[Offwidth]

Interesting development just as JD contract talks restart:

http://www.theguardian.com/society/2016/apr/28/equality-watchdog-warns-junior-doctors-contract-potentially-illegal

[Stewart]

and I despise the Scots ... for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.

Wait a fucking minute here pal - how exactly do we stop you going to the supermarket?  You do realise we've had Sunday opening for....decades!

I believe the learned gentleman refers to this. Will still be voting for them this afternoon but don't agree they should have got involved with this one. Couldn't resist the opportunity to give Cameron a bloody nose i think.

http://www.itv.com/news/2016-03-08/why-has-the-snp-decided-to-veto-sunday-trading-law-changes/

PS all you doctors should think about heading North of the border rather than to Oz. Dumfries is always on the look-out for more consultants and is nice and central for Lakes/County/Dumby/Lomondside etc (and my missus can stay part-time if they get another consultant for her team  )

[Fultonius]

Ah....that makes some sense. That one passed me by. I also agree they probably should have abstained from that one.

Go on...bung your list vote on the Greens....you know it makes sense 

[slackline]

Study Casts Doubt On Hunt's Doctor Contracts



Original Paper


If paywalled (can't check at moment) you might be able to access it from https://sci-hub.bz/ in a few days.

[GCW]

Nice to see a paper backing up the evidence that Hunt has already ignored.

[petejh]

That just confirms what everybody already knows - that the health service isn't a true 7 day per week service because it turns into more of an emergency only service at weekends.

'The Government's main argument for imposing a new junior doctor's contract'

I thought the main argument underpinning the doctors contract was that the health service should be a true 7 day service, rather than an emergency service at weekends.

The weekend death rate is just one of those rhetorical devices that politicians - in government and the BMA - use to make their point.

[slackline]

I'm sure its not the first as I recall other studies debunking this myth, quick search has thrown it up and its essentially the same thing...

Original Paper
Editorial piece
Summary with key points

Even did some work related to this as we were looking at risk factors that predicted seven day mortality in emergency medical admissions, although never published the comparison of mortality by day of admission it was something investigated post-hoc in light of these studies that claimed there was a higher risk.

[Lund]

So what about this paper then?

http://www.internationaljournalofcardiology.com/article/S0167-5273(16)30317-5/abstract

I can't read the whole thing, but

Results
13,988,772 ACS admissions were identified. Adjusted mortality was higher for weekend admissions for Non-ST-Elevation Acute Coronary Syndromes [OR: 1.15, 95% CI, 1.14–1.16] and only somewhat higher for ST-Elevation Myocardial Infarction [OR: 1.03; 95% CI, 1.01–1.04]. Additionally, patients were significantly less likely to receive coronary revascularization intervention/therapy on their first day of admission [OR: 0.97, 95% CI: 0.96–0.98 and OR: 0.75, 95% CI: 0.75–0.75 for STEMI and NSTE-ACS respectively]. For ACS patients admitted during the weekend who underwent procedural interventions, in-hospital mortality and complications were higher as compared to patients undergoing the same procedures on weekdays.

Conclusion
For ACS patients, weekend admission is associated with higher mortality and lower utilization of invasive cardiac procedures, and those who did undergo these interventions had higher rates of mortality and complications than their weekday counterparts. This data leads to the possible conclusion that access to diagnostic/interventional procedures may be contingent upon the day of admission, which may impact mortality.

Obviously, I haven't read it as I don't have access, but from a layman's perspective it seems pretty clear: don't have a heart attack on the weekend in the US.

I also presume that "adjusted mortality" and the secondary points they make mean they didn't do something so stupid as to not correct for the number of overall admissions per day...

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

[slackline]

That just confirms what everybody already knows - that the health service isn't a true 7 day per week service because it turns into more of an emergency only service at weekends.

Another view might be that there are people going to A&E during the week when its not an emergency, this has the effect of diluting the mortality rate during those days relative to the weekend. 

[36chambers]

Interesting looking paper published today from the University of Manchester

"National study casts doubt on higher weekend death rate and proposals for seven-day hospital services"

Summary here (link to full paper at the bottom)

http://www.manchester.ac.uk/discover/news/national-study-casts-doubt-on-higher-weekend-death-rate-and-proposals-for-seven-day-hospital-services/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialPR

[tomtom]

Obviously, I haven't read it as I don't have access, but from a layman's perspective it seems pretty clear: don't have a heart attack on the weekend in the US.

