Search

This article advocates for better nurse training and their active involvement in asthma care in Great Britain. Asthma care in Great Britain varies, with poor outcomes including preventable attacks, hospital admissions, and deaths. Nurses play a crucial role in asthma management but often lack adequate training. Emphasizing post-attack reviews and quality control, the article proposes a 7-step plan for primary care practices to improve asthma management and reduce attacks.

It is widely acknowledged that compression therapy is an effective treatment option for the management of lower limb conditions; however, it is not always applied appropriately by clinicians. A lack of knowledge and clinical uncertainty, coupled with increased workload and reduced time with patients, can contribute to inappropriate decisions being made in regard to compression. This article investigates the adoption of the Hosiery Hunter® app (medi UK) and its role in guiding decision-making within clinical practice. The Hosiery Hunter® app is a novel mobile application designed to simplify the selection of medical compression hosiery for patients with lower limb conditions. Based on qualitative data from a user feedback survey, it was found that the Hosiery Hunter® app helped simplify the process of selecting the most appropriate compression therapy, saved time and provided quick and timely access to codes for prescription. All nurses surveyed agreed that they would continue using the app and would recommend it to a colleague. This article sheds light on the challenges clinicians face in the selection of compression therapy, and explores the effectiveness of adopting the Hosiery Hunter® app in support of providing appropriate, safe and effective care for all patients. [ABSTRACT FROM AUTHOR]

Online peer-to-peer communities provide environments in which people with similar health concerns can interact and exchange information that can support self-care of long-term conditions. However, current theories have not adequately accounted for how self-care support is enacted in online communities. We conducted an observational netnography to identify and analyze posts in a publicly accessible online community (discussion forum boards) designed for older people. A Straussian grounded theory approach was used to examine 659 posts in health-related message boards. Self-care support involved the construction of three interrelated identities: (1) the support seeking self, in which members described problems and requested information; (2) the empathizing self, in which they described similar experiences and offered support; and (3) the influencing self, in which they provided information or advice. Online communities appear to be an important source of peer support and information and may be a cost-effective approach to supplement standard care. [ABSTRACT FROM AUTHOR]

Policies can fail when frontline staff feel they have limited influence on policy implementation (powerlessness) or that policy has little or no personal meaning (meaninglessness) – they become alienated from the policy – but how does this alienation develop? In this article we ask whether policy alienation might be viewed as a process that develops over time: a process that ebbs and flows, interacting with the policy landscape as it shifts, rather than a psychological state. Feelings of alienation can be shared across groups of actors, as they collectively shift and initiate change. This study uses participant observation and interviews with front-line employees as they navigate a UK government policy introducing telehealthcare to improve health management of patients with chronic conditions. We find that: (i) cumulative misalignment between different policy implementation contexts allows policy alienation to develop over time; (ii) the shared experience of alienation in co-worker groups contributes to further misalignment; and (iii) front-line staff use their discretion to respond to policy alienation, which has the power to enhance or destroy policy implementation. We offer an alternative perspective for understanding how policy alienation can be prevented and policy implementation can be enhanced. [ABSTRACT FROM AUTHOR]

Ehlers–Danlos-Syndromes (EDS) is a group of hereditary, chronic and potentially disabling conditions. Few studies have tested the effects of psychological interventions to increase well-being in this population. We hypothesized that Positive Psychology Interventions (PPI), first applied to healthy and mentally ill subjects, can also be useful for people with somatic conditions and conducted a study to evaluate the efficacy of a 5-week online PPI designed to improve well-being in EDS patients. A sample of 132 EDS patients were allocated to three groups: assigned PPI, self-selected PPI, and waitlist control-group (WLC). Measures of positive and negative affect, pain disability, fatigue, and life satisfaction were administered before program start, 6 weeks later, and 1 month later. Satisfaction with the program was also evaluated. The results revealed that participants in the self-selected PPI-group, but not in the assigned PPI group, reported significantly lower levels of fatigue and higher levels of positive affect and life satisfaction compared to WLC after 6 weeks. There were no effects on negative affect and pain disability measures. Finally, 77% of the participants were satisfied or very satisfied with the program. These findings confirm and extend previous research by showing the efficacy of PPI for people with chronic illness under the condition that individuals can choose the program content. From a healthcare perspective, online PPIs could complement treatments aimed at symptom reduction and increase well-being in patients with EDS. [ABSTRACT FROM AUTHOR]

