Enhancing Junior Doctors’ Working Lives

This progress report provides an update on the work that Health Education England (HEE) has completed with partners including the British Medical Association,  the Academy of Medical Royal Colleges and the General Medical Council over the past year in response to the concerns doctors in training have raised and to help boost morale (HEE).

Enhancing junior doctors working lives
Image source: hee.nhs.uk

The full report is available to download from HEE

The press release from HEE can be read here 

Hotter bodies fight infections and tumours better – researchers show how

Science Daily | May 2018 | Hotter bodies fight infections and tumors better — researchers show how

Researchers from the Universities  of Manchester and Warwick have shown how individuals with higher body temperatures are better equipped to fight infections and tumours.  A Multidisciplinary team were involved in the study, with mathematicians from Warwick calculating how temperature increases make the cycle accelerate.  The researchers have demonstrated that small rises in temperature (such as during a fever) speed up the speed of a cellular ‘clock’ that controls the response to infections — and this new understanding could lead to more effective and fast-working drugs which target a key protein involved in this process (Science Daily).
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Higher body temperatures speed our bodies’ responses to infections, wounds and tumours – researchers at the Universities of Warwick and Manchester prove that a slight increase in body temperature and inflammation – such as a fever – speeds up cellular ‘clock’ in which proteins switch genes on and off to respond to infection.

  • Slight rise in temperature and inflammation – such as a fever – speeds up cellular ‘clock’ in which proteins switch genes on and off to respond to infection
  • New understanding could lead to more effective and fast-working drugs which target a key inflammation protein found to be critical for the temperature response
  • Interdisciplinary team of Warwick mathematicians and Manchester biologists used modelling and lab experiments to jointly make discovery (University of Warwick)

The full news item from Science Daily can be read here 

University of Warwick Hotter bodies fight infections and tumours better – researchers show how

The research is published in the Proceedings of the National Academy of Sciences

The full article is available to read here

Full reference:

Harper, C. V. , et al | Temperature regulates NF-κB dynamics and function through timing of A20 transcriptionProceedings of the National Academy of Sciences | 2018; 201803609|  DOI: 10.1073/pnas.1803609115

 

Scleroderma Awareness Month

Scleroderma & Raynaud’s UK | World Scleroderma Day

This month (June 2018)  is Scleroderma Awareness month, to help raise awareness of this autoimmune condition.  Scleroderma is a rare, chronic disease of the immune system, blood vessels and connective tissue. 2.5 million people worldwide have scleroderma, and in the UK there are 12,000 people diagnosed.  It is a severe condition and can be fatal.  Scleroderma & Raynaud’s  UK (SRUK) have created a number of resources. #WorldSclerodermaDay is on 29th June. (Source: SRUK

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Image source: WeAreSRUK

Related:
Scleroderma & Raynaud’s UK |  Early Detection of Scleroderma and Raynaud’s: Pipe Dream or Achievable Goal?

Scleroderma & Raynaud’s UK | New RAIRDA Report: Reduce, Improve, Empower

Scleroderma & Raynaud’s UK | Meet Chloe

Developing pathways for alcohol treatment

Guidance on referring alcohol dependent patients from hospital to specialist alcohol treatment in the hospital or in the community | Public Health England

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This guidance is about developing pathways for referral and care and for patients whose routine alcohol screening in secondary care suggests that they may be alcohol dependent.

It can be used by people implementing the Preventing ill health by risky behaviours – alcohol and tobacco CQUIN in acute, mental health and community trusts. It can also be used by NHS commissioners and planners and those planning, commissioning and providing community alcohol treatment.

The guidance aims to:

  • show the components of treatment for dependent drinking
  • describe what helps patients’ smooth passage through their treatment for alcohol dependence

Full guidance: Developing pathways for referring patients from secondary care to specialist alcohol treatment

Researchers predict almost 1 in 4 people worldwide to be obese by 2045 if current rates continue

University College London| June 2018 | Almost 1 in 4 people worldwide to be obese by 2045

Research presented in Austria at the recent European Congress on Obesity in Vienna, Austria (23-26 May) indicates that if obesity levels continue at their current rates, 25 per cent of the population will be obese by 2045.

