Completed Rapid Evidence Syntheses

• Alcohol reduction and harm

  We have completed three Rapid Evidence Syntheses related to Alcohol reduction and harm:

  1.  Interventions for Alcohol-Related Harms

  A large number of overviews of reviews have been published on interventions for alcohol use and related harms. We report NICE guidance and draw on evidence from 52 overviews published between 2010 and 2023. There is much more evidence at this level relating to effectiveness than to barriers and facilitators for interventions.

  There is considerable variation in the reporting and methods used in the overviews and in their included reviews; some of the evidence presented is likely to be more reliable (higher certainty) than other evidence.

  The full RES on 'Interventions for Alcohol-Related Harms' can be downloaded here

   

  2.  Alcohol Care Teams and other hospital-led interventions for alcohol harm

  There is relatively limited evidence for the impact of alcohol care teams (ACTs); mostly from case studies of implementation (uncontrolled before-and-after data). A comparative cohort study did not support effectiveness.

  There is considerable low to moderate certainty evidence that brief interventions in hospital settings may be effective in the short to medium term for reducing consumption.

  There is some low to moderate certainty evidence that perioperative interventions for risky drinkers may be effective.

  The full RES 'Alcohol Care Teams and other hospital-led interventions for alcohol harm' can be downloaded here - (form required)

   

  3.  Brief interventions for alcohol in primary care and pharmacy settings

  Brief interventions for alcohol in primary care are recommended by all guidelines identified in a systematic review of guidelines. There is moderate certainty evidence that brief interventions in primary care probably reduce weekly consumption of alcohol but probably do not impact other measures of drinking. The reduction found is, on average, equivalent to approximately one pint of beer/week.

  The evidence for the effect of brief interventions in adolescents and young adults is less clear. 

  The full RES 'Brief interventions for alcohol in primary care and pharmacy settings' can be downloaded here - (form required)

• Antimicrobial photodisinfection

  Antimicrobial photodisinfection (APDT) involves using a light (photo)-sensitive agent which is then irradiated in situ using a specific wavelength. The effect of the radiation is to make the agent cytotoxic.

  In the APDT the cytotoxicity is intended to kill micro-organisms present at the treatment site. 

  Initial searches found limited and preliminary evidence for the use of APDT in nasal disinfection and wounds research. 

  There is more evidence for use of APDT in dentistry and oral health where there are several systematic reviews of APDT as a treatment for periodontitis. 

  The most recent of these reviews identified 31 small RCTs but found no clear evidence of effect in clinical outcomes.

  The full RES on 'Antimicrobial Photodisinfection' can be downloaded here - (form required)

• Apps (mHealth) designed to improve and manage mental health

  We have completed six Rapid Evidence Syntheses related to mHealth (Apps/Online platform) interventions, focussing on improving and managing mental health and wellbeing:

  1. eQuoo

  eQuoo is a gamified mHealth intervention (app) aimed at young adults (18-28 years), designed to teach psychological concepts through a combination of education, stories and gamification.

  It is available for smartphones and included in the UK NHS app library where it is described as using “adventure games designed by psychologists to help you increase your emotional fitness and teach you new psychological skills” and giving “tips on how to communicate more effectively and maintain your mental wellbeing”.

  We found there to be some limited relevant evidence from a trial conducted in young adult volunteers. 

  There is an existing randomised controlled trial (RCT) of eQuoo in healthy young adults but this has not been fully reported and we do not have comparative data for the outcomes. 

  There are a large number of other technological interventions which include gamification for mental health or wellbeing support but mixed evidence for the impact of gamification on outcomes including adherence.

  The full RES on 'eQuoo' can be downloaded here - (form required)

   

  2. S12 Solutions

  S12 Solutions is designed to improve the process by which someone is assessed under section 12 of the Mental Health Act 1983 which provides for detention and treatment in hospital without consent.

  S12 Solutions is a platform, delivered via an app and website, that connects AHMPs with available local doctors who are section 12 approved, in order to facilitate section 12 assessments, and then allows completion of forms and data capture within the platform. The aim of the innovation is to improve the timeliness and ease of conducting section 12 assessments, with concomitant benefits to systems, healthcare professionals and service users.

  We found there to be relevant but extremely limited non-comparative evidence for some positive impacts of S12 Solutions on processes of section 12 assessments, reported by health professionals.

