Preventable deaths and deprivation

These charts show that the risk of preventable deaths is at least three times higher for people living in the most deprived local areas compared to those living in the least deprived | The Health Foundation

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In May 2019 the Office for National Statistics published the latest statistics related to avoidable mortality and socioeconomic inequalities. This explores deaths that are considered avoidable in the presence of timely and effective health care (amendable mortality) or public health interventions (preventable mortality).

The data show that the risk of preventable deaths is at least three times higher for people living in the most deprived 10% of local areas compared to the least deprived 10%.

While the preventable mortality rate has fallen since 2001, its fallen at a faster rate for people living in the least deprived local areas. Between 2001 and 2017 it fell by 36% for the least deprived 10% of areas, but only 25% for the most deprived 10% of areas.

Full detail at The Health Foundation

Virtual reality can improve quality of life for people with dementia

Virtual reality (VR) technology could vastly improve the quality of life for people with dementia by helping to recall past memories, reduce aggression and improve interactions with caregivers, new research has discovered | University of Kent | via ScienceDaily

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Many people with dementia (PWD) residing in long-term care may face barriers in accessing experiences beyond their physical premises; this may be due to location, mobility constraints, legal mental health act restrictions, or offence-related restrictions.

In recent years, there have been research interests towards designing non-pharmacological interventions aiming to improve the Quality of Life (QoL) for PWD within long-term care.

The authors of this study explored the use of Virtual Reality (VR) as a tool to provide 360°-video based experiences for individuals with moderate to severe dementia residing in a locked psychiatric hospital.

The paper discusses the appeal of using VR for PWD, and the observed impact of such interaction. It also presents the design opportunities, pitfalls, and recommendations for future deployment in healthcare services. This paper demonstrates the potential of VR as a virtual alternative to experiences that may be difficult to reach for PWD residing within locked setting.

Full article: Tabbaa, L. et al. |  Bring the Outside In: Providing Accessible Experiences Through VR for People with Dementia in Locked Psychiatric Hospitals | Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, 2019 | DOI: 10.1145/3290605.3300466

See also: VR can improve quality of life for people with dementia | ScienceDaily

Immunotherapy raises risk in peanut allergy

OnMedica | April 2019 | Immunotherapy raises risk in peanut allergy

A systematic review (SR) that reviewed the efficacy and safety of oral immunotherapy versus allergen avoidance or placebo (no oral immunotherapy) for peanut allergy,  has concluded that current oral immunotherapy treatments result in a large increase in anaphylaxis and other allergic reactions, rather than preventing them as intended.

The SR included 12 studies randomised controlled trials from the USA, UK, Europe and Australia  with more than 1,000 patients who were followed for a year  compared with allergen avoidance or placebo, current oral immunotherapy increases risk.

The authors writing in The Lancet, say that their findings favour avoidance over current forms of oral immunotherapy if a patient wishes to avoid peanut-induced anaphylaxis and allergic reactions, and that the increased risk of reactions associated with these regimens might be a substantial barrier to widespread adoption by patients with peanut allergies.

They say their findings highlight the gap between outcomes measured in the clinic and the allergy relief outcomes that patients desire after oral immunotherapy for peanut allergy (via OnMedica)

Read the full news story at OnMedica

Summary

Background

Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear. We systematically reviewed the efficacy and safety of oral immunotherapy versus allergen avoidance or placebo (no oral immunotherapy) for peanut allergy.

Methods

In the Peanut Allergen immunotherapy, Clarifying the Evidence (PACE) systematic review and meta-analysis, we searched MEDLINE, EMBASE, Cochrane Controlled Register of Trials, Latin American & Caribbean Health Sciences Literature, China National Knowledge Infrastructure, WHO’s Clinical Trials Registry Platform, US Food and Drug Administration, and European Medicines Agency databases from inception to Dec 6, 2018, for randomised controlled trials comparing oral immunotherapy versus no oral immunotherapy for peanut allergy, without language restrictions. We screened studies, extracted data, and assessed risk of bias independently in duplicate. Main outcomes included anaphylaxis, allergic or adverse reactions, epinephrine use, and quality of life, meta-analysed by random effects. We assessed certainty (quality) of evidence by the GRADE approach. This study is registered with PROSPERO, number CRD42019117930.

