Tuesday, February 25, 2014

'No consent' on baby ventilator move

Rohan Rhodes inquest: No consent for removing ventilator, hearing told

Rohan Rhodes Rohan Rhodes deteriorated within an hour of a nurse removing the ventilator, an inquest was told

A premature baby deteriorated soon after a ventilator was removed without the consent of his parents or senior hospital staff, an inquest has heard.

Rohan Rhodes, of Narberth, Pembrokeshire, was born 15 weeks early at Singleton Hospital, Swansea, in 2012 and was transferred to St Michael's Hospital, Bristol, for surgery.

Medical staff wept as they told the hearing near Bristol how the baby's condition dramatically worsened.

Rohan died in hospital aged 36 days.

The inquest heard the baby was not allowed to die in his mother's arms despite her wishes because staff were unable to remove lines from his body.

Rohan had been transferred to St Michael's Hospital for a surgical assessment after a heart duct which usually closes at birth had remained open.

His parents Alex and Bronwyn Rhodes told the coroners' court on Monday about concerns they had about their son's treatment.

They said that Rohan's feeding tubes were inserted "aggressively" and caused him pain.

On Tuesday, Flax Bourton Coroner's Court heard from medical staff at the hospital who said the plan had been to keep Rohan on the ventilator.

However, the hearing was told advanced neonatal nurse Amanda Dallorzo took the "autonomous" decision to extubate, or remove the baby from the machine, and apply a breathing mask instead.

Rohan's condition dramatically deteriorated and he died the following day.

Commenting on Rohan's removal from the ventilator, Dr Vel Ramalingam said: "That was not my decision. It was not discussed with me.

"My understanding was that Rohan was going to be kept on the ventilator. I was expecting to be consulted if someone was taking that sort of decision to remove him.

Rohan Rhodes Rohan died in hospital aged 36 days.

"I thought the team plan was to continue ventilation."

Nurse Suja Thomas said she was asked by Ms Dallorzo to help take Rohan off the ventilator on 29 September, the day after he arrived at the hospital.

"I asked if she was sure," Ms Thomas said. "She said we will extubate and we extubated at around 4pm.

"A member of medical staff is telling me we have to extubate, then we have to extubate. That is their decision to extubate.

"The baby deteriorated after one hour."

Rohan's heart had started slowing and he was put back on the ventilator at 19:00 BST.

Mrs Rhodes previously told the inquest how she and her husband had watched their son turn "pale and lifeless" during this period.

'Grave concerns'

Timothy Rogers, a consultant paediatric surgeon, was called at 06:00 BST the following day, 30 September, to perform emergency surgery on Rohan.

He had developed a gastrointestinal disease and required surgery to repair a perforated intestine.

Dr Rogers said Rohan, who had developed acute peritonitis, suffered numerous cardiac collapses and did not become stable enough for surgery.

At 16:00 BST, Dr Rogers said he went to find Mrs Rhodes to inform her of his "grave concerns" for her son's survival.

Rohan died in his incubator at 18:00 BST.

A pathologist previously told the inquest he found multiple perforations to Rohan's bowel and said the likely cause of death was acute peritonitis and pneumonia.

St Michael's Hospital is part of the same NHS trust as Bristol Children's Hospital, which is the subject of a new investigation into the deaths of several children over the past three years.

The hearing continues.


Monday, February 24, 2014

How do we really make decisions?

How do we really make decisions?

Winning and losing money

With every decision you take, every judgement you make, there is a battle in your mind - a battle between intuition and logic.

And the intuitive part of your mind is a lot more powerful than you may think.

Most of us like to think that we are capable of making rational decisions. We may at times rely on our gut instinct, but if necessary we can call on our powers of reason to arrive at a logical decision.

We like to think that our beliefs, judgements and opinions are based on solid reasoning. But we may have to think again.

Prof Daniel Kahneman, from Princeton University, started a revolution in our understanding of the human mind. It's a revolution that led to him winning a Nobel Prize.

His insight into the way our minds work springs from the mistakes that we make. Not random mistakes, but systematic errors that we all make, all the time, without realising.