  The overall impact of adopting S12 Solutions on both the pilot and neighbouring areas is very uncertain.

  There is no direct evidence for the impact of S12 Solutions on service users.

  There is no evidence for other technological interventions intended for the purpose of facilitating section 12 assessments.

  The full RES on 'S12 Solutions' can be downloaded here

   

  3. MyCognition

  MyCognition is a digital platform that comprises an assessment (MyCQ) and a cognitive training programme/game (AquaSnap). It is aimed at a wide range of potential users, including both adults and children and including those with specific needs or conditions.

  Given the wide range of applications for which MyCognition is marketed we have focused this synthesis on the evidence for its role in health. However it is also used for both educational and corporate interventions.

  We found that randomised trials exist for the use of the MyCognition training programme “AquaSnap” in people with diagnoses of serious mental or physical health conditions which have cognitive components. However there is very little comparative data available from these studies because none have been fully published. Our assessment is very likely to change with the publication of the RCTs assessing AquaSnap in clinical populations. 

  Cognitive training generally, and in computerised form, has been widely evaluated mainly for people with or at risk of cognitive impairment with mixed results.

  The full RES on 'myCognition' can be downloaded here - (form required)

   

  4. MyHappyMind

  yHappyMind is a preventative intervention aimed at children aged 3-11. It is intended to build resilience and therefore reduce mental health (CYPMHS) referrals in this age group.

  It is a school-based intervention which also has an app which is available to parents. It is designed to provide tools and training to build resilience and self-esteem, with the aim of preventing the development of mental health issues.

  There is no published evidence relating to MyHappyMind

  We found low or very low certainty evidence from quasi-randomised studies for the effect of similar interventions on measures of mental health and moderate certainty evidence of no effect from an RCT of a less similar intervention in primary schools.

  There is low certainty evidence from a large systematic review for the effects of school-based cognitive behavioural interventions in primary and secondary schools on anxiety.

  None of the published evidence evaluated impact on CYPMHS referrals and almost all published evidence relates to older primary school children.

  The full RES on 'MyHappyMind' can be downloaded here - (form required)

   

  5. Wysa

  Wysa is a mental health support app which uses a chatbot (an AI penguin) written by therapists that allows users to talk anonymously about mood and issues in their lives.

  It has a recommendation for use in dealing with the COVID-19 pandemic. Additional functionality includes options supporting consultation with health professionals and links with other health related apps. 

  We found there to be no comparative evidence for the impact of Wysa on mood and psychological outcomes.

  There is some evidence that people with self-reported symptoms of depression who used Wysa a lot showed greater symptom improvement than people who didn’t use Wysa very much; this difference cannot reliably be attributed to differences in their use of Wysa.

  There is some low certainty randomised evidence that a different chatbot (Woebot) may improve symptoms of depression in young adults who self-report symptoms of anxiety and depression. 

  The full RES on 'Wysa' can be downloaded here - (form required)

   

  6. Xploro

  Xploro is a digital platform designed to increase children’s knowledge about medical procedures and to reduce their anxiety when attending hospital for routine procedures.

  It uses gamification, a chatbot and a customisable augmented reality avatar. It provides information about hospital environments such as wards and operating theatres, key healthcare personnel and hospital equipment. Several games with health themes are included on the app. It is designed to be used before and during hospital attendance.

  There is directly relevant comparative but non-randomised evidence that access to Xploro may reduce procedural anxiety and increase perceived knowledge and sense of involvement in children attending hospital for planned invasive or non-invasive procedures. Xploro was considered positively (qualitative data). A systematic review found consistent but methodologically limited evidence for play interventions in children having planned invasive procedures.

  The full RES on 'Xploro' can be downloaded here - (form required)

   

• Brain health - screening and monitoring

  The innovation is described as a rapid, point-of-care mobile-based health screening and monitoring platform for “brain health” which is intended to be deployed both in clinics and remotely. The intention is stated to be to obtain repeated measures of variables over time.

  This is designed as a platform to incorporate a suite of measures which are described as neurocognitive, neuromotor and neuropsychological.

  We did not find any evidence for the impact on health outcomes of being screened, perhaps repeatedly, using this platform.

  There is some randomised evidence that screening may not change medium-term health outcomes and may have acceptability issues.

  Neither the UK National Screening Committee nor the United States Preventative Services Taskforce currently recommend screening the general population for dementia or cognitive impairment; the UK recommendation is against such screening.

