‘Workforce crisis’ in Cancer Services

Clinical oncology UK workforce census 2017 report| The Royal College of Radiologists

The clinical oncology UK workforce census report provides a unique profile of the clinical oncology workforce in the UK. This years’ figures highlight the ongoing workforce shortages putting consultants and department under intense pressure. The key findings show that:

  • Demand for cancer services continues to outstrip the workforce supply
  • Increased pressure on services mean that time allocated to supporting professional activities is being erroded, potentially impacting on the quality of services
  • Training numbers are insufficient to replenish the current shortages in the workforce
  • Experienced oncologists are being lost from the workforce through retirements.

Full report: Clinical oncology UK workforce census 2017 report

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

Positive effects of holidays are short-lived, finds study

Science Direct | June 2018 | Vacation time recharges US workers, but positive effects vanish within days, new survey finds

A survey of  1,512 Americans working part-time, full-time or self employed, conducted by the American Psychological Association, has found that almost a quarter reported that that the effects of taking a vacation are short-lived. Although this group recognised the benefits of time away from the office, such as increased energy and lessening of stress, they said these disappear as soon as they return to work (via Science Daily). 
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Forty per cent indicated that the positive benefits of taking a break lasted a few days
The majority of respondents reported taking a holiday had positive effects, their modd was positive on their return to work (68 per cent), more energy (66 per cent) and motivation (57 per cent), less stressed (57 per cent). Over half reported increased productivity levels (58 per cent).

Forty-two per cent reported dreading their return to work, over a quarter (28 per cent) end up working during their break.

The full press release is at American Psychological Association 

Spending an extra year in school boosts intelligence, finds Edinburgh researchers

University of Edinburgh | June 2018 | Extra year in class raises IQ, study finds

Scientists at the University of Edinburgh have investigated the relationship between time in education and performance on intelligence tests. They examined data from over 600000 over 6 years of age, they included results from ability tests such as memory, reasoning and factual knowledge. They conclude that a further year in education raised IQ scores by up to five points (Source: University of Edinburgh)

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The researchers acknowledge that large and robust studies are necessary to help understand why education has this effect.

The study has been published in Psychological Science 

Abstract

Intelligence test scores and educational duration are positively correlated. This correlation could be interpreted in two ways: Students with greater propensity for intelligence go on to complete more education, or a longer education increases intelligence. We meta-analyzed three categories of quasiexperimental studies of educational effects on intelligence: those estimating education-intelligence associations after controlling for earlier intelligence, those using compulsory schooling policy changes as instrumental variables, and those using regression-discontinuity designs on school-entry age cutoffs. Across 142 effect sizes from 42 data sets involving over 600,000 participants, we found consistent evidence for beneficial effects of education on cognitive abilities of approximately 1 to 5 IQ points for an additional year of education. Moderator analyses indicated that the effects persisted across the life span and were present on all broad categories of cognitive ability studied. Education appears to be the most consistent, robust, and durable method yet to be identified for raising intelligence.

Full reference:
Ritchie, S.J. & Tucker-Drob, E.M. | 2018| How Much Does Education Improve Intelligence? A Meta-Analysis | Psychological Science | https://doi.org/10.1177/0956797618774253

The article can be requested by Rotherham NHS staff here 

New predictive tool to measure blood pressure developed by Oxford and Birmingham scientists

University of Oxford|June 2018 | Reducing the need for 24-hour blood pressure monitors in general practice

A new prediction tool that uses a simple computer algorithm is able to identify patients with hypertension in 97 per cent of cases. The tool has been developed by researchers at Oxford and Birmingham Universities using data from 2000 patients in order to understand the difference between blood pressure readings taken in clinic and 24-hour blood pressure readings. From these data they developed an algorithm that is able to predict an individual’s blood pressure.  The tool may help to halve the number of patients required to wear the 24-hour blood pressure monitors for hypertension to be confirmed.
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Ninety-seven per cent of the time the algorithm was able to determine if the patient had normal blood pressure, high blood pressure or needed further investigation.

 (Source: University of Oxford).

The predictive tool is available free here

A paper based on this research has now been published in the BMJ

Abstract

Objective To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice.

Design Prospective observational cohort study.

Setting 10 primary care practices and one hospital in the UK.

