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30th December 2024
Research suggests that children or young people who attend emergency departments for care because of violence are at greater risk of experiencing this again. Dr Sarah Bekaert PhD describes schemes that are putting extra support in place to try to change future outcomes.
Is there a navigator scheme for young people in your local hospital?
These are a valuable resource and growing in number. Navigators provide support to young people who attend the hospital as a result of violence. Connecting with young people at a moment of injury or crisis, where they me be more open to intervention, the navigator works with the young person to potentially stop violence escalation. A navigator offers immediate assistance, at this reachable moment, and a pathway of support beyond the hospital.
Navigators are non-medical or nursing staff, often with youth work training, co-located with the staff in the emergency department (ED). They reach out to the young person in crisis, listen, and potentially link them into ongoing support in the community.
Young people appreciate the normality of this interaction in a fast-paced, alien environment; trust is developed, and therefore they are more likely to continue with this support beyond the hospital setting.
In one example, the Thames Valley Hospital Navigator Scheme, implemented in five emergency departments by five voluntary community sector organisations, 70% of young people referred engage with the service. In this service, referrals are made for young people who have either directly experienced violence, or the possible root causes of violence such as substance abuse or mental health crisis.
While a specific incident may bring young people to the ED, the cause may be a combination of wider issues requiring wider support such as housing, substance misuse or counselling. The navigator begins to work with the young person on these wider or ongoing challenges, starting in the hospital and continuing into the community.
The Thames Valley Hospital Navigator Scheme also brings people with lived experience such as previous drug use or mental health challenges – into the navigator role. This adds value as the young people can see how it is possible to change the pathway.
Through flexible contact and support, offered over time by navigators, positive relationships are developed with the young people.
Not having set parameters around the type of support offered is a strength of the service. They may, for example, accompany young people to community-based services, or advocate for the young person with housing or the GP. Sometimes a formal referral can be made, such as to mental health services or mentorship programmes. The navigator journeys alongside the young person to a point of stability and thriving beyond.
Evaluation of the Thames Valley scheme has shown that most benefitted from a short-term intervention, with 52% achieving a successful outcome within three months. A further 24% received signposting – a brief intervention where the young person was linked straight into appropriate services – and 24% required support beyond three months.
In the hospital, navigators provide invaluable support to the ED team. Navigators can step in to reassure and calm patients, freeing up nursing and medical staff time. More specifically, the support has been shown to respond to a gap in services for young adults – the transition years between child and adult services. For example, in the Thames Valley scheme, 35% of young people referred into the scheme were aged between 18 and 25 years, representing the largest age group supported by the service.
The service also responds to another current societal need, offering rapid response to young people experiencing mental health challenges. While 37% were referred for violence, a significant 27% were referred for mental health support.
Such services also have the potential to contribute to reduced ED reattendance. For example, in the Thames Valley scheme, 77% of young people who accepted navigator support did not re-attend the emergency department within a six-month follow-up period – early signs of an effective demand reduction approach.
There is potential cost saving by reducing ED reattendance, and wider socio-economic savings for society. The cost-benefit saving of hospital navigator schemes has been estimated to be £4.90 per £1 spent with the financial benefits across several public agencies, including acute health.
Consequences of violence have implications for the individual, community and society – these include anxiety, depression, drug and alcohol use, and the likelihood of reactive perpetration. Considering the wider societal impact of an initiative aimed at reducing and preventing violence related injury, the cost benefit of such early intervention schemes has been estimated at £82 for every £1 spent.
In the Crime Survey for England and Wales figures, 1.1 million violent offences were recorded for the year ending December 2022. These occurrences of violence often result in hospital care. A Youth Endowment Fund report states that in 2021, for young people there was a 12% increase in violence against the person – offences such as harassment, common assault, actual or grievous bodily harm.
