Big baby birth trial, Uveitis, Telephone triage, Burns

Inside Health

BBC

Health & Fitness, Science

4.4 • 575 Ratings

🗓️ 3 October 2017

⏱️ 28 minutes

🔗️ Recording | iTunes | RSS

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Summary

Mention arthritis and most people think of older people with osteoarthritic hips or knees. But children get arthritis too, although it's an inflammatory condition where the child's immune system attacks the lining of the joints causing pain, swelling and stiffness. But the joints aren't the only part of the body affected. Around one in six of the 12,000 children in the UK with juvenile idiopathic arthritis also develop worrying inflammation in their eyes, uveitis. This is a silent, symptomless condition which can result in significant visual impairment and even blindness. But a new drug treatment, tested in the UK, has proved to be so successful for this group of children that it has revolutionised treatment both in this country and around the world. The benefits were so large that the trial was stopped early and the new therapy adopted as frontline treatment. Dr Mark Porter visits the Bristol Eye Hospital and meets paediatric rheumatology consultant, Professor Athimalaipet Ramanan to find out more.

Bigger babies can get stuck in the final stages of labour - a condition called shoulder dystocia. Most are delivered safely but there are both enormous risks to the baby through lack of oxygen and a traumatic experience for the mother. Professor of Obstetrics at Warwick Medical School, Siobhan Quenby, tells Mark that a nationwide trial of big baby births aims to find out whether delivering the child two weeks early, at 38 weeks, reduces shoulder dystocia and makes the birth safer for mother and child.

A report by NHS England highlights cost savings of around £100,000 for GP practices that use telephone triage for patients. But the first independent evaluation of this system, where everyone speaks to a doctor on the phone before they get a face to face appointment suggests that policy makers should reconsider their unequivocal support. Inside Health contributor Dr Margaret McCartney, herself a GP, reviews the findings.

Several thousand people a year, many of them children, are admitted to hospital every year with serious burns. One of the country's leading centres for burns victims is at the Queen Elizabeth Hospital in Birmingham. As well as serving 13 million people in the local area, the Healing Foundation UK Burns Research Centre treats injured service personnel, airlifted from conflict zones in Iraq and Afghanistan. Mark gets a tour of the unit from director Naiem Moieman and finds out about the newest research on burns treatment which uses some of the oldest remedies.

Transcript

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0:00.0	Hello, I'm Greg Jenna and good news, Your Dead to Me is back for a new series. Here we go. Yes, we'll explore Emperor Nero's notorious reign with Professor Marybeard and Patton Oswald. I would not want my daughter having the remote control, not alone an empire. We'll dissect the decadent life of Philippe Duke-Dor-Leon with Tom Allen. I've often tried to pretend I'm an aristocrat and being very quickly knocked down. And there'll be so much more with comedians like Olga Koch, Mike Mosniak and Rihalina. I'm excited. You're dead to me, the comedy podcast that takes history seriously. Listen first on BBC Sounds. Hello, thank you for listening to this edition of Inside Health. I hope you enjoy it. Coming up today, I meet the team behind a pioneering new treatment to protect the vision of children with arthritis.
0:44.5	The trial was stopped early, which is sort of once-in-a-lifetime event,
0:48.8	and an independent data safety monitoring committee decided that it was unethical on account of how effective this
0:55.7	treatment was to carry on beyond the 90 patients we had recruited, which needless to say,
1:02.0	was a remarkable success and called for a lot of celebrations.
1:06.2	GP Margaret McCartney examines the impact of telephone triage. Far from relieving pressure on a
1:12.6	stretch service, could telephone consultations actually be making matters worse? And burns.
1:18.7	I visit a state-of-the-art unit testing some surprisingly old remedies. But first, babies, big babies.
1:26.8	Every year in the UK, nearly 3,000 gets stuck in the final stage of labour, a condition called shoulder dystitia.
1:34.3	The baby's head delivers normally, but the rest of the body can't follow, because the shoulder gets wedged behind the pelvis.
1:40.7	And the bigger the baby is, the more likely it is.
1:43.7	A team from the University of Warwick
1:45.6	is about to embark on a trial of a different way of helping women with bigger babies deliver
1:50.4	safely. Chivorn Quemby is Professor of Obstetrics at Warwick Medical School and has witnessed
1:56.1	shoulder dystosia more times than she would like. What happens is that midwife or a doctor has delivered the head,
2:02.6	but the body doesn't follow.
2:04.6	Immediately they identify this, they press an emergency buzzer.
2:08.6	Once they press the emergency buzzer,
2:10.6	then lots of healthcare professionals run into the room.
2:13.6	So the technique involves increasing the size of the mother. So that's to do an episiosomy
2:19.2	or a small cut in the perineum. So abduct the hips. That means to put the knees up against the chest.
2:25.0	That increases the size of the bony pelvis. Then someone presses down on the baby's shoulder to
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