Epidemiological studies project a significant rise in cases of chronic subdural haematoma over the next 20 years. Patients with this condition are frequently older and medically complex, with baseline characteristics that may increase peri-operative risk. The intra-operative period is only a small portion of a patient's total hospital stay, with a majority of patients in the United Kingdom transferred between institutions for their surgical and rehabilitative care. Definitive management remains surgical, but peri-operative challenges exist which resonate with other surgical cohorts where multidisciplinary working has become the gold standard. These include shared decision-making, medical optimisation, the management of peri-operative anticoagulation and the identification of key points of equipoise for examination in the future trials. In this narrative review, we use a stereotyped patient journey to provide context to the recent literature, highlighting where multidisciplinary expertise may be required to optimise patient care and maximise the benefits of surgical management. We discuss the triage, pre-operative optimisation, intra-operative management and immediate postoperative care of patients undergoing surgery for a chronic subdural haematoma. We also discuss where adjunctive medical management may be indicated. In so doing, we present the current and emerging evidence base for the role of an integrated peri-operative medicine team in the care of patients with a chronic subdural haematoma. [ABSTRACT FROM AUTHOR]

Background: The risk of bloodstream infections may be increased in hospitalized patients receiving ready‐made parenteral nutrition (PN) multichamber bags (MCBs) compared with customized PN; however, as highlighted in recent international guidelines, there are no comparable data relating to home PN (HPN). Methods: Data from a prospectively maintained database were analyzed to compare incidence rates of catheter‐related bloodstream infections (CRBSIs) between patients receiving customized HPN compared with MCB HPN at a national UK referral center between May 2018 and August 2020. Results: Sixty patients with chronic intestinal failure were commenced on MCBs and 45 received customized HPN for a total of 5914 and 7641 catheter days, respectively. No difference in CRBSI incidence was found (0.51/1000 catheter days for MCBs, 0.39/1000 catheter days for customized HPN; incidence rate ratio, 1.29; 95% CI, 0.26–6.37). Eighteen patients were switched from customized HPN to MCB HPN. The study period covered 7401 catheter days receiving customized HPN and 4834 days on MCBs. No significant change was noted in the CRBSI rates following this switch (0.27/1000 catheter days receiving customized HPN vs 0.21/1000 catheter days on MCBs; incidence rate ratio, 1.31; 95% CI, 0.12–14.3). Conclusion: The use of MCBs for HPN patients is not associated with an increased risk of CRBSI. This study will inform international guidelines and provide reassurance for the continued, safe use of MCB HPN. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Day care services support older people living with long-term conditions (LTC's). Aims: The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom. Methods: Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks. Results: Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services. Conclusion: Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported. [ABSTRACT FROM AUTHOR]

This article uses a socio‐material approach, social practice theory, to provide new insights into the self‐management of chronic illness. It demonstrates how this theory can bridge arguments about the respective roles of social and individual influences, and how it can foreground an oft‐overlooked aspect of the issue – the demands of self‐care technologies and consequences for participation in social life. Drawing on interviews and focus groups with 25 young type‐1 diabetes outpatients in London, UK, the study points to the conflicts that occur when disease management technologies compete for time and space with the social practices of everyday life, and when self‐care tasks threaten to interrupt the flow of social life and make people feel 'left behind'. The paper concludes that young people are disabled by the contingent position of self‐care activities in daily life, which oblige them to compromise either their physical health or their immersion in the social world. This disabling effect would be mitigated if social practices were reorganised to make them more amenable to the time‐space requirements of disease management. A social practice theory lens can help throw light onto this issue and make a valuable contribution to the study of the self‐management of chronic illness. [ABSTRACT FROM AUTHOR]

The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine. [ABSTRACT FROM AUTHOR]

Given the considerable emphasis placed on informed choice, the management of health information has become an increasingly important part of living with chronic illness. This paper explores the intra‐familial dynamics of managing health information in the context of chronic illness. Drawing on 77 interviews with people affected by Multiple Sclerosis in the UK (patients, partners, family members and close friends), we show how families develop their own idiosyncratic information practices, including the careful, at times strategic, seeking, sharing and withholding of information. We describe how one individual, most commonly either the patient or their partner, often takes primary responsibility for managing growing quantities of health information. Doing this is a complex task, yet its dynamics within the family unit remain invisible and unacknowledged. In this paper we: (a) stress the importance of understanding information management in chronic illness as a collective process across all those affected, patients as well as carers; (b) conceptualise the process of managing health information in this context as 'health information work'; and (c) analyse it as part of the wider care practices families engage in and as a form of care in its own right. [ABSTRACT FROM AUTHOR]