  NICE recommendations for interventions to reduce risk of, or delay the onset of, dementia relate to population-level interventions promoting healthy lifestyle.

  The full RES on 'Longitudinal Multi-Modal Cognitive Remote Tracking for Neurodegeneration' can be downloaded here

• Care homes - digital tools in residential care settings

  We have conducted three Rapid Evidence Syntheses associated to the use of digital tool in the care home residential setting:

  1. SafeSteps

  SafeSteps is an app which aims to reduce falls in care home residents. It’s important to focus on evidence from care homes in this RES because care home residents are three times more likely to experience a fall than community dwelling peers and are ten times more likely to experience injury.

  Therefore it’s unclear how relevant evidence on apps, risk assessments or interventions to prevent falling from community-based studies/sources is likely to be. One of the ways in which the app works may be by increasing staff knowledge of risk factors and strategies for preventing falls so evidence on staff training and education about falls in care homes may also be relevant; specific evaluation of this is outside the scope of this RES.

  The impact of Safesteps on falls risk is highly uncertain as is the impact of any app in care home settings. Apps which have been assessed in community-dwelling adults appear to have key differences from Safesteps

  The effect of risk assessment for falling in care home residents is unclear; NICE recommends that it is undertaken in the context of a specialist falls service and as part of a multifactorial intervention for people who already have specific risk factors.

  Evidence for the effectiveness of interventions for fall prevention in care home residents is low certainty and does not show clear effects of the interventions. There is strong evidence of effectiveness of exercise-based interventions for reducing falls in community-dwelling adults, including those at higher risk of falling. Multifactorial interventions may also be effective in community dwelling adults, but the evidence is less certain.

  The full RES on 'SafeSteps' can be downloaded here

   

  2. RESTORE2

  RESTORE 2(Recognise Early Soft Signs, Take Observations, Respond, Escalate) is a tool designed to enable care home staff to recognise and respond to signs of possible physical deterioration in care home residents. It identifies “soft signs”, supports observation taking and incorporates calculation of a National Early Warning Score (NEWS2). It includes an escalation tool and a structured communication plan (SBAR).

  There is a RESTORE2 mini (Soft signs) version available which only uses the soft signs approach. Its use, or that of an equivalent tool, was recommended by the British Geriatric Society in their guidance on managing the COVID-19 pandemic in British care homes.

  We found no comparative evidence and very limited evidence evaluating the impact of RESTORE2 on patient or service outcomes for people in residential care.

  There is evidence which varies in strength and relevance for use of each of the components of RESTORE2, or similar interventions.

  The full RES on 'RESTORE2' can be downloaded here

   

  3. Update for SafeSteps and RESTORE2-mini (soft signs)

  The interventions considered are the SafeSteps fall prevention tool and the RESTORE2-mini (Soft Signs) for identification of signs of possible physical deterioration. The fall prevention tool is an app, while the RESTORE2-mini (Soft Signs) is available as a digital tool or a downloadable paper-based form. Both tools are designed to be used by carers for older adults in residential care settings.

  • SafeSteps fall prevention app was the subject of a previous RES in February 2020.
  • RESTORE2-mini (Soft Signs) was included in a RES on RESTORE2 in July 2020.

  We identified limited additional evidence for the updates of the RES for SafeSteps and RESTORE2- mini (Soft Signs) respectively.

  In this update we identified evaluations of SafeSteps as a COVID-19 tracker. 

  We did not find highly relevant evidence syntheses of apps for falls prevention in residential care. 

  We identified a recent clinical practice guideline for fall prevention in residential settings and hospitals.

  In this update we identified limited additional evidence for RESTORE2-mini (Soft Signs). 

  The full RES on 'Digital tools in residential care settings (part I): Update for SafeSteps and RESTORE2-mini (Soft Signs)' can be downloaded here

   

  As part of the update for SafeSteps and RESTORE2-mini (soft signs), we also looked at questions related to the use, specifically, of digital versions of tools for falls prevention and identification of possible physical deterioration and to the use of multiple health assessments as opposed to paper-based assessment tools for fall prevention or detection of possible physical deterioration.

  We found there is very limited evidence from evidence syntheses relating to the use of digital as opposed to paper-based assessment tools for fall prevention or detection of possible physical deterioration. There is also very limited evidence relating to the use of multiple assessments compared with single assessments. A review of guidelines highlighted the need for work to establish the optimum assessment frequency.

