Jessica

10.5K posts

Jessica

Jessica

@CohenJessiae

Lover of retail, Labour member, Ukrainophile. Views my own. Occasionally I tweet in Russian (badly).

London, England Katılım Haziran 2016
438 Takip Edilen166 Takipçiler
Catherine Roy
Catherine Roy@catherineroyuk·
After Jennifer & Agnes' preventable deaths, NHSE should focus on why the consent process was flawed. Jennifer would not have agreed to a home birth had she been told (incl. using the word death) the risks. This is implying that she requested a dangerous birth. She did not.
Alison Moore @alijanemoore also on Bluesky@AliJaneMoore

If the NHS does not support a home birth because it is "high risk" and there is talk of social services referral if such births go ahead, some women will not only freebirth but will also avoid healthcare throughout pregnancy. #commentsJump" target="_blank" rel="nofollow noopener">hsj.co.uk/patient-safety…

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Jessica
Jessica@CohenJessiae·
@DrJ_Haddock @catherineroyuk I don't quite get why it's different to discharging someone with a brain aneurysm prior to surgery with safety netting, or someone with appendicitis. Giving birth is very different but there many other examples were people are discharged home with critical pathology
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James Haddock
James Haddock@DrJ_Haddock·
@CohenJessiae @catherineroyuk And as an anaesthetist obviously I see the full spectrum of time critical emergencies...I just can't think of one where the risk is constrained in such a narrow time window/single event. The risk of most life threatening emergencies is distributed over a period measured in years.
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James Haddock
James Haddock@DrJ_Haddock·
@CohenJessiae @catherineroyuk The issue is time. In Labour when something goes wrong - say a cord prolapse, impaction, bleed you may only have a window of minutes to act for a lifesaving intervention. Labour is a unique physiological process, and I don't think there are good analogies in other specialties.
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Jessica
Jessica@CohenJessiae·
@DrJ_Haddock @catherineroyuk In all areas of medicine people are sent home faster after surgery and avoiding surgery via more medical management. Isn't this simply the over/undertreatment paradigm? Home birth isn't safe for most, but is for some. Like non-surgical appendicitis management...
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James Haddock
James Haddock@DrJ_Haddock·
@catherineroyuk Of course unfortunately as we all know even care in hospital is not always that, and we must without fear or favour confront the reasons for that and get on with changing practice.
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Jessica
Jessica@CohenJessiae·
@tombennett71 This is a very odd time for AQA to put this out as parents have swung pretty decisively anti-tech
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Jessica
Jessica@CohenJessiae·
@Birdyword I'd have thought it's easier in London because of our road infrastructure. Narrower roads, easier to get onto pavements. Maybe that's wrong, but overall London has less crime than New York (I think???)
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Jessica retweetledi
Fred de Fossard
Fred de Fossard@defossardf·
It is not worsening mental health. It is bad labour laws, bad welfare policy, high immigration and spiralling minimum wages making many young peoples' jobs unviable. It is all a policy choice.
The Telegraph@Telegraph

Britain’s youth unemployment problem is now worse than in Greece and Spain, figures show Find out how worsening mental health blamed as number of young people out of work hits highest level since 2005 🔗 telegraph.co.uk/money/jobs/car…

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Jessica
Jessica@CohenJessiae·
@catherineroyuk Yes obviously it's not available - the point is that in a narrow subset of women adverse outcomes are less likely at home. This is not only seen in birth. In lots of medical areas people are managed more medically and discharged earlier.
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Catherine Roy
Catherine Roy@catherineroyuk·
@CohenJessiae Professional knowledge was that unforeseeable complications can arise at any time in labour. This has yet to be disproved. + Changing Childbirth Annex 5: "because of the distance from further assistance, there are some limitations to resuscitation of a newborn baby in the home"
Catherine Roy tweet media
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Catherine Roy
Catherine Roy@catherineroyuk·
We've always known that home births are riskier than hospital births because emergency specialist care can be needed at any moment. But Changing Childbirth ignored this & on no evidence recommended home births for so called low risk pregnancies. 30 years of putting lives at risk.
Jonathan@jabberwock951

@AliJaneMoore @catherineroyuk If someone decides to freebirth they can change their mind at any time and come to hospital. But I can definitely see the argument that continuing risky home births 'with patient consent' just allows midwives to continue to encourage patients to see it as a sensible option.

