Insights into the transfer between children’s and adults’ services for young people with selected long-term conditions
How young people with type 1 diabetes, autistic spectrum disorder and cerebral palsy experience the transition to adult services depends on their condition and locality. Adult and children’s services need to work together to ensure they are offering young people the sources of support and resilience they need.
This NIHR-funded study found that children with type 1 diabetes were more likely to receive help shown to aid transition. For example, around two-thirds said they had met a member o...
National quality improvement programmes need time and resources to have an impact
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation.
Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length o...
Steps to better understanding resistant behaviours and the culture of bedside dementia care in hospitals
High levels of resistance to care by people with dementia can be exacerbated by responses by staff on the wards. This study sought to understand the interactions and culture underlying care by closely observing and documenting what was actually happening on ten wards in five UK hospitals, and through interviews with carers and families.
This in-depth study confirmed that people living with dementia are often resistant to care in acute hospital settings. Behaviour included wandering in wards, pu...
Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions
A 12% reduction in GP antibiotic prescriptions for respiratory conditions was achieved through the use of electronic decision and training tools. This reduction did not increase the risk of serious infections compared to usual care.
The low-cost intervention in this large NIHR-funded trial included a short training webinar for GPs and feedback on their practice’s prescribing rates. The decision support tool gave prompt access to NICE prescribing guidelines and printable patient informatio...
Centralising stroke services can save lives
Changing access to more specialised stroke centre care in one city (London) was estimated to save an additional 96 lives per year (1%) compared to the reductions occurring in the rest of England. These improvements were sustained over time. Other cities did well on quality of care indicators, including time to admission in a stroke unit and length of stay. Patients and carers reported good experiences despite slightly increased travel times to the central stroke units.
A stroke can have devasta...
A traditional implant is as effective as more expensive newer types for people over 65 having a hip replacement
A commonly used, cheaper implant used in total hip replacement surgery is as effective as more expensive options for over-65s, a new study has found.
A range of prosthetic implants is used for hip replacement, including newer and more expensive options, with different surface materials and some that do not require cement. They may wear at different rates, and all can require further surgery if they become loose. This risk is greater for younger and more active patients.
This large NIHR-funded ...
Smartphones may help people with diabetes manage their condition better
People with type 2 diabetes using smartphone apps or message services feel more confident about their ability to manage their condition, are more likely to engage in self-care activities and have a better quality of life.
Smartphone self-management technologies can be split into two main types: applications where users can record data and view information, and SMS text messages which can act as prompts or reminders. A review of 22 international studies found that smartphones could aid diabetes ...
Treating asymptomatic MRSA on discharge from hospital reduces risk of later infection
Use of medicated creams, mouthwash and body wash for six months after discharge from hospital led to a 30% lower risk of MRSA infection, compared with basic hygiene education. This study was carried out in the USA using 2,121 adults who had tested positive for MRSA in hospital, but who had no symptoms.
Meticillin-resistant Staphylococcus aureus (MRSA) bacteria have developed resistance to widely-used antibiotics. MRSA is easily transferable within healthcare settings, and people may become colo...
Better care of deteriorating patients has reduced US mortality after surgery
Improved management of deteriorating patients with surgical complications has reduced the number of deaths in US hospitals rather than it being due to fewer complications. Over the past 10 years, complication rates have remained fairly similar. It is the reduction in 'failure to rescue'that has made the main difference in mortality. It is unclear if this is because of earlier detection of patients who are deteriorating due to complications, or improved response and treatment.
Getting hospital patients up and moving shortens stay and improves fitness
Interventions to encourage patients admitted to hospital for medical problems to get out of bed and walk around increases their mobility, without increasing their risk of falls.
Older inpatients frequently spend much of their time in bed, which risks a loss of physical condition and muscle tone. This can make it harder for them to manage independently at home, and may contribute to delayed discharge.
A review summarised thirteen trials from the UK, Europe and Australia, involving 2,703 adults ...