Objective:To investigate the potential of an integrated care system that acquires vital clinical signs and habits data to support independent living for elderly people with chronic disease. Materials and Methods:We developed an IEEE 11073 standards-based telemonitoring platform for monitoring vital signs and activity data of elderly living alone in their home. The platform has important features for monitoring the elderly: unobtrusive, simple, elderly-friendly, plug and play interoperable, and self-integration of sensors. Thirty-six (36) patients in a primary care practice in the United Kingdom (mean [standard deviation] age, 82 [10] years) with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) were provided with clinical sensors to measure the vital signs for their disease (blood pressure [BP] and weight for CHF, and oxygen saturation for COPD) and one passive infrared (PIR) motion sensor and/or a chair/bed sensor were installed in a patient's home to obtain their activity data. The patients were asked to take one measurement each day of their vital signs in the morning before breakfast. All data were automatically transmitted wirelessly to the remote server and displayed on a clinical portal for clinicians to monitor each patient. An alert algorithm detected outliers in the data and indicated alerts on the portal. Patient data have been analyzed retrospectively following hospital admission, emergency room visit or death, to determine whether the data could predict the event. Results:Data of patients who were monitored for a long period and had interventions were analyzed to identify useful parameters and develop algorithms to define alert rules. Twenty of the 36 participants had a clinical referral during the time of monitoring; 16 of them received some type of intervention. The most common reason for intervention was due to low oxygen levels for patients with COPD and high BP levels for CHF. Activity data were found to contain information on the well-being of patients, in particular for those with COPD. During exacerbation the activity level from PIR sensors increased slightly, and there was a decrease in bed occupancy. One subject with CHF who felt unwell spent most of the day in the bedroom. Conclusions:Our results suggest that integrated care monitoring technologies have a potential for providing improved care and can have positive impact on well-being of the elderly by enabling timely intervention. Long-term BP and pulse oximetry data could indicate exacerbation and lead to effective intervention; physical activity data provided important information on the well-being of patients. However, there remains a need for better understanding of long-term variations in vital signs and activity data to establish intervention protocols for improved disease management. [ABSTRACT FROM AUTHOR]

Purpose: Teenage and young adult (TYA) cancer survivors experience a range of health-related problems during and beyond the active treatment period. This study examined associations between fatigue, sleep quality, and health-related quality of life (HRQOL) among TYA survivors. Methods: Self-reported data on sleep quality (Pittsburgh Sleep Quality Index), fatigue (Functional Assessment of Chronic Illness Therapy Fatigue), and HRQOL (EuroQoL-5) were gathered from United Kingdom TYA survivors between 13 and 24 years of age. TYA survivors were stratified into those on (n = 67) and off (n = 135) treatment. Linear regression analyses were used with HRQOL as the dependent variable to investigate potential associations. Fatigue and sleep were entered separately and together in the same model. Age at survey and diagnosis, gender, and ethnicity were included as covariates. Results: 85.07% of TYAs on and 62.69% of TYAs off treatment had sleep quality scores suggestive of clinically significant sleep disorders. 56.72% of TYAs on and 26.67% of TYAs off treatment reported clinically significant levels of fatigue. Strong independent associations between sleep (B = 0.05, 95% confidence intervals [CI] = 0.03–0.07, p < 0.001), fatigue (B = 0.02, 95% CI = 0.01–0.03, p < 0.001), and HRQOL were observed among TYA survivors on treatment. TYAs off treatment showed moderate to strong associations between sleep (B = 0.04, 95% CI = 0.02–0.05, p < 0.001) and fatigue (B = 0.02, 95% CI = 0.01–0.02, p < 0.001), and HRQOL, when examined separately. Sleep was not independently associated with HRQOL among TYAs off treatment (B = 0.01, 95% CI = −0.01 to 0.02, p = 0.296). Conclusion: The significant associations reported suggest that sleep quality and fatigue are potential modifiable factors associated with HRQOL. Further research is warranted to understand the direction of associations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Periodontal involvement of the furcation area (furcation involvement, FI) has been reported to confer molars a higher risk of tooth loss. Aims: The aim of this retrospective analysis was to assess the effect of FI on disease progression and tooth loss in molars of patients with chronic periodontitis undergoing supportive periodontal therapy (SPT) in a UK private practice setting. Materials and Methods: Six‐hundred and thirty‐three molars were analysed in 100 chronic periodontitis patients treated with active periodontal therapy (APT) and followed up in SPT for at least 5 years. Molars were treated with a combination of resective, regenerative or conservative approaches, according to the different clinical needs. Results: Twenty‐three molars were extracted during APT and a further 23 were lost during SPT. Multivariable analysis showed that both horizontal FI and vertical furcation component were associated with increased risk of tooth loss during SPT (OR 5.26, 95% CI: 1.46–19.03, p = .012 and OR 9.83, 95% CI: 1.83–50.11, p = .006, respectively). Conclusion: Attention should be placed on both horizontal and vertical FI in molars, owing to their association with tooth loss during SPT. [ABSTRACT FROM AUTHOR]

