New NICE guideline [NG98] Hearing loss in adults: assessment and management

New NICE guideline [NG98] Hearing loss in adults: assessment and management


Published date: June 2018                


This guideline covers some aspects of assessing and managing hearing loss in primary, community and secondary care. It aims to improve the quality of life for adults with hearing loss by advising healthcare staff on assessing hearing difficulties, managing earwax and referring people for audiological or specialist assessment and management.


For full guidance
https://www.nice.org.uk/guidance/ng98

In and out of hospital

This report from the British Red Cross proposes introducing automatic home assessments and other simple interventions for elderly and vulnerable people who are often admitted to hospital to reduce avoidable hospital admissions in vulnerable patients. The report contains analysis of first-hand accounts of frontline health and care workers who argue that there are too many missed opportunities to prevent many of these avoidable admissions.

PPA study day: Physio professor outlines new model of pain

Physiotherapists need a new model of pain that takes account of a ‘predictive’ sensory and cognitive interaction, and the influence of people’s emotions and expectations. T

his was the message from CSP fellow Mick Thacker, associate professor at London South Bank University at the Physiotherapy Pain Association (PPA) event on 26 January.

Oesophago-gastric cancer: assessment and management in adults [NG 83]

New:  NICE guideline

1.1 Information and support

1.2 Organisation of services

1.3 Assessment after diagnosis

1.4 Radical treatment

1.5 Palliative management

1.6 Nutritional support

1.7 Follow-up

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

J Bodyw Mov Ther. 2018 Jan;22(1):13-17. doi: 10.1016/j.jbmt.2016.10.001. Epub 2016 Oct 21.

OBJECTIVE: To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.
METHODS:

CONCLUSION: This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

UHCW Research: A Pritchard

New approach to NHS clinical assessment could save thousands of lives

NHS England is asking every hospital trust to adopt the Royal College of Physicians’ new clinical assessment system that could save nearly 2,000 lives and 627,000 bed days every year.

The National Early Warning Score (NEWS) has been produced by the Royal College of Physicians and is backed by the Royal College for Emergency Medicine, NHS Improvement, the Association of Ambulance Chairs and Sir Bruce Keogh, National Medical Director for NHS England.

Clinical Anatomy and Assessment of the Elbow

The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M2) 1347-1352

The elbow is a complex synovial hinge joint comprising of three articulations. Satisfactory function and stability are provided by bony and soft tissue stabilising structures. Injuries around the elbow joint are common.
Knowledge of the intricate anatomy around the elbow joint is essential to successfully assessing and managing elbow injuries and restoring good function.

UHCW Research: Alexander L Aquilina  and Andrew J Grazette

Falls risk screening tools ‘not accurate’ new report warns

The Royal College of Physicians’ National Audit for Inpatient Falls assessed 5,000 falls, and shows that although prevention across England and Wales has improved slightly, many patients are not receiving the right assessments that can help prevent harm.

The audit reveals that since 2015, many trusts and Local Health Boards (LHBs) have stopped using ‘falls risk screening or prediction tools’ (a drop from 74 per cent in 2015 to 34 per cent).

NIHR Signal Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently

 Older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. Sixty percent were discharged to independent living compared with 56% receiving standard ward care. People who had received this proper assessment were also 20% less likely to be in a nursing home after three months or more.
Older people often have multiple complex conditions combined with frailty and are more likely to lose independence after illness. Comprehensive geriatric assessment is a careful review by a multidisciplinary specialist team of people’s medical, functional, mental and social capabilities. It aims to improve recovery and enable people to maintain function and independence.
This updated Cochrane review covered 29 trials comparing this assessment with routine care for people over 65, excluding those with stroke and orthopaedic conditions. It may save NHS resources, but the quality of evidence was too low to assess this reliably.
This assessment is not carried out in all hospitals, and the mode of delivery varies. Research has yet to answer how best to deliver this assessment to those most in need.
From the NIHR Dissemination Centre

Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis

Clinical Nutrition ESPEN. DOI: http://dx.doi.org/10.1016/j.clnesp.2017.10.009

Undernutrition in cirrhotic patients is often poorly recognised until late-stages. The current UK screening tool, the Malnutrition Universal Screening Tool, can miss undernutrition in patients with ascites/fluid retention. A 6-question Liver Disease Undernutrition Screening Tool (LDUST) has been developed in America.

