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Tag: Social Care

  • Research shows the importance of ‘family’ bonds in care homes

    Research shows the importance of ‘family’ bonds in care homes

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    Care home residents receive much better care when they enjoy ‘family’ bonds with staff – but staff must be empowered to create these bonds, new research has found. 

    The study, led by the University of Leeds and funded by The National Institute for Health and Care Research, found that when care home staffing is stable and consistent and numbers are sufficient, workers have the capacity to develop ‘familial’ relationships with residents and can deliver quality, personalized care. 

    Understanding how to meet the needs and preferences of the thousands of people living in care homes is a societal priority. It is vital that we know how to use the workforce resources in care homes to promote quality and effective working.” 


    Karen Spilsbury, Lead Researcher, Professor of Nursing at the University of Leeds’ School of Healthcare

    Quality of care and quality of life varies significantly for the 441,479 people living in care homes in the UK. Previous research into the reasons for this has not provided robust explanations. 

    The study team speculated that staffing and ways of working were key influences on quality. Working with managers, residents, families, and care home staff from a range of care homes in England, the researchers set out to find out how and why staffing in care homes affects the quality of life and care of the residents. 

    The team analyzed research journal articles, care home and care organization data to look at what it is about staffing that influences quality. They analysed reports and ratings of homes from the Care Quality Commission (CQC) regulator, and networks between staff in homes. 

    According to the results, staffing considerations that might improve quality include not swapping managers too much; having sufficient and consistent staff for family-like relationships in homes and putting residents’ needs first; supporting staff and giving them freedom to act, and key staff leading by example. 

    The research also showed that where more care was provided by registered nurses, there were fewer incidents such as falls with fractures, urinary tract infections and medication errors. 

    However, simply increasing nursing input was unlikely to be a cost-effective way of reducing adverse incidents in care homes. The study found that although there might be savings to the wider healthcare system in reduced treatment costs, any savings would be wiped out by the high additional costs of employing more nurses. 

    The study also found: 

    • Care homes with a manager in-post in the 12 months prior to a CQC inspection were more likely to be rated as good or outstanding 

    • Higher staff-to-bed ratios were associated with a greater chance of a good or outstanding CQC inspection score 

    • Having experienced care staff, that is, staff in post for 5 years, was likely to improve quality, as measured by CQC ratings, and staffing consistency was important for organizing care and work 


    • Larger homes were less likely to be rated positively: but team size (not home size) may be a useful lever for promoting quality, i.e. small groups of linked residents and staff (5–15 residents per staff member based on level of resident dependency) promoted familiarity, communication and a family-like environment for cultivating relationships 

    • Use of agency nurses to cover for staff sickness or unfilled vacancies was not associated with more falls, infections, or pressure ulcers, but was associated with more medication errors 

    The report is the latest publication by NICHE-Leeds, a research partnership between the University’s School of Healthcare and care home providers which develops research projects from ideas generated by care home staff, families and residents. 

    It is the first study in the UK which has worked with a large care organization to provide novel evidence on relationships between nurse staffing and care quality in English care homes over time. 

    Professor Spilsbury, who is also NICHE-Leeds’ Academic Director, added: “Staffing in care homes matters and needs to be valued. It needs to be stable, skilled and competent, to realize the benefits of person-focused organization of care, and enhanced teamworking. 

    “Our study shows that leadership, reward and recognition of staff, and a shared philosophy of care are key to improving quality as experienced by residents.” 

    Source:

    Journal reference:

    Spilsbury, K., et al. (2024) Relationship between staff and quality of care in care homes: StaRQ mixed methods study. Health and Social Care Delivery Research. doi.org/10.3310/GWTT8143.

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  • UK Government donates £2 million worth of medical equipment to Ukraine

    UK Government donates £2 million worth of medical equipment to Ukraine

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    More than £2 million worth of lifesaving medical equipment, including ventilators, pumps and monitors, has been donated to Ukraine by the UK Government.

    To support hospitals in Ukraine the donation package will support up to 60 intensive care beds. It includes a variety of ventilators, oxygen concentrators, suction pumps, patent monitors, volumetric pumps, and heated humidifiers.

