Involving older people in improving general hospital care

User involvement is high on the NHS agenda. At King's College Hospital, London, older people helped to develop the Improving Hospital Care for Older People project by producing teaching and learning materials for staff using e-learning. The project was set up by holding focus groups with older people. Staff surveys were also conducted to explore views and identify issues to be addressed. Older people's representatives were selected and directly involved in developing learning materials. This article describes the process of working together and includes the personal reflections of some of the key players. It discusses barriers to effective user involvement work between staff and older people, and identifies some benefits and opportunities presented by this approach.     

Intravenous immunoglobulin for severe sepsis and septic shock: clinical effectiveness,cost-effectiveness and value of a further randomised controlled trial

Introduction

Prior to investing in a large, multicentre randomised controlled trial (RCT), the National Institute for Health Research in the UK called for an evaluation of the feasibility and value for money of undertaking a trial on intravenous immunoglobulin (IVIG) as an adjuvant therapy for severe sepsis/septic shock.

Methods

In response to this call, this study assessed the clinical and cost-effectiveness of IVIG (using a decision model), and evaluated the value of conducting an RCT (using expected value of information (EVI) analysis). The evidence informing such assessments was obtained through a series of systematic reviews and meta-analyses. Further primary data analyses were also undertaken using the Intensive Care National Audit & Research Centre Case Mix Programme Database, and a Scottish Intensive Care Society research study.

Results

We found a large degree of statistical heterogeneity in the clinical evidence on treatment effect, and the source of such heterogeneity was unclear. The incremental cost-effectiveness ratio of IVIG is within the borderline region of estimates considered to represent value for money, but results appear highly sensitive to the choice of model used for clinical effectiveness. This was also the case with EVI estimates, with maximum payoffs from conducting a further clinical trial between £137 and £1,011 million.

Conclusions

Our analyses suggest that there is a need for a further RCT. Results on the value of conducting such research, however, were sensitive to the clinical effectiveness model used, reflecting the high level of heterogeneity in the evidence base.     

‘The bloke can be a bit hazy about what’s going on’: men and cross-border reproductive treatment

While social science research has begun to demonstrate the significant impact of infertility and involuntary childlessness for men, far fewer studies have specifically explored the male experience of, or men’s involvement in, infertility treatment-seeking and there are few published studies which specifically describe men’s experiences with cross-border reproduction. This paper presents data from the first UK study of transnational treatment-seeking and specifically explores men’s involvement in this process. Data from interviews with 10 men and 34 women who were seeking treatment abroad are organized according to three themes: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. The paper argues that gender is an important aspect of the cross-border treatment experience and that both traditional and emergent gender identities are expressed in the process of treatment-seeking. Healthcare providers need to actively explore men’s perspectives of the treatment process in all locations, to improve quality of care by reducing men’s feelings of marginalization and enhancing their experience of treatment, especially but not exclusively, around the issue of semen collection.There has been little research which has tried to understand more about men’s experiences and involvement in seeking medical help for infertility. There are no published studies which explore the experience of travelling abroad for infertility treatment from the male perspective. In this paper, we present findings from the first UK study of cross-border treatment-seeking and specifically explore men’s involvement in this process. We present findings from interviews with 10 men and 34 women who were seeking treatment in countries outside the UK. These findings are organised according to three themes drawn from the interviews with the men and women: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. This research shows that, as is often the case with treatment-seeking in their home country, men are less likely to get involved in the planning and organization of treatment, but take responsibility for supporting their female partner. Men found some aspects of the treatment process, especially giving a semen sample, particularly difficult. Infertility practitioners in the UK and in other countries need to take account of gender differences and include a consideration of men’s experiences in a more sensitive and proactive way.     

Hospital consultants' views of their patients

Abstract A sample of 24 hospital consultants was interviewed and asked for their opinions about a proposed policy of patient access to their own general practice records. Tape recordings of 20 recorded interviews were analysed in order to obtain data about consultants' views of their patients. Consultants were divided into two main groups: those opposed to and those in favour of the proposed policy.
Three factors were identified which discriminated between the views of the two groups of consultants: whether or not patients were perceived as being competent to take an active and informed part in the consultation; patients' access to the truth; and the fallibility of medicine. It is suggested that consultants' views about patients and patient access to medical records were related to their underlying model of illness: consultants opposed to access held a biomedical model of illness whereas those in favour of access held a more psychosocial model of illness.     

More severe functional impairment in dementia with lewy bodies than Alzheimer disease is related to extrapyramidal motor dysfunction.

OBJECTIVE: The objective of this study was to compare functional impairments in dementia with Lewy bodies (DLB) and Alzheimer disease (AD) and their relationship with motor and neuropsychiatric symptoms. METHODS: The authors conducted a cross-sectional study of 84 patients with DLB or AD in a secondary care setting. Patients were diagnosed according to published criteria for DLB and AD. The Bristol Activities of Daily Living Scale (BADLS) was used to assess functional impairments. Participants were also assessed using the Unified Parkinson's Disease Rating Scale (motor section), the Neuropsychiatric Inventory, and the Mini-Mental Status Examination. RESULTS: Patients with DLB were more functionally impaired and had more motor and neuropsychiatric difficulties than patients with AD with similar cognitive scores. In both AD and DLB, there were correlations between total BADLS scores and motor and neuropsychiatric deficits. There was more impairment in the mobility and self-care components of the BADLS in DLB than in AD, and in DLB, these were highly correlated with UPDRS score. In AD, orientation and instrumental BADLS components were most affected. CONCLUSION: The nature of functional disability differs between AD and DLB with additional impairments in mobility and self-care in DLB being mainly attributable to extrapyramidal motor symptoms. Consideration of these is important in assessment and management. Activities of daily living scales for use in this population should attribute the extent to which functional disabilities are related to cognitive, psychiatric, or motor dysfunction.