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.
A five-year, 887-patient study finds high satisfaction with telemedicine-based hospital-at-home care, but does not measure whether it saves clinical resource
A large real-world cohort study of 887 patients over nearly five years finds very high patient satisfaction and perceived safety in a telemedicine-based, virtual-first hospital-at-home programme.
Unread 1 minRural hospice patients in the US receive less intensive support and rely more on unpaid family caregiving than urban peers
A US research letter finds rural hospice patients are more likely to die in nursing homes, rely more heavily on unpaid family caregiving, and receive less intensive paid hospice support than urban patients.
Unread 1 minPlacebo-controlled trial finds no benefit from pilocarpine drops for dry mouth in frail and life-limited patients
A double-blind placebo-controlled trial in the Netherlands finds no significant difference in xerostomia symptoms between pilocarpine drops and placebo in frail or life-limited patients, though the trial was underpowered.
Unread 1 minPeople with opioid use disorder have equivalent palliative care needs but markedly worse access, scoping review finds
A scoping review of 21 studies covering roughly 681,000 participants finds people with opioid use disorder have palliative care needs equivalent to the general population but face fragmented care, unmet pain management and stigma-driven access barriers.
Unread 1 minOnly a quarter of international hospital-at-home admission-avoidance models use validated frailty measures, scoping review finds
A scoping review of 15 international Hospital-at-Home admission-avoidance models finds just four used a validated frailty measure, and communication practice between professionals, patients and carers varied widely.
Unread 1 minMultidisciplinary consensus sets out age-adjusted opioid prescribing standard for chronic pain in older adults
A multidisciplinary clinical consensus sets out age-adjusted opioid selection, dosing and route-of-administration standards for treating chronic pain safely in older adults.
Unread 1 minLarge English trial finds Open Dialogue crisis care cuts psychiatric admission and re-referral, despite no effect on relapse
The first large pragmatic English trial of Open Dialogue crisis care finds no difference in relapse rates but significantly lower psychiatric admission and re-referral, with better patient-rated recovery and satisfaction.
Unread 2 minImplementation capacity, not treatment efficacy, is the primary barrier to delivering high-intensity stroke rehabilitation, international roundtable concludes
A consensus of 16 international experts concludes that delivery and implementation capacity — not the underlying evidence for high-dose, high-intensity rehabilitation — is the primary barrier to delivering it, and names home- and community-based hybrid delivery as essential to closing the gap.
Unread 1 minEmergency-department-embedded geriatric assessment discharges most older patients home with hospital-at-home support rather than admission
A retrospective cohort study of over 8,000 emergency department attendances finds that comprehensive geriatric assessment embedded at first contact converts most encounters into home discharge with hospital-at-home support, rather than admission.
Unread 1 minCompetent initial assessment, not the number of quality indicators reported, predicts OPAT readmission risk, scoping review finds
A scoping review of 18 studies covering over 5,000 patients finds outpatient parenteral antimicrobial therapy readmission risk tracks whether a competent team member performs the initial patient assessment, not how many quality indicators a service reports.
Unread 1 minClinical Frailty Scale predicts outcomes in elderly heart failure patients, meta-analysis confirms
A meta-analysis finds the Clinical Frailty Scale is a validated prognostic tool specifically in elderly heart failure populations, though the finding should not be generalised to non-cardiac frailty pathways.
Unread 1 minBehaviour-change stewardship bundle nearly doubles appropriate-duration antibiotic prescribing in OPAT for urinary tract infection
A quasi-experimental stewardship intervention for patients receiving outpatient parenteral antibiotic therapy for urinary tract infection raised appropriate-duration prescribing from 44% to 83% and cut 90-day recurrence, without increasing readmissions.
Unread 1 minAdjunctive electrical stimulation speeds recovery of oral intake in acute stroke dysphagia, small trial finds
A randomised controlled trial finds adjunctive neuromuscular electrical stimulation produces significantly faster recovery of functional oral intake than swallowing therapy alone in acute and subacute post-stroke dysphagia.
