Free Coronavirus research

In response to the outbreak in China, the publishing company Wiley is providing free access to all their articles related to coronavirus.

lab-3498585_1920

Access to medical and scientific articles includes research from the Journal of Medical Virology, Transboundary and Emerging Diseases, Zoonoses and Public Health and many more. As new articles are published, they will be made free to access, and added to this centralized resource of coronavirus research.

These important pieces of literature will remain open until April 2020 and the window of time will be extended as needed.

Full detail: Coronavirus research from Wiley

See also:

Evaluating digital health products

Resources to help anyone developing or running a digital health product to conduct an evaluation | Public Health England

data-2899901_1920

Digital health products can take different forms – for example, a service, campaign or other intervention. They might be provided through an app or website.

These resources can help with evaluations for all digital health products. They aim to help demonstrate what impact a product has and how the costs compare to the benefits. They can provide information about how to make services better, including what works and what doesn’t. They can also help demonstrate the value of a product to commissioners.

These resources will help you to evaluate digital health products or services. Follow them in order for an overview of the whole evaluation process.

Virtual clinics

This website includes a range of resources aimed at supporting colleagues / partners in the planning and implementation of non face-to-face models of care | UCL Partners

This guide, developed in collaboration with NHS clinicians, managers and patients, provides a comprehensive guide to setting up non-face-to-face clinics (also known as virtual clinics).

These can help reduce unnecessary outpatient visits, saving time and money for patients and the health service.

The NHS aims to avoid up to a third of the number of face-to-face outpatient visits over five years, removing the need for up to 30 million outpatient appointments each year.

The guide is free to use, delivered through both text and videos and includes how to develop a project plan and business case.

 

Sheffield research: Improvements in care could save the lives of more acute bowel obstruction patients

University of Sheffield | January 2020 | Improvements in care could save the lives of more acute bowel obstruction patients

Matt Lee, an NIHR Clinical Lecturer in General Surgery at the University of Sheffield Medical School, led a National Audit of Small Bowel Obstruction in 2017. 

The study identified the key causes of delays to treatment, finding that in a little over a fifth of cases, there was a delay in providing a CT scan of the patient. In these cases, 61 per cent of patients were then subsequently delayed in being diagnosed.

This compared to just six per cent if there was no delay in diagnostic imaging. Following diagnosis, around 20 per cent of patients saw a delay to their surgery, which in all cases was either due to an operating theatre not being available, or there being no anaesthetist.

Delay in Transit, published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), reviewed 686 cases of patients aged 16 and over, in an attempt to improve the high mortality rates for the condition which are currently at around 10 per cent in cases where surgery is needed.

Lee said: “There are over 22,000 admissions for bowel obstruction in England and Wales each year, of whom 6.4 per cent will die within 90 days.

  • A study by the National Confidential Enquiry into Patient Outcome and Death has discovered “significant opportunities” to improve patient care for those with acute bowel obstruction
  • Around 6.4 per cent of patients admitted each year die within 90 days
  • The report identified recurring delays at every stage of the treatment process
  • It also found room for improvement in post discharge care
  • A new report has shared recommendations to improve the chance of survival for patients with acute bowel obstruction.

There was also found to be room for improvement in clinical care, with only 55 per cent of patients being subject to an “adequate” risk assessment, and only 38 per cent having a nutrition assessment when they were discharged.
Delay in Transit makes a series of 11 new recommendations for caring for those with acute bowel obstruction, including:

  • Undertaking a CT scan with intravenous contrast promptly to ensure timely diagnosis.
  • Undertaking a consultant review in all patients with acute bowel obstruction as soon as clinically indicated, and within 14 hours of admission at the latest
  • Measure and document the hydration status of those presenting with symptoms of acute bowel obstruction to minimise the risk of acute kidney injury
  • Ensure local policies are in place for the escalation of patients requiring surgery to enable rapid access to an operating theatre.
  • Minimise delays to diagnosis and treatment by auditing the time taken between each step in the patients’ treatment (Source: University of Sheffield)

Full news release here 

Impact of a national quality improvement programme for hospital wards is unclear

NIHR  | January 2020 | Impact of a national quality improvement programme for hospital wards is unclear

An NIHR-funded study evaluates a QI programme developed by the NHS Institute for Innovation and Improvement (NHSI) and introduced in 2007  ‘The Productive Ward: Releasing time to careTM’. This programme  was designed to improve efficiency, productivity and performance at ward level in acute hospitals.

