Signals

World Stroke Organisation issues new scientific statement on vascular cognitive impairment

An international expert statement sets out new diagnostic criteria and management guidance for vascular cognitive impairment, including its overlap with post-stroke cognitive decline.

Telehome palliative care improves access and continuity, but success hinges on digital readiness, review finds

An integrative review of 33 studies finds telehealth-supported home palliative care improves access and symptom-management continuity, but success depends on digital literacy, caregiver burden and organisational readiness.

Specialist screening before OPAT referral avoided almost 14,000 inpatient days over three years, audit finds

A three-year audit of an outpatient parenteral antimicrobial therapy referral pathway finds nearly a third of referrals were not taken onto the service after specialist screening, avoiding an estimated 13,909 inpatient or IV-therapy days.

Reablement-based home rehabilitation shows weak evidence of benefit, meta-analysis finds

A GRADE-assessed systematic review and meta-analysis of 27 trials finds reablement-based home rehabilitation has low-to-very-low-certainty evidence of improving daily function, while structured exercise-based rehabilitation does show benefit.

Qualifying care-home nursing staff in palliative care improves specialist contact and pain management, trial finds

A German cluster randomised study finds a 40-hour palliative qualification course for care-home nursing staff increases specialist outpatient contact and improves pain-management follow-through.

Pharmacist involvement in OPAT teams cuts prescribing errors, meta-analysis finds

A systematic review and meta-analysis finds pharmacist involvement in OPAT multidisciplinary teams improves monitoring adherence and reduces prescribing errors, though impact on readmissions remains inconsistent.

Meta-analysis confirms exercise-based rehabilitation eases depression in rheumatoid arthritis

A meta-analysis of 15 randomised trials finds structured exercise reduces depressive symptoms in rheumatoid arthritis with moderate certainty.

Internet-delivered psychological therapy improves quality of life in persistent physical symptoms, trial finds

A randomised trial finds internet-delivered acceptance and commitment therapy improves health-related quality of life at nine months for people with persistent physical symptoms.

Individualised exercise programme improves balance and postural control in older adults, trial finds

A randomised trial finds a multisegmental, individually tailored exercise programme produces large improvements in balance and postural sway compared with an education-video control.

Home deaths best match patient preference, but specialist units deliver better pain control, Canadian cohort finds

A Canadian decedent-proxy cohort study finds home deaths most closely match preferred place of death, while palliative care units and hospices deliver better pain control, with regional policy strongly predicting access.

Geriatric rehabilitation lacks a common core, systematic review finds

A systematic review of 36 studies finds such variation in terminology, teams and assessment tools that no single study could describe a full geriatric rehabilitation pathway holistically.

A fifth of sepsis patients develop new-onset frailty by discharge, registry study finds

A Korean multicentre registry finds 22.9% of previously non-frail sepsis patients develop new-onset frailty by discharge, with fewer than half of newly-frail survivors discharged home.

Newer composite frailty tools outperform guideline-endorsed scales, study finds

A large Swedish cohort study finds newer composite frailty indices predict institutionalisation, mortality and hospitalisation more accurately than commonly used guideline tools.

Extended-interval dosing protocol completes IV antibiotic course in three visits

A single-centre implementation study of therapeutic drug monitoring-guided dalbavancin dosing achieved a full treatment course in three administration visits, with high target attainment and low discontinuation.

Carer resourcing, not clinical need, shapes advance care planning gaps in dementia

A UK cohort study of people with dementia and their carers finds advance care planning uptake tracks carer education and resourcing more closely than clinical need.

Extended home exercise after acute admission does not improve quality of life in older people with frailty, HERO trial finds

The HERO multicentre randomised controlled trial (740 participants, 15 UK sites) found a 24-week therapist-delivered home exercise programme after discharge produced no improvement in 12-month physical health-related quality of life for older people with frailty, at an incremental cost of £1,401 per participant; the authors recommend against routine commissioning.

Structured coding of dying patients linked to far higher advance care planning and community death rates, NHS audit finds

A retrospective NHS audit found patients coded onto the Gold Standards Framework were far more likely to have a documented advance care plan and to die outside hospital than uncoded patients.

Multiple long-term conditions cut year-one recovery from COVID-19 hospitalisation by a third, UK cohort finds

A UK propensity-matched cohort study found pre-existing multiple long-term conditions cut the odds of full recovery one year after COVID-19 hospitalisation by 34%, driven mainly by pre-existing respiratory disease.

Activity- and exercise-based home rehabilitation improves daily function in older adults, meta-analysis finds

A meta-analysis of 27 randomised controlled trials in community-dwelling older adults found activity- and exercise-based home rehabilitation improved daily-living function and physical performance, while reablement-based approaches showed no significant effect.

NEWS2 shows poor predictive accuracy for deterioration on virtual wards

A retrospective cohort study of 2,533 remotely monitored virtual ward admissions found that the National Early Warning Score (NEWS2) had poor predictive accuracy for hospital readmission in this setting, with an area under the curve of 0.55 — raising governance questions for risk stratification in community-based acute care.

Hospital-at-Home preserves physical activity in acute illness: a randomised clinical trial

A single-centre randomised clinical trial (n=111) found that a hybrid Hospital-at-Home model significantly increased early physical activity — patients took 1,763 more steps in the first 24 hours than inpatients — with higher patient satisfaction and no signal of excess harm.

Ceftriaxone associated with threefold mortality increase in MSSA bloodstream infections: implications for OPAT prescribing

A systematic review and meta-analysis of 11 studies (n=2,568) found ceftriaxone associated with significantly increased 30-day mortality (OR 3.33, 95% CI 2.17–5.10) compared with antistaphylococcal penicillins or cefazolin for MSSA bloodstream infections. A concurrent cost analysis of CADD-pump-based OPAT demonstrated 88% cost savings versus inpatient care, providing the delivery mechanism for safer beta-lactam alternatives.

OPAT gatekeeping avoids 13,909 IV-days through oral switch stewardship

Home-based VCSE frailty prevention reduces unplanned admissions by 35%