In 2019, the UK Home Office commissioned 18 Violence Reduction Units to develop effective ways of tackling violent crime and its causes. One approach adopted has been to provide support to vulnerable young people in specific settings, such as healthcare, as an early intervention approach. Many have implemented a navigator scheme within local Trust EDs.
There is a growing recognition in the UK of the benefits of schemes able to reach young people at a moment of crisis and/or injury such as hospital navigator schemes. The model is also being effectively implemented in other settings such as schools and custody. A focus on young people is an opportunity for early intervention and support to interrupt the cycle of violence and promote positive pathways into adulthood.
Dr Sarah Bekaert PhD is a senior lecturer in child health at Oxford Brookes University, registered nurse (RN) Child and research manager for the Thames Valley Violence Reduction Unit.
This article was originally published by our sister publication Nursing in Practice.
27th December 2024
The sodium glucose cotransporter 2 (SGLT-2) inhibitors dapagliflozin and empagliflozin cut mortality in patients with heart failure with reduced ejection fraction whether or not patients have diabetes, a large real-world study has concluded.
The analysis of SGLT-2 inhibitor drugs in patients on a national Danish registry found they were associated with a 25% lower risk of all-cause mortality, ‘supporting their effectiveness in routine clinical practice’.
Reporting in the BMJ, the researchers examined outcomes in patients with heart failure aged over 45 years with left ventricular ejection fraction less than 40% between 2020 and 2023.
In their dataset, they reviewed 6,776 patients who started SGLT-2 inhibitors (79% on dapagliflozin, 21% prescribed empagliflozin) and 14,686 patients taking other standard-of-care heart failure drugs, while taking into account time since diagnosis and other baseline characteristics.
Around 70% of patients taking SGLT-2 inhibitors were men, with an average age of 71 years, and 20% of the cohort had type 2 diabetes.
The results showed 374 deaths among SGLT-2 inhibitor users at a rate of 5.8 per 100 person-years compared with 1,602 among non-users equating to 8.5 per 100 person-years.
The 25% reduction in the risk of all-cause death compared with non-use was consistent across all patient groups, including those with and without type 2 diabetes, they found.
Analysis also showed that SGLT-2 inhibitors were associated with a 23% lower risk of cardiovascular death.
But there was no reduction in a combined measure of cardiovascular death or hospitalisation for heart failure or heart failure hospitalisation alone.
The ‘real-world’ data matches that seen in the clinical trials that had led to the recommendation of SGLT-2 inhibitors in several guidelines, including from NICE, the team concluded.
NICE recommended empagliflozin for chronic heart failure with preserved or mildly reduced ejection fraction in October 2023, following its recommendation to extend dapagliflozin use in heart failure to reduce hospitalisations in May.
‘These results support the benefits of SGLT-2 inhibitors observed in clinical trials and provide novel and important data regarding their effectiveness in real-world clinical settings and across key clinical subgroups, including patients with and without diabetes,’ the researchers from the University of Copenhagen said.
A linked editorial noted that the findings were observational but ‘provide assurance that no unexpected harm results from SGLT-2 inhibitors when they are used for treatment of heart failure outside the clinical trial setting’.
But it also stressed that SGLT-2 inhibitors are still underused, and efforts are needed to ‘tackle barriers to prescribing’ in line with best-practice guidelines.
A version of this article was originally published by our sister publication Pulse.
23rd December 2024
The NHS is using artificial intelligence (AI) to identify patients likely to become frequent users of emergency departments (EDs) across England so it can be proactive about their care and reduce demand on emergency services.
High Intensity Use (HIU) services have been rolled out to 125 EDs across England so far. These use AI-powered prediction software on routinely collected hospital data to identify the most regular attendees to EDs in their area.
These patients are then offered one-to-one coaching in their own homes to tackle the root cause of why they are visiting an ED.
Preventative care includes supporting patients with long-term conditions, like asthma or diabetes, and having a healthcare professional reach out to them to offer them personalised, preventative support and self-management techniques.
