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:

Delivering high-quality, compassionate care | via @MayoClinic @TheKingsFund

Swensen, S. The King’s Fund. Published online: 9 November 2016

Speaking at The King’s Fund Annual Conference 2016, Dr Stephen Swensen, Medical Director, Office of Leadership and Organization Development, Mayo Clinic (United States), shares lessons from the Mayo Clinic model of care.

See other presentations from this conference here

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

http://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=19&_IXSR_=JDHYY8ICb8R&_IXSS_=_IXFPFX_%3dtemplates%252ft%26_IXMAXHITS_%3d250%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26_IXFIRST_%3d1%26%252asform%3dwellcome%252dimages%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26%3d%26_IXrescount%3d90%26_IXINITSR_%3dy%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26_IXshc%3dy%26%2524%253ds%3ddementia%26_IXSUBMIT_%3dSubmit&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft

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

arrows-1668909_960_720

  • 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