The intelligence
Signals
Individual evidence items with national significance, labelled by evidence type and finding status
Signals are individual items from the weekly clinical evidence scan that carry meaning for a national professional audience. Each is labelled by evidence type, finding status, and domain.
The electronic frailty index shows a graded association with mortality, but not that identifying frailty changes what happens next
A meta-analysis of 12 studies finds mortality rising stepwise from mild to severe frailty as defined by the electronic frailty index, with substantial heterogeneity and no claim by its authors that this shows predictive performance.
Unread 2 minResistance exercise has the clearest pooled signal on frailty scores, but the range of true effects includes no benefit
A meta-analysis of ten randomised trials favours exercise on frailty scores, but heterogeneity is 88%, the prediction interval crosses the null, and superiority of any one modality is not established.
Unread 2 minA national audit finds only 16% of people diagnosed with severe frailty in England had the medication review the GP contract requires
The National Audit Office reports that GPs are not providing the required follow-up after a diagnosis of severe frailty, and that no national dataset records who is affected by deprivation.
Unread 2 minTelerehabilitation and face-to-face rehabilitation for chronic low back pain did not differ significantly, but the evidence is too uncertain to show equivalence
A meta-analysis of ten randomised trials in 562 adults finds no significant difference with content-matched delivery, at very low certainty for pain and low certainty for disability, and its authors state this is not evidence of equivalence.
Unread 2 minSeven outpatient parenteral antimicrobial therapy guidelines vary widely in methodological and reporting quality
A systematic review of English-language OPAT guidelines found seven that met its criteria, with mean methodological quality of 81.0% but mean reporting quality of 61.6%, and a lack of evidence-synthesis methods and quality assurance.
Unread 2 minMoving cardiac rehabilitation into 21 Danish municipalities halved median travel distance and narrowed geographic and educational gaps in uptake
A Danish register-based cohort of 19,080 patients finds uptake of exercise-based cardiac rehabilitation rose by 16% after decentralisation to primary care, and by 45% among those living furthest away, with uptake as the outcome and not clinical benefit.
Unread 2 minHome-based primary care for veterans with dementia was associated with less emergency department use in an instrumental-variable analysis
A cohort of 133,846 veterans aged 65 and over with dementia finds enrolees in home-based primary care were 3.60 percentage points less likely to use emergency or urgent care, although the raw rate was higher among enrolees and the estimate rests on the instrument.
Unread 2 minCommunity palliative care benefit is attributed to five interacting mechanisms, not to the site of care
A systematic review of 20 studies, analysed thematically, finds community palliative care works through symptom monitoring, patient-defined goals, caregiver capacity, task-sharing and early advance care planning, and concludes that moving only the site of care is unlikely to reproduce the effect.
Unread 2 minAn app-based integrated-care system with geriatric assessment did not reduce unplanned hospitalisation in older adults with atrial fibrillation
A six-country cluster-randomised trial of 1,260 older multimorbid patients found no difference in unplanned hospitalisation, in a population with high baseline guideline adherence and low app use.
Unread 2 minAfter rehabilitation for brain injury, clinical need was not the dominant influence on whether older adults received community therapy
A US Medicare claims cohort of 23,036 older adults finds rurality, ethnicity, marital status and Medicaid eligibility were independently associated with less home health and outpatient rehabilitation within 90 days of discharge.
Unread 2 minNo study defined patient time in patient-reported terms: a review of how care burden is measured in cancer
A systematic review of 56 studies finds time burden in cancer care is measured mainly as direct healthcare time, with time away from healthcare in about a third and no patient-reported definitions, and proposes three measurement domains.
Unread 2 minHome-based exercise rehabilitation in cancer improved fitness and quality of life, with high heterogeneity
A meta-analysis of nine randomised trials finds home-delivered exercise rehabilitation in adults with cancer improved cardiorespiratory fitness and quality of life with good adherence, but heterogeneity was high and the population was not older or frail.
Unread 2 minGreen health prescribing for older adults: many studies report benefit, few show significant effects, and certainty is low
A UK-led systematic review of 21 studies finds nature-based interventions for adults aged 50 and over often improve at least one outcome, but significant between-group effects were uncommon and certainty was low or very low.
Unread 1 minDigital interventions for chronic musculoskeletal pain show small average gains, with low certainty and no proven superior format
A network meta-analysis of 92 randomised trials finds app-based, virtual-reality and telerehabilitation interventions give small to moderate average improvements in pain and disability, but certainty is mostly low or very low and no format can be called superior.
Unread 2 minSix European countries' timely-discharge policies share principles of clear responsibility and resourced community capacity
A comparative analysis by country experts identifies 17 policies for timely hospital discharge across Denmark, France, Germany, the Netherlands, Norway and Sweden, and names the principles that underpin many of them.
Unread 2 minSelf-administered home antibiotics matched other delivery models in a large UK cohort, with failure risk concentrated in older, multimorbid patients
A cohort of 1,064 outpatient antibiotic episodes at a large UK teaching hospital finds self-administration no less safe than nurse-delivered or clinic-based care overall, while identifying the patients in whom it failed more often.
Unread 2 minPatients with recent homelessness were designated as awaiting alternative care at more than four times the rate of matched comparators in Ontario
A population-based matched cohort of 51,377 hospital patients in Ontario finds delayed-discharge designation 9.1% for patients with recent homelessness against 2.0% for matched patients from the most materially deprived neighbourhoods.
Unread 2 minIn older adults seen by liaison psychiatry, frailty outweighed psychiatric variables in predicting early mortality
A multicentre prospective cohort of 465 older adults across ten Spanish hospitals finds frailty and medical comorbidity, more than psychiatric history or diagnosis, associated with early mortality after liaison psychiatry assessment.
Unread 2 minEarlier recording of a medically-ready-for-discharge date was associated with fewer unnecessary bed days in a US hospital system
An analysis of 112,930 patient visits across four US hospitals finds earlier entry of an estimated discharge-ready date associated with fewer days spent in hospital after a patient was medically ready to leave.
Unread 2 minSaudi Arabia's national virtual hospital succeeds as governance, not yet as proven outcomes, policy analysis finds
A policy analysis of Saudi Arabia's Seha Virtual Hospital, set against international evidence from tele-ICU, hospital-at-home, virtual-ward and telestroke programmes, finds the national model succeeds as governance and workforce integration, while independent evidence of its effect on outcomes remains limited years after launch.
Unread 2 minNine in ten UK palliative care researchers want to continue the work; fewer than seven in ten expect they will be able to
A UK-wide mixed-methods survey of 256 palliative and end-of-life care researchers finds funding, workload and job insecurity are the principal threats to the research capacity the field depends on.
Unread 1 minMethylphenidate eases depressive symptoms in palliative care, meta-analysis finds, though evidence remains uncertain
A systematic review and meta-analysis of five randomised trials finds methylphenidate-based interventions improve depressive symptoms more than placebo, usual care or background antidepressants in adults receiving palliative care, though evidence certainty is very low to low.
Unread 1 minFrailty-targeted cardiac rehabilitation improves function, not survival, meta-analysis finds
A systematic review and meta-analysis of 16 studies finds frailty-targeted cardiovascular rehabilitation improves physical performance and walking distance in frail older adults with cardiovascular disease, but shows no clear benefit on mortality, hospitalisation or activities of daily living.
Unread 2 minUK day-surgery guidance names frailty explicitly for the first time at this scale
A UK Delphi-consensus statement embeds frailty, obesity and obstructive sleep apnoea explicitly into peri-operative patient selection for day surgery.
Unread 1 min