Recent developments that caught the eye
New scheme will help GPs tackle long-term conditions
The launch follows the publication of a recent report from The King’s Fund (www.kingsfund.org.uk/publications/ supporting-people-manage-their-health), which introduces the concept of patient activation and its potential for application in England.
New tool set to improve dementia care
Survey suggests sub-optimal HMB management
Results from the survey, conducted by Opinion Health, show that as many as seven in 10 GPs are either unaware that the guidelines exist, or are unfamiliar with the details.
HMB affects one in five women of reproductive age. For women who are suitable for either hormonal or non-hormonal interventions, the recommended first-line treatment for HMB is the levonorgestrel-releasing intrauterine system (LNG-IUS 20 mcg/ day). However, the survey found that only 3% of GPs routinely prescribe the LNG- IUS as a first-line treatment. The most
NHS warns against pre- heated birthing pools
Child ’ﬂu vaccination pilots show promising results
- From September 2014 the schedule for HPV vaccination, routinely offered to girls aged 12 to 13, will change from three to two doses.
The changes have been prompted by research showing that antibody response to two doses in adolescent girls is as good as a full course in the age group targeted. Girls who have not had their first dose of HPV vaccine by the time they are 15 years old should be offered the three dose schedule, as the antibody response in older girls is not as good.
BMI ‘a ﬂawed tool in children’ The use of body mass index (BMI) to diagnose obesity in children could lead to a significant number of cases to be missed, according to findings from a meta-analysis carried out at the Mayo Clinic,
The researchers found that while BMI has high specificity in identifying paediatric obesity, it has only a moderate sensitivity, so the measurement can miss children who should be considered obese.
The Mayo researchers used 37 eligible studies that involving a total of 53,521 patients aged 4-18 years. The analysis showed that around 25% of children have excess body fat despite a normal BMI.
Dr Asma Javed, the study’s lead author said: “Our research raises the concern that we very well may be missing a large group of children who potentially could be at risk for these diseases as they get older. We hope our results shine a light on this issue for physicians, parents, public health officials and policymakers.”
Survey reveals ﬂaws in mental health services
Previous research has shown that around 75% of people would go first to their GP if they were concerned about their mental health. This latest survey, carried out by the Scottish Association for Mental Health, reveals that a large majority of the 465 respondents call for better resources to manage patients’ needs.
Specifically, the survey found:
- 85 per cent of the doctors believed there was not enough local support for patients tackling mental health- related issues
- 49.9% said they last undertook accredited training on any aspect of mental health more than a year ago
- 11.4% said they had never undertaken accredited training on any aspect of mental health
- 87.3% wanted information guides on local services for referral, including social prescribing opportunities
- 81.6% wanted resources to help people self-manage their conditions.
http://www.samh.org.uk/mental- health-information/know-where-to-go/ read-our-reports.aspx
New evidence triggers cautious advice to soak up sun
Following new figures showing vitamin D deficiency in 23% of the adult population, the National Osteoporosis Society is emphasising the benefits of the seasonal sunshine.
Recent guidance from NICE’s Centre for Public Health warns that one in five adults is vitamin D deficient. This is supported by new data from the National Diet and Nutrition Survey (NDNS) highlighting evidence of an increased risk of vitamin D deficiency in both adults and children.
Claire Severgnini, Chief Executive, for the Society said: “The Sunlight Campaign is all about raising awareness of vitamin D and its importance for bone health. We want to give clear advice about how to achieve this natural health boost safely so that people can be confident about going outdoors and getting the sun exposure they need without burning and damaging their skin.”
The Society advises that baring arms and legs to the sun, without sunscreen, for just 10 minutes, once or twice a day between 11am and 3pm is enough for most people to top up vitamin D levels to last through the winter. It also emphasises the importance of avoiding sunburn.
For people unable to get enough sun, as well as infants and young children aged six months to five years, pregnant and breastfeeding women and people over 65 years, Public Health England recommends a daily vitamin D supplement to prevent deficiency.
Findings suggest need for pertussis booster A new study suggests that protection afforded by the childhood whooping cough vaccine may diminish over time, leaving vaccinated older children vulnerable to infection from the pertussis bacterium.
