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...
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...
Robot-assisted arm training after stroke helps people regain some strength and independence
People who have electromechanical or robot-assisted arm rehabilitation after stroke have better arm function and strength as well as finding it easier to complete activities of daily living. Although moderate, the improvements suggest it may be worth considering these interventions as an adjunct to usual therapy.
Many people have impaired arm function after a stroke and rehabilitation is often required. Robot-assisted arm training uses devices to support therapeutic movements. Feedback, given b...
Paracetamol and alcohol are the most common substances taken by young people and rates of poisoning are increasing
The rates of the five most common types of poisoningin young people haveincreased three to five-fold from 1998 to 2014 and is cause for concern.
A study including more than 1.7 million young people aged 10 to 24 in the UK found records of 31,509 people who had been treated for poisoning (2% of the total). Where the substance was recorded, 40% of poisonings involved paracetamol, and 33% involved alcohol. Other substances used included non-steroidal anti-inflammatory drugs, antidepressants and op...
Supervised exercise sessions increase physical activity and fitness of cancer survivors
Aerobic exercise and resistance sessions that include supervision help people living with cancer to meet guideline physical activity levels. Common behaviour change techniques that were shown to increase physical activity are goal setting, graded tasks (e.g. increasing exercise duration or intensity over time), and instruction on how to perform particular exercises.
This review update looked at the most effective ways to increase and sustain physical activity for 1,372 sedentary adults living w...
New airway device as good as tracheal tube insertion for out-of-hospital resuscitation
A supraglottic airway device works as well as a tracheal tube for paramedics resuscitating patients in cardiac arrest and is simpler to use.
People who have stopped breathing need to get air into their lungs urgently. Usually, a tube is placed through the vocal cords into their trachea to secure a reliable airway, but correct placement needs skill and practice and can interrupt chest compressions during resuscitation. More recently, paramedics have used a supraglottic airway device, placed in t...
The benefits and harms of aspirin for people with type 2 diabetes are finely balanced
Daily aspirin reduced the risk of serious vascular events among people with diabetes, while increasing the risk of major bleeding to a similar extent. Aspirin prevented one person in every 100 from having a heart attack or stroke over seven years, but an additional person per 100 experienced a major bleed.
The ASCEND study is one of three large placebo-controlled trials investigating the effects of 100mg daily aspirin for primary prevention in people without established cardiovascular disease. ...
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...
Fish oil supplements do not reduce cardiovascular deaths in people with diabetes without existing vascular disease
Omega-3 fatty acid supplements make no difference to cardiovascular outcomes in people with diabetes but without established cardiovascular disease. Serious vascular events like heart attack, stroke or deaths from these occurred in about 10% of people regardless of whether they took daily omega-3 or placebo capsules for seven years.
The ASCEND studyis a large UK trial assessing primary cardiovascular prevention for people with any type of diabetes. A companion publication assesses the use of as...
Stool test is useful before GPs refer for possible inflammatory bowel disease
A stool test by GPs has been shown to support referral decisions for young adults, not suspected of cancer, to investigate possible inflammatory bowel disease (IBD - which includes Crohn’s Disease and Ulcerative Colitis). This study supports current NICE guidelines that the calprotectin stool test can usefully inform patient referral pathways and reduce unnecessary invasive tests such as colonoscopy.
High levels of faecal calprotectin are associated with gut inflammation, as occurs in IBD...