South Bristol Community Hospital

Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF-12, the disease-specific KDQOL™-36 and EQ-5D-5L to be able to derive quality-adjusted life years), but further work was felt to be needed before recommending PREMs. Routinely collecting PROMs and PREMs in renal registries is important if we are to better understand what matters to patients but it is likely to be challenging; close international collaboration will be beneficial.

OBJECTIVE: To pilot an investigation of individualized homeopathy for symptoms of estrogen withdrawal in breast cancer survivors. DESIGN: Randomized, double-blinded, placebo-controlled trial. SETTING: Outpatient department of a National Health Service (NHS) homeopathic hospital. PARTICIPANTS: Fifty-seven (57) women met inclusion criteria and 53 were randomized to the study. INTERVENTION: After 2 weeks of baseline assessment, all participants received a consultation plus either oral homeopathic medicine or placebo, assessed every 4 weeks for 16 weeks. OUTCOME MEASURES: The primary outcome measures were the activity score and profile score of the Measure Yourself Medical Outcome Profile (MYMOP). RESULTS: Eighty-five percent (85%) (45/53) of women completed the study. There was no evidence of a difference seen between groups for either activity (adjusted difference =-0.4, 95% confidence interval CI -1.0 to 0.2, p = 0.17) or profile scores (adjusted difference = -0.4, 95% CI -0.9 to 0.1, p = 0.13) using this trial design, although post hoc power calculations suggests that 65-175 would be needed per group to detect differences of this magnitude with sufficient precision. Clinically relevant improvements in symptoms and mood disturbance were seen for both groups over the study period. CONCLUSION: Improvements were seen for symptom scores over the study period. However, presuming these improvements were caused by the individualized homeopathic approach, the study failed to show clearly that the specific effect of the remedy added further to the nonspecific effects of the consultation. Future trial design must ensure adequate power to account for the nonspecific impact of such complex individualized interventions while pragmatic designs may more readily answer questions of clinical and cost effectiveness.

OBJECTIVE: There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. DESIGN: A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. RESULTS: 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection. CONCLUSION: Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointestinal tract malignancy, and previous research showing higher-than-expected gastrointestinal tract malignancy in institutionalized adults with intellectual disability (ID) prompted a review of all deaths as a result of cancer in the Stoke Park group of hospitals for people with ID between 1946 and 1996. A 50-year, retrospective case note analysis of all deaths from cancer in an institution for people with ID was undertaken. Death from stomach cancer accounted for up to 48% of all cancer deaths. A further 25 residents had died of perforated stomach ulcers. The higher proportion of deaths specifically caused by stomach cancer in a population with ID has not been noted previously. It is postulated that the high levels of H. pylori infection found in institutionalized populations may be instrumental in this higher mortality rate and that the closure of the institutions without evaluation of H. pylori status transfers the problem unresolved to the community. Existing guidelines for the screening and eradication of H. pylori developed for the general population are inadequate when applied to people with ID, and therefore, the value of population screening and mass eradication programmes is explored.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease with typical onset between the ages of 40 and 50 years. Increasing levels of physical activity (PA) have been shown to decrease inflammation, reduce pain, increase functional ability and improve self-esteem in people with RA. Health behaviour change (HBC) interventions have recently shown promise in facilitating the promotion of PA within a range of long-term conditions. There is currently no evidence synthesis relating to HBC interventions to increase PA in the RA population. OBJECTIVES: The aim of the present study was to determine whether HBC interventions can increase PA in people with RA and identify optimal interventions or promising constituent components of the HBC interventions. METHODS: A systematic literature search was conducted to identify randomized, controlled trials investigating the effect of HBC interventions on PA level in adults with RA. Four review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria. RESULTS: Following the application of inclusion/exclusion criteria, three studies remained for inclusion. Two studies reported significant short-term (<9 months) beneficial effects of HBC upon PA (p < 0.05). Individualized interventions were significantly more effective (p < 0.05). CONCLUSIONS: Due to methodological flaws and a lack of comparison with usual care, it is not possible to conclude whether HBC interventions can increase PA in the RA population. Although it is possible to highlight promising elements of HBC interventions, such as goal setting and feedback on performance, further research on all specific components, including information provision, behaviour contracts and problem solving, is required to establish conclusive clinical guidelines.