The study, carried out by researchers from the University of Oxford, the Respiratory and Vaccine Preventable Bacteria Reference Unit in London and Public Health England, involved 300 children who had visited their GP with a persistent cough. Researchers found that 20% of these young patients had evidence of a recent pertussis infection. Of particular concern was the fact that the majority of these children had already been fully vaccinated.
The findings, published in the British Medical Journal, have led to calls for teenagers to be given a booster of the pertussis vaccine. UK children are vaccinated against the disease at two, three and four months of age, with a further “booster” vaccine given before they start school.
There were over 4,500 reported cases of pertussis in England and Wales in 2013. If, as the study suggests, the vaccine does wear off in time, the infection could be passed on from teens to young babies. Babies who are too young to start their vaccinations are at greatest risk.
The study authors recommend that the Joint Committee on Vaccination and Immunisation should conduct further investigations into whether a booster shot during the teenage years would be cost-effective.
Allergy admissions up
Admissions for allergies in NHS hospitals in England have risen by almost 8% within one year, according to new figures from the Health and Social Care Information Centre (HSCIC).
In the 12 months to February 2014, there were 20,320 admissions for allergies, compared with 18,860 for the previous 12 months – an increase of 7.7%. Of these, 68% were emergencies, a rise of just over 6% on the same period last year. The increase was particularly sharp in the case of admission for allergic rhinitis, which rose by over 12%.
- Nice updates AF advice
AF affects around 800,000 people in the UK – including around one in 10 people over 65 – but it is thought that around 250,000 others may be undiagnosed. It is also more common in people with other heart conditions such as hypertension or atherosclerosis.
Since 2012 a number of novel oral anticoagulants, which offer advantages over warfarin, have been approved by NICE, but there is evidence that these drugs are not being as widely prescribed as they could, the guidance states.
Aspects covered by the new guidance include:
- Outlining how each patient should have a clear management plan which takes into account their personal preferences and the clinician’s view
- Details of previous positive appraisals by NICE of the newer anticoagulants: apixaban, dabigatran and rivaroxaban, positioning them clearly to enable the GP to support patients in their choice of preventive medication
- The role and best use of various therapies in the management of AF, including drug therapy, cardioversion and ablation (radiofrequency pulses to destroy the area of the heart causing the arrhythmia)
- Advice on referral to specialist AF services, where symptoms have failed to respond to treatment.
- New guidance highlights weight management programmes
The number of people who are overweight or obese in England is rising. More than a quarter of adults are now classified as obese and a further 42% of men and a third of women are overweight.
Carol Weir, head of service for nutrition and dietetics at Leeds Community Healthcare NHS Trust and NICE guidance developer, said: “We need to focus on more than just diet and being more active. Using tools such as weight monitoring and setting realistic personal goals are really important.”
- The new guidance recommends that health professionals should:
- Be aware of the effort needed to lose weight, prevent weight regain or avoid any further weight gain
- Recognise the stigma adults who are overweight or obese may experience, and ensure the tone and content of all communications is respectful and non- judgemental
- Discuss the importance and benefits of making gradual, long-term changes to dietary habits and physical activity levels
- Explain the more weight lost, the greater the health benefits Refer overweight and obese adults to a lifestyle weight management programme, explaining what the programme does and does not involve, agreeing realistic goals and emphasising that no programme is a “quick fix” that can guarantee long-term success.
- Interim guidelines clarify rights of mental health patients
Since April this year, patients with mental health conditions have had the same rights as physical health patients to choose where they have their first outpatient appointment. With the help of their GP, patients can now choose to be referred to any appropriate clinical provider in the country with whom the clinical commissioning group has a contract.
- Issue covered by the guidance include:
- Determining what is “clinically appropriate” for each eligible patient
- Using Choose and Book to make referrals to mental health services
- Information on Clinical Assessment Services
- How to respond to any significant changes in where patients are referred to when patients make their choices
- Clarity on pricing and paying for mental health services.
http://www.england.nhs.uk/wp- content/uploads/2014/05/guid-choice- prov-health.pdf
- NICE supports VTE prevention device