I have been leading an admission avoidance and early supported discharge team for the last eighteen months in Mid Essex. The admission avoidance has been challenging but most member’s of the public and fellow clinicians understand admission avoidance. However, try to explain to other clinicians that you want to take the patient out of hospital earlier or tell the ward manager that the patient will be safe at home without their teams 24 hour care and devotion and that is a whole new challenge.
The National Clinical Director for Cardiovascular Disease Prevention describes a major resource to support early detection and secondary prevention in primary care
This study showed that taking daily vitamin D3 supplements for a year did not improve the ability of people with chronic heart failure to walk further, but did improve elements of their heart function.
The study was well designed, but larger studies are needed to confirm the findings more definitively.
The main limitations of the research include the fact the main focus was on men, its relatively small size, and an absence of measures relating to the main symptoms of the condition.
This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression, or specific functional difficulties in people with multimorbidity.
Emotional difficulties after stroke are common, distressing and likely to affect rehabilitation outcomes. Depression is associated with longer hospital stays, reduced participation in rehabilitation, increased physical impairment and increased mortality. Login using your SSSFT NHS OpenAthens details for full text. SSOTP - request a copy of the article from the library http://bit.ly/1Xyazai
Guidelines on caring for patients with multiple long-term conditions, issued by the National Institute for Health and Care Excellence, are open for consultation until May 12. To read the full article, log in using your NHS OpenAthens details
A major trial on the potential of statins and antihypertensives to reduce cardiovascular events in intermediate risk people has found that blood pressure lowering does not reduce the risk of such events. To read the full article, log in using your NHS OpenAthens details
"A breakthrough drug can slash levels of bad cholesterol by half without the side effects of statins," the Daily Mail reports.
Statins are a class of drug used to reduce high cholesterol levels, they are often given to people thought to be at risk of heart disease or stroke.
A complaint from some people who take statins is that they seem to trigger muscle pains and spasms. In some cases, these side effects are so troublesome that a person stops taking the drug all together.
Nurses are in a position to educate patients about the safe use of opioids as well as improve coordination and communication among the healthcare team regarding pain management strategies.
Future research should focus on the role of nurses in delivering patient-centered interventions to improve communication about pain in acute care settings. To read the full article, log in using your NHS OpenAthens details
Journal of Consulting and Clinical Psychology 84.4 (Apr 2016): 297-309.
Objective: To evaluate the impact of a physical activity intervention consisting of telephone counseling with home-based monitoring to improve fatigue and depression in individuals with multiple sclerosis (MS). To read the full article, log in using your NHS OpenAthens details
Our antipodean colleagues Burke et al have published a meta-analysis in the British Journal of Clinical Psychology looking at the psychological functioning of people living with chronic pain. This is a useful addition to the literature as it looks at chronic pain from a general perspective; not from a condition perspective or a specific population perspective like a lot of other papers have.
NICE, the UK's health watchdog, which issues guidance to doctors, is in the process of updating its guidance on drug management of osteoarthritis. Therefore, it is likely that this latest study will feed into the process.
As a result of auditing stoma prescribing practices and the effect on both patients and health economy, GP’s invested money in the colorectal service to fund a clinical nurse specialist to review stoma patients in 17 GP surgeries (Williams, I Gastrointestinal Nursing Sept 2013 Vol 11, Issue 7, 36-44)
The reviews focussed on determining if GP’s were repeat prescribing for individual patients in an appropriate manner, the patients received the most appropriate products and the correct monthly amounts were administered. Although the work aimed to identify the cost benefits associated with a review and rationalisation of patient prescriptions, ensuring timely and expert follow up was a key quality driver.
In total 429 patients were reviewed in 17 surgeries and there were significant cost savings demonstrated in some of the reviews.
The annual stoma costs for the surgeries prior to reviews was £531,694.86 and there was total potential annual savings of £115,125.10.
People with faecal incontinence did not obtain any important benefits from receiving percutaneous tibial nerve stimulation compared with a sham treatment. The treatment involves stimulating the nerves that control bowel function by passing a mild electric current through a fine needle, inserted just above the ankle.
This meta-analysis showed that a 10 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular disease events by 20%, coronary heart disease by 17%, stroke by 27%, heart failure by 28%, and death from all causes by 13%. This study strongly supports offering drug treatments to reduce systolic blood pressure levels to less than 130 mm Hg to all people regardless of whether or not they have a history of cardiovascular disease, diabetes or chronic kidney disease. This evidence is likely to be considered by guideline developers.