A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – practical systematic review of self-management support for long-term conditions

National Institute for Health Research, December 2014

Everyone who has a long-term condition (LTC), such as arthritis or asthma, has to deal with (or ‘self-manage’) their condition, sometimes with the help of a spouse, friends or a carer. In addition to physical symptoms, LTCs often have social and emotional effects on people.  The NIHR were commissioned to look at what can be done to support self-management across a wide range of LTCs and to make suggestions to those providing health services. This was done by systematically summarising the research that has been done in the area.

The report concludes that supporting good self-management is inseparable from the high-quality care all people with LTCs should receive. Supporting self-management is not a substitute for care from doctors and nurses but a hallmark of good care. Providers of services for people with LTCs should consider how they can actively support self-management.

Click here to download the full paper.

The Bigger Picture: Understanding disability and care in England’s older population

The Strategic Society Centre, November 2014

This unique research project explores disability and care at a national, regional and local authority level in England.

It brings together data from Census 2011, DWP and HSCIC ‘administrative data’, as well as from Wave 6 of the English Longitudinal Study of Ageing, to look at the prevalence of disability, need and care of different types, and to ‘paint a picture’ of the lives of different groups.

Click here for further information and to download the research.

Inclusive integration: How whole person care can work for adults with disabilities

IPPR, 18 December 2014

This report focusses on the needs of working-age disabled adults and particularly on how, as health and social care services are increasing integrated, they can be protected and more effectively met.  The report provides an empirical evidence base to demonstrate how whole person care should meet the needs of working age disabled adults. There are real challenges to integrating a health system that is free at the point of delivery with a means-tested social care system. There are also risks to the independence of disabled people if a more ‘medical’ model of the NHS was allowed to predominate over a whole person care approach.

Click here for further information and to download the report.

Model specification for child and adolescent mental health services: Targeted & specialist levels (Tiers 2/3)

NHS England, January 2015

NHS England has published the new model specification for Children and Adolescent Mental Health Services (CAMHS) targeted and specialist services (tiers 2 and 3) which treats patients with a range of emotional and behavioural difficulties such as behavioural problems, depression and eating disorders, to help improve the standards of care being given to vulnerable youngsters.

Click here for further information and to download the guidance.

Screening for psychological and mental health difficulties in young people who offend: A systematic review and decision model

National Institute for Health Research, January 2015

Young people who have offended are more likely than people who have not offended to have mental health problems and they are also more likely to offend again. It may, therefore, be important to identify the mental health difficulties in this group and give them help for these problems.
There are, however, a number of unanswered questions about identifying mental health problems in young people who offend. These include:

  • How accurate are the different ways of identifying these difficulties?
  • If a difficulty is identified, how well does any treatment given for this difficulty work?
  • Does identifying mental health problems in this way represent good value for money?

The paper seeks to identify all research that could help to answer these questions. A small number of studies were identified that looked at how accurate different tools were at identifying mental health problems in this group. Most tools had limited accuracy. A small number of studies were also identified that had looked at whether or not treatments work for mental health difficulties in young people who offend. Although there was some encouraging evidence, it remains uncertain if treatments are effective in this group. In general, the search identified few studies and those studies that were identified were often of low quality.

Click here to download the full paper.

Information: To share or not to share – The Independent Information Governance Oversight Panel’s report to the Secretary of State for Health

Department of Health, January 2015

This is the first annual report of the Independent Information Governance Oversight Panel, chaired by Dame Fiona Caldicott and set up by the Secretary of State for Health in November 2013.

It looks at whether health and social care organisations are sharing information wisely and preventing improper disclosure of personal data. It shows evidence of pockets of exemplary practice but the overall picture is of a need for improvement.

The IIGOP report concludes that a basic condition for building public trust is a commitment to more transparency about how data is collected, stored and used. Individuals must also be able to opt out of data sharing arrangements and be confident that their wishes are being respected consistently across the system.

Click here to download the full report.

Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial

BMJ, 20 January 2015

Objective:  To examine whether behavioural strategies designed to improve children’s sleep problems could also improve the symptoms, behaviour, daily functioning, and working memory of children with attention deficit hyperactivity disorder (ADHD) and the mental health of their parents.

Design: Randomised controlled trial.

Intervention:  Sleep hygiene practices and standardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call. Children in the control group received usual clinical care.

Main outcome measures: At three and six months after randomisation: severity of ADHD symptoms (parent and teacher ADHD rating scale IV—primary outcome), sleep problems (parent reported severity, children’s sleep habits questionnaire, actigraphy), behaviour (strengths and difficulties questionnaire), quality of life (pediatric quality of life inventory 4.0), daily functioning (daily parent rating of evening and morning behavior), working memory (working memory test battery for children, six months only), and parent mental health (depression anxiety stress scales).

Results:  Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months (adjusted mean difference for change in symptom severity −2.9, 95% confidence interval −5.5 to −0.3, P=0.03, effect size −0.3, and −3.7, −6.1 to −1.2, P=0.004, effect size −0.4, respectively). Compared with control children, intervention children had fewer moderate-severe sleep problems at three months (56% v 30%; adjusted odds ratio 0.30, 95% confidence interval 0.16 to 0.59; P<0.001) and six months (46% v 34%; 0.58, 0.32 to 1.0; P=0.07). At three months this equated to a reduction in absolute risk of 25.7% (95% confidence interval 14.1% to 37.3%) and an estimated number needed to treat of 3.9. At six months the number needed to treat was 7.8. Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep, at three and six months, respectively. Intervention families reported greater improvements in all other child and family outcomes except parental mental health. Teachers reported improved behaviour of the children at three and six months. Working memory (backwards digit recall) was higher in the intervention children compared with control children at six months. Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months (mean difference 10.9 minutes, 95% confidence interval −19.0 to 40.8 minutes, effect size 0.2) and six months (9.9 minutes, −16.3 to 36.1 minutes, effect size 0.3); however, this measure was only completed by a subset of children (n=54 at three months and n=37 at six months).

Conclusions:  A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD, most of whom were taking stimulant medications. The intervention also improved the children’s sleep, behaviour, quality of life, and functioning, with most benefits sustained to six months post-intervention. The intervention may be suitable for use in primary and secondary care.

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