It has already helped reduce the number of frequent attendances by more than half in some parts of the country.
Over 360,000 patients attend EDs more than five times every year.
Amanda Pritchard, NHS England chief executive, said: ‘We know that a small proportion of the population are much more likely to use A&E or ambulance services, so it is important we give them the targeted support they need this winter before they get to the front door of an emergency service – this is much better for them but will also help to relieve pressure on the NHS.
‘Initiatives like using AI to spot those who may need extra support in the community help provide more personalised care and must be central to our 10 Year Health Plan.’
South Tees Hospitals NHS Foundation Trust recruited a dedicated keyworker to offer social, practical and emotional support to 20 high-use patients, which resulted in them halving their emergency department visits – down from 33 times per year.
Black Country Healthcare NHS Foundation Trust created a HIU service at New Cross Hospital in Wolverhampton to recognise people in crisis and improve the health outcomes of those who face the highest deprivation and health inequalities in their area.
The service, combining community outreach with a dedicated clinical lead, led to a significant improvement in the wellbeing of frequent attenders and a reduction in hospital attendance by almost three fifths (58%).
Norfolk Community Health and Care NHS Trust also established a HIU service and worked closely with over 400 of the most frequent attenders to EDs.
This included one service user who suffered from a serious condition and was regularly visiting the emergency department, sometimes as often as twice a week.
The HIU service helped him to access the correct support, deal with his housing issues and start looking for work again.
Since the HIU service involvement, he has not visited the emergency department or dialled 999 again, contributing to the Trust’s 58% reduction of A&E attendances from frequent attenders and a reduction in hospital admissions of 62%.
Health Minister Karin Smyth said the HIU services offered ‘a double win for getting vulnerable patients the right support and saving the precious time of busy A&E staff’.
In February, a clinical trial at Amsterdam UMC aimed to show that an AI algorithm could reduce the number of blood cultures taken in EDs worldwide by almost a third.
A version of this article was originally published by our sister publication Healthcare Leader.
19th December 2024
Daily monitoring of the blood biomarker procalcitonin (PCT) can pinpoint when to safely stop antibiotics in adults hospitalised for suspected sepsis, reducing the duration of therapy compared with standard care, a large study finds.
It was known that optimising duration of antibiotic therapy helped to reduce overtreatment, limit unwanted effects and preserve antibiotic effectiveness by minimising resistance, a team of UK-based researchers wrote in JAMA.
However, there was currently no agreed optimal duration for antibiotic therapy for sepsis.
Clinicians tended to use clinical judgment on when to cease antibiotics, with evidence remaining uncertain for the efficacy and safety of therapy guided by inflammatory biomarkers, such as PCT or C-reactive protein (CRP).
To close this evidence gap, the National Institute for Health and Care Research (NIHR) commissioned and funded a three-arm, randomised trial across 41 NHS intensive care units, which enrolled 2,760 adult patients requiring critical care for suspected sepsis.
Eligible patients, who had started intravenous antibiotics before study enrolment, were randomly assigned to either a daily PCT-protocol, a daily CRP-protocol or standard care.
Blood was drawn daily from all participants and sent for testing according to the treatment arm, but the results were concealed from the treating clinicians to minimise bias.
Instead, clinicians received daily written advice from their local clinical research team on either standard care or on PCT or CRP biomarker-guided antibiotic discontinuation.
From randomisation to 28 days, the PCT-guided protocol led to a significant reduction in antibiotic duration compared with standard care (mean duration, 10.7 days for standard care versus 9.8 days for PCT; mean difference, 0.88 days).
For all-cause mortality up to 28 days, the daily PCT-guided protocol was noninferior to standard care, where the noninferiority margin was set at 5.4%.
‘The duration reduction is in the order of 10% in antibiotic use for sepsis, which could provide significant cost and labour savings, and might also reduce the development of antimicrobial resistance,” the study authors wrote.
