Computerised speech and language therapy can help people with aphasia find words following a stroke

BMJ (2020).Computerised speech and language therapy can help people with aphasia find words following a stroke. BMJ 368. m520 doi: https://doi.org/10.1136/bmj.m520

Aphasia is when a person has difficulty with their language or speech, and is usually caused by damage to the left side of the brain, most commonly after a stroke. Around 110 000 people in England have a stroke each year. About a third of survivors will have aphasia. Between 30% and 43% of those affected have symptoms in the long term.

Most people make some improvement with speech and language therapy, and some people recover fully. However, speech and language therapy is resource intensive and difficult to obtain in the NHS. A new study aimed to assess the clinical and cost effectiveness of self-managed computer speech and language therapy used in addition to usual care.

 

Full article available from The BMJ 

 

The King’s Fund: Delivering health and care for people who sleep rough

The King’s Fund | March 2020 | Delivering health and care for people who sleep rough: going above and beyond 

A recent publication from The King’s Fund forms the findings of a piece of research they were commissioned to produce by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government. The King’s Fund looked at what four nominated areas were doing to improve health outcomes for people sleeping rough repeatedly or on a routine basis and explore what insights they might offer to other areas.

• People who sleep rough have complex and multiple health and care needs that all too often are not met. They have some of the worst health outcomes in England.

• The NHS alone cannot reduce poor health outcomes for people sleeping rough. Tackling rough sleeping involves improving people’s health, social wellbeing and housing situation as well as supporting them to find long-term solutions.

• As part of current government efforts to reduce rough sleeping, there is a focus on improving health care for people sleeping rough. Our research explored how four different local areas are delivering effective health and care services to people sleeping rough and what other areas might be able to learn from them.

The King’s Fund identified five shared principles that the four areas had in common. We think that any area can make progress if it: takes steps to find and engage people sleeping rough; builds and supports its workforce to go above and beyond existing service limitations; prioritises relationships; tailors the local response to people sleeping rough; and uses the full power of commissioning.

The research conducted by researchers at the University of York involved focus groups with individuals with lived experience of homelessness; members of the King’s Fund also interviewed stakeholders including commissioners and health managers, clinicians and managers of housing and adult social care.

Full details are available from The King’s Fund

Delivering health and care for people who sleep rough [summary]

Delivering health and care for people who sleep rough: going above and beyond

5 Ways Research Could Save the NHS Money

NIHR| March 2020| 5 Ways Research Could Save the NHS Money

The NIHR highlight five ways in which research could save the NHS money:

More than 80% of total knee replacements can last for 25 years

Partial knee replacements may save costs compared with total knee replacements

People with COPD exacerbations prefer early discharge then treatment at home

 

A traditional implant is as effective as more expensive newer types for people over 65 having a hip replacement

Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy

Full details of the findings can be read at NIHR

 

Meds are not a ‘free pass’ to start or maintain bad habits

OnMedica | February 2020 | Meds are not a ‘free pass’ to start or maintain bad habits

Healthy lifestyle habits are still vitally important after starting medicines to control blood pressure or cholesterol, doctors have warned in the latest edition of  the Journal of the American Heart Association. The research  shows that people at risk for heart disease and stroke who started taking antihypertensives or statins gained weight and took less exercise than those not on the drugs.

The researchers reported that compared with non-initiators, BMI increased significantly more in people who initiated medication, physical activity declined, and they were significantly more likely to become obese and physically inactive. However, medication initiation was also associated with greater decline in average alcohol consumption and higher odds of quitting smoking (via OnMedica).

Read the full article from the American Heart Association 

Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study

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 

Finding a life-changing treatment for dementia

Alzheimer’s Research UK has called on government to invest in six priority research areas, which will help to deliver a life-changing treatment for dementia

Image source: https://www.alzheimersresearchuk.org/

In their 2019 manifesto, the Conservative party pledged to launch a “Dementia Moonshot” to find a cure for dementia – doubling research funding and speeding up trials for new treatments.

Alzheimer’ Research UK are now calling for action to deliver on those commitments. In this publication, Alzheimer’s UK puts forward the steps government must take to deliver its Moonshot ambition of finding a life-changing treatment for dementia.

 

 

These are:

1. Find ways to detect the diseases that cause dementia 10-15 years earlier, to broaden the search for new treatments and intervene with those most at risk of developing dementia.
2. Find ways to more effectively validate novel targets in early drug development to maximise chances of successful clinical trials.
3. Make the UK the best place to conduct clinical dementia research.
4. Expand research infrastructure to maintain the UK’s position as a world leader in dementia research.
5. Further our understanding of dementia risk reduction and prevention and dementia in the context of multi-morbidities.

Full document: Delivering the Dementia Moonshot: A plan to find life-changing treatments 

Pregnancy research review

This study examines the evidence base on UK pregnancy research needs and priorities and how it compares to the current funding landscape. The report indicates the NHS spends significantly less on pregnancy-related research compared with other health conditions.

Image source: https://www.rand.org/

 

Funding for pregnancy research totalled £255 million from 2013 to 2017, or about £51 million a year. As pregnancy care costs the NHS £5.8 billion annually, this means that for every £1 spent on pregnancy care, less than 1 penny is spent on research.

The study found that this investment is much lower than for conditions such as heart disease – 7p for every £1 spent on care – and cancer – 12p for every £1.

 

The report, commissioned by the UK Clinical Research Collaboration, shows that the £255 million spent on pregnancy research accounts for about 2.4 per cent of all direct, non-industry health research.

Key Findings

• £51m per year is invested in pregnancy research in the UK.
• For every £1 spent on pregnancy care in the NHS, around 1p is spent on research.
• Mental health research is the top priority for all stakeholders and is likely underfunded.
• Other priority topics are varied, spanning stillbirth, preterm birth, inequalities, postnatal support, and safety of medications during pregnancy. The level of funding currently provided differs across the topics identified as priorities.

Full document:  Pregnancy research review | The RAND Corporation

Additional link: RAND press release