We sought to compare LDUST with MUST in the detection of undernutrition in 50 inpatients and 50 outpatients with liver cirrhosis in a secondary care setting. This was then validated by a dietitian assessment.

UHCW Research: M. McFarlane, C. Hammond, T. Roper, J. Mukarati, R. Ford, J. Burrell, V. Gordon

and N. Burch

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N. Burch

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Affiliations

Physiotherapy app wins top rehabilitation award

A physiotherapy company specialising in the assessment and treatment of musculoskeletal conditions has won the Rehabilitation First training award for its ‘one-stop shop’ healthcare app.

The device includes a secure self-help and education website as well as tailored video exercise regimes, instant messaging, blogs and webinars.

It also offers a visual triage service which enables clinicians to see their patient and make a detailed on-the-spot assessment of their condition. They can then send patients tailored video exercises and check on screen they are being followed correctly.

Intermediate care including reablement

This new NICE guideline covers referral and assessment for intermediate care and how to deliver the service. 

Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care.

Recommendations include:
1.1 Core principles of intermediate care, including reablement
1.2 Supporting infrastructure
1.3 Assessment of need for intermediate care
1.4 Referral into intermediate care
1.5 Entering intermediate care
1.6 Delivering intermediate care
1.7 Transition from intermediate care
1.8 Training and development

Safety and quality of emergency care

Chief Inspector of Hospitals Prof Ted Baker has written to England’s NHS trusts to highlight good practice from successful emergency care departments.

The examples came from discussions at a recent CQC event attended by senior clinical and nursing staff from 16 trusts rated good or outstanding for urgent and emergency care services.

The key themes identified in Prof Baker’s letter to trusts were:

• Ambulance arrivals
• First clinical assessment
• Use of inappropriate physical spaces
• Specialist referrals
• Escalation
• Deteriorating patients
• Patient outcomes
• Staff.

Persistent pain in neonates: challenges in assessment without the aid of a clinical tool

Acta Paediatr. Accepted Author Manuscript. doi:10.1111/apa.14081

Evaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used (iii) variation between clinicians’ assessments.

Pain assessment is challenging for staff. Most parents feel confident in assessing their babies’ comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers.

UHCW Research: Joanna Bradshaw and Kathryn I Blake

Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid

Knee Surgery, Sports Traumatology, Arthroscopy October 2017, Volume 25, Issue 10, pp 3229–3236

The aim of this study was to evaluate whether glenohumeral arthroscopy is an appropriate gold standard for the diagnosis of long head of biceps (LHB) tendon pathology. The objectives were to evaluate whether the length of tendon that can be seen at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses at arthroscopy when compared to an open approach.

UHCW Research: Robert W. Jordan

New improvements to help fight sepsis

Thousands of nurses, care home staff and pharmacists will be told how to check for signs and symptoms of sepsis, as part of a new NHS plan to improve treatment of the condition.

Seven day stroke service wins Welsh national award

Twenty physiotherapists were part of an award-winning therapy team whose seven-day pilot service improved the care of stroke patients at the University Hospital of Wales.

The project involved 54 volunteer therapists and aimed to provide earlier therapy assessments in the hospital’s acute stroke unit.

Plans to improve NHS Continuing Healthcare assessment processes

This letter, from NHS England, outlines revised guidance in relation to NHS Continuing Healthcare assessments in order to promote a reduction in delayed transfers of care.

The reduction in Delayed Transfers of Care (DTOCs) is a key priority for the NHS, with delays needing to reduce from approximately 6,428 per day to 4,080 per day in order to release the needed bed capacity within health systems. It is estimated that resolution of the factors causing delays due to NHS CHC assessment could help free up to a quarter of the total number of beds the NHS is required to release

Developing trusted assessment schemes: ‘essential elements’

Through the use of a trusted assessor, we can reduce the numbers and waiting times of people awaiting discharge from hospital and help them to move from hospital back home or to another setting speedily, effectively and safely.

This guide from NHS Improvement describes how local systems could implement trusted assessment. It is for each local system, including all parties involved in a trusted assessor scheme, to agree how that scheme will operate and be funded and implemented.

Implementation guide and resource pack for dementia care

NHS England has published an implementation guide and resource pack for dementia care.

The guide defines good quality assessment, diagnosis and care in relation to NICE and other formal guidance and to the views and expectations of people living with dementia and their carers. The resources support the aims of existing operational and contracting guidance: to increase the number of people starting treatment within six weeks from referral; and to improve the quality of post-diagnostic treatment and support for people with dementia and their carers.