Is Ketamine at least as effective and with fewer side effects as electroconvulsive therapy for treatment resistant depression?

Results of a new randomized, head-to-head trial suggest intravenous ketamine is at least as effective and has fewer side effects for treatment resistant depression as electroconvulsive therapy (ECT). To date, no large, head-to-head trials have compared ECT to intravenous ketamine. 

The study, published in The New England Journal of Medicine, states that although ECT is very effective and is fast acting, it requires anaesthesia, can be socially stigmatizing, and is associated with memory problems following the treatment. Ketamine has been shown to have rapid antidepressant effects and does not cause memory loss or carry the stigma associated with ECT, he added. For these reasons, the investigators examined whether it may be a viable alternative to ECT.

Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression | NEJM

Government not taking “appalling” harms from alcohol seriously enough, House of Commons committee finds

A report from the House of Commons Public Accounts Committee says a “staggering” 82 per cent of those 600,000 dependent drinkers in England are not in treatment despite success rates of around 60 per cent and evidence that, on average, every £1 spent on treatment immediately delivers £3 of benefit and significantly more in the longer term.

The committee reports there has been an alarming increase in alcohol-related deaths, which have risen by 89 per cent over the past twenty years, with sharp rises since 2019. But the number of people receiving treatment for alcohol dependency has generally been falling. 

Government not taking “appalling” harms from alcohol seriously enough – Committees – UK Parliament

Alcohol treatment services (parliament.uk)

Global health framework published

The UK government’s has published its Global Health Framework stating its ambition to play a leading role in improving health globally and in building resilience to future threats. It outlines the actions the UK government will take over 2023 to 2025 in support of health and for a safer and more prosperous UK and world.

Its stated objectives are –

Strengthen global health security through improved preparedness and response to future epidemics, pandemics, drug-resistant infections and climate change;

Reform global health architecture, including through a strengthened World Health Organization, driving more coherent governance and collaboration across the international system.

Strengthen country health systems and address key risk factors for ill health, working towards ending preventable deaths of mothers, babies and children in the world’s poorest countries and enabling women and girls to exercise their rights.

Advance UK leadership in science and technology, strengthening the global health research base of UK and partner countries, while supporting trade and investment.

Global Health Framework: working together towards a healthier world, May 2023 – GOV.UK (www.gov.uk)

Virtual wards staffing needs to be properly planned, says report

A report by the NHS Confederation looking at virtual wards says virtual ward staffing needs to be properly planned. It says long-term establishments should be set and regularly reviewed for virtual wards and staffing plans implemented, which provide both permanent and secondment-based opportunities for clinical staff (including from social, community and primary care), to help reinforce the role of virtual wards as a permanent service which can offer real benefits to career development. It adds placements for students should include exposure to virtual wards alongside other traditional placements.

The report spoke to a range of NHS leaders, including integrated care system (ICS) chairs and chief executives, integrated care board (ICB) digital leads, clinicians, and senior operational and finance staff. It focuses on the delivery process of virtual wards; the opportunities they bring to the quality of care and impact on demand; the challenges leaders face in implementing virtual wards, including the implications for the NHS workforce; and potential solutions to improving virtual wards as they become commonplace in the NHS.

Realising the potential of virtual wards | NHS Confederation

High risk children and young people being cared for in unsafe environments, HSIB report finds

The latest interim report from the Healthcare Safety Investigation Branch (HSIB) has found children and young people exhibiting high-risk behaviours are being cared for in NHS paediatric wards which may not be a safe environment and can impact on the wellbeing of those patients and their families and pose a risk to other patients and staff.

The report comes as HSIB undertakes an investigation into the risks associated with design of paediatric wards in hospitals.. The body says it has seen and heard that there are significant challenges in caring for children and young people exhibiting high-risk behaviours.

Wards may contain many self-harm and ligature risks and NHS staff, patients and families commented to HSIB that the wards are crowded, busy and noisy, and were unsuitable for children and young people experiencing a mental health crisis and/or who have sensory needs.

The interim report states that 13 out of the 18 hospitals the investigation spoke with said that for children and young people with high-risk behaviours the paediatric ward was “not safe” and was not a suitable environment, particularly if the child or young person did not have a physical health condition. The remaining five spoke of the huge challenges they face and that they try to make the environment as safe as possible but felt more could be done.

 

Commissioners and services need a better understanding of and support for unpaid carers, report finds

A report on the “current picture of local support available for unpaid carers in England” by think tank the King’s Fund has found unpaid carers provide levels of support equivalent to four million paid care workers to family or friends, but often struggle to gain support for themselves. It says carers are a hugely diverse group – both in terms of who they are and who they care for – but policy and services do not always reflect this diversity.

The think tank interviewed commissioners and providers of support to unpaid carers and ran focus groups with unpaid carers in four areas of England, spoke to national stakeholders and reviewed existing literature and national data sets.

It says to better support unpaid carers locally, commissioners and services need to develop and maintain a good understanding of their populations, build local support offers accordingly, and embed awareness of carers in strategic-level and commissioning decisions.

Caring_in_a_complex_world_unpaid_carers.pdf (kingsfund.org.uk)