Interventions to improve antibiotic prescribing practices for hospital inpatients

Davey, P. et al. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD003543.

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Image source: Cochrane

Background: Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients.

Objectives: To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement.

Authors’ conclusions:  We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it was used in only a minority of enabling interventions. Interventions were successful in safely reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently, effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is required on unintended consequences of restrictive interventions.

Read the full review here

What can be done to tackle the youth mental health treatment gap?

Too few children and young people are getting the care they need. A new commission at Birmingham university aims to address the problem | The Guardian

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By 2020 one in three teenagers will have access to cancer treatment in England. Think about that: only one in three. There would be an outcry. It would be scandalous, horrifying, unacceptable.

It is not true, however. Unless you delete the word “cancer” and insert “mental health”, and then it is.

In medical terms, there is a treatment gap. The number of children and young people living with a diagnosable mental illness far exceeds the number who get any help. One in 10 children suffer a diagnosable mental illness, yet just one in four of them receive treatment. By 2020 the gap may close, a little, if plans in NHS England’s Five Year Forward View for Mental Health are realised, but only a little.

Read the full news story here

Systematic review of pathways for the delivery of allergy services

Diwakar L, et al. (2017) BMJ Open. 7:e012647

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Objectives: The incidence and prevalence of allergies worldwide has been increasing and allergy services globally are unable to keep up with this increase in demand. This systematic review aims to understand the delivery of allergy services worldwide, challenges faced and future directions for service delivery.

Conclusions: Demand for allergy services appears to have significantly outpaced supply. Primary and secondary care pathways in allergy seem inadequate leading to poor referral practices, delays in patient management and consequently poor outcomes. Improvement of services requires strong public and political engagement. There is a need for well-planned, prospective studies in this area and a few are currently underway. There is no evidence to suggest that any given pathway of service provision is better than another although data from a few long-term, prospective studies look very promising.

Read the full article here

Accelerating the adoption of person and community-centred approaches to health and care

A new relationship with people and communities: Actions for delivering Chapter 2 of the NHS Five Year Forward View | People and Communities Board

The report ‘A new relationship with people and communities’ outlines six high impact actions and related recommendations, supported by evidence and illustrated by examples. The actions address key pinch points in the NHS, where substantial progress can be made in the next 12 months, and where the actions can build energy around the broader agenda of changing the culture of healthcare. The annex – ‘Voluntary sector proposals’ – highlights approaches or interventions developed in the VCSE sector, which have been tested and evaluated and which have the potential for wider adoption.

Read the full overview here

Read the full report here

What’s behind delayed transfers of care?

Why are we waiting? The causes of DTOCs | By Nigel Edwards for the Nuffield Trust

As the data shows, the NHS had remained responsible for the majority of DTOCs over time, but the proportion for which social care are responsible has grown by 84 per cent since December 2010.

The data also allows us to explore the reasons for delays. The most significant change since November 2010 has been an increase in the number of days delayed due to patients waiting for a care package to be available either at home (172 per cent increase) or in a nursing home (110 per cent).

While the reduced availability of social care is often highlighted as the cause of DTOCs, 57 per cent of the delays occurred because of issues in the NHS.

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Image source: Nuffield Trust 

Read the full briefing here

Impact of fathers on children’s mental health

The Centre for Mental Health has published Fatherhood: the impact of fathers on children’s mental health

This briefing highlights the distinct role fathers can play in nurturing good mental health in their children. It explores the direct and indirect impact of fathers, from positive supervision and language development, to emotionally buffering mother and child against environmental stresses.

Improving outcomes for children and families

The Local Government Association has published Improving outcomes for children and families in the early years: a key role for health visiting services

This guide highlights the importance of health visitors and commissioners to work together to monitor and evaluate the impact of the health visiting service.

The report includes case studies demonstrating examples of innovation.