Participants 887 consecutive patients aged 18 years or more referred for ABPM in routine clinical practice. All underwent ABPM and had the PROOF-BP applied.

Main outcome measures The main outcome was the proportion of participants whose hypertensive status was correctly classified using the triaging strategy compared with the reference standard of daytime ABPM. Secondary outcomes were the sensitivity, specificity, and area under the receiver operator characteristic curve (AUROC) for detecting hypertension.

Results The mean age of participants was 52.8 (16.2) years. The triaging strategy correctly classified hypertensive status in 801 of the 887 participants and had a sensitivity of 97% and specificity of 76%  for hypertension. The AUROC was 0.86. Use of triaging, rather than uniform referral for ABPM in routine practice, would have resulted in 435 patients  being referred for ABPM and the remainder managed on the basis of their clinic measurements. Of these, 69 would have received treatment deemed unnecessary had they received ABPM.

Conclusions In a population of patients referred for ABPM, this new triaging approach accurately classified hypertensive status for most, with half the utilisation of ABPM compared with usual care. This triaging strategy can therefore be recommended for diagnosis or management of hypertension in patients where ABPM is being considered, particularly in settings with limited resources.

Full reference: Sheppard J. PMartin, U.,  Paramjit, G.,  Stevens R.Hobbs FD, R., Mant, J. et al. | 2018| Prospective external validation of the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) strategy for triaging ambulatory monitoring in the diagnosis and management of hypertension: observational cohort study | 

The paper can be read in full at the BMJ 

Pressure ulcers: revised definition and measurement

NHS Improvement | June 2018 | Pressure ulcers: revised definition and measurement

NHS Improvement have produced a series of recommendations which were developed by task-and-finish groups with a broad range of clinical and academic experience. One group looked at recommendations for definition and one at local and national measurement. The recommendations in the document are designed to support a more consistent approach to the definition and measurement of pressure ulcers at both local and national levels across all trusts.

Pressure ulcers remain a concerning and mainly avoidable harm associated with healthcare delivery. In the NHS in England, 24,674 patients were reported to have developed a new pressure ulcer between April 2015 and March 2016, and treating pressure damage costs the NHS more than £3.8 million every day. Finding ways to improve the prevention of pressure damage is therefore a priority for policy-makers, managers and practitioners alike  (Source: NHS Improvement).

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The summary and recommendations are available here

Related: Pressure ulcer core curriculum 

Tackling loneliness

The government is asking organisations with expertise and experience in tackling loneliness to provide views on the strategy framework being developed. It is believed that factors contributing to loneliness include disability, ill health and caring responsibilities. The closing date for comments is 20 July 2018.

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The Government’s Loneliness Strategy will be its first step in tackling the long-term challenge of loneliness. Loneliness is a complex issue that affects many different groups of people, and its evidence base is still developing. The current evidence base tends to measure loneliness in terms of frequency, and it shows that people who feel lonely most or all of the time are more likely to suffer ill health.

In addition, people who feel lonely more often can become more sensitive to perceived threats and withdraw further, creating a vicious cycle. As a result, the stratgey will look at approaches that reduce the risk, prevent loneliness or that intervene early, before loneliness becomes entrenched.

The Office for National Statistics (ONS) recently analysed how individual circumstances and characteristics contribute to the likelihood of experiencing loneliness, holding all else equal. The ONS found that the following were significant factors:

  • age – younger people (16-24) were significantly more likely to report feeling lonely
  • gender – women were more likely to report feeling lonely
  • marital status – widowed people were more likely to report feeling lonely
  • disability and ill-health (self-reported) – those reporting were more likely to feel lonely
  • number of adults in the household – those living alone were more likely to report feeling lonely
  • caring responsibilities – those caring were more likely to report feeling lonely
  • neighbourhood connectedness – those who do not chat to neighbours more than to say hello, or do not feel as though they belong to or satisfied with their neighbourhood were more likely to report feeling lonely
  • how often you meet up in person with family members or friends – those who met up once a month or less were more likely to feel lonely

Read more about the Government’s Loneliness Strategy

 

Resources to support safer modification of food and drink

NHS Improvement | June 2018Resources to support safer modification of food and drink

NHS Improvement has  issued a resource alert to eliminate use of the imprecise term ‘soft diet’ and assist providers with safe transition to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, which introduces standard terminology to describe texture modification for food and drink.


