Obstacle course runs: review of acquired injuries and illnesses at a series of Canadian events (RACE)

Hawley, A. et al. Emergency Medicine Journal. Published Online: 15 September 2016

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Background: The growing popularity of obstacle course runs (OCRs) has led to significant concerns regarding their safety. The influx of injuries and illnesses in rural areas where OCRs are often held can impose a large burden on emergency medical services (EMS) and local EDs. Literature concerning the safety of these events is minimal and mostly consists of media reports. We sought to characterise the injury and illness profile of OCRs and the level of medical care required.

Methods: This study analysed OCR events occurring in eight locations across Canada from May to August 2015 (total 45 285 participants). Data were extracted from event medical charts of patients presenting to the onsite medical team, including injury or illness type, onsite treatment and disposition.

Results: There were 557 race participants treated at eight OCR events (1.2% of all participants). There were 609 medical complaints in total. Three quarters of injuries were musculoskeletal in nature. Eighty-nine per cent returned to the event with no need for further medical care. The majority of treatments were completed with first aid and basic medical equipment. Eleven patients (2% of patients) required transfer to hospital by EMS for presentations including fracture, dislocation, head injury, chest pain, fall from height, and abdominal pain.

Conclusions: We found that 1.2% of race participants presented to onsite medical services. The majority of complaints were minor and musculoskeletal in nature. Only 2% of those treated were transferred to hospital through EMS. This is consistent with other types of mass gathering events.

Read the article here

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Central venous catheters: latest evidence for nursing practice

Chapman, S. Evidently Cochrane Blog. Published online: 15 September 2016

https://en.wikipedia.org/wiki/Central_venous_catheter#/media/File:Subclavian_central_veinous_catheter_xray.png

Image source: MrCarbohydrate – Wikipedia // CC BY-SA 3.0

Image shows chest x-ray with central venous catheter visible in the right subclavian vein

By Sarah Chapman

What are the things that you do to reduce the risk of catheter-related infection in patients with central venous catheters (CVCs)? Take a moment to run through them. Now think about each one and why you do it. I’ll give you some prompts; mentally tick off all that apply:

  1. It’s Trust policy
  2. NICE (or other) guidance recommends it
  3. There’s evidence that it’s effective
  4. I’ve always done it [this way]

That last one always made me (inwardly) howl with frustration whenever I heard it, but I know you evidence-seekers won’t have ticked that one. It would be great to tick the first three, but can you? There might be more howling over those. I was rather shocked (ok, call me naïve) to discover that reliable evidence supporting the replacement of peripheral venous catheters only when clinically indicated, duly recommended by the UK’s epic3 National Evidence-Based Guidelines as being both safe and cost-saving, had not translated into practice in some hospitals. This came to light in a lively #WeNurses tweetchat on the evidence and you can catch up with it in this blog.

Skin antisepsis

I’ve also blogged here about evidence from a number of Cochrane reviews on different aspects of infection prevention for people with CVCs but since then we’ve seen the publication of more reviews, including this one on skin antisepsis. Was that on your list? Here in the UK, NICE guidance (epic3 again) recommends cleansing with chlorhexidine gluconate in 70% alcohol, or povidone iodine in alcohol for patients sensitive to chlorhexidine (tick). Can we tick off evidence of effectiveness?

The review brought together data from 12 randomised studies with 3446 CVCs (number of patients unknown), comparing different skin antisepsis regimens with each other and with none. Whilst there is nothing here to overturn the guidance, the evidence is mostly low or very low quality and, beyond saying that chlorhexidine solution may be more effective than povidone iodine, any questions about which regimen is best or whether skin antisepsis benefits patients are left unanswered.

Read the full post here

Cancer patients not getting adequate pain relief

Many terminal cancer patients are not getting adequate pain relief early enough, according to an English study.| Science Daily | PAIN

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Many terminal cancer patients are not getting adequate pain relief early enough, according to a University of Leeds study.  The researchers found that, on average, terminal cancer patients were given their first dose of a strong opioid such as morphine just nine weeks before their death.  Yet many people with terminal cancer suffer with pain a long time before that, the researchers said.

The research team used UK Cancer Registry data to study a sample of 6,080 patients who died of the disease between 2005 and 2012. They found that 48 per cent of the patients were issued a prescription in general practice (primary care) for a strong opioid medication, such as morphine, during the last year of their life.

The study, published in the medical journal Pain, said efforts to improve treatment of cancer pain may be being hindered by concern over the ongoing ‘opioid epidemic’.

They cited NHS data which showed that overall opioid prescribing increased by 466 per cent between 2000 and 2010, but only increased by 16 per cent for patients with cancer.

Full reference: Lucy Ziegler et. al. Opioid prescribing for patients with cancer in the last year of life. PAIN, Published Ahead of Print 2016

Death: avoiding the unavoidable?

John Appleby examines the trends in death rates and what might lie behind them | BMJ 2016; 354:i4912

For the second year in a row, data has shown that avoidable deaths in England and Wales have increased slightly. In 2014, nearly one in four deaths could have been prevented through health interventions. Is this chance variation or the start of a new trend?  John Appleby examines the data in a briefing for the BMJ.

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Image source: http://www.bmj.com/

Commissioning for better health outcomes

The Local Government Association has published Commissioning for better health outcomes.

This report has been developed with commissioners from councils and partner organisations, building on existing learning and resources and sharing new and innovative practice developed by those working to improve public health.

The guide includes eight case study examples which were chosen to illustrate positive approaches to commissioning being taken across the country to address a wide range of public health challenges.

Engaging local people

NHS England has published Engaging local people: a guide for local areas developing sustainability and transformation plans.

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This document is for teams developing sustainability and transformation plans (STPs) in each of the 44 footprint areas, and the statutory organisations which form part of them. It is intended to clarify the expectations on stakeholder involvement, in particular patient and public participation. It also covers legal duties around engagement and consultation and will be of particular interest to communication and engagement leads for STPs and footprint leaders.

Read the full document:
Engaging local people. A guide for local areas developing Sustainability and Transformation Plans