Dr Mark Roberts, consultant in acute and geriatric medicine and chair of the British Geriatric Society in Northern Ireland, tells Claudia that health care professionals don't and wouldn't make such arbitrary decisions based on age. Instead, he says, decisions about access to intensive care beds (or in-patient care) will continue to be made at the bedside, with compassion, and with a focus on who has the greatest capacity to benefit.Some people have already decided that they won't go to hospital if NHS services are overwhelmed but they do want reassurance that they would get urgent care at home should they become seriously ill. Retired GP Dr Lyn Jenkins has written to the Prime Minister calling for this to be addressed as a priority. He's in good health, only 69 years old, but believes that he has a moral obligation not to use up scarce hospital resources if critical care beds can be given to younger people. For those who need it, he wants a quick response team to bring pain relief and supplementary oxygen and importantly, the presence of another person, a carer, so people who were very sick wouldn't be alone. GP and Inside Health regular Dr Margaret McCartney talks to Claudia about supplies of personal protective equipment and whether long-promised supplies are finally arriving and she delves into the evidence to find out whether the loss of a sense of smell or taste could be a symptom of coronavirus. Listener Rachel says she can't smell cheese, garlic or lavender oil and she's worried that she could have the virus. Producer: Fiona Hill
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Mar 24, 2020 • 28min

COVID-19 PPE; Secondary Pneumonia; Viral Load; Trauma Care in Fort William

Margaret McCartney on COVID-19 and how the military has been deployed to get protective equipment supplies to critical care staff. Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard tells of the difficult ethical decisions staff are facing. And Professor Carl Heneghan - suffering from COVID-19 symptoms himself - explains the importance of fast action when treating secondary pneumonia in the elderly; while Deirdre Hollingsworth explains the term "Viral Load". Plus Margaret McCartney visits the famous Belford Hospital in Fort William - specialising in hostile environment trauma - and hears a story of intense mountain rescue.
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Mar 17, 2020 • 29min

Covid-19 Intensive Care Beds; Ibuprofen; Laser and Glaucoma; Faecal Incontinence

The UK has one of the lowest numbers of critical care beds in Europe but as the coronavirus threatens to engulf us, drastic measures are being taken to increase capacity. Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard, tells Saleyha that the NHS has been asked to plan for doubling, trebling and then quadrupling the number of critical care beds. So far, health authorities in England, Northern Ireland, Scotland and Wales have identified how they can increase the number of beds from just under 5,000 to around 10,000 but as Nicki Credland, Chair of the British Association of Critical Care Nurses says, increased beds mean more specialist intensive care nurses in numbers that can't be invented overnight. Additional non-specialist staff are being earmarked to help fully qualified intensive care nurses in the current virus crisis.Dr Margaret McCartney addresses the confusion around two medications: ibuprofen for viral symptoms and the potential risks to Covid-19 patients who are using ACE inhibitors for their high blood pressure or heart failure. Meanwhile away from coronavirus, Saleyha reports on new advances for the treatment of glaucoma, a condition which involves increased pressure to the eye and damage to the optic nerve. It's usually treated using eye drops, but laser treatment could be coming to a hospital near you. Saleyha watches as Gus Gazzard, Professor of Ophthalmology at University College London, uses a laser to treat the high pressure in Veenay Shah's right eye. Evidence from the LiGHT trial, which showed the laser works for newly diagnosed glaucoma patients, is likely to lead to new NICE guidelines which could give patients the choice: eye drops or laser.Faecal incontinence is one of the most debilitating conditions and patients can go for years without even seeking help. But at Sandwell General Hospital in West Bromwich, a revolutionary non-surgical approach is transforming lives. Called the FINCH service, Lead Nurse Kelly Stackhouse, colorectal consultant Rajeev Peravali and patients 21-year-old Lara and 74-year-old John, tell Saleyha how the new approach works. Producer: Fiona Hill
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Mar 10, 2020 • 30min

Coronavirus Special

Inside Health gets exclusive access into Ysbyty Gwynedd, the Bangor emergency department, to see how they are preparing staff to deal with coronavirus patients arriving at the front door. Although advice is for patients to stay at home and call 111, some will be sick enough to need hospital admission. For that outcome, staff need to be properly fitted for face masks and trained in putting on personal protection equipment or PPE. Saleyha works in the department and Inside Health follows her getting kitted out with the help of Tim Hamilton Jones, an ED staff nurse tasked with the job of getting everyone ‘fit tested’.GP Dr Margaret McCartney talks about the evidence on face masks and the different types that are out there and gives the latest information on the incubation period for COVID19. It’s estimated that 80% of cases will be able to recover at home but 20% may need hospital care. Reports coming from Italy describe the demand on intensive care beds for patients with coronavirus because of the disease’s potential impact on the lungs. Dr Alison Pittard, Dean of the Faculty of Intensive Care and herself a practising ITU consultant in Leeds tells Inside Health about plans for increasing critical care bed capacity, in the NHS. The service is however already stretched before the disease has even taken hold here. As the government works out a plan of action to support the NHS to cope at this time, Inside Health talks to the British Red Cross, already working in hospitals across Wales, about supporting staff during the normal pressures, even before coronavirus struck. We hear from support workers within the Emergency Department and get an insight into what they do.Producer, Erika Wright
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Feb 25, 2020 • 30min

Cigarette Filters; Sepsis

Chris van Tulleken examines cigarette filters - the tobacco industry's hidden marketing tool. He talks to historian Robert Proctor, author of The Golden Holocaust and May van Schalkwyk explains why she wrote her paper 'No More Butts'. Plus Margaret McCartney discusses whether the media portrays a balanced view of Sepsis.

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