Thursday, 17 August 2017

Depression overshadows the past as well as the present


It is known depression makes sufferers see the present and the future as sad, but this is the first time research has shown it also casts a long shadow over people's memories of the past.

Psychologists at Germany's Heinrich Heine Universität Düsseldorf and at the UK's University of Portsmouth published their research in Clinical Psychological Science.

Now and Zen: Lower prenatal stress reduces risk of behavioral issues in kids

Expectant mothers may want to consider adopting today's trend towards stress management, in light of new research pointing to its ability to lower the risk of problematic behavior in their offspring. Researchers found that mothers who are exposed to high levels of stress during pregnancy have kids who are more than twice as likely to have chronic symptoms of hyperactivity and conduct disorder.

Personalized Blood Tests Provide Better Way to Predict Suicide Risk

A newly developed universal blood test can help to predict if a person is at high suicide risk. Indiana University researchers say the test is unique as it can be given to everyone. The scientists also report the development of personalized blood tests for different subtypes of suicidality, and for different psychiatric high-risk groups.

Researchers explain that two apps — one based on a suicide risk checklist and the other on a scale for measuring feelings of anxiety and depression – have been designed to be used in conjunction with the blood tests to enhance the precision of tests and to suggest lifestyle, psychotherapeutic, and other interventions.

NHS Health Check 40-64 dementia pilot research findings

This report summarises the findings from a pilot project into the effectiveness of dementia risk reduction messaging in NHS Health Checks. It found that the pilot project showed promise in shifting public awareness and understanding of dementia risk with 75 per cent of the 164 participants recalling the advice on dementia risk and 80 per cent reporting that the advice would impact on their behaviour.

Rethink Mental Illness examine co-production in CCG mental health service design and delivery

A new report by Rethink Mental Illness explores the important role of co-production in mental health commissioning.

‘Progress through Partnership: involvement of people with lived experience of mental illness in CCG commissioning’ argues that co-production should be the norm, not the exception.

Rethink’s report suggests that, while there is national commitment to co-production, the majority of Clinical Commissioning Groups (CCGs) do not have clear plans in place for involving people with experience of mental illness in the design and commissioning of mental health services, also known as co-production. CCGs told Rethink that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts by experience.

Rethink submitted Freedom of Information requests to 209 CCGs, with 196 responding. They also undertook a literature review, carried out interviews and drew on qualitative data from their own co-produced services.

The FOI responses showed that:
  • Only 15 percent of CCGs has used a co-production approach at least once in mental health commissioning
  • Only 8 percent had ambition to increase co-production
  • Only 1 percent explicitly stated that co-production was a standard approach to commissioning
Read more HERE

Connecting allied health professionals (AHPs)

NHS Improvement recently hosted four regional events for provider AHP leads on evidencing the quality and productivity of AHPs’ care.

The events provided an introductionopens in a new window to the Model Hospital, AHP job planning, and the early findings of a deployment tracker metric that some AHP leads are currently implementing.

'Alternative cancer therapies' may increase your risk of death

"Cancer patients who use alternative medicine more than twice as likely to die," is the stark message from The Independent. Researchers found that people who chose alternative medicine instead of conventional cancer treatments were much less likely to survive for at least five years.

Conventional treatments included surgery, radiotherapy, chemotherapy or hormone treatments. The research only applies to people who choose not to have conventional treatments.

Overall, 78% of people having conventional treatment for cancer survived at least five years, compared to only 55% of people having alternative treatment alone. The difference was biggest for breast cancer, where people who chose alternative therapies were more than five times as likely to die within five years as those who chose conventional treatments.

Latest patient-led assessments reveal quality of healthcare premises

NHS Digital has published annual patient-led assessments of non-clinical elements of care such as food and waiting areas.

This assessment focuses particularly on issues of access such as wheelchairs, mobility and signage, as well as provision of visual/audible appointment alert systems and hearing loops.

Information for nurses and midwives on responding to unexpected incidents or emergencies

Following recent terrorist incidents, the Nursing and Midwifery Council (NMC) has provided information for nurses and midwives on responding to unexpected incidents or emergencies.