    These items are urgently needed by healthcare facilities in Ukraine for the immediate use in treating people.

    The UK’s support for our friends in Ukraine is unwavering and we want to help in every way we can. This donation will support their hospitals and builds on previous deliveries of medicines and equipment to save lives.


    We will continue to work closely with the Ukrainian Ministry of Health and other partners to ensure humanitarian aid reaches the people who need it most, as quickly as possible.”


    Victoria Atkins, Health and Social Care Secretary

    The donation followed a request for help from the Ukrainian Minister of Health. The Health and Social Care Secretary also recently met with Ukraine’s First Lady, to whom she reiterated the UK Government’s ongoing support.

    Ukraine’s First Lady thanked the UK for its assistance in the medical sector and for the donation of medical supplies and they also discussed further medical co-operation in the future.

    In September last year, the UK signed a statement on international health partnerships. This recognised the importance of international co-operation and recommended building and encouraging global partnerships between government and expert bodies.

    29 partnerships have been established between 21 Ukrainian and 26 foreign healthcare institutions from 15 countries. These enable partners to share experience, training, operational knowledge and research.

    During her visit, the Department of Health and Social Care minister Lord Markham joined the First Lady at a roundtable discussion on mental health.

    Loading of the equipment took place on Tuesday 5 March, and the equipment has now been received by Ukraine. This in addition to previous donations of over 11 million items of medical equipment and medicines.

    The Covid Strategic ICU Reserve, which are Covid stockpiles, has also previously supported aid packages to Nepal, Peru, Gaza, and British Overseas Territories, and issued over 80,000 pieces of equipment into the NHS since 2020.

    This donation is part of the UK’s commitment to provide medical supplies and basic necessities on the ground, saving lives and protecting vulnerable people following Russia’s illegal invasion of Ukraine.  The United Nations estimates that almost 18 million people in Ukraine need humanitarian support.

    This donation is in addition to the £357 million of humanitarian aid the UK has committed since the start of the full-scale invasion. UK support contributes to an international response that reached 11 million people in Ukraine in 2023 and 15.8 million in 2022.

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  • AI tool predicts lethal heart rhythm with 80% accuracy

    AI tool predicts lethal heart rhythm with 80% accuracy

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    In a Leicester study that looked at whether artificial intelligence (AI) can be used to predict whether a person was at risk of a lethal heart rhythm, an AI tool correctly identified the condition 80 per cent of the time.

    The findings of the study, led by Dr Joseph Barker working with Professor Andre Ng, Professor of Cardiac Electrophysiology and Head of Department of Cardiovascular Sciences at the University of Leicester and Consultant Cardiologist at the University Hospitals of Leicester NHS Trust, have been published in the European Heart Journal – Digital Health.

    Ventricular arrhythmia (VA) is a heart rhythm disturbance originating from the bottom chambers (ventricles) where the heart beats so fast that blood pressure drops which can rapidly lead to loss of consciousness and sudden death if not treated immediately.

    NIHR Academic Clinical Fellow Dr Joseph Barker co-ordinated the multicentre study at the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre,  and co-developed an AI tool with Dr Xin Li, Lecturer in Biomedical Engineering, School of Engineering. The tool examined Holter electrocardiograms (ECGs) of 270 adults taken during their normal daily routine at home.  

    These adults had the Holter ECGs taken as part of their NHS care between 2014 and 2022. Outcomes for these patients were known, and 159 had sadly experienced lethal ventricular arrhythmias, on average 1.6 years following the ECG.

    The AI tool, VA-ResNet-50, was used to retrospectively examine ‘normal for patient’ heart rhythms to see if their heart was capable of the lethal arrythmias.

    Current clinical guidelines that help us to decide which patients are most at risk of going on to experience ventricular arrhythmia, and who would most benefit from the life-saving treatment with an implantable cardioverter defibrillator are insufficiently accurate, leading to a significant number of deaths from the condition.


    Ventricular arrhythmia is rare relative to the population it can affect, and in this study we collated the largest Holter ECG dataset associated with longer term VA outcomes. 


