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Acute Medicine

Using troponin levels to diagnose heart attacks is ‘flawed’, suggests study

A study suggests that levels of troponin vary depending on factors such as age, sex and whether an inpatient or outpatient.

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Patients who suffer suspected heart attacks could be receiving inappropriate investigations.

A leading cardiac specialist has said some patients who suffer suspected heart attacks could be receiving inappropriate investigations and unnecessary treatment due to a ‘flawed’ blood test.

A blood test which measures levels of troponin in the bloodstream is carried out when a person is suspected of suffering from a heart attack to assist in ruling out or confirming the diagnosis.

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However, a study of 20,000 consecutive patients at University Hospital Southampton NHS Foundation Trust who had blood tests for any reason and were being treated for unrelated conditions found that one in 20 had levels consistent with those seen in heart attack patients, even though there was no suspicion of a heart attack.

The results, published by The BMJ, showed levels of the protein also differed according to several factors such as age, sex and whether an inpatient or outpatient.

“This study shows the need for medical staff to interpret troponin levels carefully in order to avoid misdiagnosis of a heart attack and inappropriate treatment,” explained Professor Nick Curzen, a consultant cardiologist at UHS and study lead.

“It tells us that the upper limit of normal for the troponin test, which is derived from a group of relatively healthy people, may not be suitable for a hospital population in general.

“This is of significant concern because if it is measured in patients without a classic heart attack presentation, the level may appear raised and such patients may end up being incorrectly diagnosed as having had a heart attack.

“They may then receive inappropriate treatment which could be potentially harmful outside of this context.”

The level of troponin indicating a heart attack was originally determined by measuring it in the blood of healthy people between 18 and 40 years old.

People recording results in the highest 1% are considered to have abnormally high levels and, in the appropriate clinical circumstances, it would indicate a heart attack.

The study, carried out between 29 June and 24 August 2017, showed that 39% of all patients from the critical care units, 14% of all medical inpatients and 6% of all patients from the emergency department had a troponin concentration greater than the level that indicates a heart attack.

Prof Curzen added: “The results can be used to stimulate debate about the way troponin measurements are requested and interpreted in the future because it is certainly not quite right at the moment.”

Acute Medicine

Hospital visitors and volunteers help to reduce nursing workloads, survey finds

Nurses believe a lack of visitors is often detrimental to a patients’ health and speed of recovery.

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Two in five hospital patients get no visitors and require additional support from the nursing team.

Nurses working in acute hospitals feel that patients without visitors require additional support from the nursing team, according to a survey by the Royal Voluntary Service (RVS).

The survey also revealed that nurses believe a lack of visitors is often detrimental to a patients’ health and speed of recovery in a number of ways. These include; they are less likely to be mobile (43%), less likely to be stimulated through conversation (56%) and less likely to follow medical advice.

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It is also estimated that around 37% are more likely to have a longer stay in hospital.

The RVS states that volunteers can step in and play a “vital role” in helping to reduce the nursing workload and freeing up staff for clinical care.

Over half of the NHS nurses questioned said a volunteer presence on ward was very important and that volunteers could help with patient care in a variety of ways. In particular, they referenced; providing non-medical support and assisting at mealtimes.

Double the number of volunteers in the next ten years.

Previous research published in a Kings Fund report also found strong support for volunteering among frontline staff.

With approximately 40,000 unfilled nursing vacancies throughout the NHS in England, volunteers are becoming more important to ensure patient receive care in a timely manner.

Following the NHS Long Term plan asking hospitals to double their volunteers in the next ten years and the recognition of the help they can provide by the NHS nursing team, RVS is calling on more hospitals to make the most of volunteers to improve patient health.

Sam Ward, Director of Commissioned Services for the RVS, said; “With results showing two-fifths of patients may not see a visitor during their hospital stay, it is clear that more is needed to be done to support them.

“Volunteers offer a professional support service, encouraging mental stimulation, physical activity, and more that can play a significant role in both mental and physical recovery.

“It is vital that hospitals work together with volunteer service providers to make sure that patients across the country are able to access this support.”

 

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Acute Medicine

‘Harmful’ prescription charges for asthma medication should be scrapped, warn nurses

The majority of nurses want ‘harmful’ prescription charges for people with asthma to be scrapped.

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Patients are at risk of life-threatening asthma attacks simply because they can’t afford their medication.

Hundreds of nurses called for ‘harmful’ prescription costs for people with asthma to be scrapped after seeing patients have an asthma attack or need emergency treatment because of the high cost of prescriptions.

A report published today by Asthma UK in collaboration with The Royal College of Nursing and Association of Respiratory Nurse Specialists, includes findings from a survey of more than 600 nurses in the UK as well as 150 other healthcare professionals including doctors, pharmacists, and paramedics.

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The research highlights the harmful impact prescription charges are having on people with asthma, putting them at risk of life-threatening asthma attacks because they can’t afford their medication.

Nurses reported patients borrowing inhalers from their friends, relatives or even their own children because they couldn’t afford to buy their own – putting them at risk of taking the wrong medication, or the wrong dose.

‘An outdated and unfair policy’.

One healthcare professional told Asthma UK that she had found the money herself to pay for her patient’s prescription because she was worried about them being unable to afford their life-saving medication.

A majority of nurses surveyed (92%) want ‘harmful’ prescription charges for people with asthma to be scrapped.

Samantha Walker, Director of Research and Policy at Asthma UK and a qualified nurse, said:“It’s really worrying that nurses who are working so hard to help their patients stay well are seeing people with asthma suffer because of an outdated and unfair policy. It is high time the Government took action and urgently reviewed asthma prescription charges so that people with asthma aren’t put at risk of avoidable but potentially life-threatening asthma attacks. No one should have to pay to breathe.”

‘Only making their condition worse’.

Wendy Preston, Head of Nursing Practice at the Royal College of Nursing said: “It cannot be acceptable that some people with long-term conditions are missing out on their vital medication because they cannot afford it.

“Nurses see the impact of this every day of the week and know what happens when people do not take their vital medication.

“This will only make their condition worse and they will end up needing further treatment adding additional pressure the health and care system.

“It is time that there is equity with other long-term conditions such as diabetes where prescription charges are exempt.”

Asthma UK is urging people with asthma, nurses and other healthcare professionals to join its Stop Unfair Asthma Prescription Charges campaign and sign its petition to end prescription charges.

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