Patient safety strategies - a call for physician leadership

According to the editorial articles in the March issue of the Annals of Internal Medicine , tens of thousands of patients die each year in the US of diagnostic errors, teamwork and communiction errors and failure to receive evidence-based interventions.

A team of experts re-examined 158 patient safety topics and elected 41 for reviews that foucus on emerging data about implementing the strategies. The results have been published in the Agency for Healthcare Research and Quality (AHRQ) report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices
. Annals of Internal Medicine, 5 March 2013, Vol. 158. No. 5_Part_1
The data show that checklists and bundles, that many physicians have been unwilling to consider, can substantially improve patient safety and quality of care. It is important that physicians identify the steps that they will take in the diagnosis and care of the most common clincial problems they confront and follow the protocols with appropriate individual variation.

The report emphasizes the importance that physicians understand the team function and lead by example, hand hydiene is an example of the importance of physician behaviour in reducing hospital-aquired infections.
The reviewers wrote, "Making patients safe requires ongoing efforts to improve practices, training, information technology and culture. It requires that senior leaders supply resources and leadership while simultaneously promoting engagement and innovation by frontline clinicians" .

They recommended 10 patient safety strategies for immediate implementation.

Preoperative and anesthesia checklists

Bundles

that include checklists to prevent central line-associated bloodstream infections

Interventions to reduce urinary catheter use

Bundles of various strategies to prevent ventilator-associated pneumonia

Hand hygiene

The do-not-use list for hazardous abbreviations

Interventions to reduce pressure ulcers

Barrier precautions to prevent infections

Use of real-time ultrasonography for central line placement

Interventions to improve prophylaxis for venous thromboembolisms.

Other recommendations include developing interventions that focus on fall prevention, limiting adverse drug reactions, medication reconciliation, reducing radiation exposure from unnecessary medical procedures and developing better informed consent policies.

To read the free f/t articles :Editorial

• Strategies to improve patient safety: the evidence base matures
• Patient safety strategies: a call for physician leadership

Supplement :
Making Health Care Safer: A Critical Review of Evidence Supporting Strategies to Improve Patient Safety

Patient satisfaction - BMJ article

The patient satisfaction chasm: the gap between hospital management and frontline clinicians 
BMJ Quality & Safty 2013;22:3 242-250 Published Online First: 23 November 2012  (f/t via Athens)

Abstract

Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.

Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.

Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries. Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.

Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.

Most severely obese children have cardiovascular risk

A new study published in Archives of Disease in Childhood suggested that two thirds of severely obese children have at least one cardiovascular risk factor.

The findings were based on data from the Dutch Paediatric Surveillance Unit on children aged 2-18 between 2005 an d 2007. Paediatricians were asked to report information on children's cardiovascular risk factors - high blood pressure, fasting blood glucose levels and blood fats.

The study found that 307 out of 363 children were correctly classified severely obese, 52% were boys and they tended to be more severely obese at younger age but girls were obese at older age. Nearly 1 in 3 severely obese children came from single parent family. 67% had at least 1 cardiovascular risk factor, 56% had hypertension and 54% had high levels of bad cholesterol, 14% had high fasting blood glucose, and 1% already had type 2 diabetes.  The authors said "high prevalence of hypertension and abnormal lipids may lead to cardiovascular disease in young adulthood.” 

Critics noted some limitatons to the study, eg,  a  lack of internationally agreed criteria for diagnosing severe obesity in children, the difficulty of generalising the study results to other populations due to the small size of the study, the ethnicities of the children might also have an effect on the results.

Source: Van Emmerik NMA, Renders CM, van de Veer M, et al. High cardiovascular risk in severely obese young children and adolescents. Archives of Disease in Childhood. Published online July 23, 2012
(full text via Athens)

Increasing dietary antioxidant intake could cut pancreatic cancer risk

According to a new study published in Gut, more than 250,000 people die from pancreatic cancer each year around the world and only 3% - 5% of the patients survive beyond 5 years. It is difficult to detect and often not diagnosed until it is advanced. Smoking and type 2 diabetes are major risk factors, the researchers thought diet may have an impact in the incidence of the cancer.

The researchers examined data from the Norfolk arm of the European Prospective Investiagtion of Cancer (EPIC) study investigating the lifestyle and dietary factors associated with pancreatic cancer, including more than 23,600 participants aged  40 - 74 between 1993 and 1997. All participants had completed a comprehensive food diary tracking the type of food and amount they ate during a 7 day period, as welll as the methods they used to prepare the food, the nutrient value of each person is calculated. The nutrient intakes of the pancreatic cancer patients were comapred with 4000 healthy individuals to see if there were any difference.