It was based on three principles:

  • good ward organisation so that materials were readily accessible
  • displaying ward-level metrics such as patient safety and experience
  • use of visual aids to understand patient status at a glance.

 

While the QI initiative has shown some procedural changes on hospital wards in England in the 10 years since it was introduced. But evidence to show any sustained changes to the experiences of staff or patients is hard to find.

heart-214011_640

This study used quantitative and qualitative methods to evaluate the programme in six acute hospitals in England. It found some evidence of a lasting impact, such as wards continuing to display metrics and using equipment storage systems. But most hospitals that adopted the programme had stopped using it after three years, often due to a change in their approach to quality improvement.

Productive Ward resources are still available from NHS England’s Sustainable Improvement team, but are under review. This evaluation may be helpful in designing future similar schemes.

 

“The long-term sustainability of quality improvement programmes is rarely studied. This programme aimed to help ward staff run their hospital wards more efficiently and give them more time for patient care.

It found that the programme appeared to work best when all levels of ward staff were involved in generating ideas and carrying out the improvements. Good communication with central services, like catering and supplies, was also important.

Where staff had been given a real understanding of the underlying principles of quality improvement they were able to build on their earlier work over time, as new challenges and possibilities arose.

Dr Sophie Sarre, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London

Read the full, unabridged NIHR Signal here 

BMJ: CT screening in former or current smokers can significantly reduce mortality by almost a quarter

Mayor, S. |2020| Lung cancer: CT screening in former or current smokers significantly reduces mortality, study finds| BMJ  |368 |doi: https://doi.org/10.1136/bmj.m347

The findings of a large randomised controlled trial, now published in the NEJM, demonstrate that regular computed tomographic (CT) screening in current and former smokers reduces lung cancer mortality by around a quarter at 10 years.

bethesda-naval-medical-center-80380_640

The NELSON study included more than 13 000 men and 2 500 women aged between 50 and 74 from the Netherlands and Belgium. All of the subjects were current or former smokers, with a median smoking history of 38.0 pack years (interquartile range 29.7 pack years to 49.5 pack years) among male participants. Less than half  (44.9%) of the men in the study were former smokers.

Results showed that deaths from lung cancer were nearly a quarter (24%)  lower after 10 years of follow-up in men undergoing regular CT screening than in those not screened. Lung cancer deaths decreased from 3.3 deaths per 1000 person years in the control group to 2.5 deaths per 1000 person years in men who were screened (Source: Mayor, 2020).

Abstract

BACKGROUND

There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.

METHODS

A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.

RESULTS

Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.

CONCLUSIONS

In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580. opens in new tab.)

Interested in this study? Ask the Library & Knowledge Service to provide you with a copy here

 

The state of children’s mental health services

Children’s Commissioner | January 2020| The state of children’s mental health services

The third annual report on mental health report from the Children’s Commissioner, Anne Longfield, said that, despite years of government commitments, the publication says an extra £50 million was spent on specialist mental health services for children in 2018/19. Although 53,000 more young people started treatment, the report says many are still not getting the help that they need. NHS spending on children’s mental health continued to lag behind spending on services for adults, leaving substantial unmet need. On average, the NHS spends £225  on mental health for every adult but only £92 for every child.

girl-1026246_640

BMJ Child mental health: improvements are too slow, says report

BBC News Children ‘end up in care and custody’ over mental health

[Report] Children’s Commissioner The state of children’s mental health services

NIHR: Online patient feedback is mostly positive — but is not being used effectively

