Psychological therapies for eating disorders

People with eating disorders should have prompt access to a range of psychological therapies and be treated as outpatients as much as possible, according to a new guideline.

For the first time psychological interventions such as cognitive behaviour therapy, analytic therapy, and interpersonal psychotherapy are recommended as first line treatments in an evidence based guidelines from the National Institute for Clinical Excellence (NICE).

The guidance on eating disorders advocates a holistic approach in caring for people with anorexia nervosa, bulimia nervosa, and less common eating disorders such as binge eating.  Families and siblings of children and adolescents with eating disorders should all be included in learning about the condition and how it can be treated because they too can be affected by it, says the guideline.

“Psychological treatments have a central role in the treatment of eating disorders.  Providing those treatments along the lines set out in the eating disorders guideline presents a considerable but welcome challenge for the NHS and those professionals working in it”.

In 2000 the college identified just 25 teams in the United Kingdom with the specialist training to deal with eating disorders, less than half of what is needed.

However, the professor of adolescent psychiatry at the University of Liverpool, Simon Gowers, believes that services in eating disorders can be improved immediately without any additional resources.  “There is an opportunity with the recent development of mental health trusts to facilitate eating disorders units” he said.

Source Web

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Reconfiguration of surgical, emergency, and trauma services

Given some of the changes which may be brought about by the Wanless proposals in Wales this BMJ paper may be relevant

The Senate of Surgery of Great Britain (comprising the four surgical Royal Colleges, the dental faculties, and 10 surgical specialty associations) has published a policy paper that seeks to speak with a single voice for the surgical community (www.rcpsg.ac.uk/recreport.htm).  This policy paper signals a wish to a debate on this controversial topic

The Royal College of Physicians wants to phase out acute emergency admissions from isolated smaller units and transfer the work to properly equipped and staffed larger units.  The arguments are cogent and extensively made – in surgery, medicine, paediatrics, and maternity care. 

The impending need to comply with the European Working Time Directive – a regulation of the European Union limiting a doctor’s working week to an average of 56 hours, which comes into force in August 2004 – is adding velocity to a general demand among professional advisory bodies to concentrate the medical workforce in fewer, larger, acute centres.

At this stage in the United Kingdom electoral cycle (with an upcoming election in which the NHS is guaranteed a central place among the issues), does anyone expect to see the rapid implementation of policies that will be perceived to ‘downgrade’ the importance of perhaps 50 or more acute hospitals? 

Perhaps the senate’s members will be in a difficult position for some time to come until one of two ways forward is cleared.  Firstly, they could connect their ambition for greater centralisation of complex acute cases to the realpolitik of constituency affairs and provide the politicians with a means of winning votes by implementing them.   

Any local proposals for reconfiguration of hospital services will have to negotiate a substantial nexus of legal and political processes.  The history of these consultations teaches us that public anxieties about losing local access to emergency services carries more political clout than professional logic.  Maybe it is time for the colleges to explore this public psychology and find a way of connecting with it. 

Secondly, they could give deeper and wider thought as to how ‘managed clinical networks’ could be introduced so that local emergency units can flourish while complex emergency cases can be swiftly funnelled towards appropriate specialist centres.  According to evidence presented by the London Ambulance Service to the Turnberg review of London in 1998, perhaps only 24% of patients arriving via 999 calls are admitted to hospital. 

More work needs to be done to evaluate how small local emergency units can work in tandem with more major centres of specialist care in a way that exploits the rapidity of access that a local unit brings while gaining the diagnostic leverage of specialist colleagues.  If the price of moving the complex emergency to an appropriate centre of expertise is that this patient is accompanied by another nine or 10 patients who are not complex acute cases then another set of problems is launched.

This call by the senate for reconfiguration gives some valuable pointers as to where further policy work might be fruitful – the development of non-medical cadres, greater integration of the ambulance service, the development of information technology, and the involvement of the public. 

To these could be added the exploration of virtual diagnosis, the amalgamation of primary and secondary care in smaller communities, and the rotation of staff within clinical networks and between smaller and larger units.

Source: Web

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Dr Foster

Dr Foster, an independent, London based organisation analyses the availability and quality of health care in the United Kingdom and worldwide.  The web pages are full of  data and  allow doctors, managers, and patients to learn from what is happening in the NHS and other healthcare systems. 

One example, analyses data from 132 of the 172 acute trusts in England and shows that trusts that have acute stroke units have an 11% lower hospital mortality from stroke than trusts that don’t have such units.  This shows that the results from trials are replicated in the real world.  The data also show that hospitals with combined acute and rehabilitation units do not have reduced mortality.  A further analysis finds that hospitals that scan patients with computed tomography within 48 hours have an 8% reduction in mortality.  These are data that should be useful to people caring for patients with stroke and those organising services.

Dr Foster includes a lot of UK data relating to hospital statistics, including the Good Hospital Guide. It also publishes comparative analyses of health data from the United States and Europe.

Source: Web

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