The researchers found that within 10 years entering thte study, 49 developed pancreatic cancer, increased to 86 by 2010. They survived 6 months after diagnosis on average. Those eating a combination of the highest three quartiles of all of vitamins C and E and selenium had a decreased risk of pancreatic cancer. Researchers said the finding is not a chance finding, if the association is causal, 1 in 12 cancers might be prevented by avoiding the lowest intakes, but they point out that the study cannot show it is causal link therefore the need for studies in other populations.  

Critics say it is important to note that the study only found a correlation with pancreatic cancer risk in people taking very low levels of these antioxidants. High levels of intake was not better than moderate levels of consumption. Too high levels of intake of these supplements and other vitamins and minerals are associated with different types of danger, people should seek advice before making changes to food or dietary supplement intake.

Source: Dietary antioxidants and the aetiology of pancreatic cancer: a cohort study using data from food diaries and biomarkers. Gut  2012, doi:10.1136/gutjnl-2011-301908    Full text via Athens.

Surgery may not be the best for prostate cancer

According to a 15-year study., most patient diagnosed with prostate cancer at a very early stage will choose surgery or radiation treatments with the adverse effects of impotence or incontinence. About 10% choose no treatment at all, this is called watchful waiting or active surveillance or expectant management, normally not recommended by their doctors.  The study, published in New England Journal of Medicine, found that patients with early stage prostate cancer survived the disease whether they opt for surgery or not.

731 men diagnosed with prostate cancer after having high PSA levels were randomly assigned to radical prostatectomy or observation and followed through January 2010. They found that radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation. More than 1 in 5 in the surgery group had adverse effects from their operation.

The study suggests that most prostate cancers are not life-threatening, but most patients are given radical prostatectomy and they believe that treatment will eliminate the risk. Many men report pressurised by their doctors and families to seek aggressive treatment. The lead author of the study said the study shows that observation can be a wise and preferred option for most men diagnosed with prostate cancer detected with PSA.

However not all experts agree with the study's conclusion, but all feel that more research is needed to identify which cancer would be harmless and slow-growing. Some said that education and teaching is needed to understand the concept that not all cancers are the same.

Source : Radical Prostatectomy versus Observation for Localized Prostate Cancer. New England Journal of  Medicine 2012; 367:203-213 (July 19, 2012), Abstract only, full text via Athens 90 days after publication.

The cost of knowledge

The British Government announced on Tuesday 16 July 2012  that scientific research funded by British taxpayers' money will be free to access online by 2014, The Guardian reported. The announcement was made in response to the Finch Report that was commissioned by the Wellcome Trust in April 2012 to find a solution for open access to scientific research following the "academic spring" where thousands of researchers protested to boycot journals that publishers charged academic institutions high subscription fees for access.

The "academic spring" was sparked by a blog article posted in January this year by Tim Gowers, a distinguished mathematician at Cambridge University and winner of Fields Medal, unhappy with the high charges imposed by publishers on UK universities for access to research work produced by his peers and largely funded by taxpayers, therefore decided to decline to submit or review papers for any academic journals published by Elsevier.

Hundreds of supporting comments were posted to him, one of his readers set up a website for academics to register their protest against Elsevier. More than 12,000 signatories have now been collected of which more than 800 are medical researchers, committed to refuse to peer review , submit or undertake editorial work for Elsevier journals.  Elsevier publsihes more than 2000 journals, eg Science Direct journals.

In April this year, Harvard University informed its teaching and research staff that it could no longer afford the high prices imposed by many large journal publishers and encouraged its staff to submit their research to open access journals and resign from editorial boards that keep articles behind paywalls. The Univeristy said that the current system of journal pricing and access policies is unsustainable and universities will need to work together to take control of the scholarly publishing.

In the current publishing model, researchers submit articles to journal editors, the manuscript is sent for peer review, usually unpaid. If the work is accepted, it is published and then sold back to university libraries and other subscribers.

Advocates of open access argue that public-funded scientific research should be made freely available to the wider public and for economic benefits. However, one of  the barriers of adopting the open access model is that, apart from the publishers and prices,  research grants in the UK are distrbuted to universiities on their publication records, the more articles the academics get published in prestigious journals, the higher the chance of funding opportunities for their universities or departments, so some may be relunctant to move to open access publishing.

