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NIHR Signal A lifestyle change programme not effective for those at risk of heart disease or stroke
A package of extra support, including motivational interviewing, did not add value in terms of boosting weight loss or physical activity in people at high risk of cardiovascular disease, a new study has found. This NIHR-funded trial recruited 1,220 people deemed at high risk of heart disease or stroke. Researchers compared the clinical and cost-effectiveness of the enhanced support, which was based on cognitive theory, in either a group or individual format. A third group was referred to commun...
NIHR Signal Structured nurse ward rounds support accountability and risk management but not nurse-patient communication
Scheduling regular nurse bedside ward rounds (called ‘intentional rounding’) may not improve nurse-patient communication, as most interactions occur outside of these rounds. The rounds are intended to improve accountability and provide evidence that risks are being managed when correctly documented. Intentional rounding was introduced as a UK Government policy imperative to facilitate regular interactions between nurses and patients following high profile care failures at the Mid St...
NIHR Signal People leave hospital after surgery sooner if hospitals follow ‘enhanced recovery protocols’
Strategies to improve or enhance recovery after planned surgery can reduce the amount of time people over 60 spend in hospital, compared with standard care. These strategies include minimising fasting before operations, targeted anaesthesia, getting people up and about quickly after surgery and an early return to eating. In this review, hospital stay could be reduced by up to five days with the use of enhanced recovery protocols. Exercises and nutritional programmes to prepare for surgery (&lsq...
NIHR Signal ICU admission decision support tool showed promise but was rarely used
A decision support tool developed to help doctors determine whether patients should be admitted to intensive care showed promise in facilitating patient-clinician communication, but was not often used by doctors, with fewer than 30% using the forms. Intensive care can deliver lifesaving treatment. It can be invasive and distressing with no guarantee of success. At present, there is little to guide doctors in the decision-making process, and this NIHR-funded study sought to help doctors by devel...
NIHR Signal NHS health check attendance improves with changes to the invitation letter
Invitation letters improve uptake when they address common concerns and reasons for not attending the free NHS Health Checks. People are invited to attend a check every five years between 40 and 74 years, but uptake has been low. This trial of 6,313 patients from six general practices in Northamptonfound that presenting reasons for non-attendance countered by a GP responseincreased uptake of NHS Health Checks by 5.5%. The ‘counterarguments’ included the reduced longer-term cost to ...
NIHR Signal Impact of online or app-based assessment for urgent health problems largely unclear
Relatively little robust evidence exists on the impact of online or app-based health assessments for people seeking urgent care. The available evidence suggests that these services are not as good at making diagnoses as health professionals; though it is not clear whether this is a useful benchmark. The ‘NHS 111 Online’ service for symptom checking and triage is available in England. It aims to reduce pressure on the equivalent telephone-based service. This NIHR-funded systematic re...
NIHR Signal Whole-school programme can have a small effect on reducing bullying in secondary schools
An anti-bullying intervention trialled at 20 UK secondary schools resulted in a reduction in bullying incidents at school. The ‘Learning Together’ initiative was funded by the NIHR and designed to modify the school environment and provide social and emotional support. The trial took place over three years and involved around 3,000 pupils who were 11 to 12 years old at the start of the study. A control group of schools which did not receive the intervention was monitored for comparis...
NIHR Signal ‘Care navigation’ is being widely adopted in primary care, but in varying ways
Clinical Commissioning Groups (CCGs) in England are implementing care navigation in primary care to help people with non-medical issues to access alternative services. This ‘social prescribing’, facilitated by nominated care navigators, also aims to reduce the pressure on general practice, and forms part of the NHS Long Term Plan. This NIHR-funded study shows that the role is fulfilled in different ways by people with a wide variety of job titles. This may make it harder for patient...
NIHR Signal Impact of a national quality improvement programme for hospital wards is unclear
The Productive Ward quality improvement programme has shown some procedural changes on hospital wards in England in the 10 years since it was introduced. But evidence to show any sustained changes to the experiences of staff or patients is hard to find. This NIHR-funded study used quantitative and qualitative methods to evaluate the programme in six acute hospitals in England. It found some evidence of a lasting impact, such as wards continuing to display metrics and using equipment storage sys...
NIHR Signal Computerised speech and language therapy can help people with aphasia find words following a stroke
People with aphasia caused by a stroke showimprovements in retrieving words when they useself-managed computerised speech and language therapy in addition to usual care from a speech and language therapist. No improvements are seen in patients’ conversational abilities or their quality of life. Aphasia is a complex language and communication disorder. It can affect people’s abilities to read, listen, speak, and write or type. Symptoms vary: some people may mix up a few words, while ...
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