  Recent overviews of reviews did not identify relevant studies for the use of digital falls assessments.

  A recent scoping review on “smart” nursing homes identified that the use of technology in nursing homes is relevant to both falls prevention and automatic monitoring of health conditions and notification of emerging medical events.

  A scoping review of clinical guidelines for falls assessment across settings including long- term care identified the need for screening on admission and routinely thereafter and the need for reassessment with significant changes or functional status.

  The full RES on 'Digital tools in residential care settings – digital vs paper (part II)' can be downoaded here

   

• Chronic kidney disease (CKD) in primary care

  We have completed two Rapid Evidence Syntheses related to Chronic Kidney Disease (CKD) diaagnosis in primary care.

  1. Early identification of Chronic Kidney Disease in primary care

  The focus of this RES is interventions to improve the early diagnosis of chronic kidney disease (CKD) in primary care; the barriers and facilitators to these interventions; and the associated equity considerations. This RES is designed to consider the evidence for all interventions for this indication and is not restricted to a particular approach in the first instance. 

  There is some evidence from a systematic review that in non-randomised but rigorous studies interventions in primary care probably improve identification of people with CKD.

  There is considerable evidence from evidence syntheses relating to characteristics of successful interventions and barriers and facilitators to their implementation and success.

  We found no directly relevant evidence from reviews for the impact of interventions on health equity.

  The full RES 'Early identification of CKD in primary care' can be downloaded here - (form required)

   

  2. Healthy.io

  The intervention consists of a urine analysis kit for semiquantitative albumin-creatinine ratio (ACR) testing which is sent to a person’s home address and a smart-phone app healthy.io which is used to complete the test. Test results are then available to healthcare providers.

  The intervention is intended to be used in Greater Manchester for people considered at risk of developing chronic kidney disease (CKD) who are invited to annual health checks which include urine analysis for CKD, but who do not have a completed urine analysis within the previous 12 months. In the first instance it will be used for people with diabetes and hypertension in this group.

  We found there is directly relevant evidence from uncontrolled studies in people with diabetes without an up-to-date test showing variable uptake and completion and high acceptability of Healthy.io among people who complete screening.

  There were high rates of non-participation due to digital exclusion.

  Evidence on the impact on health outcomes and clear data on test accuracy are lacking and lack of a control group limits the conclusions that can be drawn.

  There is some indirectly relevant randomised evidence that a different smartphone-based home testing intervention may increase screening uptake in unselected people with hypertension.

  The full RES on 'Healthy.io' can be downloaded here

• Digital care plan for dementia

  A care plan for dementia is a written plan of actions agreed between people with dementia, family members, carers and the health professionals responsible for dementia care. This plan aims to identify personal beliefs and health needs of people with dementia, and the services and support suitable for them, and to outline arrangements for future day-to-day care. 

  A dementia care plan is often paper-based, and this may make it difficult to share between people with dementia and caregivers. Alternatively, the care plan can be recorded electronically, using information and communication technology. 

  This RES focuses on digital dementia care plans and does not draw on the literature for dementia care plans more widely.

  We found no direct evidence on:

  • the effectiveness of using digital care plans, compared with non-digital care plans, an alternative digital care plan, or no care planning, in people with dementia;
  • the experience of patients, carers and staff who use digital care plans; and
  • the barriers and facilitators to adoption of digital care plans in dementia care.

  There is some evidence to support adoption of digital advance care plans for dementia. However, such advance care plans are a more specific and limited intervention than care plans. 

  The full RES 'Digital care plans for dementia' can be downloaded here - (form required)

• Extended Reality (XR) digital interventions for anxiety-based avoidance in children with autism and/or learning disabilities

  There is little evidence on the effects of using extended reality (XR) digital interventions for anxiety-based avoidance in children with autism spectrum disorders. Where available, the evidence on whether XR digital interventions reduce anxiety in children with autism is uncertain.

  There is no evidence regarding the effects of XR therapies with parental involvement, and no evidence regarding children with learning difficulties.

