iCBT may be an effective treatment for PTSD via @Mental_Elf

Tomlin, A. The Mental Elf Blog. Published online: 29 September 2016

B0007068 Man using computer
Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

NICE recommends a range of psychological and drug treatments for PTSD such as trauma-focused cognitive behavioural therapy, but does not recommend computer-based psychotherapies. A recent systematic review and meta-analysis from the Netherlands may persuade the guideline developers to think again.

The aim of this meta-analysis was to evaluate the effectiveness of Internet-delivered Cognitive Behavioural Therapy (iCBT) compared to inactive (waitlist control or treatment-as-usual) and active other interventions in reducing PTSD symptoms.

Overall, the results show that iCBT is superior to waitlist, with a trend suggesting that iCBT is more effective than active controls (e.g. psychoeducation and supportive counselling).

  • iCBT compared to waitlist or treatment as usual (11 comparisons from 10 studies of 1,139 participants) found a moderate pooled effect size (g = 0.71, 95% CI 0.49 to 0.93, P < .001) with moderate heterogeneity
  • iCBT compared to other interventions (3 comparisons from 3 studies) found a small pooled effect size (g = 0.28, 95% CI -0.00 to 0.56, P = .05) with low heterogeneity

The effects were strongest when iCBT interventions were therapist-assisted and longer than eight sessions. This echoes what we know from other web-based psychotherapy evidence.

When comparing iCBT to waitlist, visual inspection of the funnel plot and Egger’s test (P = .34) did not indicate the presence of publication bias.

Read the full overview here

Read the original research here

Adolescent Awareness and Use of Electronic Cigarettes: A Review of Emerging Trends and Findings

Greenhill, R. et al. Journal of Adolescent Health. Published online: 29 September 2016


Adult electronic cigarette (e-cigarette) use is increasing globally, and early studies have suggested that similar trends may be observed among the adolescent population, albeit at lower levels.

The current literature review presents data collected since 2014 from 21 cross-sectional studies and one cohort study that were all published in English. In particular, it focuses on awareness, ever use, past 30-day use, and regular use of e-cigarettes.

The article suggests that adolescents are nearing complete awareness of e-cigarettes. Furthermore, in relation to ever use and past 30-day use, higher prevalence rates continue to be reported across time, especially in the United States. Nonetheless, reported regular use of e-cigarettes remains much lower than past 30-day use, although conclusions are limited due to inconsistencies with measurement and consequent lack of cross-cultural applicability. The majority of studies do not report whether adolescents use non-nicotine e-cigarettes.

There is a current absence of longitudinal studies that explore any association between e-cigarettes and tobacco use and little qualitative data that may illuminate how and why adolescents use e-cigarettes. Through addressing these methodological limitations, future research will be able to inform health care and policy more effectively.

Read the abstract here

Primary and acute care system (PACS)

NHS England launches frameworks to increase integration of health and care services


NHS England has published Integrated primary and acute care systems (PACS) – Describing the care model and the business model

A PACS can be defined as a population-based accountable care model, with general practice at its core. It is organised around patients’ needs and aims to improve the physical, mental and social health and wellbeing of its local population.

However, it will also include most hospital based care, as well as primary, community, mental health and social care services. By aligning the goals and incentives of hospitals with other health and care providers, it offers the potential for a radical new approach to population health.

The integrated (PACS) Framework outlines the next steps required to set up the model – including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.

This puts clinicians in the driving seat by pooling and allocating resources to areas that will have the greatest impact on the health of their local community and creates a shared responsibility towards the most vulnerable patients.

Enhanced Health in Care Homes model

One in seven people aged 85 or over is living permanently in a care home. The evidence suggests that many of these people are not having their needs properly assessed and addressed. As a result, they often experience unnecessary, unplanned and avoidable admissions to hospital, and sub-optimal medication.

The enhanced health care homes model  lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of services.

Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

These plans can help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams  to deliver high quality and financially sustainable care.

The enhanced health in care homes (EHCH) care model is one of a number of new care models that are delivering whole population healthcare. It will become a core element of the multispecialty community provider (MCP) and primary and acute care system (PACS) models.

Image source: http://www.england.nhs.uk

Unsafe discharge from hospital

hospital-1338585_960_720The House of Commons Public Administration and Constitutional Affairs Committee (PACAC) has published Follow-up to Parliamentary and Health Service Ombudsman (PHSO) report on unsafe discharge from hospital.

The inquiry found that the discharge failures identified by the May 2016 PHSO report are not isolated incidents but examples of problems that patients, relatives and carers are experiencing more widely.  The committee identified a need for more data to be gathered on the scale and impact of these discharge failures.  It identified a lack of integration between health and social care is preventing seamless discharge processes, coordinated around the patient’s needs.

Increase in the number of people dying with dementia

Public Health England has published a range of products which examine the deaths of people recorded with dementia between 2012 and 2014.

