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NIHR Signal Ways of integrating care that better coordinate services may benefit patients
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. Strong leadership and patient engagement are among factors influencing successful implementation. The NHS is undergoing reconfiguration to better coordinate services around patients. This NIHR-funded review looked at the international literature to understand how new care mo...
NIHR Signal People with COPD exacerbations prefer early discharge then treatment at home
People with flare-ups of COPD (chronic obstructive pulmonary disease) prefer to be managed at home rather than in hospital. Hospital stay was on average four days shorter when people were discharged early to the hospital at home scheme, and there was no noticeable increase in readmissions in this group. This NIHR-funded trial aimed to establish the costs and outcomes of hospital at home compared with staying in hospital for treatment. The findings support current guidance that hospital at home...
NIHR Signal New insights into living with inflammatory bowel disease
Living with inflammatory bowel disease as a `hidden’ condition can lead to feelings of isolation and exclusion. These experiences are characterised by exhaustion, feelings of damaged body image, loss of control and living with the fear of complications. The condition can be unpredictable and have a profound impact on quality of life, disrupting social relationships and interactions with the outside world. The ongoing emotional and psychological difficulties caused by this chronic, long te...
NIHR Signal Delirium is common among adults receiving palliative care and could be better recognised
Between a quarter and two-thirds of adults admitted to specialist palliative care units experience delirium, or acute confusion. The findings come from a mixed methods project which included a systematic review of the number of people living with delirium. Estimates are mostly applicable to older adults with advanced cancer. The project also included interviews with nurses in Australian palliative care units to look at delirium assessment and use of screening tools. The findings highlighted th...
NIHR Signal Telemedicine programme can prolong life for heart failure patients
A comprehensive programme of daily telemedicine monitoring and 24-hour access to a physician-led hotline can reduce the number of deaths and the time spent in hospital, among patients with heart failure. A year-long study of 1,571 patients who had been admitted to hospital with heart failure within the past 12 months found that those assigned to daily telemonitoring, monthly health education and telephone support from specialist staff, were 30% less likely to die than those assigned to usual ca...
NIHR Signal Guided online interventions can help people recover from depression
Internet-based interventions combined with remote professional support can improve outcomes for people with depression. Those receiving the intervention show better initial response to treatment and higher recovery rates compared with control groups who are either waiting for treatment or receiving less support. This meta-analysis shows people using guided internet therapy are over twice as likely to respond to treatment and achieve remission. This finding reinforces current NICE guidance which...
NIHR Signal Supporting families of those in intensive care improved family satisfaction but didn’t reduce family distress
A multicomponent support intervention for family members of patients in intensive care didn’t reduce their anxiety, depression or distress around the overall experience. However, it increased satisfaction with the quality of staff communication and delivery of care. Family members of critically unwell patients on intensive care often need to be involved in care decisions. Yet they may feel unsupported and bewildered in the process. This intervention, delivered in five US intensive care un...
NIHR Signal Self-monitoring of blood glucose provides no important benefit for most people with type 2 diabetes
Patients with type 2 diabetes who monitor their blood glucose themselves may see small, short-term improvements in blood sugar control. This is not enough to be clinically important or outweigh the costs and personal inconvenience of long-term self-testing. Self-monitoring is a well-established strategy for type 1 diabetes and for people with type 2 who need insulin. The benefit for all people with type 2 is debatable. This review pooled 24 randomised controlled trials comparing self-monitoring...
NIHR Signal No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
NIHR Signal Routine measurement of grip strength can help assess frailty in hospital
Training clinical staff to routinely measure grip strength can help identify frail older hospital inpatients. This could help tailor their care. This NIHR-funded study was conducted across five acute medical wards in one hospital in England over a nine-month period. Nursing staff were trained to measure grip strength of people aged over 80 years. They were instructed to assess if those with low grip required nutritional supplements and to refer them to physiotherapy for consideration of strengt...
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