Is the amyloid cascade hypothesis of Alzheimer’s disease too big to fail? It proposes that brain deposition of β amyloid protein is the critical early event in the pathogenesis of Alzheimer’s disease and has been the centrepiece of dementia research for decades. The hypothesis suggests that removing β amyloid will reverse or prevent the clinical expression of dementia. However, in all phase III clinical trials to date, treatments targeting β amyloid have failed to improve cognitive outcomes despite reducing brain β amyloid.
Dementia
Leading models of Dementia care highlighted
NHS England has highlighted 3 models as examples of how to care for people with Dementia. You can read the NHS England news report here.
The models come from schemes running in Gnosall, Northumberland, and Rotherham and Doncaster and are highlighted in a report – Models of Dementia Assessment and Diagnosis: Indicative Cost Review
Initial drug treatment in Parkinson’s disease
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Parkinson’s disease is a progressive neurodegenerative disorder characterised by tremor, rigidity, bradykinesia, and a wide spectrum of non-motor symptoms including sleep disorders, hyposmia, bladder and bowel dysfunction, fatigue, dementia, and other neuropsychiatric symptoms.
Although the disease has no cure, available treatments effectively control motor symptoms and improve quality of life. Several drug classes are licensed for use as monotherapy in early Parkinson’s disease and adjuvant therapy in later disease
Is this a new era for dementia?
A blog article by Professors Alistair Burns and Martin Rossor:
“The current national and international focus on dementia has been widely welcomed as a vehicle to raise the profile of, and attract attention to, what has been a hitherto relatively neglected area of scientific interest and clinical practice…
…The news a few weeks ago of the putative efficacy of a disease modifying treatment for Alzheimer’s disease has ignited widespread public, professional and political interest and enthusiasm…”
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Being underweight in middle age is associated with raised dementia risk, large study finds
People who are underweight in middle age are at increased risk of developing dementia, while increasing weight and obesity offer protection against the condition, a large cohort study has found.
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A number of previous studies have looked at the association between weight and dementia, and most have found that the risk of dementia increased among adults who are overweight or obese, although some studies have found the opposite. Most of these studies have been small, which led the present researchers to conduct a much larger analysis of the link.
Brain training, exercise, and healthy eating slow cognitive decline in elderly people at risk, study finds
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A comprehensive programme incorporating individual support for healthy eating, regular exercise, and brain training, plus managing metabolic and vascular risk factors reduced cognitive decline in older people at risk for dementia, results reported in the Lancet show
Leading change in diagnosis and support for people living with dementia
According to The King’s Fund, there are an estimated 850,000 people with dementia in the United Kingdom – a figure set to double over the next two decades – plus an estimated 500,000 carers for people with dementia.
On 24 February, The King’s Fund and the Alzheimer’s Society are hosting a one-day conference to celebrate recent progress in support for people and families living with dementia.
Free content available from HSJ
| Lessons from Japan: Tackle the dementia challenge by supporting carers |
| Scrap the programme: Successful change starts with a change platform |
| Rising Stars: Seven lessons from an executive coach to sustain leadership energy |
| How to take part in Challenge Top-down Change |
| Rising Stars: Six ways to optimise NHS leadership potential |
World Alzheimer’s Month 2014
World Alzheimer’s Month 2014
September 2014 sees the third international campaign to raise awareness through World Alzheimer’s Month. This year the theme is ‘Dementia: Can we reduce the risk?’ and looks at how we can adopt healthier brain lifestyles.
Some useful websites and
elearning resources.
- Alzheimer’s Society – information, training, resources, treatments and news
- Alzheimer’s Research UK – range of booklets available for download
- Alzheimer’s and Dementia resources – (Alz.org) symptoms, signs and support
- Alzheimer’s Disease International – (Alz.co.uk) Global information, knowledge and solutions
- The Open Dementia Programme: Social Care and Institute for Excellence – free elearning modules
- Management of dementia in primary care – in association with the Alzheimer’s Society – free elearning from BMJ Learning after logging in with Athens account.
- NICE Evidence for wider searching of healthcare databases and ejournals – NHS Athens account required for full-text articles.
Updates from NICE: Eyes on Evidence
This month in Eyes on Evidence
Acid-suppressive drugs and oesophageal adenocarcinoma in Barrett’s oesophagus
A systematic review and meta-analysis indicates that proton pump inhibitors reduce the risk of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett’s oesophagus.
Prescriptions for anxiolytics and hypnotics and risk of death
A population-based cohort study in UK primary care suggests that people who are prescribed anxiolytic and hypnotic drugs have a significantly increased risk of death from any cause over a 7-year period.
Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.
Bedtime schedules and children’s cognition and behaviour
Two analyses of 7-year-olds in the UK Millennium Cohort Study suggest that not having a regular bedtime is associated with impaired cognition in girls and behavioural difficulties in both girls and boys.
Trained glycaemia alert dogs for people with type 1 diabetes
A small UK intervention study suggests that trained glycaemia alert dogs may be able to notify people with type 1 diabetes during blood glucose variations.
NICE opens consultation on the NICE Accreditation Process Manual Update
NICE is inviting comments on its proposals to update the NICE Accreditation Process Manual.
Evidence Updates
NICE has recently published Evidence Updates on:
- Physical activity and the environment
- Autism in adults
- Opioids in palliative care
News from NHS Networks – Acute
NHS England will transfer £1,100 million from the mandate to local authorities.
The number of opiate and crack cocaine users in England has fallen again according to independent research published by Public Health England.
Action to tackle smoking, drinking, sedentary behaviour and poor diet could reduce the risk of dementia in later life alongside other conditions such as heart disease, stroke and many cancers, according to the UK Health Forum and Public Health England..
NHS England has issued guidance to trusts with inpatient beds on publishing staffing data on NHS Choices.
Many more news topics available from NHS Networks
Dementia Resource Toolkit survey
Please help by completing this online survey
The National Skills Academy for Health is focussed on providing practical, high quality training and skills development support for the healthcare support workforce. Following a number of requests from the sector we are looking at developing a resource toolkit to support the embedding of good #dementia care and awareness across the health sector.
We would really appreciate your feedback and ideas on what a dementia resource toolkit would look like and whether you think it would be something you would find useful. Please take a few minutes to complete our short survey – your feedback is important to us and much appreciated.
http://www.surveygizmo.com/s3/1615928/Dementia-Toolkit-Research
The Spring 2014 : The End of Life Journal is now online
The Spring 2014 issue of the free journal for nurses caring for dying people at home, in hospitals and care homes is now available online. This issue is mobile-friendly making it easier to read on your mobile device or tablet.
Articles include
CLINICAL PRACTICE DEVELOPMENT
NURSING CASE REVIEW
LEGAL DISCUSSIONS
PROFESSIONAL ISSUES
PERSONAL REFLECTIONS
Grand Round: 19 March 2014
On Wednesday, 19th March 2014, the Grand Round will feature a presentation by Rachel Ruddy, entitled ‘Dementia‘.
The lecture takes place at 1:00pm
in the lecture theatre, 1st Floor, Macclesfield District General Hospital. It will be preceded by a hot buffet from 12:15pm, this meeting is sponsored by Astra Zeneca. Due to only having one sponsor the food will be limited.Next week , the Grand Round topic on Wednesday, 26th March 2014 will be a presentation by Dr I Losa entitled ‘Recent advances in immunisation’.
BMJ topics: August 2013
Here’s a selection of content from this month’s BMJ – click on this link if you want to read the full issue.
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Patient information leaflets: “a stupid system” Margaret McCartney
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The growth of medical marijuana Owen Dyer
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GPs taking on out of hours work face higher indemnity fees Gareth Iacobucci
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Don’t call low risk lesions cancer, experts say Michael McCarthy
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Physician Payment Sunshine Act José G Merino
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The Liverpool care pathway: a cautionary tale Katherine E Sleeman and Emily Collis
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Medical savings accounts: Singapore’s non-solution to healthcare costs Martin McKee and Reinhard Busse
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India’s new policy to protect research participants Jeremy Sugarman, Anant Bhan et al
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Government’s plans for universal health checks for people aged 40-75 Felicity Goodyear-Smith
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Leading healthcare in London: time for a radical response? Naomi Fulop and Rosalind Raine
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BMJ Best Practice looks at Assessment of Dementia
In this module Best Practice begins with an overview, then goes on to emergencies, diagnosis and finally resources relating to this increasingly common syndrome.
Dementia is a syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living. Decline in cognition is extensive, often affecting multiple domains of intellectual functioning. [1] [2]
The prevalence of dementia is approximately 1% at the age of 60 years, and doubles every 5 years, to reach 30% to 50% by the age of 85 years.
Continue reading at BMJ Best Best Practice
Finally: make sure you keep checking Google Play for the new Android version of the Best Practice App, and the app store for the updated version of the IOS Best Practice App.