Figures show the number of deaths with a mention of dementia was:

  • 6.6% of all deaths in 2001
  • 15.8% of deaths in 2014

This is most likely due to an increase in awareness and recording of dementia.

New reports have been produced by the Dementia Intelligence Network (DIN) in collaboration with the National End of Life Care Intelligence Network (NEoLCIN) and draw on national data to see if there have been changes in dementia deaths over time, who the people dying with dementia are, where they die and the cause of their death.

The findings suggest that people who live in more deprived areas die with dementia at a younger age than those who live in more affluent areas.

There are also considerable differences between the place of death for people who have dementia and the general population. People with dementia are considerably more likely to die in hospitals and care homes and less likely to die at home or in end of life care settings such as hospices.

Read the Dementia Intelligence Network (DIN) and the National End of Life Care Intelligence Network (NEOLCIN) reports here

Read the PHE press release here 

Image source: http://www.yhpho.org.uk/

Improving the health of the public by 2040

The Academy of Medical Sciences has published a report ‘Improving the health of the public by 2040’.

Image source: http://www.acmedsci.ac.uk/

Over the coming decades, the UK population will face a wide range of complex health challenges and opportunities, many of which can only be fully addressed through strategies to secure and improve the health of the public as a whole. The  report explores how to organise our research environment to generate and translate the evidence needed to underpin such strategies.

This report concludes that while public health research has provided fundamental insights into human health, there remains much we do not know about the complex array of interlinking factors that influence the health of the public, and about how to prevent and solve the many health challenges we face as a population.

Solving these challenges will require shifting towards a ‘health of the public’ approach, involving disciplines that would not usually be considered to be within the public health field. This is turn requires six key developments:

  1. Rebalancing and enhancing the coordination of research.
  2. Harnessing new technologies and the digital revolution.
  3. Developing transdisciplinary research capacity.
  4. Aligning perspectives and approaches between clinical and public health practice.
  5. Working with all sectors of society, including policymakers, practitioners, the commercial sector and the public.
  6. Engaging globally.

Read the full report here
Read the press release here

Cardiovascular disease: getting serious about prevention


This series of slides highlights the work done by PHE and partners, and makes the case for the steps to be taken around prevention in the future.

This publication brings together Public Health England’s (PHE’s) broad-ranging work in addressing cardiovascular disease, the second leading cause of premature death and ill health. It sets out the main programmes already underway and the next steps in tackling cardiovascular disease going forward.

The publication is intended for those involved in the commissioning and provision of services for cardiovascular disease and its prevention, including:

  • clinicians
  • local authorities
  • service commissioners
  • public health specialists
  • the third sector
  • PHE staff

Access the full document:  Action on Cardiovascular disease: getting serious about prevention

World Heart Day

Today (29 September) is World Heart Day, and the World Heart Federation is raising awareness about cardiovascular disease (CVD). This infographic has been produced to provide a global snapshot of cardiovascular disease facts and figures.

Image source: http://worldheartday.org/

To mark World Heart Day, the British Heart Foundation (BHF), Public Health England (PHE) and NHS Choices are encouraging people to use an innovative online tool to find out how old their heart is and know their cardiovascular risk.

The self-assessment Heart Age Tool:

  • Tells you your heart age compared to your real age
  • Explains why it’s important to know your blood pressure and cholesterol numbers
  • Gives advice on how to reduce your heart age

A study published today in BMJ Open and led by BHF funded researchers at UCL, looked at the data of 575,000 individuals who used the Heart Age Tool over a 6 month period.

Nearly 9 in 10 men under 40 (87%) had a heart older than they were, compared to 41% of women of the same age. Of these, over a quarter (28%) had a heart age greater than their chronological age by at least 5 years.

The study, the largest of its kind, also found a significant proportion of the public were unaware of their own cardiovascular risk factors. Currently cardiovascular disease (CVD) causes more than a quarter (27%) of all deaths in the UK, around 155,000 people each year, and coronary heart disease is the UK’s single biggest killer. Despite this, most cases in people under 75 are preventable.

Full reference:Patel RS, et al.   Online self-assessment of cardiovascular risk using the Joint British Societies ( JBS3)-derived heart age tool: a descriptive study BMJ Open published online 28 September 2016

Commissioning healthcare in changing times

NHS Clinical Commissioners has published Making difficult decisions: commissioning healthcare in changing times.

This report aims to support CCGs in making decisions about prioritisation of resources and changes to local services. It sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes.

The report contains tips  from academic research and insight from those interviewed during the report, including commissioners, patient groups and NHS England. These tips are:

  • Identify opportunities for improvement and safe and cost-effective change in service provision.
  • Plan the change management process in advance.
  • Base decision-making on robust data where available.
  • Manage stakeholder perceptions through active engagement, consultation and nurturing trustworthy relationships.
  • Recognise that local community, clinician and political support is vital, and engage these interests early.
  • Develop an integrated communication and engagement strategy from the start
    Read Making Difficult Decisions.

Read the full report here

Image source: http://www.nhscc.org/