No difference was found in antibiotic duration for standard care compared with the daily CRP-guided protocol and the all-cause mortality for CRP compared with standard care was inconclusive.
The researchers from the University of Manchester, Northern Care Alliance NHS Foundation Trust and the Clinical Trials Unit of the University of Warwick’s Medical School also noted that the trial could not provide evidence for biomarker use in initiating antibiotic therapy as participants had commenced treatment before enrolling.
Chief investigator Professor Paul Dark, professor of critical care at the University of Manchester, said the simple protocol could significantly change the way sepsis is treated and combat antibiotic overuse and resistance.
‘It is also a powerful illustration of how precision medicine can make a real difference to patient care when treatment is tailored to individual test results of each patient,’ he said.
Professor Dark, who is also an NHS consultant in critical care medicine at Salford Royal, said sepsis had been at the forefront of UK policymaking since a 2013 Health Service Ombudsman report focusing on sepsis patients who were not treated urgently enough.
‘Ever since then, developing better diagnostics and treatment guidance for GPs and hospital clinicians to help them recognise sepsis at an early stage has been a national priority,’ he said.
Figures suggest there are at least 245,000 sepsis cases diagnosed in the UK every year.
In late 2023, research presented at the European Society of Emergency Medicine Congress suggested that two of the four internationally recommended sepsis screening tools are inadequate for recognising the condition.
Earlier this year, NICE released updated guidance on identifying and managing sepsis in over-16s recommending better targeting of antibiotics for suspected sepsis.
The updates specified that secondary care teams should target antibiotic use as more is learned about a patient’s condition to ensure the right people receive treatment as soon as possible but the medicines are not overused.
12th December 2024
A machine learning model can more accurately estimate the age of acute ischemic brain lesions than current methods, with researchers predicting the software could mean up to 50% more stroke patients receive appropriate treatment.
The efficacy and appropriateness of stroke treatment depended on the progression stage or biological age of the lesion and whether it was deemed to be reversible, researchers wrote in the journal NPJ Digital Medicine.
‘Biological age is closely related to chronometric lesion age – i.e. time from symptom onset – although these ages disassociate due to variability in tissue vulnerability and arterial collateral supply,’ they said.
Acute ischemic lesions scanned with non-contrast computerised tomography (NCCT), become progressively hypoattenuated over time, the research team explained, a feature which helped to estimate biological lesion age.
At present, clinicians measured the relative intensity (RI) of a lesion on NCCT using a method termed Net Water Uptake (NWU).
However, the researchers noted this approach could be confounded by alternative sources of hypointensity, was also insensitive to additional ischemic features and dependant on lesion segmentation.
For this trial, researchers from Imperial College London and University of Edinburgh, UK, and the Technical University of Munich, Germany, developed a convolutional neural network – radiomics (CNN-R) model to optimise lesion age estimation from NCCT.
They noted that machine learning models had several advantages over current methods for stroke assessment such as the ability to screen high-dimensional imaging features for associations with ischemia progression, including those imperceptible to experts, as well as account for lesion anatomy variability and signal heterogeneity.
They trained the CNN-R model on chronometric lesion age, while validating against chronometric and biological lesion age in external datasets of almost 2,000 stroke patients.
Analysis showed the deep-learning model was approximately twice as accurate as NWU for estimating chronometric and biological ages of lesions.
‘The practical importance of our results lies in the CNN-R lesion age biomarker providing more accurate estimates, compared to current methods, of stroke onset time (unknown in ~20% of cases), and lesion reversibility, both currently used for decisions regarding revascularisation treatments,’ the researchers wrote.
As well as validating the method in a large, independent cohort, the researchers said they had demonstrated the technique could be embedded within a central pipeline of automated lesion segmentation and clinically-based expert selection.
Future research should assess whether the higher accuracy of a CNN-R approach to lesion age estimation carries over to predicting lesion reversibility and functional outcomes, they added.