Results

12 trials (n=1041; median age across trials 8·7 years [IQR 5·9–11·2]) showed that oral immunotherapy versus no oral immunotherapy increased anaphylaxis risk, anaphylaxis frequency, and epinephrine use similarly during build-up and maintenance . Oral immunotherapy increased serious adverse events, and non-anaphylactic reactions , I 2=0%, high-certainty; upper tract respiratory reactions: 1·36, I 2=0%, moderate-certainty; lower tract respiratory reactions: 1·55, I 2=28%, moderate-certainty). Passing a supervised challenge, a surrogate for preventing out-of-clinic reactions, was more likely with oral immunotherapy. Quality of life was not different between groups (combined parents and self report. Findings were robust to IRR, trial sequential, subgroup, and sensitivity analyses.

Interpretation

In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed.

Funding

None.

NICE launches online resource to help development and adoption of new health technologies

NICE |  April 2019 | NICE launches online resource to help development and adoption of new health technologies

NICE has launched a new tool- HealthTech Connect- to help identify and support new technologies from inception to adoption in the UK health and care system.

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HealthTech Connect is for health technologies (medical devices and diagnostic and digital health technologies)that:

  • offer measurable benefits to patients (or other health and care service users) compared to those already offered by current routine practice in the UK, or
  • provide measurable benefits to the UK health and care system compared to those already offered by current routine practice in the UK.

HealthConnect will help the UK health and care system to better plan for the introduction and adoption of health technologies – for example by reconfiguring services or enabling reimbursement (Source: NICE).

NICE launches online resource to help development and adoption of new health technologies [press release]

 

NHS England: Thousands more set to get help as NHS rolls out mental health job coaches

NHS England | April 2019 | Thousands more set to get help as NHS rolls out mental health job coaches

A scheme that provides support to people with mental health conditions to gain employment is to be expanded, announces NHS England. The Individual Placement and Support (IPS) is to be extended to a further 28 areas meaning 80 per cent of England will have access to the programme; i
t is anticipated that by 2023/24, 50000 people will have befitted from the programme. As well as being referred to the IPS through their GP or a mental health professional, patients are also able to self- refer.

 

The scheme provides employment specialists offer coaching and advice, along with practical tips on finding a job and preparing for interviews. They can also search for jobs and engage with employers directly on patient’s behalf to identify well-suited roles – acting as a crucial link between patient, their employer and medical team.

 

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Patients are able to call on the trained specialists who are embedded within health teams, at any time. They work alongside psychologists, mental health nurses and other health professionals and can speak to potential employers about how best to support people so that they can work effectively, while staying in good health (Source: NHS England).

Full details about the scheme are available from NHS England

Introducing asthma guidance in Shropshire schools

NHS England | April 2019 | Introducing asthma guidance in Shropshire schools

School nurses in Shropshire have developed and implemented asthma management guidance to provide support and treatment for school children with asthma. 

At the outset the school nursing team undertook an audit of primary and secondary children across Shropshire. Responses demonstrated that:

  • 10% of pupils with asthma had an asthma care plan in place
  • 44% of schools had written guidelines on managing an acute asthma episode
  • 57% of schools had received education and training to support them to manage children with asthma conditions
  • 50% of asthma inhalers kept by schools weren’t appropriate for pupils to use efficiently during an attack

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As a result of this a steering group was established and the group produced guidance on managing asthma in school:

  • Schools should have an identified asthma lead who will act as a key contact and take responsibility in ensuring oversight and coordination of the guidance principles into practice, as well as staff education, training and support;
  • School staff should ensure that children with asthma have their relieving medication with them in school and take steps where this isn’t the case to maximise safety;
  • Children with asthma should have easy access to their relieving medication at all times while in school;
  • Children with asthma should have an individual healthcare plan highlighting their specific triggers and symptoms;
  • School staff should document when children take their medication, self-administered or otherwise; and,
  • School staff should be equipped and trained to manage an acute asthma attack within the school setting. (Source: NHS England)