Resources to support safer modification of food and drink are here

In the media:

BBC News Patients ‘choked on hospital soft food’

The Telegraph  Safety alert after hospital patients choke on hash browns and peas

Mail Online Hundreds of NHS patients have choked, with two DYING, after being fed solid food when it should have been minced or puréed because they had difficulty swallowing, reveals damning report

England’s poorest areas are fast food hotspots

Public Health England | June 2018 | England’s poorest areas are fast food hotspots 

New figures from Public Health England (PHE) reveal England’s poorest areas are fast food hotspots, with 5 times more outlets found in these communities than in the most affluent.

 

The analysis demonstrates that the most deprived communities have over a quarter (26%) of fast-food outlets including chip shops and pizza takeaways.

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The new figures also show a variation in the number of fast food outlets across England, ranging from zero in some wards to over 100 in others.

Many local authorities across England have taken action to address their food environment and PHE is encouraging them to learn from each other. At least 40 areas have developed policies to restrict the growth of new takeaways and fast food outlets, and PHE has helped develop stronger planning guidance to support other areas in doing this.

More than third of children in England are overweight or obese by the time they leave primary school, a figure even higher in some deprived communities. This increases their risk of being overweight or obese adults and suffering preventable diseases including type 2 diabetes, heart disease and some cancers.

Dr Alison Tedstone, Chief Nutritionist at Public Health England, said: It’s not surprising soem childrne find it difficult to resist hte lure of fast food outlets when many neighbourhoods are saturated with them. Local authorities have the power to help shpae our environment and support people in making healthier choices. They need to question whether these fast food hotspots are compatible with their work to help families and young children live healthier lives (Source: PHE).

Related:

Department of Health and Social Care Childhood obesity: a plan for action, chapter 2

Developing new care models through NHS vanguards

The vanguard programme, one of NHS England’s attempts to better meet patients’ needs and deliver savings by developing new care models to integrate health and social care services, has not delivered the depth and scale of transformed services it aimed for at the beginning of the programme, according to this report by the National Audit Office.

A key objective of the programme was to design new care models that could be quickly replicated across England. NHS England selected 50 sites to act as ‘vanguards’ which might entail, for example, joining up GP, hospital and community and mental health services in an integrated network or single organisation in one area to improve healthcare for patients.

NHS England’s early planning assumption was £2.2 billion of funding for new care models between 2016-17 and 2020-21, but it used much of the funding to reduce deficits faced by hospitals. Actual direct funding of vanguards was £329 million over three years from 2015-16, with another £60 million spent by NHS England on central support for vanguards. Consequently, with less funding for transformation, the original intention to expand the programme was not realised.

Despite not meeting its original intention to expand the models across the country, vanguards have made progress in developing new care models. NHS England forecasts that vanguards will make net savings. As at April 2018, it estimated that vanguards would secure £324 million net savings annually by 2020-21, which is 90% of the £360 million that had been expected.

Full report:  Developing new care models through NHS vanguards

See also: National Audit Office press release

Apps and algorithms may ‘support but will never replace’ GPs, says RCGP

RCGP |June 2018 | Apps and algorithms may ‘support but will never replace’ GPs, says RCGP

The Vice Chair of the Royal College of GPs,Professor Martin Marshall, has responded to a technology company Babylon’s claims that a new app is able to demonstrate clinical knowledge comparable to a GP.  Prof Marshall said: “The potential of technology to support doctors to deliver the best possible patient care is fantastic, but at the end of the day, computers are computers, and GPs are highly-trained medical professionals: the two can’t be compared and the former may support but will never replace the latter.

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“No app or algorithm will be able to do what a GP does. Every day we deliver care to more than a million people across the UK, taking into account the physical, psychological and social factors that may be impacting on a patient’s health; we consider the different heath conditions a patient is living with, and medications they might be taking, when formulating a treatment plan. Much of what GPs do is based on a trusting relationship between a patient and a doctor, and research has shown GPs have a ‘gut feeling’ when they just know something is wrong with a patient.

The full, unedited piece is at RCGP

In the News:

BBC News Babylon claims its chatbot beats GPs at medical exam