Assessment of vision in schoolchildren is routinely performed, but the effectiveness of the screening programmes has not been reviewed. A survey of health district screening programmes for vision in schools was performed at the end of 1984. The response rate from districts in England and Wales was 81%. All 165 of the districts that responded screened for loss of distant visual acuity; 96% screened for loss of colour vision, 73% for squint, and 67% for loss of near visual acuity. The frequency with which districts screened varied considerably. Some districts screened yearly, and various different types of tests were used. In many districts children were screened in unsuitable places, such as corridors, assembly halls, and toilets. Criteria for referral varied from one district to another, and few districts collected data appropriate for monitoring their screening programmes. Many districts screened more intensively than could be justified on the basis of the conditions tested for and the likely benefit of remedial treatment.

For the majority of patients with end-stage kidney failure (ESKF) replacement of excretory renal function by dialysis or transplantation (RRT) can extend life and alleviate symptoms. Historically, the availability of RRT has been insufficient and this remains the case for much of the world. However, RRT is now widely available in healthcare systems of higher income countries. Increasing numbers of elderly patients are developing ESKF. RRT in this population is largely by dialysis, comorbidity is high and life expectancy short. Evidence of effectiveness coupled with the burden of treatment among these individuals has raised concerns that health services in high-income countries may have moved from an era of unmet need into one of potential over-treatment. Alongside the requirement to make treatment more patient-centered, this has driven the development of comprehensive conservative care as an alternative approach for older comorbid individuals with ESKF, with the potential for acceptable symptom control and reduced treatment burden. This paper provides a largely UK-perspective on treating ESKF without RRT. Emphasis is on the need for high-quality evidence to inform treatment decisions. Complexities of defining, delivering and improving treatment of ESKF without dialysis care are explored. Quantitative and qualitative evidence are summarized and the relationship with palliative and terminal care examined. A framework is suggested for classifying management of ESKF and recommendations made to improve delivery of nondialysis care in the future. For patients with a poor prognosis, such treatment may not result in significantly different survival or quality of life when compared with dialysis. There is a key need to generate the best possible evidence of person-centered health outcomes associated with the various treatment options for ESKF and to present this to patients in a balanced, personalized way that allows them to make the treatment decision most appropriate for them.

This article defines shared decision making in patient care and describes the background to this philosophy. The shared decision making approach is part of a wider initiative to promote patient-centred care and increase patient involvement in clinical decisions. Shared decision making recognises patients' rights to make decisions about their care and is used to assist them to make informed and individualised decisions about care and treatment. As well as reviewing the principles of shared decision making, the article offers practical guidance on how nurses can implement this initiative, including information on sharing expertise, agenda setting, assessing risks and benefits, setting goals, and support and follow up.

This paper considers the role of collective forms of day care for older people and their carers during the enforced closure of services in 2020 due to COVID‐19. The study provides a unique opportunity to examine how the sector adapted to these unprecedented times. The paper draws on qualitative data collected from 8 case studies conducted in England, during which 120 interviews were held with older people, their carers, staff, and managers of services and local stakeholders. The findings demonstrate how day centres reimagined their services to meet the needs of older people and their carers in new and imaginative ways. They offer insights into the potential role day care centres could play in the new place‐based partnerships envisaged in recent legislation. The study provides an opportunity to consider the importance of day care services in the light of their enforced closure, providing a more nuanced understanding of day care provision. The impact of COVID‐19 on the social care sector meant that many day care centres were not fully operational and consequently the samples may not reflect the experiences of all centres.