  THE FULL RES 'EXTENDED REALITY (XR) DIGITAL INTERVENTIONS FOR ANXIETY-BASED AVOIDANCE IN CHILDREN WITH AUTISM AND/OR LEARNING DIFFICULTIES' CAN BE DOWNLOADED HERE

• Family and community-focused approaches to promoting and supporting breastfeeding

  There are some uncertainties, but evidence generally supports the use of extra family- and community-focused approaches over and above routine breastfeeding services or the UNICEF Baby Friendly Initiative Accreditation. 

  There is evidence that shows that 1:1 counselling, education via home visits, using digital technologies, and peer support are the most effective intervention options. There is less evidence to support group counselling and community-level education. 

  We did not find evidence that local breastfeeding drop-ins, social groups and at-scale, integrated mass media, and community mobilisation interventions are effective.

  In general, evidence suggests that the information provided about breastfeeding often does not meet the needs and expectations of women for a range of reasons.

  The full RES on 'Family and community-focused approaches to promoting and supporting breastfeeding' can be downloaded here

• Financial and debt advice in primary care

  People who are experiencing financial hardship may attend primary care repeatedly with a range of mental and physical issues which may be linked to or exacerbated by insufficient money to live adequately.

  Provision of support and advice around financial issues within primary care, or via primary-care mediated referral to other bodies able to provide financial advice has been suggested as a possible way of addressing root causes of condition deterioration and provide one form of appropriate support.

  Due to indirect and limited evidence the impact of proividing financial and debt hardship advice and support in general practice and in community pharmacies is unclear.

  There is consistent and directly relevant qualitative evidence suggesting that Citizens Advice Bureau service recipients and/or providers fed back positive experience of using Citizens Advice Bureau services in primary care.

  The full RES on 'Financial and debt advice in primary care' can be downloaded here - (form required)

• Health information exchange

  Health information exchange refers to any digital architecture that enables health care providers (and patients) to appropriately access and securely share centrally stored clinical information electronically within and between care settings and organisations.

  For this RES, we focus on any type of health information exchange systems that can be used to share care records across multiple health care settings. 

  This RES took the approach of a scoping review: we did not assess the certainty of the evidence. However, where possible we commented on evidence limitations as they were reported in the included reviews.

  There is limited and inconsistent evidence on the technology quality (i.e. system quality, service quality, information quality) of health information exchange systems. The system adoption rates vary largely between different care settings, and key facilitators have been identified for promoting use of health information exchanges.

  There is a considerable amount of evidence on the benefits and impact of using health information exchanges, but most of the evidence has limitations in terms of reliability and consistency. The evidence suggests that use of health information exchange may improve workflow efficiency and reduce emergency department costs and total costs of care.

  There is limited evidence on clinical outcomes and patient safety outcomes.
   

  The full RES on 'Health information exchange' can be downloaded here - (form required)

• Heart Failure Prognosis - SomaScan

  This RES focuses in SomaScan, which is a proteomic assay that looks to to improve prognosis of heart failure, by identifying proten signatures associated with good, and bad, prognosis.

  We found there to be preliminary evidence that SomaScan assays findings may correlate with prognosis in some groups of people with heart failure (HF).

  There is validated evidence from large prospective cohorts that SomaScan has predictive value for secondary events in people with coronary heart disease (CHD). This is indirectly relevant evidence for people with HF.

  The full RES on 'SomaScan' can be downloaded here

• Housing

  This RES aimed to answer the following questions:

  1. What is the impact of poor housing?
  2. What is the evidence that housing quality and condition affects the physical and mental health of residents?
  3. What is the evidence that different ways of improving housing quality and condition affects the physical and mental health of residents?

  We found that:

  • There is low to moderate certainty evidence that houses with damp, mould, inadequate warmth, and inadequate air quality affect various aspects of respiratory health and cardiovascular health. Additionally, hazardous home environments are related to a greater number of falls at home.
  • There is low to high certainty evidence that improving housing conditions by reducing dampness, eliminating mould, improving warmth and energy efficiency, and removing environmental hazards improves several physical health outcomes, including respiratory health, general physical health, and fall rates.
  • The relationship between poor physical housing conditions and mental health is less clear, however there is some evidence of low to moderate certainty that housing precarity and overcrowding are related to poorer mental health.

  You can watch the webinar 'Healthier Futures Seminar: What is the health impact of poor housing?' on YouTube

  The full RES 'What is the health impact of poor housing?' can be downloaded here

• Infection prevention and control

  Behaviour change techniques (BCT) are one type of intervention used to improve compliance with infection prevention and control (IPC) guidelines, and may be a component of multimodal strategies.

