Study of emergency admission, readmission and the ‘weekend effect’

Shiue, I. et al. (2017) BMJ Open. 7:e012493

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Objectives: Excess mortality following weekend hospital admission has been observed but not explained. As readmissions have greater age, comorbidity and social deprivation, outcomes following emergency index admission and readmission were examined for temporal and demographic associations to confirm whether weekend readmissions contribute towards excess mortality.

Conclusions: Associations with emergency hospitalisation were not identical for index admissions and readmissions. Further research is needed to confirm what factors are responsible for the ‘weekend effect’.

Read the full article here

Public health implications of four decades of neoliberal policy

Garnham, L.M. Journal of Public Health. Published online: 2 March 2017

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Background: The UK has long had a strong commitment to neoliberal policy, the risks of which for population health are well researched. Within Europe, Scotland demonstrates especially poor health outcomes, much of which is driven by high levels of deprivation, wide inequalities and the persistent impacts of deindustrialisation. The processes through which neoliberalism has contributed to this poor health record are the subject of significant research interest

 

Conclusions: In formerly industrial parts of west central Scotland, policy developments since the 1970s have generated multiple and sustained forms of deprivation. This case study suggests that a turn away from neoliberal policy is required to improve quality of life and health

Read the full abstract here

Social media is not to blame for depression in young people

For all we hear about an escalation in mental health problems in adolescence, there is no persuasive evidence that the internet is to blame | McCrae, N. for The Conversation

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My colleagues and I recently conducted a systematic review of the evidence and found only a weak correlation between teenagers’ use of social media and depression.

After its launch in 2004, the social networking website Facebook rapidly expanded to global coverage. Since the advent of smartphones, instant messaging sites such as WhatsApp have become the most popular means of communication for younger people, who spend much of their lives fixated on digital devices, oblivious to everything around them. Some experts believe that this immersion in cyberspace has negative psychological and social effects, and news reports and opinion pieces in newspapers often portray the internet as a danger to the young.

We examined research measuring social media use and depression in young people up to 18 years of age. Eleven studies, with a total of 12,646 participants, were included. Overall, we found a small but statistically significant relationship between online social interaction and depressed mood.

Read the full blog post here

Read the systematic review here

People who are dying should be asked about their spiritual beliefs

NICE has published new guidance calling on healthcare professionals to ask adults in the final days of life about their religious or spiritual beliefs.

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Cultural preferences and spiritual beliefs should be included in discussions about the care a person, and those close to them, want to receive, says NICE.

Knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations.

The 2016 End of Life Care Audit reported nearly half of all deaths in England occurred in hospital. Spiritual wishes were only documented for one in 7 people who were able to communicate their desires.

Read the full overview here

Read the full guidance here

Reactions on Twitter to updated alcohol guidelines in the UK

Stautz K. et al. (2017) BMJ Open. 7:e015493

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Objectives: In January 2016, the 4 UK Chief Medical Officers released a public consultation regarding updated guidelines for low-risk alcohol consumption. This study aimed to assess responses to the updated guidelines using comments made on Twitter.

 

Conclusions: This descriptive analysis revealed a number of themes present in unsupportive comments towards the updated UK alcohol guidelines among a largely proalcohol community. An understanding of these may help to tailor effective communication of alcohol and health-related policies, and could inform a more dynamic approach to health communication via social media.

Read the full article here

NHS acute hospitals report

The Care Quality Commission has published The state of care in NHS acute hospitals: 2014 to 2016: findings from the end of CQC’s programme of NHS acute comprehensive inspections.

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

The report has been derived from three years’ worth of CHC inspections into the quality of care being provided by NHS acute hospitals. It finds that most hospitals are delivering good quality care and looking after patients well, however, some trusts have blind spots about the quality of care they are delivering in a particular core service, even in some trusts rated good overall.

 

Related: CQC right to say care is at risk due to unprecedented pressure on hospitals | NHS Providers

Sicker patients the main reason for A&E winter pressures

Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.

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Eighty per cent of NHS finance directors who responded to the latest Kings Fund survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. In contrast, only 27 per cent pointed to poor access to GPs and 20 per cent identified shortages of clinical staff as key factors.

The survey also highlights the effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.

Read the full report here

 

Obesity linked to heightened risk of certain cancers

Obesity is strongly linked to the risk of developing certain major cancers, according to a re-analysis of research published in The BMJ | OnMedica | BMJ

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Links between obesity and cancer risk are strongest for 11 cancers related to digestive organs and hormones, says the review. Obesity could also be linked to other cancers, but the quality of the evidence is not sufficiently strong to draw those conclusions yet.

Obesity prevalence has more than doubled over the past 40 years, and the evidence to date suggests that it is linked to a heightened risk of developing particular cancers, but methodological flaws in some published studies have weakened the strength of the associations found.

To better gauge the quality of the evidence and the strength of these associations, the researchers comprehensively reviewed published studies looking at obesity and cancer risk.

From among 204 reviews that analysed obesity measurements, such as body mass index (BMI), weight gain, and waist circumference, and the risk of 36 cancers, 95 included continuous measures of obesity.

Only 13% of the associations for nine cancers were based on strong evidence, meaning the results were statistically significant and excluded bias.

Strong associations were found in studies that looked at heightened risk of oesophageal, bone marrow, colon (in men), rectal (in men), biliary tract system, pancreatic, endometrial (in premenopausal women), and kidney cancers.

Read more via OnMedica

Link to the research: Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ 2017;356:j477. DOI: 10.1136/bmj.j477

 

 

Shifting the balance of care

Imison C, Curry N, Holder H, et al. Shifting the balance of care: great expectations.  March 2017 | Nuffield Trust.

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Moving care out of hospitals into the community can deliver holistic, patient-centred care closer to home.  In most cases however, it is unlikely to save money, according to a  report published today by The Nuffield Trust.

The report is based on a review of 27 schemes to reduce hospital activity, which included changes to urgent and emergency care pathways; speeding up discharge; managing ‘at risk’ groups; supported care at home; and cutting down on admissions.

Most of the initiatives demonstrated the potential to improve patient experience, and in some cases, outcomes. The evidence on cost savings was much less clear cut, partly because good economic evaluations have often not been carried out.

Several schemes did seem to be cost-effective in the right circumstances, but where schemes had been evaluated, most were cost neutral or were more expensive.

Download the full report here 

Report summary available here

 

Report highlights alarming level of readmission for COPD patients

COPD: Who cares when it matters most? | National Chronic Obstructive Pulmonary Disease Audit Programme

A new report from the Royal College of Physicians and the British Thoracic Society shows that 43% of patients admitted for hospital treatment of chronic obstructive pulmonary disease (COPD) were readmitted at least once in the 3 months following discharge, representing a considerable increase from 33% in 2008.

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

COPD: Who cares when it matters most?,  demonstrates that, although COPD was the single most common cause of readmission, over 50% of readmissions were in older people with multiple health conditions.

The report also highlights improvements in the safety and efficiency of COPD care. The report shows that inpatient mortality has decreased from 7.9% in 2003 to 4.3% in 2014.

Fewer patients are dying after discharge from hospital. There has been a marked decrease in the average length of stay in hospital for acute exacerbation of COPD, which fell from 6 days to 4 days in the same period.

Recommendations to improve treatment and care of patients with COPD include:

  • early identification of individuals at risk of deterioration
  • careful assessment of patients with multiple healthcare needs and conditions
  • improved discharge planning, particularly for vulnerable and frail patients
  • the development of integrated approaches to COPD care.

Download the full report here