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Jessica
Jessica@CohenJessiae·
@catherineroyuk Professional knowledge is often wrong! That's why you need studies. Even though home birth is only safe for a few women, many more want it, and they are not put off by the extreme warnings they get (as I have seen).
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Catherine Roy
Catherine Roy@catherineroyuk·
@CohenJessiae I wouldn't rely on Birthplace to make decisions about my one child. Also, should I trust a study done to justify a radical change of policy based on no evidence and contrary to professional knowledge?
Catherine Roy tweet media
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Jessica
Jessica@CohenJessiae·
@catherineroyuk On my home birth group Women routinely post consent documents with "death" in there. Many women do not believe the risks are real. Even after signing the document.
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Jessica
Jessica@CohenJessiae·
@catherineroyuk I'm referring to the birthplace study, which found it was a low risk option for a very narrow group of women (multiple, no risk factors, previous vaginal birth)
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Catherine Roy
Catherine Roy@catherineroyuk·
@CohenJessiae Is the evidence you have stronger than Changing Childbirth recognising that some babies born at home need intubation?
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Jessica
Jessica@CohenJessiae·
@Londondwel77743 @tombennett71 Lower. I used to live at a station with no barriers; there was definitely more fare evasion then. TfL have put in barriers in almost all tube stations now - that alone has massively reduced fare evasion. You'll never notice evasion on the overground...
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Tom Bennett OBE
Tom Bennett OBE@tombennett71·
Would 100% welcome this on London Underground. Every passenger should also be a contributor to the community. Mild but effective deterrent to fare dodging accompanied by a huge impact on the profile of commuters-caused by a tiny adjustment. Target the recidivist anti-social minority.
Aakash Gupta@aakashgupta

BART spent $90 million on new fare gates. They're recovering about $10 million a year in fares. That's a 9-year payback on paper. The actual return hit in six months. Embarcadero station went from 112 hours of corrective maintenance in the six months before installation to 2 hours after. Daly City saved 109. Balboa Park saved 75. Across the system, 961 hours of cleanup work disappeared. Corrective maintenance is the term BART uses for graffiti, heavy soiling, vandalism, the damage that needs a crew not a janitor. At several stations it dropped to zero. Crime fell 41% year over year. Riders who reported seeing fare evasion on their trip dropped from 22% to 10%. Citations issued by BART police went from 2,200 in January to under 1,000 in July, because there was nothing to cite. The gates were a filtering project disguised as a revenue project. Old BART gates were waist-high orange fins designed in the 1970s. You could hop them in under a second. That made the station effectively a public space, and the rider mix reflected that. The new gates are 72 inches of polycarbonate with 3D sensors that detect tailgating. You either pay or you don't enter. Once you don't enter, you also don't smoke on the platform, sleep in the elevator, or harass other riders. BART tried hiring more police for years. Blitz operations at high-traffic stations. Increased patrols. Dedicated transit cops. None of it moved the numbers the way six feet of polycarbonate did. The $10 million in recovered fares is the smallest line in the return. Fare revenue used to cover 70% of BART operations. After the pandemic it collapsed to 22%. The gates won't fix that gap directly. They fix the precondition for fixing it: a system that office workers, families, and tourists are willing to use again. Ridership growth at stations with new gates outpaced ungated ones before the rollout finished. A $400 million annual deficit is heading to voters in November as a sales tax measure. Voters don't approve sales taxes for transit agencies they don't feel safe in. The $90 million on gates is buying BART the right to ask the public for more money. That's the real return on six feet of polycarbonate.

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Kelsey Piper
Kelsey Piper@KelseyTuoc·
@underverse @ZachWritesStuff I agree they used to get better results while paying less. however, it's pretty fucking terrifying to have a healthcare system that at any time can massively deteriorate in wait times and health outcomes if the government screws up.
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Londondweller
Londondweller@Londondwel77743·
@CohenJessiae @tombennett71 3.8% is still much higher than than when I first moved to London in 2002. I would genuinely never see it. It’s not that great to say that we have a lower rate than America : given how many black people there are in the US, it’s unsurprising that they have a higher crime rate
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Karen Vaites
Karen Vaites@karenvaites·
An international lens on phonics over-teaching, care of @Suchmo83 and Mark Goodrich:
Karen Vaites tweet media
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