  BCTs are systematic procedures included as an active component of an intervention designed to change behaviour.

  There is directly and indirectly relevant evidence from multiple high quality systematic reviews which include both Randomised Control Trials (RCTs) and non-RCTs that interventions which include behavioural change techniques may be effective in producing modest improvements in adherence to clinical guidelines in aspects of infection control.

  The full RES on 'Behaviour change techniques for guideline compliance in infection prevention and control' can be downloaded here

• Innovations for managing respiratory conditions - Propeller

  Propeller Health incorporates a telehealth solution using a sensor, mobile apps, predictive analytics, and feedback to help patients and providers understand and control asthma and other respiratory disease.

  There is evidence from two randomised trials that Propeller may improve some measures of asthma control compared to management without digital tools. This may not be directly relevant to the UK because it is based on people from the USA many of whom had uncontrolled asthma at enrolment.

  There were methodological and reporting issues which reduce the certainty of the evidence.

  The full RES on 'Propeller' can be downloaded here - (form required)

• Managing multiple long-term conditions

  There is overwhelming evidence highlighting multiple long-term conditions as a key driver of higher use of health care services. However, there is limited evidence about their impacts on health outcomes.

  There is limited evidence on the contribution of common mental health disorders and severe mental illness (as part of multiple long-term conditions) to poor health outcomes and use of health care services.

  Evidence suggests that multiple long-term conditions increase total health care costs by 50% to 180% and emergency department use by 12% to 155%. 

  There is much more evidence on clinical effectiveness than cost-effectiveness on the impact of complex interventions for managing multiple long-term conditions on various outcomes. The evidence is limited for the clinical and cost-effectiveness of most interventions in people with multiple long-term conditions where mental health conditions are a component.

  The full RES on 'The burdens and management of multiple long-term conditions' can be downloaded here

• Nursing recruitment and retention in care homes

  No literature was identified that had directly investigated the recruitment and retention of registered nurses in care homes in the UK context. 

  Job satisfaction is the most important factor in retention. There is moderate certainty evidence that a range of individual factors are associated with people’s job satisfaction in care home settings. A range of recruitment and retention strategies were identified in the literature, but there was little evidence of their effectiveness.

  There is indirect evidence that recruitment of registered nurses to care homes is related to attractiveness of working in long-term care and students’ perceptions of residential aged care. There is moderate certainty evidence that age, health status, the opportunity for self-determination and autonomy, psychological empowerment, job involvement, work exhaustion, work stress, and relationships with residents are important factors associated with job satisfaction.

  There is limited evidence on the effectiveness of recruitment and retention strategies, but literature suggested a range of potentially useful strategies.

  The full RES on 'The recruitment and retention of registered nurses in care homes' can be downloaded here

• Place-based interventions: Rapid umbrella review

  In this review, a place-based intervention was defined as “any intervention, policy, programme, or action that aimed to improve health and reduce health inequalities that was delivered at a local or regional level, excluding national-level interventions”.

  We identified evidence regarding the impacts of physical, place-based interventions, but a notable lack of evidence on social and economic place-based interventions.

  We found tentative evidence for the positive effects of physical place-based interventions on health and health behaviour outcomes, particularly physical activity.

  There is mixed (uncertain) or weak evidence for the health impact of interventions relating to transport, new supermarkets, and multi-component interventions.

  We found a lack of evidence on the effects of place-based interventions on health inequalities, due to poor reporting of the published systematic reviews and/or insufficient data collection in primary studies.

  The review of 'Place-based interventions to improve public health and reduce health inequalities: a rapid umbrella review update' can be downloaded here

• Pressure ulcer identification - SEM Scanner

  The manufacturers say that a SEM scanner detects changes in fluid contents of human skin and subdermal tissues, to a tissue depth of several millimetres, by measuring 'capacitance', an electrical property of the locally examined tissue site to store electric charge.

  Draft Medical Technology Guidance from NICE reports insufficient evidence to recommend the SEM Scanner for pressure ulcer prevention. There is not enough evidence to know whether use of SEM Scanner improves identification of people at risk of pressure ulcers, and whether it reduces the number of people who develop a pressure ulcer. Independent economic assessment finds that it increases costs.

