Talking to acutely sick patients . . . and other stories
BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4422 (Published 17 August 2016) Cite this as: BMJ 2016;354:i4422
Resuscitating discussion
A Canadian study recorded how 15 resident doctors approached the discussion of goals of care and resuscitation preferences with patients over the age of 65 admitted to an acute medical ward (Postgrad Med J doi:10.1136/postgradmedj-2016-133951). They found that asking patients about their previous experiences with life sustaining treatments was a good way of establishing rapport and understanding. The avoidance of medical jargon was also important. The authors suggest that further direct qualitative studies like this may help to improve communication with acutely sick patients.
Comorbidities in childhood epilepsy
Nearly 80% of children with epilepsy have a comorbid disorder, according to data from the Norwegian Patient Registry (Pediatrics doi:10.1542/peds.2016-0921). All types of disorders were more common in children with epilepsy, with additional medical disorders recorded in 55%, neurological disorders in 41%, and developmental/psychiatric disorders in 43%. Children with complicated epilepsies had the highest overall levels of comorbidity, but the risk of medical and psychiatric comorbidities was also substantial among children with uncomplicated epilepsies.
HYENA gives birth to DEBATS
Connoisseurs of silly acronyms may remember the HYENA study, which reported on the link between HYpertension and Exposure to Noise near Airports (Environ Health Perspect 2008;116:329-33. doi:10.1289/ehp.10775). DEBATS (Discussion sur les Effets du Bruit des Aéronefs Touchant la Santé) is the acronym of an observational study of people living near three French airports, using estimates of aircraft noise, questionnaires, and blood pressure recordings. The study is ongoing, but so far there is debatable evidence that exposure to aircraft noise at night time may be associated with increased risk of hypertension in men (Occup Environ Med doi:10.1136/oemed-2016-103648).
Outcomes from atrial fibrillation ablation
Catheter ablation for persistent atrial fibrillation can require patience but is usually crowned with some success, according to a case series of 188 consecutive patients (84% male) treated at the Liverpool Heart and Chest Hospital over three years (Open Heart doi:10.1136/openhrt-2015-000394). Over a mean follow-up of 46± (SD 16) months (range 4-72), 139 (75%) patients experienced recurrence of arrhythmia after a single procedure and 90 (48%) after their final procedure. But at the final follow-up of nearly four years, 82% of patients reported an improvement in symptoms.
Discrete choices in rheumatoid arthritis
Most people with recently diagnosed rheumatoid arthritis can expect good disease control, but the choice of agents can involve trade-offs between potential harms and benefits. A survey of 152 patients with early rheumatoid arthritis explored patient preferences and found that benefits generally were weighed more highly than harms (Rheumatology doi:10.1093/rheumatology/kew280). Also, most respondents were willing to accept a small extra risk of cancer or serious infection in exchange for a 15% absolute increase in the chance of a major improvement in symptoms. But people need to choose as individuals; no patient is most patients.
Understanding before intervening
A hospital based improvement team sought to reduce unplanned readmissions from residential care homes. They set up a community based geriatric team that could be accessed directly by care homes, and a communication tool to facilitate transfer of information between homes and hospital. These had no discernible effect. Subsequent independent process evaluation found that care home staff were unconvinced that the improvement interventions were aligned with their needs or tackled their concerns (BMJ Open doi:10.1136/bmjopen-2015-010988). Projects of this kind are unlikely to succeed without a shared view of the problem to be dealt with.
Netting for health
The annual Ofcom Communications Market Report for 2016 is the subject of an interesting blog by Simon Denegri, National Institute for Health Research national director for patients and the public in research (http://bit.ly/2b3jbUy). Across the UK, 44% of people say they use the internet to find information on health related problems (Northern Ireland 57%, Wales 47%, England 45%, Scotland 31%). Given that the average Briton spends more time on media and communications than sleeping, the internet needs to be recognised as our most important distributor of health knowledge (Ofcom news http://bit.ly/2axm9SV).