It is estimated that UK universities spend about £200m a year for purchasing access to the scientific journals, unfortunately many are restricted by the licence agreement with publishers to extend the journal access to their affiliated NHS organisations, NHS hospitals will have to pay for their journal access. In 2008, the British Government officially formed 5 academic health science centres (AHSC), these are partnerships between a university and NHS Trust with the aim to improve the quality of health services by bringing research, educaton and patient care closer together. The AHSCs should use the collective bargaining power with publishers to strike a deal to address the issue of HE/NHS inequality of access to electronic library resources.

If you are NHS doctors, authors and users of journal articles, would you consider following Harvard's action?

BNF free app for NHS Athens users

An official BNF app has been launched by NICE and is now available as a free download for anyone with an NHS Athens account who uses Android and iPhone smartphones or iPod touch. Users will need to enter their NHS Athens details to activate the content.

The BNF app offers access to the latest prescribing information from the BNF at the touch of a button and allows for browsing, searching BNF content, and receiving updates. Once downloaded, the app can be run without an internet connection meaning that professionals can access the BNF wherever they are.

Eligible health and care professionals in England who do not yet have an NHS Athens password can register directly from their Smartphone by following the instruction displayed in Apple App store  and 

Google Play .

To download the app on Android, users will require the minimum operating system: 2.3.3 and up. Iphone and Ipod touch users will require the minimum operating system: iOS 4.3 or later.

To use the NICE BNF app for the first time, you will need to:

1. Click on 'Sign in'  

2. You will be asked to sign in with your NHS Athens account.   
3. Enter your NHS Athens username and password     

4. If you do not have an Athens account, click Register.     

5. Click Sign in again.        

6. Downloading to device may take up to 10 minutes

For help or further details, ask the librarian at your NHS Trust.

Resources for GP AKT exams

The following resources may be of interest to GP trainees preparing for the AKT exam.


RCGP AKT sample questions - November 2011

GPST Society - run by the GP trainees in South-East Scotland to support other trainees in the area. The resources include guides and tips on passing the AKT exam, suggestions of useful resources etc, would be useful to GP trainees in other parts of UK.

gpst.info - run by Dr Mahibur Rahman, a GP who works in Birmingham, also the director of a commercial website, Emedica. The gpst.info website has some free MCQ questions for MRCP and tips for assessment, also advertisements about Emedica.

Books via Athens - click on books@ovid
Oxford Handbook series including : Oxford Handbook of General Practice. 3rd ed. and Oxford Textbook of Primary Medical Care. 1st ed.
BMJ Learning - GP trainee ( access via Athens )

Useful journal via PubMed Central (UK) - free open access
British Journal of General Practitionrs - 12 months after publication

BMJ Careers free articles : written by GP trainees
MRCGP applied knowledge test
MRCGP examination: applied knowledge test and clinical skills assessment
GP exam to change - July 2010

See also post on MRCP, MRCS free exam questions

Living Books About Life - free ebooks

"Living Books About Life" is a collaboration between Open Humanities Press and 3 academic institutions: Coventry University, Goldsmiths, University of London, and University of Kent.

Funded by the Joint Information Systems Committee (JISC), 21 living books are created and published by Open Humanities Press (OHP), the unifying theme is life: e.g., air, agriculture, bioethics, cosmetic surgery, electronic waste, energy, neurology and pharmacology.

The editors said that the series represents an exciting new model for publishing, in a sustainable and low-cost manner in the future. These books can be freely shared with other academic and non-academic institutions and individuals. They constitute an engaging resource for researching and teaching relevant science issues across the humanities, a resource that is capable of enhancing the intellectual and pedagogic experience of working with open access materials.

All the books in the series are open to ongoing collaborative processes of writing, editing, updating, remixing and commenting by readers, thus engaged in rethinking ‘the book’ itself as living.

The attributions/bibliography of each book often links to free full-text, some have video clips added. You may be able to download these books to e-book readers such as Kindle and the iPad!

Breast cancer screening review

Yesterday, the media reported that following an open letter by Susan Bewley, professor of complex obstetrics at King's College London, to the government's cancer chief, an independent investigation into breast cancer screening has been set up to try to settle the growing controversy around its benefits and potential harms.

The NHS Breast Cancer Screening Programme began in 1988 and claimed that the scientific evidence demonstrates clearly that regular mammographic screening between the ages of 50 and 70 reduces mortality from the malignancy.