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Researchers from University College London (UCL), Medical Anthropology, were involved in the discovery that to prevent of type 2 diabetes from going above 10% in 2045, global obesity levels must be reduced by 25%, from 14% to just over 10%.

For example, in the United Kingdom, current trends predict that obesity will rise from 32% today to 48% in 2045, while diabetes levels will rise from 10.2% to 12.6%, a 28% rise. To stabilise UK diabetes rates at 10%, obesity prevalence must fall from 32% to 24% (via UCL).
The full news item is available from UCL 

Under pressure: Safely managing increased demand in emergency departments

Winter 2017/18 saw an unprecedented demand for health and care support services. Emergency departments bore the brunt of this demand. This report features practical solutions from staff and calls for wider action for health and social care services to work together | Care Quality Commission

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

This report aims to contribute to the discussion about how those working in health and social care can come together in a more systemised way to encourage early and effective planning for not only winter pressures but for all periods of peak demand.
The report suggests that there is a need to develop a shared understanding of what an effective escalation strategy looks like – and longer-term, how health and care providers and commissioners collaborate to meet the needs of their local populations, with a stronger focus on keeping people well and helping them stay out of hospital.

The report concludes that the ongoing trend of increasing demand on health and social care services is not abating and it is clear that action is needed now to address the pressures on emergency departments, and in turn keep patients safe. Whilst the report recognises that there are no simple solutions to this problem, it identifies examples of good practice and potential immediate steps to take to manage these issues.

Full report: Under pressure. Safely managing increased demand in emergency departments

Emergency readmissions to hospital for potentially preventable conditions on the rise, new research shows

Nuffield Trust | June 2018 | Emergency readmissions to hospital for potentially preventable conditions on the rise, new research shows

Data analysed by the Nuffield Trust shows that readmissions within 30 days of discharge for preventable conditions such as pneumonia and pressure sores increased by almost a fifth (19 per cent) between 2010/11 and 2016/17.

The new findings from QualityWatch, a major research programme from the Nuffield Trust and the Health Foundation, looked at hospital data detailing patient diagnoses and the reasons behind emergency hospital readmissions during this time (Nuffield Trust).

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Key findings:

  • Between 2010/11 and 2016/17, the number of emergency readmissions within 30 days increased from 1,157,570 to 1,379,790, a rise of 19.2%. The proportion of patient hospital stays that were followed by a readmission grew from 7.5% to 8%.
  • Potentially preventable emergency readmissions to hospital grew from 130,760 to 184,763 – an increase of 41.3%. This means that the proportion of patient hospital stays that were followed by these types of readmission grew from 0.8% in 2010/11 to 1.1% in 2016/17.
  • Patients readmitted to hospital in an emergency with pneumonia increased from 41,003 in 2010/11 to 70,731 in 2016/17, an increase of 72.5%. The increase in pneumonia readmissions was greater than the overall increase in pneumonia cases.
  • Emergency readmissions for pressure sores almost trebled from 7,787 in 2010/11 to 22,448 in 2016/17. The increase in the number of patients being readmitted with a pressure sore superseded the overall increase in the number of pressure sore diagnoses in hospital.
  • The number of patients readmitted with venous thromboembolism grew by a third, from 16,890 in 2010/11 to 23,006 in 2016/17.

The full press release from the Nuffield Trust is available here 

Related:

Numbers of GPs who want out within 5 years at all-time high, finds survey

London School of Hygiene and Tropical Medicine| May 2018 | Numbers of GPs who want out within 5 years at all-time high, finds survey

Research from the University of Manchester indicates that the number of GPs considering leaving direct patient care has risen to 39 per cent, from 37 per cent in 2015. 13% of GPs aged under 50 years indicated that there was a considerable or high likelihood of leaving direct patient care within five years and 45% stated that there was no likelihood (Ninth National GP Worklife Survey 2017).

work-2005640_1920The Ninth National GP Worklife Survey is the first survey since 2015, it  focuses upon GPs’ experiences of their working lives, asking questions about: satisfaction with various aspects of their work (including physical working condition, remuneration, variety, and ability to use their skills); sources of pressure at work (including resource pressures, demands from a variety of sources, and workload); overall experience of their work (including complexity and need to work quickly); and future working intentions (including intentions to increase or decrease working hours and intentions to quit practice). There were  2195 respondents to the survey.