Wednesday, 16 August 2017

Randomised feasibility trial into the effects of low-frequency electrical muscle stimulation in advanced heart failure patients


Low-frequency electrical muscle stimulation (LF-EMS) may have the potential to reduce breathlessness and increase exercise capacity in the chronic heart failure population who struggle to adhere to conventional exercise. The study’s aim was to establish if a randomised controlled trial of LF-EMS was feasible.

UHCW Research: Ennis, Stuart, McGregor, Gordon and Banerjee, Prithwish

Inpatient Monitoring of Decompensated Heart Failure: What Is Needed?

Current Heart Failure Reports pp 1–5 DOI 10.1007/s11897-017-0352-x 

Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients.

UHCW Research: Ali, Danish

Evidence Based Data in Hand Surgery and Therapy

XXII. FESSH Congress & XII. EFSHT Congress 21-24 June 2017 | Budapest, Hungary

See 3.5 Systematic Review of the Management of Distal Radial Fractures

UHCW Research: Helen Hedley

Shortlist of nine inspirational nominations for Kate Granger Awards

Nine nominees make up the final shortlist for this year’s Kate Granger Compassionate Care Awards.

The finalists were selected from 117 entrants in the three award categories. The shortlist is made up of three nominees in each of the three award categories. The first award is for an individual working in the NHS or delivering NHS funded services. The others are for teams or organisations who are part of the NHS, or who deliver NHS funded services. These services can be delivered in hospitals, or in a primary care, community or residential setting.

The north-south NHS divide: how where you are not what you need dictates your care

This report, from the Medical Technology Group, outlines the findings of an examination of data from 209 CCGs to assess patient access to medical technology. It finds wide variation in access between the north and south of England and argues that CCG performance against access indicators should be made clearer to patients.

Awards recognise best use of patient feedback

NHS England is backing awards to recognise the best initiatives to improve NHS services through the use of insight and feedback from patients and staff.

The “using insight for improvement” category of the Patient Experience Network National Awards 2017 opened for entries on 31 July and will close on 24 November. 

Revised ACO contract to replace MCP and PACS versions

In July 2016, NHS Improvement published the multispecialty community provider (MCP) emerging care model and contract framework. As well as describing the MCP care model in more detail, it introduced the MCP Contract and business model that underpins it. An initial draft version of the MCP Contract was published in December 2016 for a period of public engagement and informal feedback.

Following this feedback, the Accountable Care Organisation (ACO) Contract and supporting documents have now been revised for use by local commissioners to inform the early stages of their procurement processes. Importantly, the Contract can now be used for accountable care models generally, including MCP and integrated primary and acute care system (PACS) models.

The ACO Contract has been produced following intensive joint work with a number of vanguards with whom we are co-developing the approach to ensure that the Contract is able to help facilitate local plans.

We will be working with commissioners in the most advanced areas to test the revised Contract and to improve it further and plan to release an updated version for formal consultation in 2018.

Report from the UK Shape of Training Steering Group

The UK Shape of Training Steering Group (UKSTSG), chaired by Professor Ian G Finlay, has today published its report providing policy advice and structure to guide implementation of the recommendations from Professor David Greenaway’s independent Shape of Training review.
See also the GMC's response.

Resources to support safe transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks

A resource alert has been issued by NHS Improvement to support providers to safely manage the transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks.

Patient safety incidents are occurring due to the accidental administration of medication intended for intravenous use via a neuraxial device, and vice versa, resulting in the patient receiving drugs through the wrong delivery route, which in some cases has been fatal.

To prevent these errors a new dedicated connector for neuraxial and regional block devices – NRFitTM (ISO 80369-6:2016) has been developed and is now being introduced to the NHS. Devices with this connector are not compatible with Luer connectors, preventing the risk of drugs being delivered through the wrong route. Industry has now adopted this new ISO standard for use throughout the UK and NRFitTM is now the dedicated connector for neuraxial devices. The Surety® devices introduced as an interim safety measure while the new ISO standard was being developed will now be discontinued.

Using mesh does not improve results in vaginal prolapse surgery

Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh. This large pragmatic study looked at over 3000 women with vaginal prolapse. Half of these were randomised; the rest contributed data but were not part of the main evaluation. The study separately compared mesh and biological grafts to a repair without these additions.

