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.
Annual testing to monitor blood lipids (fat and cholesterol) was both effective and saved money long term in by reducing cardiovascular disease in people with or without known heart disease.
Given the relatively low cost of treating high lipids (typically by using statins) it was more cost effective to over-treat people than to under-treat them.
The findings of this detailed modelling study are broadly in line with guidance. They also add clarity to previous uncertainties around the frequency of lipid monitoring and its relationship to diagnosis, prognosis and treatment.
As an Advanced Nurse Practitioner I usually work with high admitting care homes in the community of Cornwall to focus on complex patients at risk of admission and supporting the care/nursing staff to proactively manage long term condidions and frailty.
Following a successful four years reducing avoidable acute admissions it was agreed that I would test a similar model within the local acute hospital trust to assist with winter pressures.
My experience of care home patients suggests that the sooner they can be investigated, diagnosed and treated the less likely they are to decompensate or lose functional ability. Many care home patients are medically complex, comorbid, frail and have an element of dementia, they require and deserve consistent oversight to ensure their inpatient journey is productive, well informed and personalised.
My role within the acute trust is to proactively identify the individual and to drive a safe, supported and timely discharge, hopefully within 72 hrs if medically optimised.
Wirral Alliance, a group of seven GP practices with a patient population of 40,000 and 789 diagnosed with COPD, rolled out a nurse-led initiative PACE in April 2012 to improve patients’ quality of life and reduce COPD hospital admissions.
By equipping patients to control their COPD and reduce the severity and number of exacerbations, the NHS can avoid unnecessary costs and more importantly, help patients avoid the distress and disruption of an emergency hospital admission.
Nurse-led monthly clinics and patient group support meetings are held to identify the patients who are at most risk of hospital admission.
A nurse offers a one-hour review in the GP practice, providing a full respiratory assessment.
Patients with asthma who were treated with a fixed dose combination of the long acting beta-agonist (LABA) salmeterol plus the inhaled glucocorticoid fluticasone had no higher risk of asthma related death or hospital admission than those on fluticasone alone,1 shows a randomised study that provides some reassurance after previous safety concerns. To read the full article, log in using your NHS OpenAthens details
Objectives: To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual.
Many middle-aged and older persons have more than one chronic condition. Thus, it is important to synthesise the effectiveness of interventions across several comorbidities. The aim of this systematic review was to summarise current evidence regarding the effectiveness of Tai Chi in individuals with four common chronic conditions—cancer, osteoarthritis (OA), heart failure (HF) and chronic obstructive pulmonary disease (COPD). To read the full article, log in using your NHS OpenAthens details
A study from the Netherlands suggests that more than half of children with a diagnosis of asthma may not have the disease.
Asthma is one of the most common chronic diseases in childhood. According to guidelines, a diagnosis of asthma should be confirmed using lung function testing in children aged over 6 years. To read the full article, log in using your NHS OpenAthens details
As the New Care Models Programme marks its first anniversary, the Commissioning Redesign Manager for Long Term Conditions at the NHS Solihull CCG, outlines the vital work its vanguard is doing:
The Solihull Together for Better Lives vanguard is committed to supporting people to stay independent and out of hospital.
As part of this commitment, local health and social care partners have implemented the integrated care and support in Solihull (ICASS) programme to improve care for frail, older people.
In a guest blog to coincide with the launch of our report on integrating physical and mental health care, Tessa Jelen writes about the importance of information and support – for both physical and mental wellbeing – for people diagnosed with a long-term condition. Tessa was a member of a focus group we ran as part of our research that explored service user perspectives on what well-co-ordinated, integrated care would look like.
The knowledge, skills, experience and resources of voluntary, community and social enterprise (VCSE) organisations are crucial to the widespread implementation of care and support planning suggests a new discussion paper from National Voices.
The report, What is the role of VCSE organisations in care and support planning?, argues that charities have a vital role in supporting people to develop care and support plans, and in working with people with long-term conditions and their clinical teams to put the plans into practice.
