NHFT Libraries Health News: 05/18/12

Friday, 18 May 2012

Alliance aims to deal with dementia

Alliance aims to deal with dementia:
GROUPS and organisations are set to come together to try and improve life for thousands of people living with dementia in Northamptonshire. Evening Telegraph

Digital service launched for new parents

Digital service launched for new parents:
The NHS Information Service for Parents, launched today by the Prime Minister, will give new parents information and advice they can trust covering a wide range of issues related to staying healthy in pregnancy, preparing for birth and looking after their baby.
By signing up to the service, parents-to-be and new parents will receive regular emails and text messages containing relevant and timely NHS approved advice as their pregnancy develops and as their child grows.
Links to videos showing midwives demonstrating practical advice such as bathing your baby, and parents discussing issues that affected them and how they supported each other, will also be sent at appropriate times.
The care and attention a child receives when young will affect their health, behaviour and ability to learn throughout their lives. A recent survey suggests that 85% of parents want more practical help on caring for their baby to provide the best possible start for their children.
Parents will be invited to sign up to the new service at booking appointments with midwives, and organisations where parents already go for advice and support will have the option of including a sign-up facility directly on their own websites.
Prime Minister David Cameron said:

“Parents are nation-builders. It’s through love and sheer hard work that we raise the next generation with the right values. That’s why this government is doing everything possible to support parents.
“We’re focused on making life easier for parents day-to-day, from extending childcare to increasing the number of health visitors. The parenting classes and films we’re launching this week are an important part of that, providing clear, professionally-led advice on everything from teething to tantrums.”

Health Secretary Andrew Lansley said:

“We all want to give our children the best start in life. But sometimes, particularly for first-time parents, bringing a new baby home can be a daunting as well as a happy experience.
“That is why we are determined to help people become more confident in becoming a parent – from pregnancy to the start of their children’s lives.
“From now on, this new information service will be at parents’ sides to support them in the first stage of their child’s journey, guiding them with relevant information and first-hand experience from other parents.”

Visit www.nhs.uk/parents to sign up to the service or to find out more.

Free parenting classes

Free parenting classes are also being made available for all parents of children aged 5 years and under in 3 trial areas:

Middlesbrough
High Peak in Derbyshire
Camden in London

All mothers and fathers in these areas will be entitled to a voucher – available from children’s centres, health visitors and professionals who have contact with families, and from Boots stores – covering the cost of a course of parenting classes.
The National Childbirth Trust, Coram, Save the Children, and the Fatherhood Institute are among those who are delivering the classes.
Up to £5m has been made available for the trial which runs until March 2014. This includes funding for redemption of parenting class vouchers and an independent evaluation.
The trial will help government understand how classes could be made available to every parent. Decisions on national roll out will be informed by the independent evaluation.

Relationship support for first-time parents

To support first-time parents with the transition to parenthood, expert organisations will deliver relationship support sessions in 4 trial areas of the country from this summer.
Research shows that the birth of a new child can be a stress point for couples. A trial starting in July will offer subsidised relationship support sessions for all expectant mothers and fathers and those with children up to the age of 2 in the trial areas:

York and Leeds
North Essex
Hackney and City of London
Islington and Westminster

The sessions – which will be delivered by Relate, The Tavistock Centre for Couple Relationships and the Fatherhood Institute – are designed to help parents understand that it is normal for their relationship to go through a transition period after they have a child and to give them strategies to work through this as a couple.
Parents will have the choice of face to face and/or online support and the trial will be managed and promoted by the National Childbirth Trust.
The aim is to encourage couples to feel that it is normal to access relationship support in the first few years of their child’s life – just as they would go to an antenatal class.
The offer will be distributed by professionals working in the early years – for example, from nurseries, children’s centres, midwives and health visitors.
Up to £1m has been made available for the trial, which will run until March 2014. Department of Health

Why we should talk more about death

Why we should talk more about death: Why doctors should talk more about death BBC News

