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Managing quality in community health care services

From children’s services to care for older people and end-of-life support, the community sector plays a key part in meeting the challenges facing our health and care system. This report presents findings from a small-scale study into how quality is managed in community services. Community health care services provide vital care out of hospital for millions of people. From children’s services to care for older people and end-of-life support, the community sector plays a key part in meeting the challenges facing our health and care system. This report presents findings from a small-scale study into how quality is managed in community services. It explores how community care providers define and measure quality and recommends important next steps to support better measurement and management of quality.  
The King's Fund
about 7 years ago
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24

Exploring CQC’s well-led domain

The CQC’s inspections focus on five key lines of enquiry as part of its ‘well-led’ domain. This paper sets out what boards can do in these five areas and draws on examples of good practice in leadership and culture in health care. Following the Francis Report into the failures of care at Mid Staffordshire NHS Foundation Trust, and the government’s response to the report, the Care Quality Commission (CQC) has introduced a more rigorous and wide-ranging approach to inspecting health care providers. The main purpose of inspections is to assess the quality of care delivered to patients. In making this assessment, CQC now also analyses the leadership and organisational culture of providers.  
The King's Fund
about 7 years ago
2
1
37

An Introduction to Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) is a form of partial cardiopulmonary bypass used for long-term support of respiratory and/or cardiac function. This technology arose from cardiopulmonary bypass used for cardiac surgery. Initial systems used bubble oxygenators which were poorly suited for prolonged use because of their tendency to hemolyze blood. Membrane oxygenators made long-term use of ECMO possible. The first report of successful ECMO support of an adult was published by Hill in 1972.  
perfusion.com
almost 7 years ago
Www.bmj
1
11

Accessibility of trial reports for drugs stalling in development: a systematic assessment of registered trials

Design A systematic assessment of the availability of published research reports for publicly registered trials testing drugs stalling in clinical development (“stalled drugs”) and drugs receiving regulatory licensure in the same time period (“licensed drugs”).  
bmj.com
almost 7 years ago
Www.bmj
1
8

State governments’ delays in fund transfer are affecting India’s national health mission, report says

Health ministry officials in Delhi are concerned that delays in the release of funds by state governments are hurting India’s National Health Mission and AIDS prevention programmes, Reuters reports.1  
bmj.com
almost 7 years ago
Www.bmj
1
48

High potency cannabis

A recent study by Di Forti and colleagues suggests that daily use of “skunk”— cannabis with high levels of Δ9-tetrahydrocannabinol (Δ9-THC) and low levels of cannabidiol—is a contributory cause of schizophrenia.1 The study compared patterns of cannabis use in first episode cases of psychosis and matched controls recruited from areas in south London. It found equally high rates of cannabis use in cases and controls, but cases were three to five times more likely to report daily use of skunk than controls, and this association persisted after statistical adjustment for confounders. The researchers estimated that one in four new cases of schizophrenia in this area of London were attributable to skunk, if the association is causal.  
bmj.com
almost 7 years ago
Www.bmj
1
26

Medical cannabis: US researchers battle for access to the plant

Despite more states approving medical cannabis, federal laws make it extremely hard to study its safety and effectiveness. Suzy Frisch reports  
bmj.com
almost 7 years ago
Www.bmj
1
38

Multiple sclerosis: summary of NICE guidance

Multiple sclerosis (MS) is the most common cause of serious physical disability in working age adults and affects over 100 000 people in the United Kingdom.1 It causes a range of symptoms and disability and requires a broad multidisciplinary approach. A 2008 report, however, suggested delays and limited access to specialist services for affected people.2 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).3 The guideline scope does not include disease modifying drugs as these have been covered in other NICE guidance.  
bmj.com
almost 7 years ago
Static.www.bmj
1
44

Opioids for low back pain

Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.  
bmj.com
almost 7 years ago
Www.bmj
1
21

Medicare paid $32m for questionable HIV prescriptions, investigators find

Medicare, the US health insurance plan for elderly and disabled people, paid out $32m (£19m; €24m) in 2012 for dubious HIV drug prescriptions, a new report has found.1  
bmj.com
almost 7 years ago
Www.bmj
1
33

Resuscitating drowned children

The World Health Organization published its global report on drowning in November 2014, reporting a staggering 372 000 deaths a year from all types of water immersion. Worldwide, drowning is in the top 10 causes of death in children and young people, particularly in males and those aged under 5. An estimated 21 children and young adults are drowned every hour.1 Other public health matters have had disproportionately greater attention, despite the numbers of deaths from drowning being equivalent to two thirds of global deaths from malnutrition and over one half of deaths from malaria.  
bmj.com
almost 7 years ago