BACKGROUND: A Lycra arm sleeve has the potential to reduce glenohumeral subluxation (GHS) in people with stroke (PwS). Aims were (1) to provide feasibility data to inform a future fully powered randomized controlled trial, (2) to understand whether patients would be willing to be randomized, (3) to measure changes in GHS at 3 months after wearing the sleeve when compared to not wearing the sleeve. METHOD: PwS ≥18 years with ≤3/5 shoulder abduction strength and able to give informed consent were recruited. The feasibility data on recruitment, screening, and retention rate at 12 weeks were collected. Participants were asked if they would be happy to be randomized into one of the two groups. The immediate group received the Lycra sleeve on recruitment and wore for up to 10 hours/day for 3 months. The delayed group received the sleeve after follow-up assessment at 3 months. GHS was assessed using diagnostic ultrasound method. RESULTS: Over one year, 257 patients were screened, 34 patients were eligible, and 31 (91%) were recruited. Retention at 3 months was 27 (87%). Of those eligible, all found randomization to be acceptable. In the immediate group, GHS showed reduction from 2.6 ± 0.7 cm (95% CI 2.0-3.1 cm) at baseline to 2.2 ± 0.4 cm (CI 2.0-2.5 cm) at 12 weeks. In the delayed group, mean GHS remained unchanged over 3 months period (2.3 ± 0.5 cm, CI 1.9-2.7 cm). CONCLUSION: Recruitment was harder than anticipated, but there was high retention demonstrating feasible methodology. There is some indication of a clinical effect of Lycra sleeve on GHS early after stroke.

Context: There is a view in England that collective forms of day care for older adults are &lsquo;out-dated&rsquo;. However, recent studies in the UK and internationally suggest that these services have the potential to address contemporary policy aspirations. Objective(s): This paper reports findings from a study that explored the role of collective day care in England in order to consider a reimagining of services. Method(s): The paper draws on qualitative data collected from 8 case-studies in which 120 interviews were held with older people, their carers, staff and managers of services and local stakeholders. Interviews with managers included questions about the costs and resources used in running services. The reimagined models of care were refined in workshops with research partners. Findings: Analysis of the data revealed three themes underpinning day care provision: the importance of space, place and transport; inclusive and person-centred practice; and the need for purposeful activities. Three models of reimagined day care were developed: 1) small scale collective care for low to moderate needs, 2) larger scale preventative and social provision and, 3) collective care for people with complex and personal care needs. Limitations: Recruitment of sites began after Covid-19 restrictions were lifted in 2021, some sites had not reopened or declined to take part, consequently the study may not reflect the full range of day care services that exist. Implications: The findings illustrate the potential of different models of collective day care services to work together as part of an ecosystem that addresses contemporary policy aspirations.

There is a widespread view amongst policy makers, as well as some senior managers and commissioners in local authorities, that collective forms of day care for older people are outdated and not aligned with wider policy ambitions. However, there is also growing recognition, amongst advocacy organisations such as Carers UK and Age UK, that many older people and their caregivers would welcome the opportunity to attend collective day care services, as well as growing interest amongst providers of services and older people themselves about the need to transform provision. As health and social care commissioners in England develop Integrated Care Systems, there is potential for reimagined day care for older people to play an important role in delivering person-centred, preventative and place-based care for older people and their caregivers, including enabling older people to live at home for longer as well as addressing wellbeing, loneliness and social isolation. The presentation will outline findings from case studies visited as part of a National Institute for Health Research, School for Social Care Research study exploring the experiences of and aspirations for collective day care in England, from the perspectives of older people, their carers, those who work in or manage services, as well as local stakeholders from the health and care system. For this research, day care is defined as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs. Case studies visited included a range of models of day care for older people including day centres for people living with dementia, small-scale day care based in a hosts home, to large-scale preventative provision for older people. The study explored: peoples experiences of attending; impact on wellbeing and health of older people and their caregivers; what an ideal model of day care would look like; experiences of day care through the COVID-19 pandemic; and relationships with local health and community partners. Our findings highlight the role day care can play in providing opportunities for connection and friendship for older people who attend, supporting caregivers to sustain their caring role, and supporting physical and mental wellbeing and health of older people and their caregivers. Highlighting the importance of personal connections, joy and purposeful activity, design of the physical space and connections with local place, the presentation will discuss innovations in practice that may support a ‘reimagining of day care’, ensuring it meets the aspirations of older people and their caregivers, as well as supporting wider policy ambitions including how social care services can contribute to the wider preventative health agenda.