Which app should I use? | The BMJ

Patients and doctors are making increasing use of health apps, but there is little guidance about how well they work. Stephen Armstrong reports

health app

There are well over 150 000 health apps available in Europe1—from those designed to improve general wellness to apps that monitor medical conditions, apps for clinicians, and apps that function as medical devices. There have been more than 102 billion downloads of health apps worldwide yet there is little regulation or guidance available for doctors or patients on quality, safety, or efficacy.

What is the problem?
Since the UK government founded the Cochrane Centre in 1992, evidence based medicine has been at the heart of healthcare.2 With the burgeoning apps market, however, things are different.

“There’s a huge and growing number of health apps out there, and with that comes a wide variation in quality, testing, and evaluation,” says Sarah Williams, senior health information officer at Cancer Research UK. “As with any new technology there’s a lot we still need to understand about whether they can be effective, especially in the long term, and, perhaps more importantly, whether they’re helping the people who really need it.”

Technically any app that makes efficacy claims needs to be able to produce some evidence to support its claims under the European Directive on Misleading Advertising. This may, however, not include the high quality evidence from randomised controlled trials that clinicians have come to expect.

“People are increasingly using apps to monitor, manage, and even treat conditions but have no information on whether or how the apps have been calibrated, and it’s hard to find any information on the research used in development,” explains Patricia Wilkie, chair of the National Association for Patient Participation. “It’s a very murky area.”

Read the full article via Which app should I use? | The BMJ.

Government to review NHS funding of nursing in care homes

The Department of Health is to review the rate paid by the NHS to private care providers (nursing homes) for nursing services.

Registered nursing care for residents, who are assessed to be eligible, in nursing homes is funded by the NHS. The rate payable for this financial year is currently £112.00 a week per resident.

This review will consider whether the rate paid is reflective of the costs of providing this important service and supports high quality out-of-hospital care.

The department intends to complete the review in this financial year.

NHS-funded nursing care was introduced by the Health and Social Services Act 2001, which made care provided by registered nurses in nursing homes an NHS responsibility.

via Government to review NHS funding of nursing in care homes – News stories – GOV.UK.

NHS IQ publishes findings of research on seven day services

NHS Improving Quality has published an interim report on findings of a project that looked at success strategies for seven-day services in health and social care.

The full results will be published later this year once the second phase of research is completed. NHS IQ is encouraging those working towards seven day services to read the interim report and take part in an online survey aimed at healthcare professionals and commissioners.


Value in health and care

The Health Foundation has published How should we think about value in health and care?  This paper sets out the case for people taking an active role in their health and care. It identifies evidence-based approaches that engage people and communities, and how tools can be developed to support implementation across the NHS and local communities. The paper also explores the broader behavioural, cultural and systemic changes needed and makes recommendations for how the health and care system can become more person- and community-centred.


A&E delays: why did patients wait longer last winter?

Research into increased waiting times in A&E, October-December 2014/15.


In quarter 3 2014/15, the performance of accident and emergency departments (A&E) against the 4-hour standard reached its lowest in 10 years.

This detailed report shows that the target 4-hour emergency care indicator is a measure of the performance of the whole health and care system, not just emergency care departments; the findings show that across England the rest of the hospital struggled to cope with the increase in admissions because of very high occupancy rates.

via A&E delays: why did patients wait longer last winter? – Publications – GOV.UK.

Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4596 (Published 05 September 2015)

Nick Freemantle and colleagues discuss the findings of their updated analysis of weekend admissions and the implications for service design

Any modern, effective healthcare system should prevent premature deaths from treatable causes, improve quality of life for people with long term conditions, aid recovery from acute conditions, and ensure safe care. At the same time it should provide patients with as positive an experience as reasonably possible. Intuitively, reduced provision of healthcare at weekends adversely affects all of these domains. The relation between service organisation across the week and excess mortality cannot be easily studied using randomised controlled trials, so the evidence base for designing healthcare services relies on an observational approach.

Our previous study of all NHS hospital admissions in England during the financial year 2009-10 indicated that admission at the weekend (Saturday and Sunday) was associated with a significantly increased risk of in-hospital death compared with midweek admission, but being in hospital at the weekend was associated with reduced risk of death.1 These findings were replicated in an analysis of 254 leading hospitals in the US.1

Because six years have elapsed since our last assessment of weekend mortality we have updated our analysis using data from NHS English hospitals and on related deaths in 2013-14. The original analysis was built on our previous work developing the QUORUM metric for comparing hospital death rates.2 This metric identified that the risk of death is highly predictable in NHS admissions. The three main objectives of the current analysis were to characterise the patient population admitted at weekend; examine whether, after robust adjustment for case mix, weekend admission carries an increased 30 day mortality risk compared with midweek admission; and estimate whether mortality risk differs between hospital stay at weekends and during the week.


via Increased mortality associated with weekend hospital admission: a case for expanded seven day services? | The BMJ.

Coffee, tea, caffeine intake, and the risk of cancer in the PLCO cohort

Cancer Services News

British Journal of Cancer: 113, 809-816 (01 September 2015)



The association between coffee intake, tea intake and cancer has been extensively studied, but associations are not established for many cancers. Previous studies are not consistent on whether caffeine may be the source of possible associations between coffee and cancer risk.


In the Prostate, Lung, Colorectal, and Ovarian cancer screening trial, of the 97 334 eligible individuals, 10 399 developed cancer. Cancers included were 145 head and neck, 99 oesophageal, 136 stomach, 1137 lung, 1703 breast, 257 endometrial, 162 ovarian, 3037 prostate, 318 kidney, 398 bladder, 103 gliomas, and 106 thyroid.


Mean coffee intake was higher in lower education groups, among current smokers, among heavier and longer duration smokers, and among heavier alcohol drinkers. Coffee intake was not associated with the risk of all cancers combined (RR=1.00, 95% confidence interval (CI)=0.96–1.05), whereas tea drinking was associated with a decreased risk…

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Alcohol use disorders

The Lancet: DOI: http://dx.doi.org/10.1016/S0140-6736(15)00122-1

Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management.

Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder.

The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.

via Alcohol use disorders – The Lancet.

Prudent diet may attenuate the adverse effects of Western diet on cognitive decline

Dementia News

Alzheimer’s & Dementia: DOI: http://dx.doi.org/10.1016/j.jalz.2015.08.002

The influence of mixed dietary patterns on cognitive changes is unknown.

A total of 2223 dementia-free participants aged ≥60 were followed up for 6 years to examine the impact of dietary patterns on cognitive decline. Mini-mental state examination (MMSE) was administrated. Diet was assessed by a food frequency questionnaire. By factor analysis, Western and prudent dietary patterns emerged. Mixed-effect models for longitudinal data with repeated measurements were used.

Compared with the lowest adherence to each pattern, the highest adherence to prudent pattern was related to less MMSE decline (β = 0.106, P = .011), whereas the highest adherence to Western pattern was associated with more MMSE decline (β = −0.156, P < .001). The decline associated with Western diet was attenuated when accompanied by high adherence to prudent pattern.

High adherence to prudent diet may diminish the adverse effects of high…

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