Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial

Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial | BMJ.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract

Objective To evaluate the effectiveness and costs of a multifaceted flexible educational programme aimed at reducing antibiotic dispensing at the practice level in primary care.

Design Randomised controlled trial with general practices as the unit of randomisation and analysis. Clinicians and researchers were blinded to group allocation until after randomisation.

Setting 68 general practices with about 480 000 patients in Wales, United Kingdom.

Participants 34 practices were randomised to receive the educational programme and 34 practices to be controls. 139 clinicians from the intervention practices and 124 from control practices had agreed to participate before randomisation. Practice level data covering all the clinicians in the 68 practices were analysed.

Interventions Intervention practices followed the Stemming the Tide of Antibiotic Resistance (STAR) educational programme, which included a practice based seminar reflecting on the practices’ own dispensing and resistance data, online educational elements, and practising consulting skills in routine care. Control practices provided usual care.

Main outcome measures Total numbers of oral antibiotic items dispensed for all causes per 1000 practice patients in the year after the intervention, adjusted for the previous year’s dispensing. Secondary outcomes included reconsultations, admissions to hospital for selected causes, and costs.

Results The rate of oral antibiotic dispensing (items per 1000 registered patients) decreased by 14.1 in the intervention group but increased by 12.1 in the control group, a net difference of 26.1. After adjustment for baseline dispensing rate, this amounted to a 4.2% (95% confidence interval 0.6% to 7.7%) reduction in total oral antibiotic dispensing for the year in the intervention group relative to the control group (P=0.02). Reductions were found for all classes of antibiotics other than penicillinase-resistant penicillins but were largest and significant individually for phenoxymethylpenicillins (penicillin V) (7.3%, 0.4% to 13.7%) and macrolides (7.7%, 1.1% to 13.8%). There were no significant differences between intervention and control practices in the number of admissions to hospital or in reconsultations for a respiratory tract infection within seven days of an index consultation. The mean cost of the programme was £2923 (€3491, $4572) per practice (SD £1187). There was a 5.5% reduction in the cost of dispensed antibiotics in the intervention group compared with the control group (−0.4% to 11.4%), equivalent to a reduction of about £830 a year for an average intervention practice.

Conclusion The STAR educational programme led to reductions in all cause oral antibiotic dispensing over the subsequent year with no significant change in admissions to hospital, reconsultations, or costs.

 

 

Fall in suicides among mental health patients linked to improvements in mental health services | BMJ

via Fall in suicides among mental health patients linked to improvements in mental health services | BMJ.

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Suicides among vulnerable mental health patients have fallen in England and Wales as a result of mental health trusts implementing best practice recommendations, after the move to providing more care into the community, a study has found.

 

Behaviour change among overweight and socially disadvantaged adults: A longitudinal study of the NHS Health Trainer Service

Taylor & Francis Online :: Behaviour change among overweight and socially disadvantaged adults: A longitudinal study of the NHS Health Trainer Service – Psychology & Health -.

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Abstract

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre–post changes in Body Mass Index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008–2009; N = 4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change.

CCG performance could be measured against 120 indicators | News | Health Service Journal

via CCG performance could be measured against 120 indicators | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Clinical commissioning groups could be judged against up to 120 performance measures, the National Institute for Health and Clinical Excellence has revealed today.

 

Health bodies caution against Cabinet Office open data push | News | Health Service Journal

via Health bodies caution against Cabinet Office open data push | News | Health Service Journal.

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A government consultation on more open use of data has found strong support for increased transparency in public services. But health organisations have urged caution due to the potential for leaks of sensitive information

 

LIFT companies seek NHS Property Services links | News | Health Service Journal

Companies set up under a public-private partnership scheme are positioning themselves to become key partners to NHS Property Services, the firm formed to manage health service assets

via LIFT companies seek NHS Property Services links | News | Health Service Journal.

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A systematic review on use of Chinese medicine and acupuncture for treatment of obesity

A systematic review on use of Chinese medicine and acupuncture for treatment of obesity – Sui – 2012 – Obesity Reviews – Wiley Online Library.