BMJ Best Practice looks at Dementia
Dementia is a syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living. Decline in cognition is extensive, often affecting multiple domains of intellectual functioning. The most common causes of dementia are degenerative or vascular; other causes include infection, inflammatory diseases, neoplasm, toxic insults, metabolic disorders, or trauma. It is important to consider potentially reversible conditions during diagnosis. A number of conditions can present in a similar way to dementia syndrome and need to be considered during the evaluation. These include mild cognitive impairment (MCI), delirium, depression, amnesic syndromes, aphasia, or normal ageing.
Log into BMJ Best Practice with your Athens account to view a wide range of topics, their conditions, diagnosis, treatment and evidence:
AQuA News – June edition
In this month’s edition you will find:
• Workshop to launch AQuA’s SMS/SDM Commissioning Framework
• AQuA members shortlisted for care awards
• Lessons learnt from AQuA’s In-hospital Mortality work
• AQuA Reducing Avoidable Hospital Mortality
• Deep Dive Into: Latest programme dates
• AQuA’s Lean Network
• Robert Francis master class
• Introduction to Lean, Cohort 4 – hold the dates!
• Patient Safety Ambassadors
• Advanced Team Training Programme
• A New Role for Finance in Quality Improvement
• Community SAFE – programme update
• Patient Safety Champions
• Living Well with Dementia
• Integrating health and social care teams
• Whole person care: From rhetoric to reality
• Spreading the word about Shared Decision Making (SDM)
• ‘Train the Trainer’ event to support SDM spread in the NW
• Don’t just Screen – Intervene project
• Mental Health and Long Term Conditions (LTC) newsletters now available
• Quality profiles for NHS Mental Health Trust
Latest news articles from BMJ
Rescue boards are set up in England to deal with “significant deterioration” in A&E departments
- Italian government sets up a stem cell trial to assuage public demands
- Doctors call for countries to step up the fight against rheumatic heart disease
- High dose NSAIDs may double the risk of heart attacks and heart failure, says new study
- Indian generics manufacturer Ranbaxy agrees to pay $500m to settle US fraud and drug safety charges
- Governments must agree unified approach to use of e-cigarettes, report says
- Dutch doctors to receive more clarity over use of advance euthanasia directives for patients with dementia
- Spend less on drug enforcement and more on treating hepatitis C, say campaigners
- WHO agrees to set up body to act on non-communicable diseases
- Number, type, and availability of new drugs are on the increase in Europe
- WHA calls for five demonstration projects on health research relevant to the developing world
- Government to increase number of GPs and emergency medicine doctors
- Workplace wellness programs show little benefit, US report says
- Critical care patients have major health and financial problems 12 months after discharge, finds study
- WHO to probe claims that Dutch scientists restricted access to novel coronavirus
News update from NHS Networks
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A survey commissioned by the all-party parliamentary group for continence care has vividly demonstrated a decline in the level of provision for continence care services in England.
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Dementia is a major and growing challenge for both health and social care.
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The Children and Young People’s Health Forum was asked by the secretary of state to help develop a new strategy for improving care for children and young people.
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The NHS Confederation has published a briefing for non-executive directors (NEDs) interested in improving their understanding of their organisations’ data.
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The Stroke Association is the UK’s leading charity for people affected by stroke and has recently taken over running a fortnightly email bulletin from the now defunct Stroke Improvement Programme.
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This narrative was developed with service users, by National Voices and partners and shows what coordinated care would look like from the perspective of patients, service users, families and carers.
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NHS England has published its latest bulletin for CCGs.
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This letter invites local areas to express an interest in becoming ‘pioneers’, demonstrating the use of ambitious and innovative approaches to delivering integrated care.
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New recommendations, published by the Royal College of General Practitioners, the Royal College of Radiologists and the Society and College of Radiographers, have outlined improvements for patients by ensuring that timely and appropriate medical imaging services such as scans are provided to them and their referring doctors.
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This report looks at the nature of employee voice and the impact of social media.
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This case study is part of a series designed to share good practice and lessons learned by local NHS organisations involved in major reviews of local health services.
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The Dementia Challenge report describes achievements in the three main areas of the challenge: driving improvements in health and care, creating dementia friendly communities and better research.
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Bob Ricketts, director of commissioning support, strategy and market development for NHS England, will outline the vision for service transformation.
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Health sector regulator Monitor and NHS England are working together to reform the way NHS services are paid for.
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The government has announced plans for a more joined up health and social care system by 2018.
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A new guide by the BMA will help doctors tackle some of the dilemmas that they face on a daily basis.
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The direct specialised commissioning function of NHS England is supported by a devolved clinical leadership model.
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This report was commissioned as part of a review of HIV services in London and the aim was to gather data from patients to better understand patterns of service use and what they value in HIV services.