Prof Kahneman and his late colleague Amos Tversky, who worked at the Hebrew University of Jerusalem and Stanford University, realised that we actually have two systems of thinking. There's the deliberate, logical part of your mind that is capable of analysing a problem and coming up with a rational answer.

This is the part of your mind that you are aware of. It's expert at solving problems, but it is slow, requires a great deal of energy, and is extremely lazy. Even the act of walking is enough to occupy most of your attentive mind.

Prof Daniel Kahneman Daniel Kahneman's insights into the mind spring from the systematic errors we make all the time

If you are asked to solve a tricky problem while walking, you will most likely stop because your attentive mind cannot attend to both tasks at the same time. If you want to test your own ability to pay attention, try the invisible gorilla test devised by Chris Chabris, from Union College, New York, and Daniel Simons from the University of Illinois.

But then there is another system in your mind that is intuitive, fast and automatic. This fast way of thinking is incredibly powerful, but totally hidden. It is so powerful, it is actually responsible for most of the things that you say, do, think and believe.

And yet you have no idea this is happening. This system is your hidden auto-pilot, and it has a mind of its own. It is sometimes known as the stranger within.

Most of the time, our fast, intuitive mind is in control, efficiently taking charge of all the thousands of decisions we make each day. The problem comes when we allow our fast, intuitive system to make decisions that we really should pass over to our slow, logical system. This is where the mistakes creep in.

Our thinking is riddled with systematic mistakes known to psychologists as cognitive biases. And they affect everything we do. They make us spend impulsively, be overly influenced by what other people think. They affect our beliefs, our opinions, and our decisions, and we have no idea it is happening.

It may seem hard to believe, but that's because your logical, slow mind is a master at inventing a cover story. Most of the beliefs or opinions you have come from an automatic response. But then your logical mind invents a reason why you think or believe something.

Dr Laurie Santos and monkeynomics Dr Laurie Santos studies monkeys to learn how deep seated our biases really are

According to Daniel Kahneman, "if we think that we have reasons for what we believe, that is often a mistake. Our beliefs and our wishes and our hopes are not always anchored in reasons".

Since Kahneman and Tversky first investigated this radical picture of the mind, the list of identified cognitive biases has mushroomed. The "present bias" causes us to pay attention to what is happening now, but not to worry about the future. If I offer you half a box of chocolates in a year's time, or a whole box in a year and a day, you'll probably choose to wait the extra day.

But if I offer you half a box of chocolates right now, or a whole box of chocolates tomorrow, you will most likely take half a box of chocolates now. It's the same difference, but waiting an extra day in a year's time seems insignificant. Waiting a day now seems impossible when faced with the immediate promise of chocolate.

According to Prof Dan Ariely, from Duke University in North Carolina, this is one of the most important biases: "That's the bias that causes things like overeating and smoking and texting and driving and having unprotected sex," he explains.

Confirmation bias is the tendency to look for information that confirms what we already know. It's why we tend to buy a newspaper that agrees with our views. There's the hindsight bias, the halo effect, the spotlight effect, loss aversion and the negativity bias.

This is the bias that means that negative events are far more easily remembered than positive ones. It means that for every argument you have in a relationship, you need to have five positive memories just to maintain an even keel.

Roulette wheel We feel the pain of financial loss much more than the pleasure of a gain

The area of our lives where these cognitive biases cause most grief is anything to do with money. It was for his work in this area that Prof Kahneman was awarded the Nobel Prize - not for psychology (no such prize exists) but for economics. His insights led to a whole new branch of economics - behavioural economics.

Kahneman realised that we respond very differently to losses than to gains. We feel the pain of a loss much more than we feel the pleasure of a gain. He even worked out by how much. If you lose £10 today, you will feel the pain of the loss. But if you find some money tomorrow, you will have to find more than £20 to make up for the loss of £10. This is loss aversion, and its cumulative effect can be catastrophic.

One difficulty with the traditional economic view is that it tends to assume that we all make rational decisions. The reality seems to be very different. Behavioural economists are trying to form an economic system based on the reality of how we actually make decisions.