Aims: The aim of this economic analysis was to estimate the economic impact of the On the Ground Education Programme (OGEP) within one local University Health Board (UHB) in Wales. Background: The burden of managing chronic oedema can be considerable to the NHS. Developing innovative solutions to the care and management of patients with chronic oedema has the potential to deliver prudent, cost-effective and high quality care within NHS Wales. Design: The study was a pilot Evaluation of the OGEP using retrospectively and prospectively collected patient recalled data. Methods: A questionnaire collected health care service use data prior to receiving the OGEP (baseline) and at 3 months follow-up from 97 patients during the period June 2016 and January 2017. In addition, we analysed a patient reported health outcome using the EQ-5D 5L, which was completed by patients at the same two assessment points. Results/Findings: The total cost of managing chronic oedema in the 97 patients recruited was £563 729 (mean patient cost £5812 SD (£5870) at baseline and £445 098 (including the addition of intervention costs) (mean patient cost £4589 (SD £5465) at 3 months follow-up. Improvements in the EQ-5D 5L score increasing from 0.40 (SD 0.25) at baseline to 0.54 (SD 0.23) at 3 months follow-up. Conclusions: Our research show health care resource use and costs decreased, while health-related quality of life scores increased. [ABSTRACT FROM AUTHOR]

The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated, with collaboration and engagement throughout any transition. This paper provides an overview of the evidence relating to the delivery of effective, integrated out-of-hospital care, with a discussion of the literature. It also considers how one Clinical Commissioning Group has begun the process of integration with the focus on community nursing services for the provision of better care for patients with an evidence-based approach. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this literature review is to identify the most common tools used to measure burden in carers of people with Parkinson's disease (PD), heart failure (HF), multiple sclerosis (MS) and chronic obstructive pulmonary disease (COPD). Method: Databases such as Medline, PsycINFO, CINAHL and Academic Search Complete were searched. Studies in which carer burden was measured were included. Results: Zarit Burden Inventory and Caregiver Reaction Assessment were most commonly used to measure carer burden, regardless of the chronic condition. A wide range of other instruments were also used. Conclusions: Even though a range of tools are available, further improvements are necessary in order to enable healthcare professionals to identify carers experiencing high burden. [ABSTRACT FROM AUTHOR]

Background: Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified. Aims: To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs. Design: A cross-sectional secondary analysis of data from a randomised controlled trial. Setting/participants: Patients with advanced chronic disease and refractory breathlessness recruited from three National Health Service hospitals and via general practitioners in South London. Results: Of 105 patients recruited, the mean cost of formal care was £3253 (standard deviation £3652) for 3 months. The largest contributions to formal-care cost were hospital admissions (>60%), and palliative care contributed <1%. When informal care was included, the total cost increased by >250% to £11,507 (standard deviation £9911). Increased patient disability resulting from breathlessness was associated with high cost (£629 per unit increase in disability score; p = 0.006). Increased breathlessness on exertion and the presence of an informal carer were also significantly associated with high cost. Patients with chronic obstructive pulmonary disease tended to have higher healthcare costs than other patients. Conclusion: Informal carers contribute significantly to the care of patients with advanced disease and refractory breathlessness. Disability resulting from breathlessness is an important clinical cost driver. It is important for policy makers to support and acknowledge the contributions of informal carers. Further research is required to assess the clinical- and cost-effectiveness of palliative care interventions in reducing disability resulting from breathlessness in this patient group. [ABSTRACT FROM AUTHOR]

The article discusses introduction, procedures, and perceived benefits of group consultations to patients in Great Britain. Topics explored include the delivery of clinical care to multiple patients per session, clinical outcomes and reduction in hospital admissions attributed to group consultations, and the possible impact of group consultations on relationship between patients and general practitioners.