    We found the AI tool performed well compared with current medical guidelines, and correctly predicted which patient’s heart was capable of ventricular arrhythmia in 4 out of every 5 cases.


    If the tool said a person was at risk, the risk of lethal event was three times higher than normal adults.


    These findings suggest that using artificial intelligence to look at patients’ electrocardiograms while in normal cardiac rhythm offers a novel lens through which we can determine their risk, and suggest appropriate treatment; ultimately saving lives.”


    Professor Andre Ng, Professor of Cardiac Electrophysiology and Head of Department of Cardiovascular Sciences at the University of Leicester 

    He added: “This is important work, which wouldn’t have been possible without an exceptional team in Dr Barker and Dr Xin Li, and their belief and dedication to novel methods of analysis of historically disregarded data.”

    Dr Barker’s work has been recognized with a van Geest Foundation Award and Heart Rhythm Society Scholarship and more research will be carried out to develop the work further.

    For the full paper, please visit  https://academic.oup.com/ehjdh/advance-article/doi/10.1093/ehjdh/ztae004/7591810

    The NIHR Leicester BRC is part of the NIHR and hosted by the University Hospitals of Leicester NHS Trust in partnership with the University of Leicester, Loughborough University and the University Hospitals of Northamptonshire NHS Group.

    Source:

    University Hospitals of Leicester NHS Trust

    Journal reference:

    Barker, J., et al. (2024). Artificial intelligence for ventricular arrhythmia capability using ambulatory electrocardiograms. European Heart Journal. doi.org/10.1093/ehjdh/ztae004.

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  • IVF solutions could help address the falling birth rates among UK’s aging population

    IVF solutions could help address the falling birth rates among UK’s aging population

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    With the UK’s birth rate falling, more awareness and support are needed for people struggling or putting off starting a family to ensure future generations.

    The Department of Health and Social Care recently reported that more must be done to adapt for the onset of the UK’s ageing population. With an ageing population comes a myriad of social and economic challenges – many of which need to be addressed as early as possible.

    Many people have put starting a family on hold, whether it be due to fertility factors outside of their control, or due to a wish to delay until they have that foothold. Fertility, however, does not wait for all, and thus more fertility and IVF offerings are helpful in reducing concerns they don’t need when planning for their dream family. 

    “Fertility care and developments in assisted reproduction technologies are increasingly important in a society that is slowly skewing towards an ageing population,” says James Barr, Managing Director of Bridge Clinic London. 

    When foregoing family life in the past, many chose to pursue career opportunities or other factors. It’s important to remember that patients can have both options available – family life and a career – to them if they know where to look.”

    James Barr, Managing Director, Bridge Clinic London

    “Britain’s ageing population is a concern that does requires action now before its effects are irreversible. We are all living longer, and that’s a testament to modern medicine. But combine this with a falling national birth rate, and society will soon encounter problems.”

    Barr believes clinics also have a responsibility to raise awareness for people struggling with finding the right care option. “People who may have either put an end to starting a family or have delayed the process can speak to an IVF partner to discuss their options and potentially a more accessible offering they might have previously not been aware of. For those seeking alternative routes to starting a family, simply having an introductory conversation with clinician could spark the beginning of a journey towards parenthood, as without this consultation they often feel they have lost hope or believe their budget cannot accommodate it.

    “Advancements in IVF solutions such as egg storage and sperm donation are now available to help patients who may feel that now is not the right time to start or extend their family or may be unsure. Transparency of fertility options and their costs, including potential add-on treatments, should be clear from the onset to build needed trust with potential patients who may be experiencing uncertainty and emotional pressures.

    “Starting a family can be expensive and issues around childcare costs have been making headlines which could be steering patients away from starting a family. Affordable and accommodating IVF options being available is the first step to address this, now it is time for the government to implement reassurances for patients that the next step – specifically, childcare costs – will be prevented from spiralling beyond control.”

    Barr concludes: “A falling birth rate is a difficult challenge for any society to combat and overcome, but there are always solutions. Building the foundations of trust and reassuring patients that IVF is an affordable and accommodating process to start a family.

    “In years gone by, an ageing population would be difficult to overturn. Today, fertility clinics are on-hand to encourage people who are either struggling or unsure about starting a family and help gradually address the issue of an ageing population.”