The 1st systematic review of breast cancer screening came from the Nordic Cochrane Centre, part of the Cochrane Collaboration, published in The Lancet in 2000. The review was based of 8 large RCTs with more than 182,000 women in the Nordic countries. The authors found that the quality of the trials were low and the data showed that for every 1000 women screened biennially throughout 12 years, only 1 breast-cancer death was avoided whereas the total number of deaths was increased by 6. The authors concluded that "Screening for breast cancer with mammography is unjustified".

The most recent update of this review was published on 19 January 2011. The authors said that it is not clear whether screening does more good than harm and women invited to screening should be fully informed of both the benefits and harms.

Source: Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2011, Issue 1

Do we need to drink 8 glasses of water a day?

A Scottish GP, Margaret McCarthney, wrote a feature article in the BMJ last week that the common recommendation to drink 6 to 8 glasses of water a day is "debunked nonsense", as a result, hundreds of comments, some agreeing, many disagreeing, were sent to the BMJ and other media.

The GP argued that there is no high quality evidence to support the recommendation and that too much water can lead to hyponatremia and other problems. She said that the "Hydration for Health" initiative, sponsored by Danone, maker of bottled water Volvic and Evian, has vested interests to re-inforce the myth. Dr McCarthney argued that reports that drinking more water can improve concentration and mental performance in kids have lacked evidence and that Hydration for Health has oversold the benefits of drinking more water without clear evidence to support it. "We should just say no", she said.

An expert noted that there is well established literature on the negative effects of dehydration on mental skills in adults and children. Another said that the author failed to mention an important US report(2004) that reviewed all studies.

Dr McCartheny argued that her article was to examine the evidence of the benefits that Danone claimed via "Hydration for Health" and was not a systematic review on the subject and she did not imply that it is dangerous for children to drink 6-8 glasses of water a day.

Source: Waterlogged? BMJ 2011; 343:d4280 doi: 10.1136/bmj.d4280 (Published 12 July 2011) , full text via Athens

Provenge therapy for advanced prostate cancer

Prostate cancer is one of the most common malignancy in North American males causing more than 30,000 deaths each year, up to 30% experience recurrence.

Chemotherapy and hormonal therapy are the usual treatment available to these patients, but many patients have progressed to castrate-resistant prostate cancer (CRPC) and chemotherapy has significant side effects.

A new study was published online in the journal Maturitas in May about a novel therapeutic cancer vaccine, Sipuleucel-T, or Provenge, produced by Dendreon Ltd, for the treatment of CRPC after randomized trials showed significant survival advantage compared to controls.

In April 2010, the US FDA approved the vaccine therapy for advanced prostate cancer that has failed to respond to hormone therapy. The therapy involves taking the patient's own immune cells, externally activated against prostate cancer antigen PAP and infuse back into the patient. The patient's own immune system will then create T-cells to attack these cells.


Provenge does not cure prostate cancer but trials show that it extends survival by 4 months or years for some patients. Phase I and Phase II trials show that the vaccine is safe but some patients suffer side effects such as fatigue, headache, back pain, joint pain etc. It is advised that patients should discuss the risks and benefits with their physicians.

Source: "Vaccine therapy with sipuleucel-T (Provenge) for prostate cancer". Maturitas 2011 Aug;69(4):296-303. Epub 2011 May 31

sitting for long periods doubles risk of blood clots in the lungs

According to a new study published by the BMJ, women who sit for long period of time everyday are 2 to 3 times more likely to develop blood clot in their lungs than more active women. The study is the first to prove that a sedentary lifestyle increases the risk of developing a pulmonary embolism.

US researchers followed almost 70,000 female nurses for 18 years and collected information about their lifestyle through biennial questionnaires. They found that the risk of pulmonary embolism was more than twice higher in women who spent more than 41 hrs a week (outside work) sitting comapred with those who spent less than 10 hrs a week. The study also showed that physical inactivity correlated with heart disease and hypertension.

The authors concluded that physical inactivity is associated with pulmonary embolism in women and suggest that the incidence of pulmonary embolism could be redudced by discouraging physical inactivity among the general public.

Source: Physical inactivity and idiopathic pulmonary embolism in women: prospective study. BMJ 2011; 343:d3867 (Published 4 July 2011) Open access

Risk of irregular heart rhythm from NSAIDs is low

The use of NSAIDs, commonly known as painkillers, including ibuprofen are already known to be associated with cardiovascular risk but a new study, published in the BMJ, showed for the first time a link between the drugs and atrial fibrillation or flutter (AF) also known as irregular heart rhythm.

