Miss any of the clinical and practice news affecting the profession during July 2018? Catch up with our summary of the main study headlines and clinical breakthroughs.
Nurses ‘at least as good’ as doctors for primary care provision
“diagnose, intervene, live with chronic condition”
Nurses delivering primary care obtain the same or better health outcomes as doctors and achieve higher levels of patient satisfaction, suggests a new review of research evidence.
“Trained nurses can probably provide equal or better quality of care compared to primary care doctors”
The Cochrane Review specifically set out to explore the impact of substituting nurses for doctors with nurses carrying out a range of tasks including diagnosis, treatment, prescription and referral.
Findings from 18 trials were examined, including studies looking at nurses providing initial care, ongoing care for physical health issues and follow-up care for long term conditions.
The reviewers found care delivered by nurses instead of doctors probably generated similar or better patient health for a wide range of conditions. It appeared to deliver better results for blood pressure, while other clinical outcomes were pretty much the same as those achieved by doctors. Meanwhile, patient satisfaction and quality of life were likely to be higher for those seen by nurses.
The research team found nurse consultations were likely to be longer than those conducted by doctors and there was evidence that patients were more likely to attend follow-up appointments.
Review lead author Miranda Laurant said the research demonstrated nurses could be deployed effectively to expand the primary care workforce.
“It doesn’t suggest that we can or should eliminate doctors from the primary care level; instead it shows that, in the cases assigned to them, trained nurses can probably provide equal or better quality of care compared to primary care doctors,” she said.
“Doing so may allow doctors to spend more time focusing on more complex cases or cases that utilise their more advanced training,” she added.
Guidance sets out change in pressure ulcer recording at end of life
Nurses must stop attempting to distinguish between “avoidable” and “unavoidable” pressure ulcers to help ensure all are properly investigated and ulcers that occur at the end of life should also no longer be recorded separately, according to guidance from NHS Improvement, which will start to be rolled out this year. The guidelines on the definition and measurement of pressures ulcers are designed to ensure a more consistent approach across trusts in England.
Specialist nursing care ‘improves life expectancy of cancer patients’
Cancer after care led by nurses may be ‘attractive’ option
Source: University of Aberdeen
Patients with lung cancer live longer, avoid unnecessary admissions and cope better with treatment when cared for by specialist nurses, according to a new study. The research by the University of Nottingham and London South Bank University, which looked at more than 100,000 lung cancer cases, found many patients fared better if they received an assessment and care from a specialist nurse.
Alert over delayed bowel care for patients with spinal injuries
Trusts told to regularly reveal data on ‘avoidable’ patient deaths
An alert has been issued to the NHS in England after concerns were raised about patients with spinal injuries facing delays in receiving specialist care to clear their bowels. Such delays can result in a brain haemorrhage, high blood pressure, extreme discomfort and ultimately death, warned NHS Improvement. Reasons for the delay cited included lack of staff training, confusing local policies and the belief that digital removal of faeces represented assault.
Mild cognitive impairment risk cut by ‘aggressive’ BP lowering
Intensive blood pressure control has been shown for the first time to reduce the risk of mild cognitive impairment, according to preliminary findings from a large US trial. They provide the strongest evidence to date about reducing risk of mild cognitive impairment and dementia through treating hypertension. The trial compared an intensive strategy with a systolic blood pressure goal of less than 120mmHg versus a standard care goal of less than 140mmHg.
‘Z-drugs’ leave dementia patients at a higher risk of bone fractures
Staff caring for dementia patients must be trained in understanding their identity, NICE says
Dementia patients taking prescribed sleeping drugs, commonly known as “Z-drugs”, are at a higher risk of experiencing bone fractures, according to UK researchers. They highlighted that the non-benzodiazepine hypnotic pills zolpidem, zopiclone and zaleplon were commonly prescribed to help patients suffering from insomnia. However, they found that Z-drug use was associated with a 40% increased risk of any type of fracture, with higher doses leading to higher risks.
Government announces HPV vaccine to be given to boys in England
The government has announced that boys aged between 12 and 13 in England will be offered the human papilloma virus (HPV) vaccine to protect them from cancer. The move follows similar announcements in Scotland and Wales, sparked by new advice from the Joint Committee on Vaccination and Immunisation.
Paediatric patients lose an hour of sleep in ‘noisy hospital wards’
Mental health child
Sick children lose more than an hour’s sleep per night on noisy hospital wards, according to new UK research, which suggests it could harm their recovery. The study carried out at Southampton Children’s Hospital found the noise on paediatric medical wards exceeded the 30 decibel maximum recommended by the World Health Organization.
Nurses start pioneering chemo service for patients at work
Chemotherapy service to treat patients at work
Patients on Merseyside are benefitting from a pioneering service that allows them to receive treatment for cancer in their workplace. The service, delivered by the Clatterbridge Cancer Centre Foundation Trust, involves a specialist chemotherapy nurse visiting the patient and delivering their cancer treatment in a safe and suitable area at their workplace.
Spikes in air pollution linked to rise in respiratory healthcare visits
generic traffic pollution
Air pollution is clearly linked to peaks in admissions to hospitals and visits to primary care for certain respiratory conditions, according to researchers who studied data on pollution in Dundee and Perth and matched it to the records of patients with bronchiectasis. They said the links between the worst periods of pollution and when patients were seeking healthcare assistance was “absolutely clear”.
Supplemental oxygen aids hypertension in sleep apnoea patients
Supplemental Oxygen and OSA
Source: American Thoracic Society
Supplemental oxygen can be used to eliminate the rise in morning blood pressure for patients with obstructive sleep apnoea, according to a small study, led by UK researchers. They found it eliminated the rise experienced by patients who stopped using continuous positive airway pressure.
Better communication during patient handovers ‘could save lives’
Improving communication between paramedics, prehospital critical care teams and emergency staff could “enhance” the care and wellbeing of critically ill or injured patients, according to UK studies. Researchers from the University of Stirling found that improving the accuracy and quality of patient information during handovers yielded positive results across eight clinical variables.
‘Invisible’ stool blood linked to higher risk of all-cause mortality
Crohn’s and colitis
Unseen stool blood is linked to a heightened risk of death from all causes, as well as from bowel cancer, according to Scottish researchers. It was particularly associated with increased risk of dying from circulatory, respiratory, digestive, blood, hormone and neuropsychological diseases, and other types of cancer.
‘Encouraging’ results from using care bundle to cut stillbirths
A major independent evaluation has concluded that best practice guidance on reducing stillbirths has probably helped to prevent baby deaths. The evaluation of the Saving Babies’ Lives Care Bundle found a 20% reduction in the number of stillbirths at 19 “early adopter” trusts.