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  • Research highlights the need for continued surveillance of emerging SARS-CoV-2 variants and vaccines

    Research highlights the need for continued surveillance of emerging SARS-CoV-2 variants and vaccines

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    Researchers at the Francis Crick Institute and the National Institute for Health and Care Research Biomedical Research Centre at UCLH have highlighted the importance of continued surveillance of emerging SARS-CoV-2 variants and vaccine performance as the virus continues to evolve.

    Published today as a research letter in The Lancet, their study compared the newer monovalent COVID vaccine, which specifically targets the XBB variant of Omicron (as recommended by the World Health Organisation), with older bivalent vaccines containing a mix of an Omicron variant and the original strain of COVID-19, which the UK deployed in Autumn 2023 before turning to monovalent vaccines1. 

    The researchers found that both vaccines generated neutralizing antibodies against the most recent strain of Omicron, BA.2.86. However, the new monovalent vaccine generated higher levels of antibodies against a range of other Omicron variants.

    The team collected blood and nasal mucosal samples both before and after a fifth dose vaccination from 71 participants of the Legacy study, a research collaboration between the Crick and the NIHR University College London Hospitals Biomedical Research Centre. They compared the antibody levels before and after vaccination.

    All 36 participants who received the bivalent vaccine and 17 who received the monovalent vaccine had boosted levels of antibodies against all variants tested, including the newest strain BA.2.86, which caused a wave of infection this winter. But those with the newer monovalent vaccine had 3.5x higher levels of antibodies against the XBB and BQ.1.1 strains after their booster vaccination.

    Since the Omicron virus is highly transmissible and the virus replicates in the nose and throat, the researchers tested the levels of antibodies in the participants’ nasal cavity.

    They found that the monovalent vaccine increased their ability to produce mucosal antibodies against most of the tested variants, whereas the bivalent vaccine didn’t provide a significant boost.

    Neither vaccine increased neutralizing antibody levels in the nasal cavity against the newest variant, BA.2.86, suggesting that current vaccines may be less likely to stop transmission or prevent asymptomatic or mild illness, while still protecting against severe disease.

    This highlights the importance of careful vaccine updates and continuing to complement a vaccination program with the development of antibody drugs that work against all variants, as some more vulnerable people don’t respond well to vaccines.

    The UK’s strategy to deploy stocks of older vaccines paid off last year, as both vaccines provided equal protection against the newest strain. However, ongoing monitoring is needed, as the virus is continuing to evolve, so vaccine-induced antibodies might not work so well in the future. In the long run, vaccines that are effective against all new variants and can block COVID-19 being transmitted from person to person are needed.”


    Emma Wall, Senior Clinical Research Fellow at the Crick and Consultant in Infectious Diseases at UCLH

    David LV Bauer, Group Leader of the RNA Virus Replication Laboratory at the Crick, said: “The situation this winter could have been different if the newly emerged BA.2.86 and JN.1 variants were substantially distinct from older Omicron variants, but fortunately this wasn’t the case.

    “Most new variants arise quicker than most clinical trials can produce data. But laboratory analysis can provide a detailed picture very quickly. Continued surveillance will help us stay on top of viral evolution.”

    Source:

    The Francis Crick Institute

    Journal reference:

    Shawe-Taylor, M., et al. (2024) Divergent performance of vaccines in the UK autumn 2023 COVID-19 booster campaign. The Lancet. doi.org/10.1016/S0140-6736(24)00316-7.

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  • Study connects public spending cuts to increased frailty

    Study connects public spending cuts to increased frailty

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    Frailty entails a reduced resilience to adversity. A recent PLoS ONE study used a period of austerity public spending in England to note the changes in frailty in individuals aged 50 years and above.

    Study: Frailty before and during austerity: A time series analysis of the English Longitudinal Study of Ageing 2002–2018. Image Credit: Paul Maguire/Shutterstock.comStudy: Frailty before and during austerity: A time series analysis of the English Longitudinal Study of Ageing 2002–2018. Image Credit: Paul Maguire/Shutterstock.com

    Background

    Following the global financial crisis in 2008/9, many countries implemented policies of austerity to varying degrees as they aimed to reduce public budget deficits through a combination of lower public spending and higher taxes.