Danish researchers examined the records of more than 32,000 patients who had a first diagnosis of AF between 1999 and 2009 and compared each to 10 randomly selected control patients.They found that patients starting treatment with non-aspirin NSAIDs had 40-70% increased risk of AF compared to non-users. New users of cox-2 inhibitors, the newer forms of the drugs, were associated with a 70% increased risk.

The lead author concluded that the overall increased risk was still low and patients taking these medicine should not stop them but should discuss the potential risks with doctor. One-off doses or short courses of over-the-counter-strength ibuprofen are still considered safe.

In an accompanying editorial, the author said doctors should be cautious when precribing NSAIDs to older people because of the higher risk of AF.

Critics say that this was a population-based case control study with many strengths, but the lack of data on the amount of NSAIDs taken by the patients, confounders, lifestyle factors etc. could have affected the results.

Source: Schmidt M, Christiansen CF, Mehnert F, et al. Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study. BMJ 2011; 343:d3450 ( open access)

Editorial : Gurwitz JH. NSAIDs and atrial fibrillation. BMJ 2011, 343: d2495 (open access)

Anticholinergic medication may put elderly at risk

According to a new study, a group of researchers in the UK and US re-analysed data collected between 1991 and 1993 as part of a large ongoing MRC study into the decline of mental functioning in people over 65 to determine whether the use of anticholinergic drugs increases the cognitive impairment risk and death in older people.

Anticholinergic drugs block the chemical acetylcholine which is vital in the transmission of electrical impulses between nerve cells, also have an effect on concentration, memory and causes confusion. Drugs with anticholinergic effects are commonly used in many areas of medicine, eg, eye drops Timolol Maleate, warfarin for blood thinning, the painkiller Codeine, allergy tablets Piriton, incontinence drug Ditropan, the antidepressant Seroxat and the sleeping pill Nytol.


Researchers examined more than 80 drugs having anticholinergic effects and classified them with score into 3 groups : severe, moderate and mild based on potential harm. Drugs with a severe risk include Piriton, Nytol and Ditropan.


Researchers found that nearly half of the elderly patients in the study took 1 or more of these drugs, 4% were taking drugs with definite anticholinergic properties. The results showed that 20% of those taking drugs with a total score of 4 or more died by the end of the two-year study, compared with only 7% of those taking no anticholinergic drugs. Those taking several of the drugs had a 4% worse score in key tests to check the function of their brain. They concluded that the use of anticholinergic drugs increases the risk of cognitive impairment and mortality.


Critics say that the data were collected 20 years ago and may not reflect the current prescribing practice. Although the use of anticholinergic drugs was associated with increased death, it may have been influenced by some underlying conditions. It is important that people should not stop taking prescribed anticholinergic medication before speaking to their GP.


Source: Anticholinergic Medication Use and Cognitive Impairment in the Older Population: The Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatrics Society. Article first published online: 24 JUN 2011 (full text via Athens)

More calcium does not reduce fracture risk

It is already known that calcium along with vitamin D are important in keeping bones healthy. In the US, the guideline for calcium intake was 1000 mg a day for women under the age of 50, 1200 mg for older women with the upper intake level of 2000 mg because of kidney stones and other risks caused by high calcium intake. In the UK, the recommended Ca intake for adults is 700 mg a day.

Several recent studies linked calcium supplements to increased risk for cardiovascular events and kidney stones in women. A new study published in the BMJ looked at the relationship between calcium and risk for fractures and overall bone health involving more than 61,000 Swedish women, followed up for 19 years.

The study found that women with the lowest Ca intake, below 750 mg, had a higher risk of fractures or develoing osteoporosis, but increasing intake of Ca did not reduce the risk of fracture further. Women who had the highest Ca, 1100+ mg seemed more at risk of broken hip. It concluded that moderate levels of calcium intake were best for bone health and more was not better.

The large size of the study with better precision is regarded a strength of the study, but critics say researchers used a questionnaire covering diet and lifestyle to find out how much calcium women were getting from food may result in recall bias. Experts suggest women should get enough calcium from a balanced diet, eg half pint of milk, green vegetables and nuts.


