General hospital care for children with learning disabilities has scope for improvement
Less than half of NHS staff surveyed said they were routinely informed that a child has learning disabilities through a dedicated flagging system on admission.
Many general hospital staff lack confidence and organisational support in providing care for children and young people with learning disabilities. In an NIHR national hospital staff-awareness survey, staff were uncertain or unaware of local policy and practice. Only half of the children’s hospitals had a learning disability nurse, ...
High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy.
Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital.
Reminders help GPs to find and manage inherited cholesterol disorders
GPs and practice nurses assess more adults with inherited raised cholesterol (familial hypercholesterolaemia) when prompted by reminders. More patients have repeat cholesterol tests and assessments for heart disease, in line with NICE guidelines.
This NIHR-funded study used electronic health records from six GP practices to identify patients with total cholesterol greater than 7.5mmol/l. Reminder messages appeared when their records were opened during consultations and prompted GPs to carry out...
Adrenaline can restart the heart but is no good for the brain
Treating cardiac arrests with adrenaline during resuscitation by paramedics slightly increases survival compared with placebo. Though adrenaline initially helped restore circulation in a third of cases, 3.2% of people survived to 30 days compared to 2.4% of people in the placebo group. Severe brain damage was nearly twice as likely in those who survived after adrenaline injections.
Cardiac arrest occurs when the heart no longer pumps blood around the body, usually due to an irregular heart rhyt...
Text messages improve diabetes self-management and blood sugar control
In adults with poorly controlled diabetes, text messages offering advice and support can improve self-management and blood sugar control.
This trial included 366 adults with type 1 or type 2 diabetes in New Zealand. An automated system delivered individually tailored text messages to participants over a nine-month period to support self-management of blood sugar. The control group received usual care, comparable to that in the UK.
The text message group had a small reduction in blood sugar lev...
‘Virtual wards’ reduce readmissions in people after hospitalisation for heart failure
People with heart failure who receive care via virtual wards following discharge from hospital have lower rates of heart failure-related readmission and death than people discharged to other types of care.
However, virtual wards did not show similar benefits when offered to people leaving hospital with other high-risk chronic diseases.
This systematic review included randomised controlled trials of virtual wards, defined as with four operational criteria to be intensive multidisciplinary team ...
A fifth of people, who have no improvement on antidepressants at four weeks, respond if given more time
An adult with acute depression not yet responding to an antidepressant drug has a 1 in 5 chance of substantial symptom reduction between 5 and 8 weeks if they continue taking it. In those unresponsive after eight weeks, 1 in 10 will respond between 9 and 12 weeks.
Changing treatment plans too early can mean needlessly discarding first choice anti-depressants. This is the first systematic review to calculate the proportions of people with a delayed but positive response at different time points....
Ultrasound shows potential for confirming the diagnosis of pneumonia in children
Ultrasound scans of the lungs can be more accurate than chest X-rays for diagnosing pneumonia in children in some circumstances.
A review of the published evidence found that lung ultrasound was more sensitive (missed fewer cases) and about as specific (gave about the same number of false alarms) as chest X-ray, when used to confirm suspected community-acquired pneumonia in children. While pneumonia is a clinical diagnosis, X-ray is often used for confirmation.
Ultrasound also spares the child...
A reminder that too much oxygen increases mortality in acutely ill adults
In acutely ill adults, liberal use of oxygen supplementation is found to increase the risk of death compared with more conservative oxygen strategies. More liberal oxygen therapy increases patient mortality in hospital by about 11 deaths amongst every 1,000 people exposed. Deaths also increase after 30 days follow-up, without improving other important health outcomes, such as disability, infection or length of hospital stay.
Oxygen is routinely used for acutely ill patients and is widely consid...
Outpatient video consultations are feasible but challenging for the NHS
Video consultations may be a useful substitute for face-to-face consultations for some hospital outpatient appointments. This NIHR funded study provided insights into the conditions which made them better. When these practical and clinical conditions are met, video consultations can be safe and effective and are liked by staff and patients. But there are challenges in embedding new technology in routine practice, and these challenges may have been under-estimated.
This high-quality implementati...