    The former was prioritized in the UK, where government spending was cut across social care, local government budgets, and welfare. The spending on NHS also began to fall in the 2010s while the population continued to age. This has been noted in the leveling off and increase in life expectancy rate since 2014.

    A multi–system decline over a lifetime leads to frailty, which leads to reduced capacity and lower resilience to recover from shocks. It is associated with adverse events, such as longer hospital stays, higher risk of falls, poor quality of life and death.

    Studying changes in frailty in the context of austerity is important as it gives us a sense of the health of older individuals and their likelihood to live independently in the long term.

    About this study

    Data for this study was obtained from the nationally representative English Longitudinal Study of Ageing, ELSA, (2002 to 2018).

    The main objective was to examine whether frailty rose at different rates during periods of austerity than before. Multilevel interrupted times series analysis (ITSA) was used to study the correlation between frailty and austerity.

    Additionally, frailty trajectories of similarly aged individuals in 2002 and 2012 were analyzed using accelerated longitudinal modeling.

    The main outcome variable of interest was a frailty index score based on Rockwood’s frailty deficit model. In this approach, the score is the proportion of deficits in a given individual, ranging from 0 (no deficits) to 1.

    The scores were square–root transformed because the distribution was stronglyright–skewed.

    Key findings

    A total of 16,410 individuals were included in the analysis, of which 8,977 were women. Across all years, the mean age was 67. The range of the frailty score was between 0 and 0.76 and had a mean and median of 0.15 and 0.12, respectively.

    It was documented that frailty increased with age and was higher in women (mean of 0.16), compared to men (mean of 0.14). It was also highest for the poorest individuals.

    During periods of austerity (2012-2018), the frailty score rose faster compared to the period before the implementation of austerity (2002-2010). Using a diverse cohort of individuals, this study constructed individual wealth measures and a robust frailty index score before and after austerity.

    It was also observed that when public spending on health rose (2000s to 2010s), the mean population frailty fell. However, this gain was largely reversed due to the accumulation of frailty deficits during austerity.

    Therefore, the population may be less resilient to more austerity in the 2020s, compared to the 2010s.

    A key limitation of this study is that the frailty index score relies on self-reported measures. One cannot rule out changing trends in how an interviewee answers questions in questionnaires.

    It could also be the case that the rise in frailty in the 2010s simply reflects the aging of the cohort and is not really driven by austerity.

    Third, the ELSA experiences non–random attrition from males, those in poor health conditions, and those from lower socio–economic backgrounds.

    This non-random attrition could also have biased the results. A final limitation is common across all observational studies in that this is a study of correlations, and causality cannot be established. 

    Conclusions

    This study documented that compared to pre-austerity periods, the period of austerity was associated with higher increases in frailty with age. This finding is in line with previously observed increases in mortality.

    The results are highly policy-relevant, whereby reduction in public spending adversely affects health and mortality.

    Many countries are currently facing budget challenges owing to the pandemic, energy crisis, and inflation. Proposals to cut public spending should be evaluated carefully based on the findings documented here. 

    Future research should shed light on the causes of deterioration in health outcomes during periods of austerity compared to before.

    Furthermore, the specific deficits encapsulated in frailty should be analyzed to see if the results are driven by individual deficits more susceptible to short-term austerity. 

    Journal reference:

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  • Primary-care-based housing program shows promise in addressing social determinants of health

    Primary-care-based housing program shows promise in addressing social determinants of health

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    Brigham researchers found that participation in a housing program was associated with fewer outpatient visits, improved physical and mental health, and stronger connections to their primary care clinics and care team. 

    Lack of safe and affordable housing is a critical issue in the United States and creates immense challenges for patients’ health, well-being, and ability to access care. Investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, evaluated data from a social determinants of health screening and housing intervention program initiated in 2018 to help prevent homelessness and improve health care utilization and outcomes. 

