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.
Scoping review catalogues 27 interventions to improve advance care planning among structurally vulnerable populations
A scoping review of 70 studies identifies 13 barriers, 13 facilitators and 27 interventions relevant to advance care planning among people experiencing housing instability, poverty, racialised identity, serious mental illness or substance use.
Unread 2 minSame-day emergency care shows markedly lower mortality than short-stay admission, but the authors caution this may reflect patient selection
A two-site English cohort study of 43,970 patients finds same-day emergency care associated with substantially lower 30-day mortality and reattendance than short-stay admission, though the authors caution the difference likely reflects lower-acuity patient selection rather than pathway superiority alone.
Unread 2 minRural and outer-regional areas set to carry double their population share of unmet palliative care need by 2045, Australian workforce model finds
A national Australian workforce-planning model projects that specialist palliative care supply will fail to keep pace with mortality-driven demand through 2045, with rural and outer-regional areas bearing a disproportionate share of unmet need.
Unread 2 minPreferred place of death tracks public understanding of palliative care, national Swedish survey finds
A national Swedish population survey finds preferences for place of end-of-life care and death correlate strongly with how well people understand palliative care, with misunderstanding — such as believing palliative care hastens death — associated with a preference for dying in hospital rather than at home.
Unread 2 minPhysiotherapy and occupational therapy staffing in day services slows functional decline over two years, Japanese cohort finds
A propensity-matched cohort of 1,908 older adults using adult day services in Japan finds those attending services staffed with physiotherapists and occupational therapists had significantly slower decline in activities of daily living over 24 months than those attending unstaffed equivalents.
Unread 2 minPhone-based frailty screening matches clinical scale accuracy without internet or in-person assessment
A South Korean validation study finds an automated interactive-voice-response frailty screening tool performs comparably to the Clinical Frailty Scale, offering a scalable, low-tech case-finding model for community-dwelling older adults.
Unread 2 minOnly a quarter of hospitalised patients in large US health system had a documented surrogate decision-maker, audit finds
A retrospective cohort of almost 980,000 US hospital encounters finds only 26.6% had documentation of a medical power of attorney, with documentation varying significantly by sex, marital status and diagnosis.
Unread 2 minHospital at Home policies risk leaving behind the dementia patients who could benefit most
A UK policy scoping review finds current Hospital at Home implementation criteria risk excluding people with dementia who lack digital proficiency or carer support, even though such schemes could otherwise reduce inequalities for this group.
Unread 2 minDay-hospital long-acting antibiotic pathways show strong real-world clinical success, though the economic case remains modelled rather than proven
A nine-centre Italian retrospective study of 160 patients treated with long-acting lipoglycopeptides in a day-hospital setting reports an 86.8% clinical success rate and a low adverse-event rate, with modelled cost savings the authors describe as hypothesis-generating rather than proven.
Unread 2 minComponent-level meta-analysis finds social support and behavioural activation outperform specialist techniques in non-specialist-delivered mental health care
A Bayesian component network meta-analysis of individual participant data from 30 trials finds strengthening social support, behavioural activation and problem management drive most of the benefit in non-specialist-delivered psychosocial interventions, while specialist techniques such as cognitive reframing showed detrimental effects when delivered by non-specialists.
Unread 2 minAdding primary-care rehabilitation to device-aided Parkinson's therapy improves motor-skill maintenance, small RCT finds
A randomised controlled trial finds that adding three months of tailored primary-care physiotherapy and occupational therapy rehabilitation to device-aided Parkinson's disease therapy improves motor-skill maintenance and perceived health at 6 and 12 months compared with device-aided therapy alone.
Unread 2 minReproducible case-finding rule identifies frequent-attender frail patients for proactive assessment
Baseline analysis of a Swedish randomised trial shows a simple, reproducible case-finding rule can identify multimorbid, frequent emergency attenders as a target group for proactive community assessment.
Unread 2 minNearly a third of older adults with severe breathlessness are lonely, national English cohort finds
A nationally representative English cohort finds loneliness affects almost a third of adults aged 50 and over with severe breathlessness, with deprivation, living alone and depressive symptoms the strongest predictors.
Unread 1 minLargely unsupervised balance training nearly halves fall rate in community-dwelling older adults, trial finds
A multicentre randomised trial finds 12 weeks of self-administered dual-task balance training, with only a sixth of sessions supervised, nearly halved the fall rate compared with self-administered single-task training.
Unread 1 minInternational researchers propose standardised outcome to fix inconsistent cognitive-outcome reporting after stroke and cardiac care
A new position paper proposes a standardised composite outcome, MACE-Cog, to address widespread inconsistency and incompleteness in how cognitive decline is measured and reported after stroke and cardiac interventions.
Unread 2 minEthnic minority patients more likely to enter palliative care via specialist referral, national cohort study finds
A national retrospective cohort of over 200,000 deceased patients in England finds no significant ethnic disparity in overall primary-care palliative identification, but ethnic minority patients were more likely to enter via specialist referral, with differing survival by ethnic group.
Unread 2 minEarlier specialist palliative contact roughly halves end-of-life hospitalisation in pancreatic cancer, national Finnish cohort finds
A nationwide Finnish register study finds patients with pancreatic cancer who had specialist palliative care contact more than 30 days before death were hospitalised far less often, and far more likely to receive care at home, in their final month of life.
Unread 2 minBrief GP-delivered psychological intervention improves quality of life a year after ICU discharge, trial finds
A secondary analysis of a randomised trial finds a brief GP-delivered intervention for ICU survivors with PTSD symptoms produced a delayed but clinically meaningful quality-of-life improvement at 12 months.
Unread 1 minVocational rehabilitation trial finds no benefit on work limitations, and mixed results on retention and cost
A UK multicentre RCT finds occupational-therapy-delivered job-retention vocational rehabilitation shows no benefit over self-help advice on work limitations at 12 months, and was not cost-effective from an NHS perspective.
Unread 1 minSystematic review sets out what makes advance care planning work in nursing homes
A PROSPERO-registered systematic review identifies the structural and process determinants that distinguish nursing homes that implement advance care planning well from those that do not.
Unread 1 minSystematic review finds telerehabilitation a comparable alternative to centre-based cardiac rehabilitation after acute coronary syndrome
A systematic review of 12 randomised trials finds app- and web-based telerehabilitation performs comparably to centre-based cardiac rehabilitation after acute coronary syndrome or revascularisation, with gains in adherence and quality of life.
Unread 1 minPICCs carry far fewer complications than midline catheters in outpatient antimicrobial therapy, US cohort finds
A US retrospective cohort of over 1,100 outpatient parenteral antimicrobial therapy patients finds midline catheters carry more than three times the complication risk of peripherally inserted central catheters.
Unread 1 minParamedic-delivered end-of-life protocol linked to far fewer emergency visits and more home deaths, Finnish cohort finds
A Finnish retrospective cohort finds cancer patients enrolled in a structured, paramedic-delivered end-of-life protocol spent more time at home and died at home six times more often than those not enrolled.
Unread 1 minNearly half of NHS hospital physiotherapists report losing rehabilitation space, survey finds
A Chartered Society of Physiotherapy member survey finds 49% of NHS hospital physiotherapists report losing rehabilitation space, with members linking the loss to rising waiting lists and worsening patient disability.
Unread 1 min