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Flour could be fortified with folic acid in a bid to reduce birth defects

The plans to fortify flour with folic acid are thought to be an effective way of reaching younger women from the most deprived backgrounds.

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Flour could be fortified with folic acid in a move to reduce neural tube defects.

The government has announced it will consult on the mandatory fortification of flour with folic acid to prevent fetal abnormalities. It is estimated that 700 to 900 pregnancies are affected by neural tube defects each year in the UK.

The consultation will launch in early 2019 to consider the evidence around folic acid fortification as well as the practicality and safety.

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Evidence from the Scientific Advisory Committee of Nutrition (SACN) suggests that expectant mothers can take folic acid during pregnancy to significantly reduce the risk of foetal abnormalities such as spina bifida and anencephaly.

Women are missing out on nutrients.

Women who are trying to become pregnant are advised to take a daily supplement of 400 micrograms of folic acid before they conceive and during the first 12 weeks of pregnancy. However, around half of pregnancies in the UK are unplanned, so many women are missing out on these nutrients early in their pregnancy.

The plans to fortify flour with folic acid are thought to be an effective way of reaching those with the lowest folate intakes – for example, younger women from the most deprived backgrounds.

The consultation will also consider if there are any risks to other members of the general public. These include whether additional folic acid in the diet will mask the diagnosis of conditions such as pernicious anaemia, which is a deficiency in the production of red blood cell.

The proposal already has the support of the UK Chief Medical Officers and the Scientific Advisory Committee on Nutrition.

‘Safe and beneficial for all’.

Steve Brine, Public Health Minister, said: “All women should be able to access the nutrients they need for a healthy pregnancy and in turn, reduce the risk of devastating complications.

“We have been listening closely to experts, health charities and medical professionals and we have agreed that now is the right time to explore whether fortification in flour is the right approach for the UK. My priority is to make sure that if introduced, we are certain it is safe and beneficial for all.”

Professor Dame Sally Davies, the Chief Medical Officer, said: “The evidence shows that fortifying flour with folic acid is a practical way of reducing folate deficiencies in pregnant women and reducing birth defects.

“However, as with any intervention of this kind, we need to be certain it is also safe, and that means considering what the wider implications would be for the rest of the population who eat flour.

“I am pleased to see the government taking action on this issue and hope to see the wider scientific community feed in their views to this important consultation which could benefit and improve the lives of many women and babies in this country.”

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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