New addition to Horizon Scanning

The list of topics available on the Horizon Scanning page has just grown to 20.  The latest one to be included is Learning Disabilities which sends the latest information direct to your inbox.  Why not sign up and give it a try – subscription is FREE. Click here.

Sample feed includes:

Behavioural family therapy used to support system around person with learning disabilities and mental health needs by John Northfield

Studies have suggested a higher incidence of mental health problems in people with learning disabilities, although there are some differences in estimates, which have varied in studies looking at people with learning disabilities who also have a co-morbid psychiatric disorder from 14 to 39%. There is also evidence of increased likelihood of family members and […]
People with learning disabilities have faced a range of barriers when attempting to negotiate the legal system. Public law is complicated but this new guide hopes to provide clear, accurate advice in a range of areas, The guide, called ‘Know Your Rights’ has been broken down into six main themes: Housing Social and Health Care

CQC finds half of learning disability services did not meet essential standards   by John Northfield

Last year, the BBC  screened its secret filming at the Winterbourne view home in Bristol which showed shocking scenes of abuse. The subsequent inquiry led to arrests and convictions, but there were concerns that this was not an isolated incident. The care services minister stated his determination to strengthen safeguards and the Care Standards Commission […]

EBSCOhost: Innovating for Life Awards.

British Journal of Midwifery • May 2012 • Vol 20, No 5   AWARDS
2nd March 2012  Royal Society, London

Cow & Gate joined forces with journals, Infant and the British Journal of
Midwifery to present the Innovating for Life Awards, designed to encourage and reward initiatives that demonstrate innovation in infant and maternal care amongst the midwifery and neonatal professions and
recognise the critical role they play in giving babies the best start in life.

The winners were announced at a ceremony on 2nd March 2012 at the Royal Society, London. The judges drew up a shortlist of three midwifery entries and two neonatal entries, and the winners were announced by Dr. Janet Warren, Head of Medical Affairs at DANONE Baby Nutrition.

Project title: Improved parental education and IT website
Lead applicant: Alison Cooke, Parent Education Midwife, Parent Education Midwifery Team, East Cheshire NHS Trust.
A new Parent Education programme to optimise education in the class setting and increase postnatal education in the ward. The team’s goal is to provide enhanced customer service, improving choice and convenience for mothers and their families, which in turn will create a better and more positive maternity experience.

Dementia ‘not being diagnosed’

Fewer than half of people with dementia ever receive a formal diagnosis, according to a new parliamentary report.

Around 800,000 people in the country currently have dementia, with numbers expected to rise to more than a million by 2021.

However, a report published this week by the parliamentary group on dementia has found a “shocking” variation in the number of people with dementia who are diagnosed.

In England, just 41% of people receive a diagnosis, and in parts of Wales diagnostic rates are as low as 32%.

via http://www.networks.nhs.uk/news/dementia-2018not-being-diagnosed2019

 

Benefits of cognitive stimulation for people with dementia

Overview: Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group, aimed at general enhancement of cognitive and social functioning. Family caregivers can be trained to provide cognitive stimulation on a one-to-one basis.