Aim The aim of this study was to discover and describe how patients, carers and case management nurses define safety and compare it to the traditional risk reduction and harm avoidance definition of safety. Background Care services are increasingly being delivered in the home for patients with complex long-term conditions. However, the concept of safety remains largely unexplored. Deign A sequential, exploratory mixed method design. Methods A qualitative case study of the UK National Health Service case management programme in the English UK National Health Service was deployed during 2012. Thirteen interviews were conducted with patients ( n = 9) and carers ( n = 6) and three focus groups with nurses ( n = 17) from three community care providers. The qualitative element explored the definition of safety. Data were subjected to framework analysis and themes were identified by participant group. Sequentially, a cross-sectional survey was conducted during 2013 in a fourth community care provider (patient n = 35, carer n = 19, nurse n = 26) as a form of triangulation. Findings Patients and carers describe safety differently to case management nurses, choosing to focus on meeting needs. They use more positive language and recognize the role they have in safety in home-delivered health care. In comparison, case management nurses described safety similarly to the definitions found in the literature. However, when offered the patient and carer definition of safety, they preferentially selected this definition to their own or the literature definition. Conclusion Patients and carers offer an alternative perspective on patient safety in home-delivered health care that identifies their role in ensuring safety and is more closely aligned with the empowerment philosophy of case management. [ABSTRACT FROM AUTHOR]

Objective. The global prevalence of non-communicable diseases (NCDs), such as diabetes mellitus and coronary heart disease, continues to rise. Internationally, people of South Asian origin (i.e. by birth or heritage) are much more likely to develop and live with NCDs compared to the general population. The South Asian diaspora population is highly heterogeneous, varying by socioeconomic status, migration history, religion and ethnicity. This article reports the findings of a study to explore the types of support accessed by Punjabi Sikhs living in Birmingham and the Black Country, UK, who were living with NCDs. Design. The study sought to develop a greater understanding of past experiences of accessing support and the importance of relationships in the mobilisation of resources for self-management. It was nested within a larger programme of research which explored attitudes to prevention of chronic diseases in local communities in the region. Seventeen Punjabi Sikh men and women were recruited through purposive sampling. Narrative interviews were conducted and analysed by the research team. Sociological theories on systems of support and social relations were consulted to inform the interpretation of data. Results. The study findings suggest that participants interpreted chronic disease self-management in relation to four primary systems of support: health services for disease management; multiple sources of care, including traditional Indian medicines and the Internet, for symptom management; community groups for lifestyle management; and the family for emotional and physical care. Within these systems of support, participants identified barriers and facilitators to the maintenance of a healthy lifestyle. We focus on intra-group diversity; exploring the intersection of views and experiences by age, gender, generation and caste. Conclusion. The findings have implications for the design and delivery of primary care and community services which support the prevention and management of NCDs in an increasingly diverse population. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal shockwave therapy (ESWT) is popular, and effective in the management of chronic tendon conditions in the elbow, shoulder, and pain at and around the heel. Methods: An online database for the Assessment of Effectiveness of Extracorporeal Shock Wave Therapy for Soft Tissue Injuries (ASSERT) was implemented to prospectively collect information on the effectiveness of ESWT across the UK. All clinicians followed a standardised method of administration of the ESWT. The primary outcome measures are validated outcome measures specific to the condition being treated. A Visual Analogue Score for pain and the EuroQol were completed alongside the condition specific outcome tool at baseline 3, 6, 12 and 24 months post treatment. Conclusion: The development of the database has enabled the evaluation of effectiveness of ESWT for patients suffering chronic conditions (plantar fasciopathy, elbow, Achilles tendinopathy, greater trochanter pain syndrome and Patellar tendinopathy). [ABSTRACT FROM AUTHOR]

The dual combination of a physical long-term condition coupled with mental health illness can increase the complexities of effective patient care. Greater integration of services spanning the health and social care spectrum have the potential to reduce fragmentation, enhance communications and ultimately support patient care. This short article discusses the reasons for this being a worthwhile philosophy and the case for change. [ABSTRACT FROM AUTHOR]