Conclusions Aiming for target below 130 mm Hg rather than 140 mm Hg for systolic blood pressure in people with cerebrovascular disease in primary care led to a small additional reduction in blood pressure. Active management of systolic blood pressure in this population using a <140 mm Hg target led to a clinically important reduction in blood pressure.
More than a quarter of patients have no drug treatment prescribed for chronic obstructive pulmonary disease (COPD) in the first year of diagnosis despite having symptoms and poor lung function, an analysis of UK general practice data has shown. To read in full, use your NHS ATHENS login
The aims of this review were to determine the level of evidence for exercise training in the management of patients with chronic obstructive pulmonary disease (COPD) and provide evidence-based recommendations on exercise training. To read the full article, log in using your NHS Athens
The researchers found that around half (53.5%) of children aged 6 to 17 years diagnosed with asthma probably didn’t have the condition after all. This means they could be taking asthma drugs they don’t need, needlessly exposing them to potential side-effects.
The cause of the problem, they say, is that GPs are not using some of the recommended lung function tests to confirm an asthma diagnosis in children over the age of six. Instead, they are relying mainly on a history of symptoms like coughing and wheezing.
For example, only 16.1% of the 652 children diagnosed with asthma in the Dutch study had a spirometry test.
It is important to recognise that these results may not represent the situation in England. That said, as it is such a common condition, there are no set English guidelines for diagnosis of childhood asthma, and it is likely that many diagnoses are made on symptom history alone.
The health watchdog for England and Wales, NICE, is aware of this potential issue and is currently reviewing its guidance to improve asthma diagnosis.
There is a plethora of treatment options available for asthma and COPD and although choice is usually a good thing, too much choice can make decision making harder -- and local formularies can easily become outdated: so how should the correct drug and device be selected? To read the full article, log in using your NHS Athens
Aims
To explore the information needs of long-term indwelling urinary catheter users, the consequences for patients of inadequate information and how these needs could be met. Login using your SSSFT NHS Athens for full text. SSOTP - request a copy of the article from the library http://www.sssft.nhs.uk/library
Background
Facilitating persons with a chronic condition to take an active role in the management of their condition, implicates that nurses acquire new competencies. An instrument that can validly and reliably measure nurses’ performance and their perceived capacity to perform self-management support is needed to evaluate current practice and training in self-management support. Login using your SSSFT NHS Athens for full text. SSOTP - request a copy of the article from the library http://www.sssft.nhs.uk/library
Conclusions Our rule resulted in excellent prediction of heart failure in the large domain of the elderly with shortness of breath, and would help general practitioners to select those needing echocardiography.
There are inconsistent data on mortality in people with multiple sclerosis (MS). We performed a meta-analysis of all-cause, cause-specific and gender-specific crude mortality rates (CMRs), and standardised mortality ratios (SMRs) in MS, and estimated the rate of change of CMR and SMR over the past 50 years. To read the full article, log in using your NHS OpenAthens details
NICE Quality Standard 10: In February 2016, this quality standard was updated. A new statement on emergency oxygen during an exacerbation has been added and the other quality statements have been updated.
Based on NICE guidance and quality standards the potential indicators, now open for consultation, aim to improve healthcare by supporting both national frameworks and local quality improvement initiatives.
They are developed to be used by GP practices and CCGs for service development and improvement as well as for the Quality and Outcomes Framework (QOF) and the CCG Outcome Indicator Set (CCG OIS).
Conclusions The relative effect of DPP-4 inhibitors on the risk of heart failure in patients with type 2 diabetes is uncertain, given the relatively short follow-up and low quality of evidence. Both randomised controlled trials and observational studies, however, suggest that these drugs may increase the risk of hospital admission for heart failure in those patients with existing cardiovascular diseases or multiple risk factors for vascular diseases, compared with no use.
Conclusions In people with diabetes, RAS blockers are not superior to other antihypertensive drug classes such as thiazides, calcium channel blockers, and β blockers at reducing the risk of hard cardiovascular and renal endpoints.