Unread 1 minTelerehabilitation matches in-person stroke therapy for arm recovery only when dose is matched, systematic review finds
A systematic review of four randomised trials finds telerehabilitation is non-inferior to conventional in-person stroke rehabilitation for arm motor recovery only in the one trial that matched therapy dose between arms, with smaller, non-dose-matched trials showing mixed results.
Unread 1 minSix mechanisms determine whether mobile health improves home-based palliative care, realist review finds
A realist review of 126 studies identifies six mechanisms through which mobile health interventions improve home-based palliative care outcomes, and cautions that mHealth must be tailored to local infrastructure and technology competence rather than treated as a substitute for workforce capacity.
Unread 1 minRural palliative care access breaks down as a pathway and workforce problem, not simply a shortage of beds, systematic review finds
A mixed-methods systematic review of 34 studies finds rural palliative care access breaks down cumulatively across recognition, entry, reach and continuity stages, with distance, workforce shortages and weak specialist-generalist referral links driving the biggest barrier.
Unread 1 minPeople with ADHD have significantly poorer outcomes from standard NHS talking therapies, large cohort study finds
A retrospective cohort of over three million adults using NHS Talking Therapies in England finds people with diagnosed ADHD have significantly poorer recovery and higher deterioration rates than a matched comparison group, despite both groups improving overall.
Unread 2 minOPAT coordination consistency depends on a designated lead and checklist process, not on clinical suitability, US study finds
A mixed-methods US study across Veterans Affairs hospitals finds marked heterogeneity in outpatient parenteral antimicrobial therapy governance, with postdischarge coordination gaps concentrated at sites lacking a designated OPAT lead and checklist-based processes.
Unread 1 minNon-immersive exergames and remote exercise show the most consistent cognitive benefit for older adults, network meta-analysis finds
A Bayesian network meta-analysis of 51 randomised trials finds digital exercise interventions produce domain-specific cognitive benefits in older adults, with remote exercise and non-immersive exergames flagged as practical options for rural and resource-limited settings, though certainty of evidence is very low for most comparisons.
Unread 1 minMemory clinic patient volumes more than doubled over 25 years as referral thresholds broadened, national survey finds
A repeated national survey of Dutch memory clinics spanning 1998 to 2023 finds patient volume per clinic has more than doubled as the proportion of attendees diagnosed with dementia has fallen, with a third of clinics reporting infrastructure not yet ready for new disease-modifying treatment pathways.
Unread 1 minLandmark African trial finds early oral step-down non-inferior to prolonged IV antibiotics for severe childhood pneumonia
A large randomised trial across 13 hospitals in five sub-Saharan African countries finds stepping down to oral amoxicillin once children with severe community-acquired pneumonia improve, with total treatment as short as four to five days, is non-inferior to prolonged intravenous-only care.
Unread 1 minInpatient stroke rehabilitation is near-universal across Europe, but community and telerehabilitation provision lags well behind, survey finds
A cross-sectional survey of stroke rehabilitation services in 30 European countries finds inpatient provision is near-universal, but early supported discharge, community-based rehabilitation and telerehabilitation are markedly less consistently available.
Unread 1 minExercise improves short-term function in frail older adults but its effect on actual falls remains unproven, meta-analysis finds
A meta-analysis of 14 randomised trials finds short-term exercise improves gait speed and functional mobility in frail older adults, but falls-incidence data were too sparse to pool, leaving the link between functional gains and actual falls reduction unresolved.
Unread 1 minCommunity nursing time per palliative patient fell by two-thirds over a decade even as referrals rose, national data show
A decade-long national analysis of community nursing services in England finds referrals rose by roughly half while median time on caseload fell by two-thirds, with end-of-life care increasingly compressed into shorter, more out-of-hours contact.
Unread 1 min