In 2011, the World Alzheimer’s Report recommended that cognitive stimulation should be routinely offered to people with early stage dementia. However, in recent years, increased interest in its use in dementia has provoked concern about its effectiveness and potential negative effects on wellbeing.
See the NHS Evidence topic page on dementia for a general overview of the condition.
Current advice: NICE recommends that people with mild-to-moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme. This should be commissioned and provided by a range of health and social care staff with appropriate training and supervision, and offered irrespective of any drug prescribed for the treatment of cognitive symptoms of dementia.
The guidance also raised a need for more research into both the clinical and cost effectiveness of cognitive stimulation, both compared to and in combination with acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine).
NICE has a pathway on dementia, which brings together all related NICE guidance and associated products on the condition in a set of interactive topic-based diagrams.
New evidence: A Cochrane review evaluated the effectiveness and impact of cognitive stimulation interventions aimed at improving cognition for people with dementia, including any negative effects (Woods et al. 2012).
The review included 15 randomised controlled trials involving 718 people with mild-to-moderate dementia, mainly in the form of Alzheimer’s disease or vascular dementia. Participants were treated in small groups and involved in different activities, including discussion of past and present events and topics of interest, word games, puzzles, music and practical activities like baking or indoor gardening. All activities were designed to stimulate thinking and memory. Improvements following cognitive stimulation were compared with those seen without treatment and with ‘standard treatments’, which could include medicine, day care or visits from community mental health workers, or in some cases alternative activities such as watching TV and physical therapy.
Results showed that those who received cognitive stimulation interventions scored significantly higher in cognitive function tests. These benefits were still observed 1 to 3 months after treatment. In addition, positive effects on social interaction, communication and quality of life or wellbeing were observed in a smaller number of the trials, based on self-reported or carer-reported measures.
Where family members were trained to deliver cognitive stimulation on a one-to-one basis, no additional strain or burden on care givers was reported.
Commentary: “The caveat to the findings of this Cochrane review is that many of the studies were low quality and with small sample size. Study populations varied and the protocols and content of therapy quite diverse. Cognitive stimulation therapy is not an easily defined intervention. Disappointingly, there is no evidence for an effect on function, mood or difficult behaviour.
Old man doing a crossword“Important questions remain: Is there a need for maintenance sessions to sustain benefit beyond 3 months? What ‘dose’ of stimulation is needed? What is the active ingredient(s)? How much therapist training is needed and are the benefits clinically meaningful? Is it cost effective?
“Despite the limitations there is evidence here to support the principle of ‘use it or lose it’. That one study achieved this by using family carers as therapists, without detriment to them could help carers with the question ‘What can I do?’ and to deal with their frustration of feeling powerless.
“For professional carers there is a message to develop a culture of stimulation for people with dementia in their care and keep people’s brains active if we want to do the best for them. There is more to supporting people with dementia than just administering care.” – David Anderson, Consultant in Old Age Psychiatry with Merseycare NHS Trust and Honorary Senior Lecturer at the University of Liverpool.

This month in Eyes on Evidence

Data from the National Joint Registry for England and Wales indicates high failure rates for metal-on-metal hip replacements.
A Cochrane review shows cognitive stimulation therapies have beneficial effects on memory and thinking in people with dementia, as well as positive effects for wellbeing.
Developing more integrated support for people with mental and physical health problems could improve outcomes, by recognising the role of emotional and mental health problems in reducing people’s ability and motivation to manage their physical health.

Do renin-angiotensin system drugs reduce mortality in hypertension?

This systematic review provides good quality clinical evidence that  angiotensin-converting enzyme inhibitors reduce the risk of death in patients with hypertension. The benefits of angiotensin receptor blockers in reducing mortality are uncertain.
Angiotensin receptor blockers (ARBs) are no better than placebo or angiotensin-converting enzyme  inhibitors in reducing the risk of death, disability, or hospital admission for any reason. However, more patients stopped treatment early with ARBs than with placebo due to side effects.
An example from the Quality, Innovation, Productivity and Prevention collection on how the University Hospitals of Leicester NHS Trust has reduced delays, complications and costs around central venous access for patients.
Potential disinvestment opportunities highlighted this month are:
  • Biofeedback training for the management of faecal incontinence in children.
  • Non-pharmacological interventions for breathlessness.

Evidence Updates

This month NICE has published online via NHS Evidence an Evidence Update on constipation in children and young people.
How to get access, via NHS Athens on Apple and Android devices, to authoritative and practical information on the selection and clinical use of medicines from the British National Formulary.

AQuA Improvement Methodologies (AIM) in End of Life Care

AQuA Improvement Methodologies (AIM) in End of Life Care
Cohort 10 (July – Sept 2012)

The AQuA Improvement Methodology programme in End of Life Care is geared at front line staff/operational leaders in End of Life Care wanting to gain an introduction to the fundamentals and concepts of quality improvement. Delegates will work on their own End of Life Care improvement project and develop a project plan, aim and measures throughout the programme. Suitable for staff with a basic knowledge of quality improvement tools or for experienced staff wanting to refresh their knowledge and skills.
Book online at: www.nhsevents.org

Booking closes 31 July 2012 (each individual in the team is required to book a place)