Health secretary says GPs have 'ethical duty' to save NHS costs

Health secretary says GPs have 'ethical duty' to save NHS costs: GPs have an 'ethical duty' to save NHS costs and must be transparent about how they are spending taxpayers' money, health secretary Andrew Lansley has said. GP Online

''50,000 fewer patients wait over 18 weeks''

''50,000 fewer patients wait over 18 weeks'': New stats show an average wait for admitted patients of 8.1 weeks, lower than it was in May 2010 Public Service

Mortality among inpatients with diabetes: key findings for England

Mortality among inpatients with diabetes: key findings for England:
This analysis of mortality among inpatients with diabetes used data on over 13 million hospital admissions to assess case-mix and risk factors for inpatient mortality and identify trust level variation in the risk of an inpatient with diabetes dying.The key finding of this analysis was that inpatients with diabetes are 10% more likely to die than those without the condition.

Half of hospital costs are on over-60s

Half of hospital costs are on over-60s:
Analysis of the Hospital Episode Statistics payment by results (PbR) data has revealed that the over-60s account for nearly half of hospital admissions in England and more than half of hospital income from admissions.
Figures show that 43% of all hospital admissions paid under mandatory PbR were of people aged over 60 and accounted for £10.9bn, or 51% of hospitals’ income from admissions that attracted a manda... Healthcare Today

What does the abandonment of two commissioning support services mean for the NHS reforms?

What does the abandonment of two commissioning support services mean for the NHS reforms?:

Richard Vize explores the development of the commissioning support services and the wider implications for the health sector. Are cracks beginning to show?
Just weeks after the health reforms passed into law, serious cracks have emerged in the new system that could derail both the quality and financial stability of NHS services.
The NHS Commissioning Board has revealed that as a result of its "Checkpoint 2" tests for the viability of the plans for 25 regional commissioning support services, two have had to be abandoned: West Mercia and Peninsula (Devon and Cornwall). A further nine require "more rapid management" to stop them from failing.
The support services are often wrongly described as providing "administrative functions" for clinical commissioning groups. This does not begin to articulate the breadth of their work and their importance in determining whether the reforms succeed or fail.
They will lead change and service redesign, identify gaps in services, spot and manage risks, identify service providers, manage tendering, negotiate contracts and do much else besides.
Getting the support services off the ground would be difficult enough if they were just run of the mill public sector bodies. But they will eventually be "free standing", selling their services into the NHS. So the commissioning board has been charged with setting them up not only to help CCGs reform the health service but to then blossom into commercial, independent organisations. It takes a fertile imagination to see how a board steeped in a culture of central control can be an incubator for business start-ups.
Any weaknesses in the operation of the support services will be exposed in both service quality and financial stability. The turbulence in the NHS as real-term funding cuts collide with the reforms means there is a serious risk of a financial failure or a local deterioration in quality that goes unspotted or unchecked. The cuts alone increase this risk substantially; support organisations teetering on the brink of failure are unlikely to identify problems and work with providers to address them in time.
The Treasury has been worried about handing over £60bn of public money to new and unaccountable organisations. With the dire verdict of the NHS Commissioning Board on the state of the nascent commissioning support services they now have reason to be terrified.
No-one has ever claimed that GPs' skills lie in managing NHS finances – their strength is in understanding patient needs and clinical pathways. The support services are vital for effective financial control.
The commissioning board now has to fill the gap left by the abandoned services. The strategic health authorities are moving quickly, and neighbouring services whose preparations are going well could be asked to take over. While expansion has its advantages, changing boundaries and taking on new CCGs and populations will make the further development of their existing operation more complex.
The board also announced it has abandoned plans for a national communications and engagement service for CCGs. The service would have had the advantage of keeping costs down but looked suspiciously like a Ministry of Information for the board, which would have undermined the notion of a locally accountable NHS. Noises are still being made about a nationally co-ordinated communications service, but the hope must be that CCGs will now have more freedom to develop an approach to communications and engagement tailored to their own area – albeit made out of cheap cloth.
But even this is symptomatic of how desperately difficult it is for managers, GPs and the national board to stop the reforms from toppling over. Overlay the problems in support services with the setbacks and difficulties CCGs are experiencing as they struggle to establish themselves, and the wealth of management talent leaving the service, and you have a national picture of growing uncertainty and risk. Staff across the system are fighting to make it all work, but the chances of something going badly wrong are escalating.
Guardian Professional.