Lead author Dr Adam Marcus, of Imperial College London’s Department of Brain Sciences, estimated up to 50% more stroke patients could be treated appropriately because of this machine learning method.
‘We aim to deploy our software in the NHS, possibly by integrating with existing artificial intelligence-analytic software that is already in use in hospital Trusts,’ he said.
Study senior author Dr Paul Bentley, of Imperial College London’s Department of Brain Sciences and consultant neurologist at Imperial College Healthcare NHS Trust, said the information would help clinicians make emergency decisions about stroke treatment.
‘Not only is our software twice as accurate at time-reading as current best practice, but it can be fully automated once a stroke becomes visible on a scan,’ he said.
The study follows research released last month showing artificial intelligence-enabled electrocardiography (ECG) can accurately predict an individual patient’s risk of future cardiovascular events as well as their short and long-term risk of dying.
Lead author of this study Dr Arunashis Sau, an academic clinical lecturer at Imperial College London’s National Heart and Lung Institute and cardiology registrar at Imperial College Healthcare NHS Trust, said compared with cardiologists the AI model could detect more subtle detail in the ECGs.
11th December 2024
Three quarters (75%) of the public support sharing some of their personal health data to aid the development of artificial intelligence (AI) systems in the NHS, a Health Foundation report has found.
The research surveyed 7,201 people across the UK between June and July 2024 and found that 29% were happy for any of their health data to be used to develop AI systems and a further 46% were happy to use ‘some’ of their data for this purpose.
A quarter of people (25%) however were not happy to share any of their data for this purpose.
When surveyed about the type of data being shared, 59% were willing to share data on eye health, 58% on the medicines they are taking and 57% were willing to share long-term conditions, dental health and medical test data, such as blood tests or scans.
However, less than half (47%) were willing to share smartphone-tracked data, such as sleep activity, and only 44% were happy to share sexual health information.
Those from lower socio-economic households were significantly less likely to support the use of their health data for developing AI technologies compared to those from other socio-economic groups.
Those of a higher managerial level, administrative or professional in their work, were more likely to think that using technology makes the quality of healthcare better, with 65% of this group saying this, compared to just 41% of casual or lowest-grade workers and others who depend on the welfare state for their income.
The survey also showed that most people trust the NHS with their health data, with 68% saying they trust GP practices and 66% stating trust in local NHS hospitals and clinics.
However, only 40% said they trusted companies providing the NHS with software to collect, store and use data.
The report called for policymakers and NHS leaders to ‘actively engage with the public to understand and address concerns’, especially with social groups who are less supportive.
Director of innovation and improvement at the Health Foundation, Dr Malte Gerhold, said: ‘It is only with the public’s support that the Government will successfully achieve its ambition of shifting the NHS from analogue to digital.
‘It is encouraging that most people are open to sharing their data to develop AI systems in the NHS. When properly implemented, we know that AI has the potential to free up staff by supporting clinical and administrative tasks. However, these systems are only as good as the data used to design and develop them.’
However, he added: ‘There are significant differences between socioeconomic groups in levels of support for sharing data for AI development and for taking part in activities to shape how technology is used in the NHS.
‘Policymakers, NHS leaders and those involved in designing and implementing healthcare technologies must proactively engage with people across different social groups to ensure that healthcare technologies help tackle inequalities, rather than worsen them.’
In July, a survey from the Health Foundation revealed that NHS staff and patients are both split on the use of AI in healthcare.
And in April a white paper from the Microsoft company Nuance reported that over a third of patients are in favour of clinicians using AI in consultations to improve documentation processes such as clinical letters.
A version of this article was originally published by our sister publication Healthcare Leader.
Patients with syncope typically present with a transient loss of consciousness, which can have a broad spectrum of causes. Here, Professor Martin Möckel, of the EUSEM syncope group, summarises how group’s new European consensus provides detailed, process-driven guidance on managing and caring for patients with suspected syncope in the emergency setting.