  There is moderate certainty evidence that skin status – in particular persistent redness – does predict whether a pressure ulcer of Grade 2 or above (an open wound) will develop

  There is clear evidence that some interventions are effective in reducing the incidence of pressure ulcers in people identified at risk of developing them.

  The full RES on 'SEM Scanners' can be downloaded here - (form required)

• Reducing neurogenic dysphagia - Phagenyx

  Phagenyx is a device which is designed to reduce neurogenic dysphagia (dysfunction of eating).

  This is dysphagia arising from the disruption of any of the neurological systems or processes involved in the execution of a coordinated safe swallow and occurs in people following stroke and in other conditions such as multiple sclerosis which impact muscle control. 

  Phagenyx is classed as a pharyngeal electrical stimulation intervention and comprises a base station and a treatment catheter. It is applied over a period of days.

  Phagenyx may not change clinical outcomes in people with dysphagia following stroke (low to moderate certainty evidence) but probably increases the likelihood of decannulation in people with tracheotomy and dysphagia following stroke (moderate quality evidence).  This is based on randomised controlled trials.

  Evidence in neurogenic dysphagia in other conditions is limited.

  The full RES on 'Phagenyx' can be downloaded here - (form required)

• Remote Spirometry

  Spirometry is a test used to assess lung function. It is used as part of the diagnostic process for long term respiratory conditions including asthma and COPD, and also to monitor these conditions.

  Remote spirometry in the approach being considered for implementation in Greater Manchester involves home delivery of the spirometry hand-held device together with a smartphone with a pre-installed app to the patient’s home. The patient is guided through the spirometry tests over a video call with a physiologist. Once the test is completed data are accessible immediately to the physiologist, and subsequently to the patient’s doctors.

  We found there to be indirectly relevant evidence for the use of remote supported spirometry at home in people with asthma or COPD; an ongoing study which will supply directly relevant evidence has not yet reported.

  There is considerable indirectly relevant evidence which reports some relevant data for the comparability of measurement properties and some for patient experience.

  There is indirectly relevant evidence which is of very low to moderate certainty for the impact on patient health outcomes. The evidence is impacted by indirectness, some inconsistency and incompleteness of results and methods which are not always well reported.

  The full RES on 'Remote Spirometry' can be downloaded here - (form required)

• Restricting advertising in public spaces

  1. Implementing policies that restrict the use of outdoor spaces for advertising harmful commodities

  There is some limited research evidence regarding the implications of policies that restrict the use of outdoor spaces for advertising alcohol and gambling. We found no research evidence regarding policies to restrict advertising for payday loans.

  Limited evidence suggests that implementing restrictions on alcohol marketing in outdoor places may reduce the awareness of alcohol advertising in adults, whilst it is uncertain if restricting or banning alcohol advertising could reduce alcohol consumption in adults and adolescents.

  There is consistent evidence on the causal relationship between exposure to advertising of gambling commodities and positive attitudes towards gambling, intentions to gamble and increased gambling activity.

  The full RES on 'Implementing policies that restrict the use of outdoor spaces for advertising harmful commodities' can be downloaded here

  2. Implementing policies that restrict the use of public sector-owned space for advertising unhealthy foods

  There is limited evidence regarding the implications of restricting the use of public sector-owned spaces for advertising unhealthy foods and non-alcoholic beverages (i.e., those high in fat, salt, and/or sugar).

  Direct evidence from evaluations of Transport for London’s (TfL’s) policies of restricting the advertising of unhealthy foods suggests potential impacts on reducing unhealthy food purchase behaviours.

  Possible facilitators of the implementation of advertising restriction policies include:
  • Public engagement and consultation
  • Building partnerships with key stakeholders
  • Strong political will and champions with political power
  • Rights-based reframing of issues such as protecting children.

  Barriers include industry opposition and loss of government revenue.

  The full RES on 'Implementing policies that restrict the use of public sector-owned space for advertising unhealthy foods' can be downloaded here

• Smoking cessation interventions

  In this RES, we focussed on smoking cessation interventions in families with children with asthma.

  We searched for existing systematic reviews of primary studies of any design in the first instance. 

  Overall we have low confidence in the evidence on the barriers and facilitators to stop smoking interventions in:

  • Children with asthma,
  • Those from disadvantaged communities,
  • Those from minority ethnic backgrounds.

  We downgraded our confidence as the current evidence is limited and largely indirectly relevant: it is unclear if the smoking cessation interventions included are family-based with mHealth components; and the participants included are smokers in general rather than children with asthma or other sub-populations defined in this RES, or both.