Elemental diet (ED) has been used widely in the treatment of gastrointestinal disorders, especially with the management of Crohn's disease. This modality of diets provides all essential nutrients, and contains protein in the form of free amino acids that are theoretically easily absorbed . High output ileostomies are a rare but important complications of stoma formation following bowel surgery. Treatments could be challenging and include anti-diarrhoeals, octreotide and proton pump inhibitors. There is very little research regarding the use of elemental diets in the treatment of patients with post-operative high ileostomy outputs. Adequate management of high output ileostomies might prevent significant morbidity. In this case report, we describe a patient who underwent a subtotal colectomy for ulcerative colitis complicated by refractory high ileostomy output despite maximal standard medical therapy for years. The ileostomy output was dramatically reduced following the introduction of an elemental diet. This case suggests a possible role for the introduction of an elemental diet in the management of high output ileostomies. Besides presenting this case with high output ileostomy, we reviewed the role of ED in other gastrointestinal disorders. [ABSTRACT FROM AUTHOR]

The article presents insights on the National Institute for Health and Care Excellence (NICE) guideline "Multi-morbidity: Clinical Assessment and Management." Topics covered include the failure of modern medicine to address the implications of multimorbidity, the recognition of multi-morbidity as an important clinical issue that merits a clinical guideline and the empowerment of patients in clinical decision making.

Background: home visits and telephone calls are two often used approaches in transitional care but their differential effects are unknown.Objective: to examine the overall effects of a transitional care programme for discharged medical patients and the differential effects of telephone calls only.Design: randomised controlled trial.Setting: a regional hospital in Hong Kong.Participants: patients discharged from medical units fitting the inclusion criteria (n = 610) were randomly assigned to: control (‘control’, n = 210), home visits with calls (‘home’, n = 196) and calls only (‘call’, n = 204).Intervention: the home groups received alternative home visits and calls and the call groups calls only for 4 weeks. The control group received two placebo calls. The nurse case manager was supported by nursing students in delivering the interventions.Results: the home visit group (after 4 weeks 10.7%, after 12 weeks 21.4%) and the call group (11.8, 20.6%) had lower readmission rates than the control group (17.6, 25.7%). Significance differences were detected in intention-to-treat (ITT) analysis for the home and intervention group (home and call combined) at 4 weeks. In the per-protocol analysis (PPA) results, significant differences were found in all groups at 4 weeks. There was significant improvement in quality of life, self-efficacy and satisfaction in both ITT and PPA for the study groups.Conclusions: this study has found that bundled interventions involving both home visits and calls are more effective in reducing readmissions. Many of the transitional care programmes use all-qualified nurses, and this study reveals that a mixed skills model seems to bring about positive effects as well. [ABSTRACT FROM PUBLISHER]

The article reports a study which examined literature evidence which exists on management of chronic cough in patients receiving palliative care. The review of the literature revealed 11 studies on management of chronic cough. Of these, only five provided levels of evidence of 2 or above; the remainder were case reports or case series. This indicates that there is very little evidence to support guidelines for the management of chronic cough in advanced, progressive disease.

Objective. The purpose of this study was to examine results for older adults attending treatment based on Acceptance and Commitment Therapy (ACT) for chronic pain. Both clinical outcome and treatment process variables were examined. Subjects. Participants were 40 adults with chronic pain age 60 and older selected from a larger consecutive sample of 470 adults of any age. The mean age for the smaller study sample was 64.3 years, most were women, 62.5%, and they had longstanding (median 171 months) and highly disabling pain. Intervention. The treatment consisted of 3 or 4 weeks of residential treatment delivered by a team of psychologists, physiotherapists, occupational therapists, nurses, and physicians. It was designed to increase daily functioning not by decreasing pain, but by increasing psychological flexibility. This includes the ability to change or persist with behavior in a practical, accepting, open, aware, values-directed, and committed fashion. Results. Participants showed significant improvements in physical disability, psychosocial disability, and depression at posttreatment and at a 3-month follow-up. They also showed significant increases in components of psychological flexibility. In secondary correlation analyses measures of psychological flexibility were significantly correlated with key outcome measures. Conclusion. To our knowledge, this is the first study of ACT for chronic pain specifically looking at older adults, and preliminary results are promising. [ABSTRACT FROM AUTHOR]

Chronic conditions place a significant burden on the Australian health care system, and this burden continues to increase. This literature review examines the concepts of chronic illness and chronic condition self-management (CCSM), particularly in the context of asthma. It explores the implementation of, and barriers to, CCSM in the modern health care system with a focus on CCSM in children and adolescents, and the differences that need to be recognized when dealing with Indigenous Australian children. [ABSTRACT FROM AUTHOR]

