GPs experience the digital divide while Alexa offers health advice


Health information verified by the NHS was made available this week for users of the Alexa device with Amazon voice assistance.

The Amazon algorithm now uses information from the NHS website to provide information on how to treat and manage conditions such as migraine, flu and chickenpox.

Voice search technology has become increasingly popular and by 2020 half of all Internet searches should be done through voice assisted technology.

The Department of Health and Social Care has stated that the connection with Amazon has the potential to reduce pressure on general practitioners and other NHS services.

NHSX, a new program that deals with improving health care through the use of technology, would examine ways to make more NHS services available to all patients through digital technology.

Matt Hancock, Secretary of State for Health and Social Care, said: "We want to give each patient the best possible control of their health and technological care, as this is a great example of how people can access a Reliable NHS service and world-leading comfort of their home, reducing the pressure on our hard-working doctors and pharmacists.

"Through the long-term NHS plan, we want to embrace the advances in technology to build a health care system that is suitable for the future and NHSX will lead this revolution to bring benefits to all patients, physicians and caregivers."

The Royal College of General Practitioners (RCGP) said that vocal research has the potential to help some patients but that the government must guard against creating a "digital divide" between those who could afford the technology and those who could not.

"While some patients may want to use symptom monitors in this way, not everyone will be happy to do so and many people will not be able to pay for this equipment, thus increasing health inequalities and making access to care even more difficult for some of the most vulnerable people in our society, "said RCGP president Helen Stokes-Lampard.

The RCGP also stated that it was important that older and frail people, with complex health needs, did not rely on this technology as the sole source of health advice.

Report on maternity and perinatal care

An improvement in access to mental health support for pregnant women and new mothers was seen in the latest National Maternity and Perinatal Audit (NMPA).

The second organizational report provided a snapshot of the maternity and neonatal services of the NHS in England, Scotland and Wales.

It showed that 93% of trusts in England participated in a perinatal mental health network compared to 70% in 2017. Health councils in Wales have seen an increase from 71% to 86%, while increase in health councils in Scotland was from 43% to 79%.

However, no improvements in smoking cessation and weight management support were available, available to 72% of trusts and 45% of health councils.

Prof. Lesley Regan, president of the Royal College of Obstetricians and Gynecologists (RCOG), commented: "The report stresses that the challenges of the workforce persist between the profession of obstetrics and gynecology, while demands on maternity and neonatology services are growing" .

The audit is a collaboration between the RCOG, the Royal College of Midwives, the Royal College of Pediatrics and Child Health and the London School of Hygiene & Tropical Medicine.

Lyme disease quality standards Published

The National Institute for Health and Care Excellence (NICE) published its quality standard for Lyme disease this week, which covered the diagnosis and management of Lyme disease in people of every age. It also included public awareness of disease prevention.

The statements said that:

  • People with migrant erythema are diagnosed and treated for Lyme disease based on a clinical evaluation, without laboratory testing

  • People with suspected Lyme disease without erythema migrant who have a negative enzyme immunoassay (ELISA) test performed within 4 weeks of beginning symptoms repeated the test 4-6 weeks later if Lyme disease is still suspected

  • People with Lyme disease have an initial antibiotic treatment, with the antibiotic, the dosage and duration determined by their symptoms

  • Local authorities organize health promotion activities with organizations in their area to raise public awareness on how to prevent Lyme disease

The statements are designed to promote measurable quality improvements in support. They will be attracted to GP clinics, community pharmacies, A&E and after-hours services to ensure a high standard of care.

The charity of Caudwell LymeCo, which contributed to the quality standard, said it hopes the statements "contribute in some way to improving diagnosis rates in the early stages, preventing more people from becoming chronically ill".

Loss of hearing in adults

A final quality standard on assessment and management of hearing loss in adults has been published by NICE.

It included people who had hearing loss for the first time in adulthood, whether they started in adulthood or earlier. He described the high quality assistance in the priority areas of improvement.