Heart services face closure or merger

Heart services face closure or merger: Heart services treating hundreds of thousands of patients face being closed or merged with others over fears they are too small, it has emerged. The Daily Telegraph

Rise seen in mixed-sex NHS ward breaches

Rise seen in mixed-sex NHS ward breaches:
The number of breaches of rules on mixed-sex NHS wards rose by nearly 100 last month, according to new figures. The Independent

Statins 'may even help healthy over-50s'

Statins 'may even help healthy over-50s':

Everyone over the age of 50 should be given statins because the “cholesterol-busting” drugs reduce the risk of a heart attack even in healthy people, according to the Daily Telegraph and many other papers today.
The story is based on a systematic review of 27 studies looking at the effect of lowering low-density lipoprotein cholesterol (LDL, the “bad” cholesterol) using statin therapy in 175,000 individuals. It found that for every 1.0 mmol/L reduction in cholesterol, taking statins reduced the risk of heart attacks, strokes and other “major vascular events” by about a fifth (21%), even among those without existing vascular disease or at low risk of developing it.
Current guidelines recommend prescribing statins for people who have at least a 20% chance of developing cardiovascular disease within 10 years. Doctors normally calculate this risk by looking at a range of factors including the patient’s age, blood pressure, cholesterol levels, whether they smoke and whether they have diabetes.
This large review of studies suggests the cholesterol-lowering drugs are suitable for those without existing heart or vascular disease and those who are not considered at high risk of developing it. The 21% reduction in risk of heart disease and stroke sounds impressive.
However, it’s worth noting that the number of people who stand to benefit from statins gets smaller as the risk threshold for treatment is reduced. For example, one thousand people at low risk would need to be treated (have a 1 mmol/L reduction in bad cholesterol) for five years in order for 11 of them to benefit. This suggests that someone at low risk may wish to consider whether the possible benefit of taking statins would outweigh the inconvenience.
An accompanying editorial argues that the current guidelines should be revised to use age as an indicator for statins (over 50 years old), rather than expensive screening tests. The commentary forms part of a running debate as to whether middle-aged people without any known risk of cardiovascular disease should be “medicated”, and if so, how much (whether with statins, aspirin or a “polypill”, as previously suggested).

Where did the story come from?

The study was carried out by researchers from Oxford University and the University of Sydney. It was funded by several institutions including the British Heart Foundation, the UK Medical Research Council and Cancer Research UK.

The study was published in the peer-reviewed medical journal, The Lancet.
The study – in particular the commentary arguing for all over 50s to take statins - was covered widely and accurately in most of the media.

What kind of research was this?

This was a meta-analysis of individual patient data from 27 trials looking at the effects of lowering LDL cholesterol with statin therapy, including trials of those without vascular disease or at low risk of cardiovascular disease.
The authors pointed out that their previous analysis of studies suggested that statin therapy to reduce LDL cholesterol in people without a history of vascular disease ultimately reduced their risk of heart attacks and strokes by about a fifth. However, uncertainty remains as to whether statins have an overall “net benefit” in this group, given that they are at low risk to begin with. The authors said that at least half of all heart attacks and strokes (vascular events) occur among individuals without previous disease.
The authors said they have now taken individual patient data from each trial within the database, allowing a more complete assessment of the effects of lowering LDL cholesterol in low-risk individuals.