Source: "Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study". BMJ 2011; 342:d1473 (Published 24 May 2011) Open access

Google Chromebooks

Google launched Chromebooks on 15 June 2011. What are Chromebooks? These are laptops with the Chrome OS, an operating system based on the web browser. In fact the browser is all you have - "Nothing but the web"! Chrome promises effortless computing, easier, faster and better without the need for expensive IT support.


According to reviewers, Chromebook users can do most of the things they do with their PCs and laptops in the Chrome browser without storing any data on their machines, but you can't run Microsoft office or play games on an iPad. Everytime you boot up a Chromebook, it will give the latest version of its software and security patches, filter out the spam and check viruses, so it eases the burden of spam, software updates, security and hardware failure. In the event of computer breakdown or lost, your data will be safe becuase they are stored in Google's cloud.


The cloud is simply a place for storing data instead of keeping it, you merely have access to them through servers operated by the cloud providers. Google claims that Chromebooks come with an encrypted file system by default, so they are very safe. Many computing security experts have expressed reservations about the security of the cloud, however supporters say that while there are drawbacks, most cloud services are adequate and safe.

Avoiding hospital admissions: what does the research evidence say?

Emergency admissions represent around 65% of hospital bed days in England. It is a major concern for the NHS, despite considerable efforts to reduce emergency admissions, only a few PCTs succeeded between 2007 and 2009.

The King's Fund has published a paper which considers the research evidence for a range of interventions to avoid emergecy or unplanned hospital admissions addressing the following key questions:
- What interventions work to reducing avoidable admissions?
- Who is at risk and how do we identify them?
- Which admissions are potentially avoidable?
- Which interventions work in primary, secondary and emergency care as well as discharge from hospital?

Some of the findings on interventions in A&E :
- A recent systematic review of the evidence for the effectiveness of GPs working in EDs found that this intervention may result in fewer referrals for admissionn but the evidence is weak.
- A study of a GP service aimed at patients who are referred for urgent medical admission by a GP in the ommunity showed a small reduction in admissions to the medical assessment unit.
- Making a senior emergency medicine clinician available to review patients in the ED has been shown to reduce inpatient admissions by 12 % and specifically reduced admissions to the acute medical assessments unit by 21%.

The paper finds that there is insufficient evidence to support many of the interventions currently being implemented and concludes that policy-makers, providers and commissioners can introduce a number of changes that have proved to be effective in reducing admissions and includes recommendations for all of these groups, emphasising the importance of using evidence-based interventions.

Source: "Avoiding hospital admissions: what does the research evidence say?" King's Fund , Dec 2010

Free access to research articles on E. coli bacteria

During the past few weeks, a significant increase in the number of patients as a result of eating salad infected with E.Coli has been reported in Europe, especially in Germany.

The Executive Vice President Corporate Communications of Springer Science+Business Media, said, "As a global scientific, technical and medical publisher, Springer plays a major role in the distribution of scientific information and access to knowledge and research. Therefore we are making all studies, published up to now on the E. coli bacteria, freely available online on SpringerLink. By doing this, we hope to play a small part in helping researchers and medical professionals solve, or at the very least alleviate, this crisis."

Springer Science+Business Media is offering all journal articles and book chapters which deal with the E. coli bacteria free of charge at SpringerLink. The articles can be found by using the search terms "Enterohaemorrhagic and Escherichia and coli".


A total of over 400 scientific articles are available to print out or download from now until 1 September 2011. The articles which are available free of charge concern the better-known and less aggressive strain E. coli 0157:H7.

Springer Science+Business Media is a leading global scientific publisher, in the science, technology and medicine (STM) sector, the group publishes around 2,000 journals and more than 7,000 new books a year, as well as the largest STM eBook Collection worldwide.

UCLP library project

In March 2009, 5 academic health science centres (AHSC) were officically formed and recognised by the Government, these are partnerships between a university and NHS Trust with the aim to improve the quality of health services by bringing research, educaton and patient care closer together. AHSCs include :

Cambridge University Health Partners
Imperial College AHSC
King's Health Partners
Manchester AHSC
UCL Partners

JISC Collections, the UK academic community e-content procurement service, major STM publishers and database suppliers have agreed on a 1-year pilot programme that will allow the univeristies at the AHSCs to extend access to their subscribed content to their partner NHS organisations. Publishers include Elsevier, Nature, Springer, Thomson Reuters and Wolters Kluwer Health have granted extended access at no additional cost for 2011.

Works are underway to link the resources to Athens, once activated, they will be available through MyAthens. The project will end on 31 December 2011.