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This update has been released in response to the government’s consultation on safeguarding power of entry between 11 July 2012 and 12 October 2012.
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New chair-elect for the Royal College of General Practitioners (RCGP).
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This briefing examines what the NHS mandate means for mental health services and the people who use them.
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NHS England has published detailed data about the first four of the 14 hospitals involved in the review of mortality data.
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Figures published by Public Health England (PHE) show that confirmed cases of whooping cough in England have continued to decrease in 2013 with 434 cases reported in March.
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Report from NHS Change Day.
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The Local Government Association and PHE have produced a guide for local councillors about the national child measurement programme (NCMP).
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The National Institute for Health and Care Excellence (NICE) is seeking to recruit the following professional members to the NICE accreditation advisory committee.
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Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures.
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NHS England has written to NHS Trust medical directors and area team medical directors setting out interim arrangements for issuing healthcare professional alert notices.
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This publication supports local authority health and wellbeing boards to develop and update pharmaceutical needs assessments (PNAs).
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The Care Bill will modernise the law to put people’s wellbeing at the heart of the care and support system.
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Health Matters – Tuesday 14 May
The topic this month is “East Cheshire NHS Trust – Researching Today for a Better Tomorrow”
Members of our Clinical Research Team are delivering the next Health Matters public talk on Tuesday, 14 May, 7.00-8.00pm, in the new Lecture Theatre at Macclesfield District General Hospital.
The Trust is actively involved in research in a number of key areas including cancer, dementia, Parkinson’s disease, medicines for children, cardiology, haematology, rheumatology, and stroke.
The purpose of this Health Matters talk is to demystify clinical trials, explain how they work, and look at some of the exciting research currently under way. The session will be introduced by Dr Susan Knight, and the talk will be given by our research nurses including Clare Vandor, Barbara Townley, Beverley Jones, and Joanne Shippey.
Members of staff are welcome to come along – to book your place please contact the Communications and Engagement Department on 01625 661560 or email us at ecn-tr.YourVoice@nhs.net.
Making it Real tools
Extract from The King’s Fund
Think Local Act Personal
Making It Real tools
The Making it Real programme encourages organisations that pay for or provide social care services to get real about improving people’s lives. These tools have been produced in order to support this programme and include practical examples of what organisations are doing to transform their services, in partnership with the people who use them and will help people to understand and engage in the personalisation of the care and support agenda.
End of Life Journal – Spring Issue 2013
End of Life Journal is the free, online, peer-reviewed, quarterly journal that publishes articles on all aspects of nursing practice relating to end-of-life care. It is primarily aimed at generalist nurses working in hospital, community and care home settings. However, many articles will also be of interest to the specialist palliative care nursing audience as well as members of the wider multidisciplinary team. The journal focuses on care for patients with both malignant and non-malignant disease and their family and friends.
Articles include:
CLINICAL REVIEW
CLINICAL SKILLS
CLINICAL PRACTICE DEVELOPMENT
ETHICAL/LEGAL DISCUSSIONS
NURSING CASE REVIEW
NATIONAL END OF LIFE CARE PROGRAMME UPDATE
Dementia care varies
“The standard of care provided for people with dementia is “patchy”, the National Institute for Health and Care Excellence (NICE) has said.
Some people with the condition were not getting even basic levels of care, it added. The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.”
NICE’s dementia guidance includes 10 standards it wants the care sector to follow.
One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.
Latest BMJ news: 28 March 2013
Vitamin D sufficiency in pregnancy  Robyn Lucas, Fan Xiang, and Anne-Louise Ponsonby |
| Taking the sting out of lumbar puncturePaul Rizzoli |
| What should clinical commissioning groups do on 1 April 2013?Clare Gerada |
| Future proofing the Quality and Outcomes FrameworkVeena S Raleigh and Niek Klazinga |
| Inaccuracy of forehead thermometersGervase Vernon |
| Evidence base needs to be developed for the whole process of end of life careSuzanne M Kite, Fiona Hicks, Elizabeth Rees, Claire Shepherd, and Christopher Stothard |
| Protests about having to structure time off to enable the NHS to work at weekends as it does in the week may be hypocriticalKevin J H Newman |
| The NHS working at weekends as it does during the week is a non-starterS Blair |
| Training of young surgeons would be problematic if the NHS worked at weekends as it does during the weekStephen Brearley |
| Would doctors routinely asking older patients about their memory improve dementia outcomes? NoMargaret McCartney |
| How do we know whether medical apps work? |
Library & Knowledge Service blog 