Self-monitoring improves control of high blood pressure compared with GP monitoring alone
Allowing patients who have inadequately controlled high blood pressure to monitor their own blood pressure at home helps their GPs to optimise their management. Patients who self-monitor and visit or talk to their GP when needed for medication adjustments achieve 4mmHg lower systolic blood pressure over 12 months compared with those relying only on the measurements made by a GP without self-monitoring.
Effects are similar if patients write down their measurements to send to the GP or do so via ...
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...
Single routine offer of a blood test for prostate cancer did not save lives
Offering all men aged 50 to 69 a single, screening prostate-specific antigen (PSA) blood test did not prevent deaths from prostate cancer.
This large trial included 573 UK general practices and over 400,000 men. It found that men who were invited to have a PSA test were 19% more likely to be diagnosed with prostate cancer, but no less likely to die from the condition, over an average 10 years of follow up. Forty per cent of men took up the offer.
Controversy over PSA testing has persisted for ...
Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs
An electronic referral system including consultant-led triage and an advanced oral surgery service in primary care results in fewer people requiring oral surgery in hospital. It comes at a lower overall cost than the previous arrangement. About two-thirds of patients could be treated safely in enhanced primary settings rather than hospital.
This NIHR-funded study implemented several changes, an electronic referral system which standardised and improved the level of information provided in refer...
Case managers improve outcomes for people with dementia and their carers
Using a case manager to coordinate health and social care improves the challenging behaviour of people with dementia and reduces the burden on caregivers. Quality of life of caregivers improves the most when case managers have a professional background in nursing.
This NIHR-funded review compared the effectiveness of standard community treatment and interventions with case managers overseeing the interventions for people living with dementia. It considered evidence from 14 trials in a number of...
Sending patient reminders improves immunisation uptake
Contacting patients by telephone or mail about recommended immunisations leads to eight more people in every 100 being immunised. Text messages, postcards or automatic dialling techniques and recorded voices are the reminder methods that have the highest certainty of being effective.
In the UK over 90% of children currently receive the recommended immunisation programme, but this is still below optimal to prevent infection. The uptake of the influenza vaccination in over 65s is also below natio...
A third of health practitioners do not get vaccinated against flu
Flu vaccination uptake amongst healthcare workers in England is below the NHS target of 75%. Reasons may include mixed views on the vaccine’s effectiveness, side effects and belief they are unlikely to catch or transmit flu.
Surprisingly, practical barriers such as time and access to vaccination were not mentioned in this systematic review of qualitative studies for the Department of Health. Though it included mainly North American studies, the findings are consistent with issues raised i...
How commissioners use research evidence
Researchers want their work to be used and useful, but may not always understand the context in which decisions are made. Most health and care organisations aim to base decisions on the best available evidence, but accessing and interpreting the right evidence at the right time is hard. Researchers need to do what they can to make their research as useful as possible to those making decisions under pressure.
The NIHR has funded six particular studies in the past five years on the use of eviden...
Person-centred care improves quality of life for care home residents with dementia
A person-centred care intervention for people with dementia living in care homes improved their quality of life, reduced agitation and improved interactions with staff. It may also save costs compared with usual care.
The WHELD intervention involves training staff in person-centred care, with a focus on improving social interactions and appropriate use of antipsychotic medications. An early study suggested it could halve antipsychotic use.
This larger-scale NIHR trial conducted across 69 UK nu...
Hospital admission rates and costs increase in line with BMI
Each 2kg/m2 rise in body mass index (BMI) above the normal-weight threshold in women aged 55-79 leads to a 5% rise in annual hospital admissions and 7% rise in healthcare costs. In England, £662 million of the annual hospital admission costs in 2013 could be attributed to overweight or obesity in women of this age group.
This large study, partly funded by the NIHR, looked at over one million women participating in the NHS breast cancer screening programme. Five-year data on hospital admis...