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Summary

Obesity is a major health hazard and despite lifestyle modification, many patients frequently regain any lost body weight. The use of western anti-obesity drugs has been limited by side effects including mood changes, suicidal thoughts, and gastrointestinal or cardiovascular complications. The effectiveness and safety of traditional Chinese medicine including Chinese herbal medicine (CHM) and acupuncture provide an alternative established therapy for this medical challenge. In this systematic review, we used standard methodologies to search, review, analyse and synthesize published data on the efficacy, safety and relapse of weight regain associated with use of CHM and acupuncture. We also examined the rationale, mechanisms and potential utility of these therapies. A total of 12 electronic databases, including Chinese, English, Korean and Japanese, were searched up to 28 February 2010. Randomized controlled trials (RCTs) for CHM and/or acupuncture with comparative controls were considered. We used the Jadad scale to assess methodological qualities, the random effect model in the pooled analysis of therapeutic efficacy to adjust for heterogeneity and funnel plots to explore publication bias. After screening 2,545 potential articles from the electronic databases, we identified 96 RCTs; comprising of 49 trials on CHM treatment, 44 trials on acupuncture treatment and 3 trials on combined therapy for appraisal. There were 4,861 subjects in the treatment groups and 3,821 in the control groups, with treatment duration ranging from 2 weeks to 4 months. Of the 77 publications written in Chinese, 75 had a Jadad score <3, while 16 of the 19 English publications had a Jadad score of >3. Efficacy was defined as body weight reduction ≥2 kg or body mass index (BMI) reduction ≥0.5 kg/m². Compared with placebo or lifestyle modification, CHM and acupuncture exhibited respective ‘risk ratio’ (RR) of 1.84 (95% CI: 1.37–2.46) and 2.14 (95% CI: 1.58–2.90) in favour of body weight reduction, with a mean difference in body weight reduction of 4.03 kg (95% CI: 2.22–5.85) and 2.76 kg (95% CI: 1.61–3.83) and a mean difference in BMI reduction of 1.32 kg m^–2 (95% CI: 0.78–1.85) and 2.02 kg m^–2 (95% CI: 0.94–3.10), respectively. Compared with the pharmacological treatments of sibutramine, fenfluramine or orlistat, CHM and acupuncture exhibited an RR of 1.11 (95% CI: 0.96–1.28) and 1.14 (95% CI: 1.03–1.25) in body weight reduction, mean difference in body weight reduction of 0.08 kg (95% CI: −0.58 to 0.74) and 0.65 kg (95% CI: −0.61 to 1.91), and mean difference in BMI reduction of 0.18 kg m^–2 (95% CI: −0.39 to 0.75) and 0.83 kg m^–2 (95% CI: 0.29–1.37), respectively. There were fewer reports of adverse effects and relapses of weight regain in CHM intervention studies conducted in China than studies conducted outside China. CHM and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies.

BBC News – Government offers NHS bill concessions

The government has promised the health secretary will keep ultimate control over the NHS in England, as it pushes for Parliament to pass its health bill.

via BBC News – Government offers NHS bill concessions.

Physical activity for cancer survivors: meta-analysis of randomised controlled trials | BMJ

Source:Physical activity for cancer survivors: meta-analysis of randomised controlled trials | BMJ.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract

Objective To systematically evaluate the effects of physical activity in adult patients after completion of main treatment related to cancer.

Design Meta-analysis of randomised controlled trials with data extraction and quality assessment performed independently by two researchers.

Data sources Pubmed, CINAHL, and Google Scholar from the earliest possible year to September 2011. References from meta-analyses and reviews.

Study selection Randomised controlled trials that assessed the effects of physical activity in adults who had completed their main cancer treatment, except hormonal treatment.

Results There were 34 randomised controlled trials, of which 22 (65%) focused on patients with breast cancer, and 48 outcomes in our meta-analysis. Twenty two studies assessed aerobic exercise, and four also included resistance or strength training. The median duration of physical activity was 13 weeks (range 3-60 weeks). Most control groups were considered sedentary or were assigned no exercise. Based on studies on patients with breast cancer, physical activity was associated with improvements in insulin-like growth factor-I, bench press, leg press, fatigue, depression, and quality of life. When we combined studies on different types of cancer, we found significant improvements in body mass index (BMI), body weight, peak oxygen consumption, peak power output, distance walked in six minutes, right handgrip strength, and quality of life. Sources of study heterogeneity included age, study quality, study size, and type and duration of physical activity. Publication bias did not alter our conclusions.

Conclusions Physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancer other than breast cancer were also included, physical activity was associated with reduced BMI and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.