Transient loss of consciousness (TLOC) is a brief period of unconsciousness followed by a complete recovery. Loss of consciousness can result from a variety of reasons, including traumatic and non-traumatic causes.
Syncope, which is defined as a decrease in blood pressure with a subsequent global cerebral hypoperfusion and loss of postural tone, is a subset of TLOC. It is a major healthcare issue, as approximately half of the population will likely experience at least one syncope episode during their lifetime.1
Patients with syncope represent approximately 1–5% of patients visiting the emergency department (ED).2
In 2018, the European Society of Cardiology (ESC) published guidelines for the diagnosis and management of syncope, which, for the first time, explicitly addressed management in the ED.2
The ESC guidelines2 proposed three risk categories: low-risk, neither high- nor low-risk and high-risk. These are important for determining how treatment should proceed after an initial assessment in the ED. Whereas low-risk patients can be discharged into outpatient care, high-risk patients require careful monitoring and admission to hospital.
Recently, a European prospective cohort study quantified that 75.3% of syncope patients in European EDs were at high risk and required further work-up.3 The European Society for Emergency Medicine (EUSEM) syncope group, therefore, aimed to establish a consensus to create a universal core process for diagnosing syncope, risk stratification and its initial management in the ED.
The group assessed current clinical practices in different European countries through literature searches. A modified three-step Delphi process was then used and a universal core process map for syncope management in European EDs was subsequently modelled.4
The map allows regional specifications due to different healthcare systems while ensuring that all critical steps from admission to diagnosis are carried out and that no high-risk situation is overlooked.
From an emergency medicine perspective, the care process starts with the patient who has presented with a TLOC. Thus, the first step after triage is to determine non-syncopal causes of the TLOC such as seizures, head trauma or physical shock.
Then, a systematic work-up is suggested to determine vital parameters including blood pressure, heart rate, oxygen saturation, temperature and respiratory rate; history; physical examination; ECG; and lab tests, with haemoglobin and blood glucose being the minimum.
At this stage, syncope as a symptom of an underlying cause (e.g. aortic valve stenosis) or as part of an acute disease-like infection is determined and the patient is referred to a care pathway for the principal disease as appropriate.
The ESC guideline criteria are used to stratify any remaining unexplained syncopes and patients are scheduled for further ambulatory care (low risk only), monitoring or hospital care, mainly to determine cardiac syncope or other rare causes of TLOC. The core process diagram included in the consensus allows European EDs to create regional digital flow charts.
Most TLOC presentations can be clarified by following the pathway. However, certain specific situations need special attention.
These patients may not have typical high-risk criteria but present with injuries due to reflex or orthostatic syncopes with nearly no prodromes. These patients need specialist care and individual therapeutic regimens. They should be admitted or sent to dedicated syncope units.
Older patients with dementia and no observed TLOC may have syncope even though a geriatric fall might be suspected. A thorough cardiovascular evaluation is recommended in these patients, who almost always present with high-risk features and comorbidities. Measurement of cardiovascular markers such as copeptin could help determine or rule out true syncope.
Transient coma is a major challenge in the emergency setting. It is associated with high mortality and is usually a result of severe underlying pathologies. It must not be confused with syncope in the ED.5
The spectrum of syncope patients presenting with TLOC in the ED can be broad.
In the ED, the challenge is to determine cardiac syncope, geriatric falls or other diagnoses as the cause in this heterogeneous group of patients because it has been determined that three-quarters of patients have high-risk features and need urgent further hospital-based monitoring and subsequent work-up.
The 2018 ESC guidelines included recommendations for managing syncope in the ED but lacked detailed instructions on patient management. The EUSEM consensus aids informed decision-making regarding risk stratification, ruling out life-threatening causes and distinguishing syncopal and non-syncopal causes of loss of consciousness to achieve efficient and optimal patient care.