Dan Ariely argues that the implications of ignoring this research are catastrophic: "I'm quite certain if the regulators listened to behavioural economists early on we would have designed a very different financial system, and we wouldn't have had the incredible increase in the housing market and we wouldn't have this financial catastrophe," he says.

These biases affect us all, whether we are choosing a cup of coffee, buying a car, running an investment bank or gathering military intelligence.

Monkey Humans aren't the only species that shows loss aversion

So what are we to do? Dr Laurie Santos, a psychologist at Yale University, has been investigating how deep seated these biases really are. Until we know the evolutionary origins of these two systems of thinking, we won't know if we can change them.

Dr Santos taught a troop of monkeys to use money. It's called monkeynomics, and she wanted to find out whether monkeys would make the same stupid mistakes as humans. She taught the monkeys to use tokens to buy treats, and found that monkeys also show loss aversion - making the same mistakes as humans.

Her conclusion is that these biases are so deep rooted in our evolutionary past, they may be impossible to change.

"What we learn from the monkeys is that if this bias is really that old, if we really have had this strategy for the last 35 million years, simply deciding to overcome it is just not going to work. We need other ways to make ourselves avoid some of these pitfalls," she explained.

We may not be able to change ourselves, but by being aware of our cognitive limitations, we may be able to design the environment around us in a way that allows for our likely mistakes.

Dan Ariely sums it up: "We are limited, we are not perfect, we are irrational in all kinds of ways. But we can build a world that is compatible with this that gets us to make better decisions rather than worse decisions. That's my hope."

HORIZON: How You Really Make Decisions is on Monday 24 February, 9pm, BBC2


VIDEO: Paedophile priest's 20 years on run

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Paedophile priest Paul Cullen's 20 years on run in Tenerife

24 February 2014 Last updated at 14:55 GMT

Fugitive paedophile priest Paul Cullen evaded capture by the police for more than 20 years living on the Spanish island of Tenerife.

But the 85-year-old was not living under an alias - he was using his own name in the resort of Los Cristianos.

Cullen has admitted dozens of charges of historical sex abuse against seven children in Derbyshire and Nottinghamshire, dating back to 1957.

Simon Hare reports.


VIDEO: The Holocaust survivor and her music

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Holocaust survivor Alice Herz-Sommer dies aged 110

24 February 2014 Last updated at 07:16 GMT

The oldest known survivor of the Nazi Holocaust, Alice Herz-Sommer, has died in London at the age of 110.

The accomplished pianist spent two years in a Nazi concentration camp in Terezin after being born into a Jewish family in Prague in 1903.

Grainne Harrington reports.


VIDEO: Army's new drone ready for take-off

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Army's new Watchkeeper drone to patrol Wiltshire skies

24 February 2014 Last updated at 13:14 GMT

A drone, bought by the Army for £850m, is to begin flying over Wiltshire this week.

It is the first time an "Unmanned Aircraft System" (UAS) has been cleared to use civilian airspace in the UK, on what is likely to become a permanent arangement.

Ben Moore reports.


VIDEO: Piers Morgan's CNN show to end

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Piers Morgan's CNN show to end amid mediocre ratings

24 February 2014 Last updated at 15:34 GMT

Piers Morgan's prime-time talk show on US TV network CNN is to end.

The former Daily Mirror editor told The New York Times it had been "a painful period" for the show, which has suffered lacklustre ratings.

CNN's audience had tired of hearing a Briton weigh in on American cultural issues, he said.

Mr Morgan said he was in discussions with CNN about a new role at the channel following the end of the show, probably in March.

Nick Higham reports.


VIDEO: China pandas arrive in Belgium

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China pandas arrive in Belgium amid diplomacy row

24 February 2014 Last updated at 01:06 GMT

Two giant pandas have been flown into Belgium on a 15-year loan from China's Sichuan region.

While there was a celebrity welcome for Xing Hui and Hao Hao, the pair's arrival has also inflamed a political row between the country's French and Dutch-speaking regions.

Elaine Jung reports.