No big shift in government Health Bill amendments

via No big shift in government Health Bill amendments | News | Health Service Journal.

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The government was this week expected to announce a series of changes to its Health Bill, with the intention of staving off opposition when the legislation returns to parliament next week

 

Healthy convenience: nudging students toward healthier choices in the lunchroom

Healthy convenience: nudging students toward healthier choices in the lunchroom.

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Abstract

Background In the context of food, convenience is generally associated with less healthy foods. Given the reality of present-biased preferences, if convenience was associated with healthier foods and less healthy foods were less convenient, people would likely consume healthier foods. This study examines the application of this principle in a school lunchroom where healthier foods were made more convenient relative to less healthy foods.

Methods One of two lunch lines in a cafeteria was arranged so as to display only healthier foods and flavored milk. Trained field researchers collected purchase and consumption data before and after the conversion. Mean comparisons were used to identify differences in selection and consumption of healthier foods, less healthy foods and chocolate milk.

Results Sales of healthier foods increased by 18% and grams of less healthy foods consumed decreased by nearly 28%. Also, healthier foods’ share of total consumption increased from 33 to 36%. Lastly, we find that students increased their consumption of flavored milk, but flavored milk’s share of total consumption did not increase.

Conclusions In a school lunchroom, a convenience line that offered only healthier food options nudged students to consume fewer unhealthy foods. This result has key implications for encouraging healthy behavior in public schools nation wide, cafeterias and other food establishments.

NICE needs to move faster to keep up with NHS changes | BMJ

via NICE needs to move faster to keep up with NHS changes | BMJ.

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Health and social care experts are asking the UK National Institute for Health and Clinical Excellence (NICE) to produce guidance more quickly as it expands its role. They also want more to be done to measure the effect of new quality standards on the care of patients.

 

Nearly half of GPs dealing with ‘burnout’

via Nearly half of GPs dealing with ‘burnout’ | News | Health Service Journal.

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Close to 50 per cent of doctors suffer from emotional exhaustion related to burnout, according to researchers.

 

Letters on PCT and SHA staff transfers sent today

via Letters on PCT and SHA staff transfers sent today | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Primary care trust and strategic health authority staff across England are today being sent letters explaining where their function is to be transferred to in the restructured NHS

 

Don’t flush away your toilet worries

News : NDS.

The Government’s first ever national cancer campaign to raise awareness of the symptoms of bowel cancer will be launched today by Care Services Minister Paul Burstow.

DH warns over severe weather

via DH warns over severe weather | News | Health Service Journal.

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The Department of Health has warned people to keep an eye on local weather reports as forecasters warn that scattered snow showers and freezing temperatures are on their way to the UK

 

No evidence milk boosts brain power

Source:No evidence milk boosts brain power – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

Contrary to the headlines, this study does not show that dairy food consumption has benefits for mental functioning. All it can do is provide a “snapshot” of a group of people’s dairy consumption and their mental functioning at one point in time. Some limitations are that:

• It relied on people self-reporting their dairy intake, which introduces the possibility of error.
• It is possible that many other factors (known as confounders) might have affected the results, including exercise habits, alcohol and stress levels, although researchers tried to adjust their findings for some of these.
• As the authors acknowledge, the dietary questionnaire did not specify size of portions or servings, which undermines the accuracy of estimated intakes.

Dairy products contain many nutrients that are needed for good health, in particular for the development of healthy bones and teeth. However, they are also high in saturated fat, which is associated with heart disease and obesity. At present there is no good evidence that dairy foods are especially beneficial for brain functioning.

Find out how dairy fits into a healthy diet using the Eatwell Plate

Links to the headlines

The white stuff: Drinking just one glass of milk a day could boost your brain power. Daily Mail, January 31 2012

Links to the science

Crichton GE, Elias MF, Doreb GA, Robbins MA. Relation between dairy food intake and cognitive function: The Maine-Syracuse Longitudinal Study. International Dairy Journal 2012:22;15-23

The new UK focus on well-being: what will it mean for tackling social inequalities in health?

via The new UK focus on well-being: what will it mean for tackling social inequalities in health?.

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It is difficult to imagine who would not be in favour of improving well-being. Yet a major problem with well-being is knowing what different commentators understand by the term. First introduced by the World Health Organization in 1948,1 there is still little consensus over how well-being should be defined