Objective: To quantify problems of relational and management continuity of care in patients with multiple long-term conditions. Methods: A mailed questionnaire survey was conducted among people aged 60 years and older from 15 general practices. The questionnaire included 16 items concerning relational and management continuity of care. The number of long-term conditions was measured using the Self-Administered Comorbidity Questionnaire. Results: Data were analysed for 1,125 participants, a response rate of 37%. There were 123 (11%) with no long-term conditions, 225 (20%) with one, 284 (25%) with two, 218 (19%) with three and 275 (24%) with four or more. Factor analysis confirmed two factors with seven items for management continuity (alpha 0.88) and nine items for relational continuity (alpha 0.83). Experiences of difficulties with management continuity were higher in participants with three long-term conditions or more (adjusted odds ratio 2.01, 95% confidence interval 1.09 to 3.73), with 'poor' self-rated health (2.21, 1.21 to 4.02), or at least three hospital outpatient attendances each year (2.60, 1.32 to 5.12). The number of long-term conditions was not consistently associated with relational continuity. Difficulties of relational continuity were experienced by participants with 'poor' self-rated health (2.11, 1.16 to 3.85). Patients with more frequent general practice consultations experienced fewer difficulties of relational continuity (0.63, 0.42 to 0.92). Conclusion: People with many long-term conditions are at increased risk of inadequate management continuity with potential negative impacts on their care. Experiences of relational continuity, with potential buffering effects, are not associated with the number of long-term conditions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Inflammatory bowel disease (IBD), a paradigm of chronic illness, requires for its safe clinical management ready access to complete information, not always possible using paper records. Aim: To develop an IBD database (DB) for both individual patient management and collating information across centres. Methods: Access® based, with a minimum dataset. Results: Prospectively collected data for 11,432 patients from 21 centres. Profile Diagnosis: Ulcerative colitis (UC) 56%, Crohn''s disease (CD) 40%, indeterminate colitis 4%. M:F ratio: UC 1.08:1, CD 0.72:1. Median age at diagnosis: UC 39, CD 30years. Operated: UC 16%, CD 47%. Thiopurine use: UC 16%, CD 29%. IBD related mortality: 0.74%. Discussion: A snapshot of this large IBD cohort shows the disease profile across the UK is similar to other large series. Unexpected gaps, sometimes large emerged (e.g. data on smoking and immunosuppression) highlighting the need for clear definition, consistency and completeness of data collection. Clinical management is made easier by the ‘at a glance’ summary, automated clinic letters, and facility for monitoring and audit, but the time required limited its ‘real-time’ use. Conclusion: Our experience shows it is possible to collect data from centres across the country which truly reflects clinical practice. We have learned as much from the process itself as from the data, principally, information needs to be well defined, validated at entry, and updated at every visit, a time consuming sequence which we had underestimated. Our lessons learned may help inform the development of a national database, and support national IBD standards and audit. [Copyright &y& Elsevier]

The article focuses on establishing quality of care for chronic diseases among cancer survivors in Great Britain. It states that long-term cancer survivors with other chronic diseases receive poorer care for those diseases compared with the general population. It reports that the proportion of patients meeting quality standards for chronic disease care was high in both cancer survivors and control patients.

Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions. • Co-occurring mental & physical health conditions are linked to higher healthcare use. • Psychological treatment may improve mental health & management of chronic conditions. • Reductions in hospital utilisation were observed following psychotherapy. • Evidence of these reductions was found 0, 6 and 12 months after treatment. [ABSTRACT FROM AUTHOR]

The article discusses the use of innovative technologies such as the telemedicine in enabling multidisciplinary community service to bring chronic obstructive pulmonary disease (COPD) care to the patients' homes in Great Britain. It offers information on the patient monitoring system called Excelicare Direct, a software program developed by AxSys Technologies Inc. The author suggests that nurses must be encouraged to use new technologies to enhance their ability in providing health services.

Virtual Scanning incorporates novel uses of colored light into its system of health assessment and therapy. Independent investigations of its effectiveness in Russia and the UK have revealed unique abilities to correct incipient and fully developed chronic conditions. As such it forms an important new addition to the field of Chromotherapy. It differs from most others, in that its development depended on discoveries the neuroscience by its inventor, and subsequent application of new models in computational neuroscience. [ABSTRACT FROM AUTHOR]

Focuses on the medical policies of Great Britain's National Health Service (NHS) treatment of chronic diseases. Impact of the NHS Improvement Plan on the administration of chronic care; Incidence of chronic disease in Great Britain; Details of health care intervention sought by patients with chronic illness; Emphasis of NHS policy on the role of primary care trusts in managing chronic diseases; Financial incentives used to encourage the role of primary care trusts; Efforts of the NHS to coordinated the services of primary, secondary, and social care organizations.