    They found that in this primary-care-based program for patients who were unhoused, facing eviction, or living in unsafe housing conditions, those who received integrated support from the program’s care team had fewer outpatient visits, reported better physical and mental health, and felt more connected to their health care clinic and clinical team. The results are published in Health Affairs. 

    It is very hard to get a patient’s blood pressure under control if they are worried about where they are going to sleep. A person’s health is extremely at risk if their housing is unstable. And since the pandemic, there has been an enormous increase in housing needs.” 


    MaryCatherine Arbour, MD, MPH, study’s lead author, medical director of the social care team at Brigham and Women’s Hospital’s Primary Care Center

    In 2018, Brigham and Women’s Hospital began screening every MassHealth patient to address social determinants of health (SDoH), a term for nonmedical conditions that influence a person’s health, such as housing, education, employment and transportation access. ,The Brigham’s 14 primary care sites all conduct SDoH screening annually for every MassHealth patient. Four of those practices have expanded the screening to all primary care patients. The housing crisis is acutely evident in these screenings. Housing referrals fielded in this screening jumped from 20 per month in 2020 to 350 per month in 2023. 

    As part of this program, a Social Care Team, including housing advocates, address patients’ social needs in partnership with clinicians. Patients with a need for housing who are referred by staff or their doctor receive housing information from a Community Resource Specialist, and a subset of patients with imminent eviction risk or unhealthy conditions receive more specialized and intensive support from a housing advocacy team. Housing Advocates support patients for six months by addressing their housing needs and helping them with clinical care navigation and management. The care team works with a variety of community partners, including legal representation, to help find housing solutions. 

    “What makes this program special is that it is embedded in primary care and uses a triaged approach to identify housing types that are more likely to be affecting someone’s health,” said Arbour. “It is a unique, integrated approach that partners community resource specialists and community health workers with the primary care team and partners the primary care team with community-based partners, including legal partners.” 

    To evaluate the program’s impact, Arbour and co-authors conducted a mixed-method, retrospective cohort evaluation study and looked at a sample of 1,139 patients over age 18 with housing-related needs who enrolled in the program between October 2018 and March 2021. The cohort was mainly comprised of female, non-white, and non-English-speaking MassHealth patients with more chronic conditions and higher emergency room use than the general population. The evaluation looked at associations between patients’ participation in the program and their utilization of health care services and chronic disease management. It also reviewed patient charts for data on housing issues, services, and outcomes, and conducted interviews that included questions about their living situations, health status, and social supports. 

    Participation in the program was linked to 2.5 fewer primary care visits and 3.6 fewer outpatient visits per year, including fewer social work, behavioral health, psychiatry, and urgent care visits. Patients also expressed mental and physical health benefits as a result of being placed in new housing, and many felt a closer connection to their primary care clinics and teams, partially due to the compassionate guidance received from the housing advocates. Another outcome was that often the first housing solution for the patient was not stable or healthy, which speaks to the complex magnitude of the unaffordable housing situation. 

    “The reduction in outpatient care was driven mostly by less urgent care, behavioral health, and social work utilization which suggests that the program is having important effects on mental health and behavioral health,” said Arbour. “Our housing advocates are amazing. Their ability to connect with patients in very stressful situations and provide them with empathy, respect, and compassion makes a big difference.” 

    The study’s limitations included a small sample size, short-term follow up, restricted data set, and self-reported data. The investigators also recognize that the program’s interventions do not address the root causes of housing insecurity and health disparities. 

    With primary care burnout on the rise, the research team plans to next explore the effects of a housing program on clinical staff and providers to see if it might also be associated with feeling more supported in confronting distressing situations with patients. 

    “Being unhoused or at risk of homelessness is incredibly stressful and detrimental for mental health,” said Arbour. “The most compelling aspect of the study to me was hearing the patients’ stories and reflections. They not only felt their physical and mental health improved as a result of the program, but they felt a sense of belonging and truly cared for by their primary care clinic.” 

    Source:

    Brigham and Women’s Hospital

    Journal reference:

    Arbour, M. C., et al. (2024) Primary Care–Based Housing Program Reduced Outpatient Visits; Patients Reported Mental And Physical Health Benefits. Health Affairs. doi.org/10.1377/hlthaff.2023.01046.

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