Monday, 14 August 2017

Older Adults Need More Follow-Up after ER Screenings for Suicide

Nearly half of adults over the age of 70 who committed suicide visited an emergency room in the year before their death.

However, when healthcare providers see older adults in the emergency room, some may be too quick to assume that the warning signs for suicide are just a natural part of aging. As a result, many older adults may not get the help they need to address suicidal thoughts, according to a new study.

According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides is higher among older adults than younger people. When older adults try to commit suicide, they are more likely to be successful compared to younger adults. This is why suicide prevention strategies are especially important for older men and women, researchers noted.

Ambulance call-outs for mental health patients in England soar by 23%

The number of ambulance call-outs for people experiencing mental health problems in England has soared by nearly a quarter in two years.

Data obtained under the Freedom of Information Act shows paramedics helped over 30,000 more patients (172,799) in crisis in 2016-17 compared with 140,137 in 2014-15, a rise of 23%.

An additional 55,000 hours were spent supporting people with their mental health last year, compared with 2014-15 – up by 32%. In London the time spent rose by 45%, according to the request for information made by the Labour MP Luciana Berger.

Friday, 11 August 2017

Mesh Oversight Group Report on vaginal mesh implant

This Mesh Oversight Group Report follows on from the Mesh Working Group Interim Report of December 2015. Both reports are about vaginal mesh implants used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women.

See RCOG's and BSUG's joint response to the report.

STP progress dashboard

This report outlines baseline data for each STP area in England relating to progress so far on STP plans against nine domains. The nine domains focus on hospital performance, patient-focused change and transformation

See this briefing from The King's Fund. Yet more performance ratings for the NHS: new STP ratings are narrowly focused and centrally driven, which relates to the dashboard.

21 teams selected to put innovative ideas into practice

The Health Foundation has selected 21 new projects to be part of the sixth round of its £1.5 million innovation programme, Innovating for Improvement.

Innovating for Improvement aims to improve health care delivery and/or the way people manage their own health care through the redesign of processes, practices and services.

The selected projects will be led by clinical teams and will develop their innovative ideas and approaches, put them into practice and gather evidence about how their innovation improves quality.

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Int J Chron Obstruct Pulmon Dis. 2016 Jun 2;11:1161-9. doi: 10.2147/COPD.S91253. eCollection 2016.

Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.

SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.

UHCW Research: C. Gelder, V. Johnson-Warrington

Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services

What is this framework? It’s the first version of a national framework to guide local, regional and national action on developing NHS-funded staff. Its sponsors are the main national organisations with NHS responsibilities. The framework applies to everyone in NHS-funded roles in all professions and skill areas, clinical and otherwise. Future updates are expected to cover people in social care as well.

What is the framework’s purpose? To equip and encourage people in NHS-funded roles to deliver continuous improvement in local health and care systems and gain pride and joy from their work. To that end, the framework aims to guide team leaders at every level of the NHS to develop a critical set of improvement and leadership capabilities among their staff and themselves.

National maternity and perinatal audit: organisational report 2017

This report finds large increase in midwife-led units co-located with obstetric units, increasing birthplace choice for pregnant women but also describes variation in availability of staff, facilities and services.  The National Maternity and Perinatal Audit (NMPA) is the largest evaluation of NHS maternity and neonatal services undertaken in Britain. It aims to help maternity and neonatal services to identify good practice and areas for improvement in the care of women and babies.

National Heart Failure Audit 2015-16 published

Improvements in patient care mean hundreds more people are surviving heart failure, a new independent study has found.

The National Heart Failure Audit 2015-16, published by the British Society of Heart Failure has found that the mortality rate for people admitted to hospital with heart failure has dropped from 9.6 per cent to 8.9 per cent. The reduction in the mortality rate means that in the region of 500 lives have been saved in the past year compared to 2014/15.

Thursday, 10 August 2017

Loneliness Epidemic Growing into Biggest Threat to Public Health

Loneliness and social isolation could be a greater public health hazard than obesity, and their impact will continue to grow, according to research presented at the 125th annual convention of the American Psychological Association.

“Being connected to others socially is widely considered a fundamental human need — crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment,” said Julianne Holt-Lunstad, Ph.D., a professor of psychology at Brigham Young University.

