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Freezing the vacant posts of diabetes nurse specialists is affecting patient care and will cost the NHS more in the long run, warns a major charity.
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PMID:An indispensible role. 2188 99

The development of Clinical Research Networks (CRN) has been central to the work conducted by Health Departments and research funders to promote and support clinical research within the NHS in the UK. In England, the National Institute for Health Research has supported the delivery of clinical research within the NHS primarily through CRN. CRN provide the essential infrastructure within the NHS for the set up and delivery of clinical research within a high-quality peer-reviewed portfolio of studies. The success of the National Cancer Research Network is summarized in Chapter 5. In this chapter progress in five other topics, and more recently in primary care and comprehensively across the NHS, is summarized. In each of the 'topic-specific' networks (Dementias and Neurodegenerative Diseases, Diabetes, Medicines for Children, Mental Health, Stroke) there has been a rapid and substantial increase in portfolios and in the recruitment of patients into studies in these portfolios. The processes and the key success factors are described. The CRN have worked to support research supported by pharmaceutical, biotechnology and medical device companies and there has been substantial progress in improving the speed, cost and delivery of these 'industry' studies. In particular, work to support the increased speed of set up and delivery of industry studies, and to embed this firmly in the NHS, was explored in the North West of England in an Exemplar Programme which showed substantial reductions in study set-up times and improved recruitment into studies and showed how healthcare (NHS) organizations can overcome delays in set up times when they actively manage the process. Seven out of 20 international studies reported that the first patient to be entered anywhere in the world was from the UK. In addition, the CRN have supported research management and governance, workforce development and clinical trials unit collaboration and coordination. International peer reviews of all of the CRN have been positive and resulted in the continuation of the system for a further 5 years in all cases.
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PMID:Extending the clinical research network approach to all of healthcare. 2203 43

These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery.
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PMID:NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. 2228 87

The aim of this study was to examine the rates and potential risk factors for 28-day re-admission following a fracture of the hip at a high-volume tertiary care hospital. We retrospectively reviewed 467 consecutive patients with a fracture of the hip treated in the course of one year. Causes and risk factors for unplanned 28-day re-admissions were examined using univariate and multivariate analysis, including the difference in one-year mortality. A total of 55 patients (11.8%) were re-admitted within 28 days of discharge. The most common causes were pneumonia in 15 patients (27.3%), dehydration and renal dysfunction in ten (18.2%) and deteriorating mobility in ten (18.2%). A moderate correlation was found between chest infection during the initial admission and subsequent re-admission with pneumonia (r = 0.44, p < 0.001). A significantly higher mortality rate at one year was seen in the re-admission group (41.8% (23 of 55) vs. 18.7% (77 of 412), p < 0.001). Logistic regression analysis identified advancing age, admission source, and the comorbidities of diabetes and neurological disorders as the strongest predictors for re-admission. Early re-admission following hip fracture surgery is predominantly due to medical causes and is associated with higher one-year mortality. The risk factors for re-admission can have implications for performance-based pay initiatives in the NHS. Multidisciplinary management in reducing post-operative active clinical problems may reduce early re-admission.
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PMID:Causes and predictors of early re-admission after surgery for a fracture of the hip. 2252 93

Despite advances in screening for and treatment of diabetes, diabetic retinopathy and maculopathy are still major causes of visual loss around the world. Systematic screening programs for diabetic eye disease have been developed in many countries. The main aim of these services is to reduce diabetes-related blindness and ease the burden of illness on the patients and their families. In the United Kingdom (UK), the NHS Diabetic Eye Screening Program offers annual digital fundus photography for all patients with diabetes over the age of 12 years regardless of their socio-economic status or ethnicity. In 2010-2011 a nationwide uptake of 79% was achieved. If disease is identified, referral to a specialized eye unit for further assessment and treatment are organized to take place within a pre-specified time frame. Internal and external quality assurance ensures efficacy and safety. This paper aims to summarize the current situation of diabetic retinopathy screening in the UK and outlines the challenges ahead.
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PMID:Screening for diabetic retinopathy and diabetic macular edema in the United Kingdom. 2272 94