The statements said:

  • Adults with earwax contributing to the loss of hearing or other symptoms, or preventing the examination of the ear or fingerprints on the ear canal, have removed earwax in primary care or ear care services. community

  • Adults with sudden onset of hearing loss in one or both ears that is not explained by external or middle ear causes are directed to immediate or urgent specialized medical care

  • Adults with rapid worsening hearing loss in one or both ears that is not explained by external or middle ear causes are addressed for urgent specialized medical care

  • Adults who have hearing problems not caused by earwax or acute infection for the first time have an audiological assessment

  • Hearing aids are offered to adults who experience hearing loss problems that affect their ability to communicate and listen

  • Adults with hearing aids have a follow-up audiological appointment 6 to 12 weeks after hearing aid installation

Dapagliflozin for the treatment of type 1 diabetes

NICE has adopted a positive position on dapagliflozin (Forxiga, AstraZeneca) in combination with insulin as an option for the treatment of type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg / m2 when the insulin alone does not provide adequate glycemic control.

In the final orientation draft, the treatment would be suitable when:

  • Patients were in insulin doses higher than 0.5 units / kg of body weight / day

  • The patients had completed a structured educational program on their condition

  • Treatment was initiated and supervised in a hospital diabetic clinic

Evidence from clinical trials showed small improvements in hemoglobin A1c (HbA1c) and weight loss levels, and very small improvements in quality of life, when patients were treated with dapagliflozin plus insulin, compared to placebo plus insulin, NICE said. .

& # 39; Yes & # 39; in Patisiran for rare conditions

NICE patisiran recommended (Onpattro, Alnilam) as an option for treating transthyretin-related hereditary amyloidosis in adults with stage 1 and stage 2 polyneuropathy.

In a draft guide, he said the evidence suggests that the interfering agent of ribonucleic acid that suppresses the production of transthyretin from the liver reduces disability and improves quality of life. There was also evidence to suggest that patisiran could provide long-term benefits by blocking the progression of amyloidosis and potentially reversing it.

The patisiran list price is £ 7,676.45 per 10 mg vial. However, the manufacturer had agreed to provide the drug to the national health service at a reserved discount.

ELISA test

The ELISA tests (Enzyme-linked Immunosorbent Assay) showed promise for therapeutic monitoring of tumor necrosis factor (TNF) -alpha-inhibitors in rheumatoid arthritis, said NICE.

However, in the final diagnostic guide, an evaluation committee decided not to recommend their habitual adoption in rheumatoid arthritis at this stage due to insufficient evidence. The next review will take place in 2022.

The tests are Promonitor, IDKmonitor, LISA-tracker, RIDASCREEN, MabTrack and internal tests used by Sanquin Diagnostic Services.

& # 39; No & # 39; to the treatment of bladder pain syndrome

Pentosan polisulfate sodium (Elmiron, Consilient Health) has not been recommended for the treatment of bladder pain syndrome with glomerulations or Hunner lesions in adults with moderate to severe pain, urgency and frequency of urination, NICE said.

Clinical studies have suggested that sodium pentos polysulfate may be more effective in relieving pain than placebo. However, in a draft guide, the experts stated that high quality tests are lacking.

A consultation period lasts up to 1st August with final guide scheduled for November 2019.

Plaque psoriasis

Risankizumab (Skyrizi, AbbVie) has been recommended as an option for the treatment of plaque psoriasis in adults.

NICE said that biological therapy could only be offered if:

  • The disease was severe, defined by a psoriatic area and severity index (PASI) of at least 10 and a dermatological quality of life index (DLQI) of more than 10

  • The disease had not responded to other systemic treatments, including cyclosporine, methotrexate and phototherapy, or these options are contraindicated or not tolerated

In the final draft guidance, an evaluation committee stated that clinical studies showed that risankizumab was more effective than adalimumab (Humira, AbbVie) and ustekinumab (Stelara, Janssen) in treating the condition.

The approval was subject to the manufacturer supplying the drug at an agreed discount.

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