Cost-Benefit Analysis Favors Intensive Early Intervention for Autism

Early therapeutic intervention is considered best practice for children with an autism spectrum disorder. But many insurance carriers and agencies are reluctant to pay for the care.

New research suggests the costs associated with the intensive treatment are quickly recovered as the children will need less services over time.

Autism spectrum disorder (ASD) affects one in every 68 children in the United States. The neuro-developmental disorder presents as difficulty socializing and communicating needs and desires, and often is accompanied by restricted interests or activities.

Stress at work is 'causing' poor mental health in men

Men are more likely to blame work for mental health problems than women, according to a new report.

32% of men with poor mental health said work was responsible for their illness, compared to just 14% of women.

Charity Mind surveyed 15,000 people across the UK about the impact of their workplace.

30 organisations across the UK took part including Jaguar Land Rover, PepsiCo, Deloitte and Barnardo's.

Only 29% of men surveyed said they'd taken time off work due to mental health issues, compared to 43% of women.

Lidocaine with propofol to reduce pain on injection

New from BestBETs:

Lidnocaine pre-treatment or mixed with propofol reduced pain at the injection site. Further research is however required to see how much of this effect is that of lidocaine alone or the change in propofol formulation.

Larotrectinib (LOXO-101) for advanced solid cancers [with an NTRK1, NTRK2, or NTRK3 gene fusion]

Due to new technologies, rearrangement of genes in cells can be discovered which result in two normally separate genes being brought together (a fusion), which can cause abnormalities in control of cell growth leading to development of solid tumor cancers. Fusions of a family of normal genes called NTRK have been found to cause normal cells to become cancerous and can happen in cells of both adults and children. Many different solid tumor cancers have NTRK fusions. Blocking the activity of these fusions with an oral drug called larotrectinib can be a new method of cancer treatment.

From the NIHR Innovation Observatory

Atezolizumab (Tecentriq) and Cobimetinib (Cotellic) for advanced/metastatic colorectal cancer - third line

The combination of atezolizumab (Tecentriq), given by injection, and cobimetinib (Cotellic), given orally, is being developed to increase the options available for the treatment of mCRC. This treatment combination will target people that have received at least two previous treatments and did not show any improvements or who initially benefitted but whose disease has since progressed. It is thought that this treatment combination will increase the survival rates for people with mCRC.
From the NIHR Innovation Observatory

Pemetrexed for the maintenance treatment of non-small-cell lung cancer [TA190]

New NICE technology appraisal guidance on pemetrexed disodium (Alimta) for the maintenance treatment of non-small-cell lung cancer.

Pemetrexed is recommended as an option for the maintenance treatment of people with locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous cell histology if disease has not progressed immediately following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.

Biopatch for venous or arterial catheter sites

Medt ech innovation briefing on Biopatch for venous or arterial catheter sites.

The technology described in this briefing is Biopatch. It is a hydrophilic foam dressing impregnated with chlorhexidine gluconate (CHG), and is used for covering central venous or arterial catheter sites.

The innovative aspects are that it releases CHG to reduce the risk of catheter-related bloodstream infections (CRBSIs), while the absorbent foam draws discharge away from the catheter site.

Baricitinib for moderate to severe rheumatoid arthritis - guidance (TA466)

New technology appraisal guidance from NICE on baricitinib (Olumiant) for moderate to severe rheumatoid arthritis in adults.

Baricitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs), only if:
  • disease is severe (a disease activity score [DAS28] of more than 5.1) and
  • the company provides baricitinib with the discount agreed in the patient access scheme.

Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma - guidance (TA465)

New technology appraisal guidance from NICE on olaratumab (Lartruvo) plus doxorubicin for treating advanced soft tissue sarcoma in adults.

Olaratumab, in combination with doxorubicin, is recommended for use within the Cancer Drugs Fund as an option for advanced soft tissue sarcoma in adults, only if:
  • they have not had any previous systemic chemotherapy for advanced soft tissue sarcoma
  • they cannot have curative treatment with surgery or their disease does not respond to radiotherapy
  • the conditions in the managed access agreement for olaratumab are followed.

Cabozantinib for previously treated advanced renal cell carcinoma - guidance (TA463)

New technology appraisal guidance on cabozantinib (Cabometyx) for previously treated advance renal cell carcinoma (kidney cancer) in adults.