Presents the issues related to medicine in Great Britain. Importance of clinical practice for patients with serious chronic disease; Responsibility of the National Health Service in medical care; Relevance of surgical consultation following ultrasonic diagnosis.

The article focuses on the lack of prominence given to gastroenterology cases in the primary care setting in Great Britain, and stresses that it should also be given prominence like other ailments. The reason demanding this prominence is the growing number of cases of gastrointestinal (GI) disease in the country, the disproportionate medical costs associated with it, and increased number of GI cancers. The importance of chronic disease management in primary care is also discussed.

Goal-setting is widely recommended for supporting patients with multiple long-term conditions. It involves a proactive approach to a clinical consultation, requiring doctors and patients to work together to identify patient's priorities, values and desired outcomes as a basis for setting goals for the patient to work towards. Importantly it comprises a set of activities that, for many doctors and patients, represents a distinct departure from a conventional consultation, including goal elicitation, goal-setting and action planning. This indicates that goal-setting is an uncertain interactional space subject to inequalities in understanding and expectations about what type of conversation is taking place, the roles of patient and doctor, and how patient priorities may be configured as goals. Analysing such spaces therefore has the potential for revealing how the principles of goal-setting are realised in practice. In this paper, we draw on Goffman's concept of 'frames' to present an examination of how doctors' and patients' sense making of goal-setting was consequential for the interactions that followed. Informed by Interactional Sociolinguistics, we used conversation analysis methods to analyse 22 video-recorded goal-setting consultations with patients with multiple long-term conditions. Data were collected between 2016 and 2018 in three UK general practices as part of a feasibility study. We analysed verbal and non-verbal actions for evidence of GP and patient framings of consultation activities and how this was consequential for setting goals. We identified three interactional patterns: GPs checking and reframing patients' understanding of the goal-setting consultation, GPs actively aligning with patients' framing of their goal, and patients passively and actively resisting GP framing of the patient goals. These reframing practices provided "telling cases" of goal-setting interactions, where doctors and patients need to negotiate each other's perspectives but also conflicting discourses of patient-centredness, population-based evidence for treating different chronic illnesses and conventional doctor-patient relations. • First study of GP goal-setting interactions for patients with multiple conditions. • Goal-setting involves novel activities in an uncertain interactional space. • GPs and patients may need to negotiate different framings of patient's priorities. • GPs may actively align with patient's goal, patients may resist GP framing of goal. • Negotiation of frames reveal conflicting discourses invoked at interactional level. [ABSTRACT FROM AUTHOR]

The author conveys his thoughts on how to fairly allocate scarce resources to deal with the healthcare demands of the population in a palliative context. Topics discussed include strategy and policy documents in palliative and end-of-life care for those with non-cancer conditions, the Cinderella nature of mental health services, and the central concern of any government to help all ill people regardless of diagnosis through its healthcare institutions.

This articles outlines the important issue of chronic oedema, its definition and the physiology of the three main categories. The care delivered in the care home (nursing) sector was the subject of a printed questionnaire and the results are presented here. They are discussed and the implications for practice and an evidenced-based approach to care delivery are considered. Several conclusions can be drawn from this study but would be strengthened by a larger study. Care for patients with chronic oedema could be enhanced and this would improve clinical outcomes; significantly fewer patients would need to be referred for GP management if an appropriate and timely first-line treatment was agreed and provided by nursing staff. An educational resource should be developed, including: a resource folder; e-learning, patient information, and a patient leg exercise regime; a crib sheet and myth buster information; and clinical competencies. A further study would be required to confirm whether fewer patients experienced falls or presented with chronic oedema when lower leg swelling was managed. [ABSTRACT FROM AUTHOR]

The article discusses the burden of caring for a sick loved-one, and it mentions how over six million adults in Great Britain are carers (caregivers). Community nurses are addressed in relation to patient care and treatment-based collaborations between nurses, families, and carers. The physical and mental health issues that impacts carers are examined, including back and neck injuries, as well as anxiety and depression. The British Care Act and care for cancer patients are assessed.

The article focuses on the concern of Helen Stokes-Lampard, chair of the Royal College of General Practitioners (GPs), over whether community nurses and GPs will be able to cope with the high demand for their services during the winter in Great Britain. She says that chronically ill patients may have to wait up to four weeks to see their GPs because of their workload. It is noted that NHS England's GP services would receive an extra investment to expand access to convenient appointments.