Does it last?

Recent studies from the US, the UK and Finland have shown that there has been a substantial rise in total knee replacements (TKR) for younger people. The study from Finland, published in Arthritis and Rheumatism, shows that, along with an overall increase in the procedure, there was also a marked increase amongst those aged 50-59, while the journal's editorial suggests that more research into outcomes for younger patients is warranted. Another study from the US dismisses the idea that this growth is simply caused by rising obesity and an increase in population numbers. The practice of rationing TKR in the UK is judged not to be cost effective by a study in the BMJ. Researchers used data from the Knee Arthroplasty Trial to show that only offering surgery to patients with a high-to-moderate Oxford Knee Score was "probably unjustified". Body Mass Index, also occasionally used as a metric for rationing, was also found to have no significant effect on cost or outcome.

Steady as she goes

Tai chi retains its status as exercise regime of choice for a range of health conditions. A recent trial of a tailored Tai chi programme to improve postural stability with people with Parkinson's disease found benefit amongst mild to moderate Parkinson's sufferers. Research in Sports Medicine offers another review of this form of exercise for falls prevention. Elsewhere, Tai chi is described as a "promising intervention" for reducing fracture risk amongst older osteopenic women. Exercise of any kind is recommended for people with chronic illness and depressive symptoms in a systematic review.

Ratings

A bad TripAdvisor review can strike fear into the hearts of owners of hotels or restaurants, but does this kind of feedback bear any relation to more formal quality assessments? A team from Imperial College matched feedback given via NHS Choices to a range of hospital quality measures and found there to be a reasonable level of agreement, especially as regards mortality and infection rates. DH announces that "the Government welcomes these findings". A study from the US looks at the relationship between patient satisfaction and healthcare use. A systematic review of the impact of patient and public involvement on NHS healthcare finds there's still room for improvement.

Halcyon daze

Healthy Ageing Across the Life Course, or HALCyon is an interdisciplinary study looking at the factors that contribute to healthy ageing. A survey of early findings from five of the eight workstreams appears in the journal Public Health. The Department of Work and Pensions has released its final report on the Active at 60 pilot into the scope for using smart technology for delivering services to older people. The Journal of Epidemiology and Community Health publishes an evaluation study of a "worksite vitality intervention" for older hospital workers.

Handle with care

Community based screening for frailty in older people is attracting a degree of attention in the literature. A review of how frailty is recognised and managed in primary care is a timely addition. The Journal of the American Geriatrics Society publishes a panel review of screening older people for particular conditions, as represented in a raft of guidelines. They find that screening for insufficient physical activity, cardiovascular risk factors and smoking are appropriate in aiming to prevent functional decline. A systematic review of screening tools for use in primary health care identifies the Tilburg Frailty Indicator and the SHARE Frailty Index as the most appropriate. A prospective study in a community context looks at Tilburg alongside the Gronigen Frailty Indicator and the Sherbrooke Postal Questionnaire.

Clean break

Fragility fractures are often linked to osteoporosis. NICE has just opened consultation on draft guidance to assess the risk of fragility fractures in adults. Responses are due in by 8 March. There's a comparison of UK case-finding strategies for management of hip fractures in the latest issue of Osteoporosis International, looking at the Royal College of Physicians strategy and the newer National Osteoporosis Guideline Group approach. Some more detail is provided on the SCOOP trial of community based screening for osteoporosis. Finally, Value in Health offers a systematic review of cost-effectiveness in strategies for selecting and treating people at risk of osteoporosis and osteopenia.

It's a mystery

Or, it's difficult to see how C diff spreads in hospital wards, as NHS Choices Behind the Headlines put it. The study from the John Radcliffe Hospital in Oxford considered ward-based transmission of Clostridium difficile, finding that contact with infected patients is not the main cause of new cases in hospital.

Venn diagram

The overlap between long term conditions relating to physical health and mental health conditions is substantial. According to a report from the King's Fund and the Mental Health Foundation, over a third of people in England with a physical long term condition also have mental health problems; on the flipside, nearly half of people in England with a mental health problem also have a long term physical health condition. Either way, this amounts to something like 4.6 million people and between £8 billion and £13 billion per year in healthcare spending. The report argues that we could do better and that the main route to improvement is through integration. Doing nothing to address the emotional and mental health problems attendant on long term conditions risks the ability of people to manage their physical health. A study from the US looks at how to improve medical adherence amongst people in primary care with co-morbid long term physical and mental conditions (diabetes, coronary heart disease and depression). An analysis of results from the CO-MED trial focuses on depression treatment in patients with general medical conditions. A Cochrane systematic review of self monitoring of blood glucose for people with type 2 diabetes finds this has limited effect on glycaemic control in patients not using insulin. A study underway in Australia, Diabetes MILES, assesses the psychological aspects of living with diabetes: an early publication examines the methods and sample characteristics.

Keep up

There's a raft of evaluations and monitoring reports for active travel programmes, including the I Bike project in Scotland, the Living Streets community walking programme and the Travel Actively projects. A study of urban, multi-ethnic school children considers the association of active travel to school with general physical activity levels. Do "use the stairs" notices work, asks a team from the New York City Department of Health and Mental Hygiene. This study examined the effectiveness of a prompt ("burn calories, not electricity") across a range of different sized buildings and found an immediate increase in stair climbing, which was also maintained after 9 months. An analysis of the Aerobics Center Longitudinal Study adds a little more to the sum of knowledge about the dynamic relationship between fitness, overweight and cardiovascular health. Exercise on prescription schemes are examined in a systematic review and meta-analysis and are found to be of uncertain value in increasing physical activity, fitness and other health outcomes. A cost effectiveness study also suggested that exercise referral schemes only delivered a "modest increase in lifetime costs and benefits."

Lies, damned lies ...

Widely reported in the press was a study by a team at Oxford University's Department of Public Health that revealed a significant improvement in heart attack mortality over the past 10 years. This was a huge study, using HES data, but although the headline numbers tell a clear story, the reasons behind them are less evident. The study shows both a reduction in heart attacks and a rise in survival from attacks; the fall in heart attacks may well be attributable to improvements in lifestyle, detection and management, but as usual further study is needed. Another day, another set of data: the fourth annual national heart failure audit reports relatively poor outcomes, with high mortality rates, particularly amongst patients not admitted to cardiology wards. In-hospital mortality rates for patients admitted to cardiology wards were less than half those for patients admitted to other wards (8% for cardiology ward patients, 15% for general wards and 17% for other wards). Less than half of all patients with acute heart failure were admitted to cardiology wards. Finally, for the cynics, a paper in BMC Public Health considers the question of how to measure and analyse this kind of data, taking US decline in coronary heart disease as a case study.