What did the research involve?

The researchers conducted a meta-analysis of data from 175,000 participants in 27 randomised trials, to explore the effects of lowering LDL cholesterol with statin therapy. Trials were included if:

They included at least one treatment where the main effect was to lower LDL cholesterol.
There were no other differences in treating risk factors.
At least 1,000 participants were recruited for a duration of at least two years’ treatment.

The “major vascular events” they looked at included heart attacks and deaths from heart attack, strokes and coronary revascularisations (surgery to unblock coronary arteries). They also looked at rates of cancer and the cause of any death that occurred.
They grouped the participants into five categories depending on their risk of a vascular event within five years and compared those taking a statin with control groups or with group taking a lower-dose statin. The risk categories were:

less than 5%
5% to less than 10%
10% to less than 20%
20% to less than 30%
30% or more

The researchers analysed the results using standard statistical methods.

What were the basic results?

The researchers found that:

Reducing LDL cholesterol with a statin reduced the risk of major vascular events (relative risk 0.79, 95% confidence interval 0.77 to 0.81 per 1.0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular mortality and all-cause mortality.
The reduction in major vascular events was at least as big in people in the two lowest risk categories as those in the higher risk categories.
For stroke, the reduction in risk in participants with a 5-year risk of major vascular events lower than 10% (relative risk per 1.0 mmol/L LDL cholesterol reduction 0.76, 99% confidence interval 0.61 to 0.95) was also similar to that seen in higher-risk categories.
In participants without a history of vascular disease, statins reduced the risks of deaths from vascular disease and any other cause (relative risk 0.91, 95% confidence interval 0.85 to 0.97).

There was no evidence that reducing LDL cholesterol with a statin increased cancer incidence, death from cancer, or deaths from other non-vascular causes.

How did the researchers interpret the results?

The researchers calculated that in individuals with a five-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1,000 over five years. They said this benefit “greatly exceeds any known hazards of statin therapy”.
They also pointed out that, under present guidelines, such individuals would typically not be regarded as suitable for statin therapy.
They concluded: "The present report shows that statins are indeed both effective and safe for people with a five-year risk of major vascular events lower than 10% who would typically not be judged suitable for statin treatment … and, therefore, suggests that treatment guidelines might need to be reconsidered."

Conclusion

Current guidelines recommend statins for people who have a 20% or greater chance of developing cardiovascular disease within 10 years. This large review of studies, which is a further assessment of previous research, suggests they may also benefit those without existing cardiovascular disease and those who are not considered at high risk of developing it. However, the individual benefit for those at low risk may be small.
Although the study looked at whether statins increased the risk of cancer and death from other causes, it did not include possible adverse effects. Statins are safe drugs that have been associated with a small risk of side effects. As the authors stated, the risk of side effects when giving statins to everyone over the age of 50 would have to be taken into account when calculating the overall benefit.
The current guidelines on statin therapy from the National Institute of Health and Clinical Excellence (NICE) are reportedly to be updated soon, at which point NICE will take this and any other new evidence into account.
There is good existing evidence that a healthy lifestyle (including regular exercise, stopping smoking and a healthy diet) are also important factors in cardiovascular health. This study helps to answer previous uncertainty about which apparently healthy individuals could benefit from taking statins.

Links To The Headlines

Give statins to everyone over 50. Daily Express, May 17 2012
NHS 'should consider giving statins to healthy people'. BBC News, May 17 2012
Statins could benefit health of millions. The Guardian, May 17 2012
All over 50s should be taking statins. The Daily Telegraph, May 17 2012
Statins 'could benefit the healthy'. The Independent, May 17 2012
Why EVERYONE over 50 needs to be taking statins: Cholesterol-busting pills cut risk of heart attack or stroke. Daily Mail, May 17 2012

Links To Science

Cholesterol Treatment Trialists' Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. The Lancet. Published online May 17 2012 NHS Choices