NIHR| January 2020 | Online patient feedback is mostly positive — but is not being used effectively

A mixed-methods study funded by the NIHR used five research streams to provide an overview of online patient feedback in the NHS.  The NIHR signal of the study underlines some highlights some key areas for improvement for organisations identified in the study  to help them make better use of online patient feedback. Importantly, the study suggests that managers could usefully review the infrastructure and processes for responding to feedback if they have not already done so (Source: NIHR).
experience-3239623_640.jpg

 

 

 

 

“Many clinicians may be surprised by the finding that the main motivation for patients who provide online feedback is to support the healthcare service, through either praise or a desire to help the service improve. What is less surprising is that, overall, healthcare providers lack the appropriate infrastructure to make good use of this feedback.

The findings of this study suggest that healthcare organisations could benefit from judicious engagement with online feedback, using it as one tool among many in a cycle of continuous quality improvement.  Elizabeth Murray, GP, Professor of eHealth and Primary Care, Co-Director of the eHealth Unit and Head of the Research Department of Primary Care and Population Health, University College London

Background: Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care. Objectives: To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts.
Design: A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations.

Setting: The UK.
Methods: We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site.

Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible).

Limitations: This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites. Conclusions: Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patients.
Future work: Intervention studies could measure online feedback as an intervention for service improvement and longitudinal studies could examine use over time, including unanticipated consequences. Content analyses could look for new knowledge on specific tests or treatments. Methodological work is needed to identify the best approaches to analysing feedback.
Full text of this article is available from the NIHR Journals Library 
Full Signal available from NIHR 

Yorkshire patients needed for irritable bowel syndrome trial

University of Leeds | January 2020| Yorkshire patients needed for irritable bowel syndrome trial

Researchers from the University of Leeds are recruiting participants to join a trial of  low-does Amitriptyline (a tricyclic antidepressant) for irritable bowel syndrome (IBS). 

abdominal-pain-2821941_640.jpg

 

 

IBS is a common gut disorder affecting one in ten people. Abdominal pain, bloating, and altered bowel habit affect patients’ quality of life substantially, and can force them to take days off work.

Low-dose amitriptyline is recommended as a treatment option for people who have persistent, troublesome IBS symptoms. It is thought to work at low doses in IBS because it has pain-relieving properties and changes bowel activity. However, there have been no large studies done in primary care to test whether or not it works (Source: University of Leeds).

Full details from University of Leeds

BBC News IBS trial to test amitriptyline as potential common treatment

 

 

Results of long-term study could help identify children at risk of future type 2 diabetes

University of Plymouth| January 2020 | Results of long-term study could help identify children at risk of future type 2 diabetes

University of Plymouth & Nestle researchers have identified biological and physiological factors which lead to the development of type 2 diabetes in adults. 

The EarlyBird cohort study followed 300 healthy children in Plymouth,  for 15 years to determine who would become at risk of developing type 2 diabetes, and why. The findings have been published in the journal Diabetes Care 

people-brasil-guys-avpaulista-109919

Jon Pinkney, Professor of Endocrinology and Diabetes in the University of Plymouth’s Peninsula Medical School and Honorary Consultant Physician in Endocrinology and Diabetes at University Hospitals Plymouth NHS Trust said:

“The rapidly rising prevalence of type 2 diabetes is one of the biggest global health challenges, and there is an urgent need to develop effective strategies for early intervention and prevention.

“The research partnership between University of Plymouth and Nestlé has shown how the risks of future type 2 diabetes can be predicted in childhood. This opens up the possibility of individualised advice and early intervention to reduce the risks of future type 2 diabetes.” (Source: University of Plymouth)

The press release from University of Plymouth also provides more information on the EarlyBird study, available here 

The abstract is available from Diabetes Care but for the full contact the Library & Knowledge Service 

University of Plymouth Results of long-term study could help identify children at risk of future type 2 diabetes

Related:

Diabetes.co.uk Genetic link to identify children at risk of type 2 diabetes