US healthcare is organised in a very different way from us, non?

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

The problem here, is that the evidence used by the Government (the papers and studies they have cited) does not actually show what they say it does...

In many ways, a 7 day NHS is great for many people (myself included) - and if the Govt said that they were doing this to make it more convenient, useful etc.. for the users of the NHS then I would have more respect for their argument.

But instead they have honed their argument over an incorrect interpretation of weekend mortality rates - politics of fear etc....

Given the  stealth privatisation of the NHS (I don't mean to sound all Corbyn, but its true - and its happening - talk to anyone who works there..) then its hard not to think that there is some underlying reason why Gove and the Govt have taken this as far as they have... (e.g. its a reason/excuse to privatise/outsource/breakup more of it..).

[GCW]

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

[slackline]

Obviously, I haven't read it as I don't have access

Plug the DOI into https://sci-hub.bz

A quick scan and Table 1 shows that there are differences in the baseline characteristics on admission for a host of co-morbidities, suggesting disease severity is different between weekday and weekend e.g. in NTSE-ACS sub-group those admitted at weekend were more likely to have hypertension, be morbidly obese, suffer from other co-morbidities like Chronic Obstructive Pulmonary Disorder.

EDIT (read a bit more now I'm on lunch) : They do adjust for these as co-variates in a multivariable (not multivariate as they incorrectly call it) logistic regression, but they report Odds Ratios which are not optimal, it would be preferable to have reported the Relative Risk as these are easier to interpret and more appropriate when conducting such cohort studies (I can't be bothered doing the conversion I'm afraid as my Pot Noodle is ready to eat), regardless the effects are small (they are statistically significant at the arbitrary p < 0.05 because of the large sample size).

Another draw-back is that it only considers in-hopsital mortality among admitted patients.  You could have your heart-attack walk out after recovery then keel over and die in your arm-chair three days later from another heart attack but that wouldn't be counted. 30-day mortality (or any fixed period) as used in the other papers cited gives a more reliable picture.



"While it is easy to lie with statistics, it is even easier to lie without them." - Frederick Mosteller

[petejh]

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

[slackline]

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

And why are you, as a member of the public, dissatisfied?

They are not emergencies and therefore do not have to be seen urgently and......can wait until the weekdays.

[GCW]

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

I'm not sure I get you Pete.

Your comment was that you thought it made sense that death rates increased at weekends.  This doesn't make sense to me for the above reason - cover is already the same as weekdays so the issue won't alter with the new contract.

The elective (7 day) comment you make still needs full elective cover for an extra two days every week.  For the same cost.  With the same staff.  Still doesn't add up.

I suspect within a couple of years it'll all collapse anyway, and I await the day with interest.

[36chambers]

Interesting looking paper published today from the University of Manchester

"National study casts doubt on higher weekend death rate and proposals for seven-day hospital services"

Summary here (link to full paper at the bottom)

http://www.manchester.ac.uk/discover/news/national-study-casts-doubt-on-higher-weekend-death-rate-and-proposals-for-seven-day-hospital-services/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialPR

Interestingly, "the study was rejected by the BMJ [British Medical Journal] after it was peer reviewed by the author [Professor Freemantle] of a previous analysis used by health secretary Jeremy Hunt to justify his imposition of a new junior doctor contract."

Source: http://www.pulsetoday.co.uk/hot-topics/seven-day-gp-access/excess-deaths-at-weekends-a-statistical-artefact-finds-major-new-study/20031777.article

I would love to see what Freemantle's reasons were for rejecting the new paper. 

[Will Hunt]

Has the government not used the argument yet that because elective cover is spread over 2 extra days, there will be less work per day (and thus less staff requirement) across the period?

As worthy as the point they are trying to make is, little posters like this:

don't convey what is actually happening because Jeremy actually has many thousands of doctors and, presumably, the same number of sick people (providing elective care on the weekends won't make more people sick) to care for across the week. So there will be elective work on more days of the week but there should be lower staffing requirements on weekdays.

The counter-argument is that with more access to the service, more people will use it, and the NHS already has a big problem with people wasting doctors' time by accessing the wrong service.

The counter-counter argument is "Well don't you want sick people to be able to get access to healthcare?" - which makes the doctors look shit.

I hope Mr Cunt isn't reading this. It probably doesn't make any sense but that shouldn't matter to him.

