Failure of paediatric asthma care

The UK has among the highest numbers of asthma deaths in children and young people in Europe. The National Review of Asthma Deaths (NRAD) concluded that only one of the 28 children and young people who died from asthma had been adequately managed. Levy and colleagues comment that of the 19 NRAD recommendations, only one has been implemented nationally in the UK, namely setting up a National Asthma Audit, which has not yet reported. We are not providing anything like adequate primary and secondary care for these patients, they say, above all by not identifying future risk and providing access to specialist advice for them. We should, Levy and colleagues urge, have zero tolerance for asthma attacks by ensuring proper follow-up, referral, and risk assessment.

The homeless are denied basic health care

Shelter estimates that there are over 320,000 homeless people in the UK. In the first study of its kind, researchers from the University of Birmingham have interviewed homeless people about their experiences of getting help from the NHS. Their findings paint a shaming picture of casual neglect, discrimination, and inadequate resources in the many services involved in their care – general practice, accident and emergency departments, mental health services, and specialist homelessness centres. Homeless people encounter huge barriers in simply registering at a practice, getting an appointment with a GP or nurse, finding appropriate treatment for mental health and addiction problems, or being adequately signposted to, already struggling and underfunded, specialist homeless services. Homeless people interviewed in this study recognised that specialist homeless centres are capable of providing high quality, responsive and supportive care. The authors emphasise the importance of spreading good practice and educating and informing healthcare workers about the rights and needs of our homeless population. An additional report from the same researchers has revealed the extent of the mental and physical health problems the homeless face.

Limitations of inflammatory marker testing

Inflammatory marker testing, such as CRP, ESR, and plasma viscosity, is used to diagnose and monitor various inflammatory and infective conditions, and cancers. Watson and colleagues at the Universities of Bristol and Exeter studied inflammatory markers in almost 140,000 patients registered with the Clinical Practice Research Datalink, assessing their diagnostic value, and providing important conclusions and recommendations. Testing multiple inflammatory markers simultaneously does not increase their ability to rule out disease, and should generally be avoided. CRP has marginally superior diagnostic accuracy for infections, and is equivalent for autoimmune conditions and cancers, so should generally be the first line test. An additional report shows that inflammatory markers have poor sensitivity and should not be used as a rule-out test. False-positives are common, and lead to increased follow-on GP consultations, tests, and referrals.