  The full RES 'Smoking cessation interventions in families with children with asthma' can be downloaded here - (form required)

• Urgent and emergency care (including ambulance handovers)

  We have completed three Rapid Evidence Syntheses related to Urgent and Emergency Care:

  1. Case management intervention for hospital attendance or admission

  This RES looks at the evidence for a case management intervention designed to reduce emergency visits and admissions to hospital in people at high risk of such visits/admissions. 

  This population was defined as: adults considered to be at high risk of hospital admissions in the next 6 months according to a risk prediction model.

  We found directly relevant low certainty evidence from randomised trials which shows variations in the effect of the case management intervention assessed on healthcare attendance outcomes

  The effect on mortality is unclear.

  The certainty of the evidence is affected by differences between the findings of different studies, concerns about the reporting of the trials and the incomplete nature of the data available currently.

  It is likely that the complete reporting and publication of the currently ongoing UK trial will change this assessment.

  The full RES on 'Case management intervention for hospital attendance or admission' can be downloaded here - (form required)

   

  2. Interventions to Reduce Ambulance Handover Time at Emergency Departments (ED)

  There is guidance from NHS England which recommends management and monitoring approaches to ambulance-ED handovers but not specific measures to improve the speed of this.

  There is very limited research evidence from uncontrolled studies on interventions to increase the speed of ambulance handovers directly.

  There is reliable evidence from systematic reviews that most interventions to reduce ED crowding are supported by limited and insufficient evidence but that fast-track interventions, advanced triage protocols, team triage and use of primary healthcare professionals in ED triage may be effective in reducing ED length of stay.

  The full RES 'Interventions to Reduce Ambulance Handover Time at Emergency Departments (ED)' can be downloaded here - (form required)

   

  3. Surge capacity in urgent and emergency primary care

  We identified some systematic reviews which are indirectly relevant to surge capacity in primary care, and some primary study evidence which is relevant to the RES.

  We did not find any evidence looking at the impact of rapid implementation of surge capacity or the impacts of different models of surge capacity provision.

  Impacts of surge interventions are difficult to determine and where evidence exists it relates to longer-term retention of surge interventions or to impact on secondary care, or both.

  The full RES 'Surge capacity in urgent and emergency primary care' can be downloaded here - (form required)

• Virtual wards (hospital at home) for acute admissions

  Virtual wards involve monitoring and treating people at home as an alternative to admission to hospital. 

  “Hospital at home” has been identified as a priority model for care. People admitted to a virtual ward have the same access to (e.g.) diagnostic services as those admitted as inpatients.

  There are different models of virtual wards with varying levels of monitoring, visits and patient or carer involvement. We define virtual wards as any arrangement in which a person who would otherwise be admitted to hospital is managed at home with access to hospital services including monitoring.

  In this RES we consider virtual wards as an alternative to acute inpatient hospital admissions or stays and consider both step-up and step-down models. Virtual wards are included in 2018 NICE guidance on alternatives to hospital care.

  There is consistent low to moderate certainty evidence from reviews of randomised trials that clinical outcomes, including mortality and readmission, for patients treated in hospital at home are probably as good or better than those treated as inpatients. The involvement of technology and different healthcare professionals in the models assessed varies, in some cases this is determined by the care needed.

  The full RES 'Virtual Wards (hospital at home) for Acute Admissions' can be downloaded here - (form required)

   

  This work has also been published in Age & Ageing:

  • Norman G, Bennett P, Vardy E R L C. Virtual wards: a rapid evidence synthesis and implications for the care of older people. Age and Ageing. 2023. 
• Work and mental health

  There is moderate-certainty evidence that (augmented) supported employment is effective and cost effective in helping people with serious mental illness including schizophrenia to obtain and maintain employment. 

  There is also moderate-certainty evidence that workplace interventions are effective and cost-effective in helping people with common mental disorders such as depression in reducing sick leave related to mental health and facilitating return to work. 

  Evidence is less certain for other interventions such as psychotherapy interventions.

  Qualitative evidence suggests that people with mental health value the meanings and benefits of obtaining and staying in employment and treat staying at paid work as a way to establish normal behaviour and mainstream life.

  The full RES on 'Supporting people living with mental health problems to return to work or stay in work' can be downloaded from here