Managing recovery from concussion

Brooks, J. et al. (2016) BMJ. 355:i5629

concussion
Image source: BMJ

Concussion is a clinical diagnosis made after a head injury with consequent associated signs, symptoms, and neurological or cognitive impairment. In the absence of strong evidence, most recommendations on the management and recovery from concussion are based on international expert consensus.

In this podcast John Brooks, academic clinical fellow in general practice, and Simon Kemp, chief medical officer for the Rugby Football Union take us through the process of guiding a patient through recovery and back into everyday life, including sport.

What you need to know

  • Concussion is temporarily altered brain function after head trauma, and typically resolves over 7-10 days

  • Thinking and remembering, mood, sleep, behaviour, and consciousness can be affected, and people commonly report headache and altered balance

  • Suggest mental and physical rest followed by a graduated return to work or school, and finally to exercise and sport

Read the full article here

Sustainability and Transformation Plan

The South Yorkshire and Bassetlaw Sustainability Plan | NHS commissioners working across South and Mid Yorkshire, Bassetlaw and North Derbyshire

Bringing together 25 partner organisations, the South Yorkshire and Bassetlaw Sustainability and Transformation Plan sets out the vision, ambitions and priorities for the future of the region’s health and care. The goal is to enable everyone in South Yorkshire and Bassetlaw to have a great start in life, supporting them to stay healthy and live longer.

Being shared widely, staff, patients and the public are invited to give their views to help shape further work and implementation of our ambitions for prevention, strengthened primary and community services and a networked approach to hospital care.

Below are three videos highlighting the journey so far:

Interventions for preventing elder abuse: applying findings of a new Cochrane review

Baker, P.R. et al. Age & Ageing. Published online: October 13 2016

B0007980 Diary Drawings: Day 601
Image source: Bobby Baker – Wellcome Images // CC BY-NC-ND 4.0

There is evidence that elder abuse is a significant public health problem that is destined to grow as population age. Countries are considering how best to act and this requires an understanding of the complex causal mechanisms contributing to its occurrence and the identification of effective interventions which can potentially make a difference.

Previously, a high quality synthesis of evidence for policy and practice has been missing. In this paper, we describe a new Cochrane review of interventions to prevent the occurrence or reoccurrence of elder abuse. Overall, the quality of the evidence available for decision making is very low and there is little to guide practice. Amongst the interventions, there is some evidence that teaching coping skills to family carers of persons with dementia might make the situation better. We argue that poor quality and wasteful research needs to be avoided, and front-line agencies be supported in undertaking comparative evaluation of their services.

Read the full Cochrane Review here

Read the full article here

How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital?

Crowther, G.J.E. et al. Age & Ageing. Published online: September 10 2016

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Image source: Stephen Magrath – Wellcome Images // CC BY-NC-ND 4.0

Introduction: in the United Kingdom dementia is generally diagnosed by mental health services. General hospitals are managed by separate healthcare trusts and the handover of clinical information between organisations is potentially unreliable. Around 40% of older people admitted to hospital have dementia. This group have a high prevalence of psychological symptoms and delirium. If the dementia diagnosis or symptoms are not recognised, patients may suffer unnecessarily with resulting negative outcomes.

Discussion: this work suggests an under reporting of dementia and symptoms associated with it in the general hospital. Improving this requires closer collaboration between metal health and hospital healthcare services and training for staff on how to access diagnostic information and recognise common psychological symptoms.

Read the full article here

Commentary on NICE and SCIE guidelines: transition between hospital and community or care home

Winfield, A & Burns, E. (2016) Age Ageing. 45 (6) pp. 757-760.

B0007092 Hospital appointment
Image source: Alex Williamson – Wellcome Images // CC BY-NC-ND 4.0

Safe and appropriate transition between inpatient settings and the community is one of the major challenges facing the modern NHS. The National Institute for Health and Care Excellence in conjunction with the Social Care Institute for Excellence published guidance on this challenging area in December 2015. This commentary provides context, summary and discussion of the key areas covered. The guidance particularly emphasises the importance of a person-centred approach in which patients are individuals and equal partners in the multidisciplinary team who should be treated with dignity and respect.

Read the full article here

Delayed transfers of care continue to worsen

Hazel, W. HSJ. Published online: 10 November 2016

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  • Delayed transfers of care reach highest level with 196,246 delayed days in September
  • NHS England figures show demand up and performance in most areas down
  • NHS Providers warn demands “only likely to increase as we move into winter”

According to performance statistics for September, released on Thursday, 196,246 delayed days occurred in the month compared to 188,340 in August – previously the highest level since monthly data started being collected six years ago.

The NHS England figures show a continued increase in demand and a deterioration of performance in most areas.