Martin Möckel MD PhD FESC FAHA
Charité – University Medicine Berlin, Germany
9th December 2024
The World Health Organization (WHO) has raised the alarm about soaring cases of tuberculosis (TB) around the world.
Last year, more than eight million people were newly diagnosed with the condition, the highest number since monitoring began in 1995, WHO said.
While TB-related deaths did fall last year from 1.32 million to 1.25 million, the total number of people falling ill with TB rose, a report said.
This means the world is not on track for international targets to reduce the burden of TB by 2027 and elimination by 2035, it added.
There is also ongoing concern about multidrug-resistant TB which the WHO described in the report as a ‘public health crisis’.
Treatment success rates for multidrug-resistant or rifampicin-resistant TB have now reached 68%.
But, of the 400 000 people estimated to have developed it, only 44% were diagnosed and treated in 2023, the report found.
Global funding for TB prevention and care decreased further in 2023 and remains far below target, it added with low- and middle-income countries bearing 98% of the TB burden.
India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%) and Pakistan (6.3%) together accounted for 56% of the global TB burden, it said.
Earlier this year, the UK Health Security Agency (UKHSA) said it was investigating an 11% rise in TB cases in England.
There were 4,850 tuberculosis cases in 2023 compared to 4,380 in 2022, representing a jump of 10.7%, according to provisional data.
Even before the Covid-19 pandemic, TB incidence was lower than this, with 4,615 cases in 2018 and 4,725 cases in 2019, UKHSA figures showed.
Some of the increase related to people born outside the UK, but in 2023 the rise was also seen in UK-born individuals, they noted.
Speaking on the findings of the latest WHO report, Dr Tereza Kasaeva, director of WHO’s Global Tuberculosis Programme said there was a multitude of formidable challenges including ‘funding shortfalls and catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics and drug-resistant tuberculosis, a significant driver of antimicrobial resistance’.
WHO director-general Tedros Adhanom Ghebreyesus added: ‘The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it.’
Dr Esther Robinson, head of the TB Unit at UKHSA, is encouraging people to speak to a healthcare professional if they think they could be at risk of TB.
‘TB is curable and preventable, but the disease remains a serious public health issue in the UK,‘ she said.
‘It is very important that those with relevant symptoms are tested for TB and appropriate treatment is started promptly. Not every persistent cough, along with a fever, is caused by flu or Covid-19.
‘A cough that usually has mucus and lasts longer than three weeks can be caused by a range of other issues, including TB.’
A version of this article was originally published by our sister publication Pulse.
Eating higher amounts of foods such as oily fish, cereals, vegetables and the nutrient vitamin D, as well as moderating alcohol intake, could reduce the risk of developing rheumatoid arthritis, a new study has revealed.
Researchers at the University of Leeds examined 32 different food groups, drinks and nutrients and determined the associated risks of developing rheumatoid arthritis. They found that some food groups could help reduce rheumatoid arthritis onset, while others, such as tea and coffee, were associated with an increased risk of developing the disease.
The findings are published in the journal Nutrients and highlight how controlling certain dietary factors could protect some people from developing the disease.
The researchers conducted a meta-analysis review of 30 studies undertaken between 2000 and 2024 involving almost 10,000 people. A total of 12 studies were conducted in Europe, 15 in America and three in Asia.
A higher intake of fruits and cereals was associated with a lower risk of rheumatoid arthritis and showed potential protective effects against its development. The association was linear, and consuming a greater amount continued to offer an increase in protection.
Vegetables, oily fish and vitamin D, followed a non-linear association. Increased consumption initially led to led to potential protective effects against rheumatoid arthritis development, but the effect plateaued beyond this level.
Drinking small amounts of alcohol (around two units per week) had a protective effect against rheumatoid arthritis, but at higher consumption levels, the risk of developing the disease increased. Excess alcohol intake negated the benefits seen at lower levels, and the protective effect disappeared at around consumption levels of 7.5 units per week.
