Patients waiting more than 18 weeks for surgery set to double to 1 million

NHS Confederation | August 2018 |Patients waiting more than 18 weeks for surgery set to double to 1 million

Analysis of waiting times shows that the number of patients being treated within the 18 week timeframe has not been met for two years. Extrapolation of these figures indicates that by 2024 1 million patients will waiting over 18 weeks for surgery, finds NHS Partners Network, part of the NHS Confederation which represents independent healthcare providers. The figures show that without urgent action the total number of people on the waiting list for surgery will hit 5.6 million – up 25 per cent – by March 2024.

NHS Partners Network is calling for the NHS to ensure tackling waiting lists as a key priority of the forthcoming 10-year plan for the health service and with NHS hospitals operating at near to full capacity for the NHS make use of the significant spare capacity in the independent sector to speed up patients’ access to care (Source: NHS Confederation).

The full story is at NHS Confederation 

Salt might not be as bad for you as previously thought, discovers Canadian study

Sundquist, J., Palmér, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. | (2018)| Long‐term improvements after mindfulness‐based group therapy of depression, anxiety and stress and adjustment disorders: A randomized controlled trial| Early intervention in psychiatry| Doi: https://doi.org/10.1016/S0140-6736(18)31376-X

A new international study published in the  journal The Lancet investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality. The authors highlight that the WHO target- consumption of less than 2g a day- is not only not practicable, it might also be pointless; as no country has managed to reach this level of salt intake.

Summary

Background

WHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomised trials or observational studies. We investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality.

Methods

The Prospective Urban Rural Epidemiology study is ongoing in 21 countries. Here we report an analysis done in 18 countries with data on clinical outcomes. Eligible participants were adults aged 35–70 years without cardiovascular disease, sampled from the general population. We used morning fasting urine to estimate 24 h sodium and potassium excretion as a surrogate for intake. We assessed community-level associations between sodium and potassium intake and BP in 369 communities (all more than 50 participants) and cardiovascular disease and mortality in 255 communities (all more than 100 participants), and used individual-level data to adjust for known confounders.

 

Findings

95 767 participants in 369 communities were assessed for BP and 82 544 in 255 communities for cardiovascular outcomes with follow-up for a median of 8·1 years. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3–5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake (p less than 0·0001 for heterogeneity). The association between mean sodium intake and major cardiovascular events showed significant deviations from linearity (p=0·043) due to a significant inverse association in the lowest tertile of sodium intake, no association in the middle tertile, and a positive but non-significant association in the highest tertile. A strong association was seen with stroke in China compared with in other countries. All major cardiovascular outcomes decreased with increasing potassium intake in all countries.

Interpretation

Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate.

The full article can be read by staff via Athens 

You can read the article in full at The Lancet 

In the media:

The Guardian Salt not as damaging to health as previously thought, says study

 

Cochrane: The Recommended Dose podcast

Cochrane Library | August 2018 | The Recommended Dose podcast: Alexandra Barratt on using both medicine and the media to explore and promote the critical role of evidence in healthcare

A new podcast from the Cochrane Library covers the medicine and the media to explore the promote the critical role of evidence in healthcare. 

This week’s guest Alexandra Barratt discusses her varied career and the reasons she’s ended up challenging conventional wisdom. She also talks about her research into the pros and cons of breast cancer screening and questions the widely-accepted idea that early detection is always the best medicine.

The podcast is also available to listen to via Soundcloud, iTunes or Stitcher 

Previous episodes are available from Cochrane here 

Hospital superbugs developing ‘tolerance to alcohol disinfectants’

Nursing Times | August 2018 | Hospital superbugs developing ‘tolerance to alcohol disinfectants’

An Australian study has found that multidrug-resistant bacterial species that can cause infections in hospitals are becoming increasingly tolerant to the alcohols used in handwash disinfectants. 

Australian researchers analysed bacterial samples from two different hospitals over a nineteen-year period between 1997 and 2015. They discovered that drug-resistant E. faecium infections had increased, in spite of  using  alcohol based disenfectants. This led  the research team to investigate if E. faecium could be developing resistance to the alcohols used in hand rubs (Source: Nursing Times).

Rotherham NHS staff can request this article here 

 

Pre-hospital care in stroke: A technological revolution

Donnan, G & Davis, S. | 2018| Pre-hospital care in stroke: A technological revolution |International Journal of Stroke|Vol. 13| Issue 6| P. 549 – 549|First PublishedAugust 3, 2018| https://doi.org/10.1177/1747493018790684

A new editorial in the International Journal of Stroke focuses on pre-hospital care in stroke, in particular the  introduction of numerous mobile stroke units (MSUs), and the advantages of being able to treat more patients within the first “golden hour” post stroke onset.

The editorial can be read at the International Journal of Stroke

 

Of interest: Remote ischaemic conditioning for preventing and treating ischaemic stroke

Open consultation: Statutory scheme to control costs of branded health service medicines

Department of Health and Social Care | August 2018|Open consultation: Statutory scheme to control costs of branded health service medicines

 This consultation seeks views on proposed changes to the statutory scheme to control the costs of branded health medicines. It is open until 11.59pm on 18 September 2018

Consultation description

The government is consulting on proposed changes to legislation to ensure that the overall growth of branded medicines sales made to the NHS by pharmaceutical manufacturers in the statutory medicines pricing scheme remains at a sustainable level.

The consultation seeks views on:

• the methodology for forecasting expected future branded medicines growth
• proposed changes to the method of calculating a payment percentage, based on allowed growth rates
• minor technical changes to the products in scope of paymentFull details are available from  Department of Health and Social Care

Documents:

Proposed changes to the statutory scheme to control the costs of branded health service medicines: consultation document  

2018 Statutory Scheme – Branded Medicines Pricing: impact assessment 

 

Adding emollients to the bath unlikely to help children with eczema

NIHR Signal| August 2018 | Adding emollients to the bath unlikely to help children with eczema|10.3310/signal-000629

A year-long trial that studied 482 children with mild eczema, the trial included few cases of severe eczema,  has found that adding emollients to bathwater has little impact on the quality of life. The randomized controlled trial compared the impact of  adding bath emollients in addition to usual care with usual care alone. They found little change in skin-related outcomes or quality of life between those that did or did not have emollients poured into their bath (Source: NIHR).

Objectives

To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children.

Design Pragmatic randomised open label superiority trial with two parallel groups. Setting 96 general practices in Wales and western and southern England. Participants 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded.

Interventions Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants.

Main outcome measures The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed.

Results 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls, 84% were of white ethnicity, and the mean age was 5 years. 96%  of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% completed questionnaires for more than 80% of the time points for the primary outcome. The mean baseline POEM score was 9.5  in the bath additives group and 10.1  in the no bath additives group. The mean POEM score over the 16 week period was 7.5  in the bath additives group and 8.4 in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group, below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects.

Conclusions This trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes.

 

Full reference: Santer M, Ridd MJ, Francis NA, et al. | 2018|  Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness |BMJ|361:k1332

The study is published in the BMJ, it can be accessed via Athens