There has been little change in the satisfaction and stressor results from the 2015 to the 2017 survey. However, the satisfaction and stressor results from 2015 were at very high levels (low satisfaction and high pressure) relative to previous years. Therefore, although the declines in satisfaction seen between previous years have not continued, the low levels of satisfaction and high levels of pressure have remained. This may have implications for recruitment, retention and patient care.

The full news item from The London School of Hygiene and Tropical Medicine is here 

The Ninth National GP Worklife Survey 2017 is available here 
Related:

RCGP GPs leaving profession at ‘incredibly worrying’ rates says College

In the media:

The Independent Shortage of GPs set to worsen with number of doctors planning to leave profession at ‘all-time high’

The Guardian Two in five GPs in England intend to quit within five years – survey

Low fat or low carbohydrate diets seem just as effective for weight loss

NIHR Signal | May 2018 | Low fat or low carbohydrate diets seem just as effective for weight loss

NIHR’s Dissemination Portal looks at the impact of a low fat or low carbohydrate diet on weight loss. The researchers report no difference between groups in a randomised controlled trial  in weight loss by 12 months. Those participants in the low fat group lost on average 5.3kg in weight, compared with -6.0 kg in the low carbohydrate group. There was no difference in the range of weight loss among individuals in both groups (NIHR).

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Importance: Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets.

Objective: To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss.

Design, Setting, and Participants: The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015; the date of final follow-up was May 16, 2016. Participants were randomized to the 12-month HLF or HLC diet. The study also tested whether 3 single-nucleotide polymorphism multilocus genotype responsiveness patterns or insulin secretion (INS-30; blood concentration of insulin 30 minutes after a glucose challenge) were associated with weight loss. Interventions: Health educators delivered the behavior modification intervention to HLF (n = 305) and HLC (n = 304) participants via 22 diet-specific small group sessions administered over 12 months. The sessions focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality.

Main Outcomes and Measures: Primary outcome was 12-month weight change and determination of whether there were significant interactions among diet type and genotype pattern, diet and insulin secretion, and diet and weight loss.
Results: Among 609 participants randomized (mean age, 40 [SD, 7] years; 57% women; mean body mass index, 33 [SD, 3]; 244 [40%] had a low-fat genotype; 180 [30%] had a low-carbohydrate genotype; mean baseline INS-30, 93 muIU/mL), 481 (79%) completed the trial. In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was -5.3 kg for the HLF diet vs -6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, -0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss. There were 18 adverse events or serious adverse events that were evenly distributed across the 2 diet groups. Conclusions and Relevance: In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom. Trial Registration: clinicaltrials.gov Identifier: NCT01826591.

Full reference:

Gardner, C. D.,Trepanowski, J. F.,Del Gobbo, L. C.,Hauser, M. E.,Rigdon, J.,Ioannidis, J. P. A.,Desai, M.,King, A. C.|Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial| Jama |Vol.319| Issue 7| 2018 Published on 22 February 2018

This article is available to NHS staff via OpenAthens here

 

What works in homelessness services

Social Care Institute for Excellence | May 2018 | A rapid evidence assessment of what works in homelessness services

Crisis commissioned the Social Care Institute for Excellence to produce a rapid evidence assessment (RAE) to understand what services work, to address and end homelessness, and to assess the quality of evidence that exists in published studies.

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Image source: crisis.org.uk

The report shows that there is potentially a wealth of evidence about what works in services to end homelessness, but the evidence base is as varied in terms of quality as it is vast in scope. The gaps in type of evidence on homelessness include experimental research including Randomised Control Trials, measurement of fidelity of services, long term outcomes and cost benefit analysis. The challenge is to coordinate and develop a more coherent approach to generating reliable evidence about what works in preventing homelessness and making that evidence more accessible to those who need it (Source: Crisis).

 

You can read the full press release at Crisis 

 

The full report is available to download here