Tea and coffee were associated with an increased risk of developing the disease. Each additional cup of tea consumed daily was associated with a 4% increase in risk. However, the baseline risk from tea was low, and the researchers stressed the many health benefits of tea. There was no evidence of an association between sugar-sweetened soda and rheumatoid arthritis risk.
Yuanyuan Dong, a PhD student at the School of Food Science and Nutrition at the University of Leeds, said: ‘Rheumatoid arthritis is a typical multifactorial disease, driven by both genetic and environmental factors. These findings offer a deeper understanding of how diet can impact rheumatoid arthritis risk and suggest potential dietary modifications for disease prevention and management.’
The researchers suggested that dietary factors contribute to the risk of rheumatoid arthritis by increasing inflammation and affecting the immune system. However, stressing the ‘one-size-fits-all’ advice to follow a generally healthy diet is not helpful for people with autoimmune diseases, and the research highlights the need for a more personalised approach.
Study co-author and PhD supervisor Janet Cade, professor of nutritional epidemiology at the University of Leeds, said: ‘The results are promising, showing that by eating higher amounts of foods like oily fish, cereals, vegetables and the nutrient vitamin D, people may be able to lower their chances of developing this painful and debilitating condition.’
She added: ‘More research will help us pinpoint exactly why these foods have the effect we have observed and develop tailored nutritional advice for people living with rheumatoid arthritis and other autoimmune diseases.’
A version of this article was originally published by our sister publication Nursing in Practice.
6th December 2024
Around half of adults in the UK struggle to access trusted health information, according to a new report.
The study, published by the Patient Information Forum and Ipsos, called Knowledge is Power, found that 53% of people felt they could trust the health information they found offline, while only 45% said they could trust the information found online.
But, eight in 10 adults with a long-term condition agreed that access to trusted health information would help them to manage their health better.
A further one in 10 adults said they had been affected by misinformation, which rose to one in five for ethnic minorities, according to the study, which surveyed 2,003 adults between May and June 2024.
One in six respondents said they did not feel listened to by their healthcare professional, rising to one in four for ethnic minorities.
The report made several recommendations including patients having the right to health information as a core part of their care, tackling inequality by making health information accessible and appropriate for all, and eliminating misinformation through robust content standards and effective signposting of credible health information from health professionals.
It also highlighted the need for a mandate to effectively deliver health information with a named lead in all NHS organisations, and embedding patient experience as a measure of NHS performance.
Melissa Moodley, UK head of healthcare research at Ipsos, said: ‘This timely research reveals a critical gap in access to trustworthy health information, with half of UK adults struggling to find reliable sources.
‘This challenge is particularly acute for those with long-term conditions and minority groups. The impact is clear: eight in 10 adults believe better access to credible health information would improve their health management.
‘These findings underscore the urgent need to improve the provision of verified, accessible health information. Doing so is not just beneficial, but essential for enhancing overall health outcomes across the UK.’
Sue Farrington, chair of the Patient Information Forum, added: ‘Credible information supports people’s health decisions, from childhood vaccinations to joint replacement surgery. For people with long term conditions, it is a core element of care.
‘Resolving these issues will ensure everyone gets the information they need, supporting the prevention agenda and contributing to the delivery of positive health outcomes for all.’
In a recent interview with Hospital Healthcare Europe, consultant clinical oncologist Dr John Conibear said: ‘What mustn’t be forgotten is the dissemination of information to patients, arming them with the knowledge of what’s available, and what’s potentially suitable for them so they can also be an advocate for their own care.’
For example, new self-management app designed for teenagers, young adults and the parents/carers of pre-teens with asthma is designed to improve knowledge of their condition, making it easier for them to monitor and control it.
A version of this article was originally published by our sister publication Healthcare Leader.
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