[Lund]

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

I don't know.  But from what I can see, the weekend effect IS real.  There seems to be study after study after study noting its existence.  I'm not mixing correlation and causation up here, haha, been given a slapping for that from someone in the past.

[GCW]

Has the government not used the argument yet that because elective cover is spread over 2 extra days, there will be less work per day (and thus less staff requirement) across the period?

It won't as there is plenty of evidence that shows increasing ease of access increases usage.

Besides, you'd still have to fully staff the clinics/ theatres etc even if running at 71.4% of current capacity.

[Lund]

Has the government not used the argument yet that because elective cover is spread over 2 extra days, there will be less work per day (and thus less staff requirement) across the period?

It won't as there is plenty of evidence that shows increasing ease of access increases usage.

Besides, you'd still have to fully staff the clinics/ theatres etc even if running at 71.4% of current capacity.

Where is this evidence?  I asked for it earlier, nobody gave it up.  Don't GPs and the need to get referral and stuff protect the hospital staff from that kind of jazz?

Even if so... is it OK to put obstacles (such as M-F only) in the way of people accessing healthcare?

[GCW]

I don't know.  But from what I can see, the weekend effect IS real.  There seems to be study after study after study noting its existence.  I'm not mixing correlation and causation up here, haha, been given a slapping for that from someone in the past.

The weekend effect = a higher proportion of people admitted at the weekend die. 
Fewer people are admitted.  Same number die.  Proportion is higher.
Doesn't really prove anything, which is why people start using statistical adjustments liked weighting of death rates.

If you think about it - someone is admitted late on a Friday, "the weekend effect" states they have less chance of dying, even though they are then cared for by the supposedly reduced weekend cover.  Equally someone admitted late on a Sunday is more likely to die, even though they have the "increased" weekday cover.

Nonsense.

[Lund]

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

And why are you, as a member of the public, dissatisfied?

They are not emergencies and therefore do not have to be seen urgently and......can wait until the weekdays.

Why should they have to wait?  My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

Oh wait, no - we can't.  SHIT I FORGOT.  God said I have to rest and think about Him at the weekend!  I forget if he said Saturday or Sunday - he's a dumb cunt, says different things to different people - so we should just do nothing on both.

[GCW]

Where is this evidence?  I asked for it earlier, nobody gave it up.  Don't GPs and the need to get referral and stuff protect the hospital staff from that kind of jazz?

Even if so... is it OK to put obstacles (such as M-F only) in the way of people accessing healthcare?

Tan S, Mays N. Impact of initiatives to improve access to, and choice of, primary and urgent care in the England: A systematic review. Health Policy (2014)
Plus others I haven't time to dig out yet.

No, I'm more than happy to remove those obstacles.  But you need more staff and more funding, and with what we have now it is impossible.

£106.5 billion budget now, true 7 day access would need an additional £30.4 billion.  If the government can afford that, let's do it!!  (in 10 years time once we have managed to increase all the staffing levels).

[slackline]

Interestingly, "the study was rejected by the BMJ [British Medical Journal] after it was peer reviewed by the author [Professor Freemantle] of a previous analysis used by health secretary Jeremy Hunt to justify his imposition of a new junior doctor contract."

Source: http://www.pulsetoday.co.uk/hot-topics/seven-day-gp-access/excess-deaths-at-weekends-a-statistical-artefact-finds-major-new-study/20031777.article

I would love to see what Freemantle's reasons were for rejecting the new paper.

It could be as simple as the topic was already covered in his previously published work...

I'm sure its not the first as I recall other studies debunking this myth, quick search has thrown it up and its essentially the same thing...

Original Paper
Editorial piece
Summary with key points

...from the last of the above three links... "cohort admitted at weekend included a greater prevalence of patients with higher predicted mortality risk than those admitted during the week.” which is what the Sutton et al paper I linked to (and you subsequently did) is saying.

The BMJ and Lancet are notoriously hard to get published in and one of the reasons is that they tend not to publish findings which are already out there.

Why should they have to wait?  My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

Oh wait, no - we can't.  SHIT I FORGOT.  God said I have to rest and think about Him at the weekend!  I forget if he said Saturday or Sunday - he's a dumb cunt, says different things to different people - so we should just do nothing on both.

This really has nothing to do with the religious heritage that our now secular country has. 

You and your wife chose to have a kid and everything that entails, deal with it.