Accident and emergency attendances were 4.9 per cent higher than in September 2015, and emergency admissions were 2.6 per cent higher than the previous year.

In September 90.6 per cent of patients were admitted, transferred or discharged from A&E within four hours of arrival, against a target of 95 per cent.

Read the full article here

12% decrease in healthcare usage due to national evidence-based website

Spoelman, W.A. et al. (2016) BMJ Open. 6:e013166

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Objectives: Healthcare costs and usage are rising. Evidence-based online health information may reduce healthcare usage, but the evidence is scarce. The objective of this study was to determine whether the release of a nationwide evidence-based health website was associated with a reduction in healthcare usage.

Design: Interrupted time series analysis of observational primary care data of healthcare use in the Netherlands from 2009 to 2014.

Setting: General community primary care.

Population: 912 000 patients who visited their general practitioners 18.1 million times during the study period.

Intervention: In March 2012, an evidence-based health information website was launched by the Dutch College of General Practitioners. It was easily accessible and understandable using plain language. At the end of the study period, the website had 2.9 million unique page views per month.

Main outcomes measures: Primary outcome was the change in consultation rate (consultations/1000 patients/month) before and after the release of the website. Additionally, a reference group was created by including consultations about topics not being viewed at the website. Subgroup analyses were performed for type of consultations, sex, age and socioeconomic status.

Results: After launch of the website, the trend in consultation rate decreased with 1.620 consultations/1000 patients/month (p<0.001). This corresponds to a 12% decline in consultations 2 years after launch of the website. The trend in consultation rate of the reference group showed no change. The subgroup analyses showed a specific decline for consultations by phone and were significant for all other subgroups, except for the youngest age group.

Conclusions: Healthcare usage decreased by 12% after providing high-quality evidence-based online health information. These findings show that e-Health can be effective to improve self-management and reduce healthcare usage in times of increasing healthcare costs.

Read the full article here

Reducing infections in the NHS

Department of Health | Published online: 10 November 2016

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Image source: David Gregory & Debbie Marshall – Wellcome Images // CC BY-NC-ND 4.0

Image shows electron micrograph of Escherichia coli close-up

Plans to prevent hospital infections include more money for hospitals who reduce infection rates and publishing E. coli rates by local area.

Health Secretary Jeremy Hunt has launched new plans to reduce infections in the NHS. He announced government plans to halve the number of gram-negative bloodstream infections by 2020 at an infection control summit.

E. coli infections – which represent 65% of what are called gram-negative infections – killed more than 5,500 NHS patients last year and are set to cost the NHS £2.3 billion by 2018. There is also large variation in hospital infection rates, with the worst performers having more than 5 times the number of cases than the best performing hospitals.

Infection rates can be cut with better hygiene and improved patient care in hospitals, surgeries and care homes, such as ensuring staff, patients and visitors regularly wash their hands. People using insertion devices such as catheters, which are often used following surgery, can develop infections like E. coli if they are not inserted properly, left in too long or if patients are not properly hydrated and going to the toilet regularly.

Read the full news story here

Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments

Wolf, L. A. et al. Journal of Emergency Nursing. Published online: November 8 2016

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Introduction: The emergency department is a unique practice environment in that the Emergency Medical Treatment and Active Labor Act (EMTALA), which mandates a medical screening examination for all presenting patients, effectively precludes any sort of patient volume control; staffing needs are therefore fluid and unpredictable. The purpose of this study is to explore emergency nurses’ perceptions of factors involved in safe staffing levels and to identify factors that negatively and positively influence staffing levels and might lend themselves to more effective interventions and evaluations.

Methods: We used a qualitative exploratory design with focus group data from a sample of 26 emergency nurses. Themes were identified using a constructivist perspective and an inductive approach to content analysis.

Results: Five themes were identified: (1) unsafe environment of care, (2) components of safety, (3) patient outcomes: risky care, (4) nursing outcomes: leaving the profession, and (5) possible solutions. Participants reported that staffing levels are determined by the number of beds in the department (as in inpatient units) but not by patient acuity or the number of patients waiting for treatment. Participants identified both absolute numbers of staff, as well as experience mix, as components of safe staffing. Inability to predict the acuity of patients waiting to be seen was a major component of nurses’ perceptions of unsafe staffing.

Discussion: Emergency nurses perceive staffing to be inadequate, and therefore unsafe, because of the potential for poor patient outcomes, including missed or delayed care, missed deterioration (failure to rescue), and additional ED visits resulting from ineffective discharge teaching. Both absolute numbers of staff, as well as skill and experience mix, should be considered to provide staffing levels that promote optimal patient and nurse outcomes.

Read the abstract here