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, ...
People take prescribed statins more reliably after discussing their advantages and disadvantages
Patients want to know more about how statins work, the reasons for prescribing them and their possible side effects.
Statins lower cholesterol and reduce the risk of recurrent stroke or heart attack. They also help prevent cardiovascular disease developing in people at high risk. At a population, level statins reduce the overall incidence of cardiovascular disease for people at moderate risk, but the benefits for an individual are less clear-cut.
This review found that people are happy to take...
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...
‘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 ...
UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care
Referrals to hospice-based specialist palliative care occur closer to death in older than in younger people and in those without cancer. Existing evidence shows that some people near the end of life have a better quality of life and symptom control if they receive specialist palliative care. This research highlights the need to better understand the reasons for any delay.
In this large NIHR-funded hospice study people aged under 50 years were referred to hospice specialist palliative care about...
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...
Structured training improves skills of wheelchair users
Structured wheelchair skills training increases wheelchair users’ skills when compared with no training, standard care or education controls. The training, as developed in Canada, is more effective for new wheelchair users than experienced users. It includes difficult everyday challenges from wheeling through gravel to negotiating high curbs.
Links have been found previously between wheelchair skills capacity (reflecting what the user can do) and: independent mobility, reduced reliance on...
Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications
Enhanced recovery programmes reduce length of hospital stay and associated healthcare costs after stomach cancer surgery, with no impact on short-term mortality or post-operative complications. They also improvepost-operative quality of life.
The enhanced recovery approach includes a range of components designed to help people to recover more quickly and have better outcomes after surgery. These include optimising people's health preoperatively, attention to detail during anaesthesia and su...
Increasing inhaled steroids for short periods reduces asthma exacerbations
Taking four times the usual dose of inhaled corticosteroids for up to two weeks can modestly reduce the chance of asthma worsening.
This NIHR-funded trial assessed increasing the inhaled corticosteroid dose compared with staying on the usual dose, as part of a self-management plan. Participants were adults and adolescents with uncontrolled asthma and had at least one exacerbation needing additional medical attention in the year before the trial.
Quadrupling the inhaled corticosteroid dose when...
Nurse staffing levels linked to reports of missed care in adult wards
Nurses are more likely to report omitting necessary care in acute inpatient wards when registered nurse staffing levels are low, even if there are additional healthcare assistants. Care categorised as planning and communication is reported as missed more often than clinical care.
NHS hospitals are responsible for ensuring that the number and skills mix of nursing staff matches patient needs. Previous reviews have shown links between lower registered nurse staffing levels and poor patient outcom...