Reports have highlighted a shortage of consultant diabetologist posts in the UK. The number of doctors completing specialist training in diabetes has increased in recent years, but little is known about their employment after they receive their certificate of completion of training. An online survey was sent to all doctors who completed specialist diabetes training from January 2008 to September 2010. Of the 95 eligible respondents, 69 (73%) completed the survey (61% men; median age 36 years). Forty-three (62%) respondents secured substantive NHS consultant posts, and of those who gave their job breakdown, 48/51 (94%) were contributing to specialist diabetes care. Five (7%) respondents held substantive academic positions, while 11 (16%) were locum consultants. Seven (9%) respondents worked abroad, with half of these attributing their emigration to lack of opportunities in the UK. When asked about alternative choices, 39% of respondents were likely to seek 'general physician' roles, which equalled the number who would consider emigrating. Overall, only two-thirds of doctors who complete specialist training in diabetes secure substantive NHS consultant positions, which suggests a failure in workforce planning and a lack of expansion of the number of consultant posts despite progression of the diabetes epidemic.
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PMID:One-third of doctors completing specialist training in diabetes fail to secure a substantive consultant post: young Diabetologists' Forum Survey 2010. 2278 66

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement.
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PMID:Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008. 2281

Community nurses provide care to patients in a variety of settings, for example health centres, community hospitals, patients' homes, residential and nursing homes. Administering subcutaneous injections to patients in the community is an everyday activity for many nurses in clinical practice. Many problems related to being 'sharps safe' are common to both community nurses and hospital staff. The majority of subcutaneous injections administered in the community are for patients with diabetes. Reducing needlestick injuries after the administration of subcutaneous injections in the community remains paramount to all NHS staff. This article provides information on what national standards to employ when administrating subcutaneous injections and what safety practices should be undertaken for good sharps management. Staff administering subcutaneous injections in the community need to ensure that they are updated on the latest developments in safety needle devices in order to prevent needlestick injuries and provide safe, effective and individualised care for their patients.
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PMID:Subcutaneous injections: preventing needlestick injuries in the community. 2287 61

Health professionals working in the field of diabetes have a wide choice of blood glucose meters to offer patients, with different meters offering different options for monitoring and recording blood glucose results. Self-monitoring of blood glucose levels can be helpful to people with diabetes in helping to maintain day-to-day control, adjusting insulin doses, detecting hypoglycaemia, assessing control during intercurrent illness and helping to provide information that can be used in the prevention of long-term complications. The newly released iCare Advanced Blood Glucose monitoring System is an easy-to-teach and use blood glucose meter using the latest technology to provide people with diabetes with easy and comfortable testing, producing accurate blood glucose test results in just 6 seconds using a small blood sample of only 0.7ul. In the current NHS climate, the iCare Advanced blood Glucose meter offers patients and health professionals the latest technology alongside cost savings by providing a test strip that is low cost but does not compromise on quality.
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PMID:iCare advanced blood glucose monitoring system. 2287 95

Diabetes is now the biggest cause of amputation, stroke, blindness and end stage renal failure. It causes many deaths from cardiovascular disease. Foot ulcers and amputations reduce the quality of life, increase mortality and involve lengthy stay in hospital. Many people who have an ulcer eventually require surgery. The economic cost to the nation is spiralling out of control with estimates of 10% of the entire NHS budget spent on diabetes. This paper aims to explore the burden of diabetic complications and how policy, guidelines and audit highlight the discrepancies in the quality of diabetes care with particular reference to diabetes foot services. The findings suggest that the NICE guidelines for diabetes foot care are not being adhered to and that the variation in preventative amputations across England is unacceptable. Diabetes UK, the national charity for diabetes is leading a campaign to improve diabetic foot care in light of the available published health information.
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PMID:Diabetic foot disease in the United Kingdom: about time to put feet first. 2305 Sep 5


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