Cabozantinib is recommended, within its marketing authorisation, as an option for treating advanced renal cell carcinoma in adults after vascular endothelial growth factor (VEGF)-targeted therapy, only if the company provides cabozantinib with the discount agreed in the patient access scheme.

Asfotase alfa for treating paediatric-onset hypophosphatasia - guidance (HST6)

New Highle Specialised Technologies Guidance from NICE on asfotase alfa (Strensiq) for treating paediatric-onset hypophosphatasia in adults and children.

Asfotase alfa is recommended as an option for treating paediatric-onset hypophosphatasia only:
  • for people who meet the criteria for treatment within the managed access arrangement (see section 4.18), and
  • for the duration of this arrangement and in line with the other conditions it specifies, and
  • when the company provides asfotase alfa with the confidential commercial terms agreed with NHS England.

Hysteroscopic sterilisation by insertion of intrafallopian implants - guidance (IPG587)

New interventional procedures guidance on hysteroscopic sterilisation by insertion of intrafallopian implants in adults.

Current evidence on the safety and efficacy of hysteroscopic sterilisation by insertion of intrafallopian implants is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance and audit.

Transcatheter aortic valve implantation for aortic stenosis - guidance (IPG586)

New NICE interventional procedures guidance on using transcatheter aortic valve implantation (TAVI) for aortic stenosis. This involves inserting a new valve through a catheter, usually by way of a large blood vessel at the top of the leg, into the heart and inside the existing faulty valve.

Current evidence on the safety and efficacy of transcatheter aortic valve implantation (TAVI) for aortic stenosis is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

Laparoscopic insertion of a magnetic titanium ring for gastro-oesophageal reflux disease - guidance (IPG585)

New interventional procedures guidance from NICE on the laparoscopic insertion of a magnetic titanium ring for gastro-oesophageal reflux disease (GORD) in adults.

Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care - guidance (DG30)

New diagnostics guidance from NICE on quantitative faecal immunochemical tests (OC Sensor, HM-JACKarc and FOB Gold) to guide GP referral for colorectal cancer.

The OC Sensor, HM‑JACKarc and FOB Gold quantitative faecal immunochemical tests are recommended for adoption in primary care to guide referral for suspected colorectal cancer in people without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway referral outlined in NICE's guideline on suspected cancer (recommendations 1.3.1 to 1.3.3).

Results should be reported using a threshold of 10 micrograms of haemoglobin per gram of faeces. Companies should provide advice about the performance characteristics of the assays to laboratories, and ensure standardisation of results

Transforming the NHS through second-order change

The NHS is facing unprecedented financial and service pressures and radical change is needed to transform the delivery of health and care services to meet the challenges of the future.

While there are many examples of first-order change – which sees variations in practice within an existing system – in health services, there are fewer examples of second-order change where more transformative change creates new ways of seeing and doing things.

This brefing from The King's Fund talks to Matthew Lewis and Julia Fernando about their work on second-order change, which includes a project to explore the barriers to and enablers for delivering this scale of change.

Accountable care organisations (ACOs) explained

Briefing from the King's Fund about accountable care organisations (ACOs). NHS England has recently outlined ambitions for sustainability and transformation partnerships (STPs) to evolve into ‘accountable care systems’ (ACSs), and proposed that these ACSs might become ACOs but only after ‘several years’. Eight areas of England have now been identified to lead their development. They comprise three core elements.

First, they involve a provider or, more usually, an alliance of providers that collaborate to meet the needs of a defined population. Second, these providers take responsibility for a budget allocated by a commissioner or alliance of commissioners to deliver a range of services to that population. And third, ACOs work under a contract that specifies the outcomes and other objectives they are required to achieve within the given budget, often extending over a number of years.

Liver cancer drug, sorafenib has been approved for routine NHS use

Liver cancer drug, sorafenib has been approved by NICE, as part of the Cancer Drugs Fund, for routine NHS use for Hepatocellular carcinoma (advanced and metastatic) - sorafenib (first line).

Developmental follow-up of children and young people born preterm [NG72]

This new NICE guideline covers the developmental follow-up of babies, children and young people under 18 years who were born preterm (before 37+0 weeks of pregnancy). It explains the risk of different developmental problems and disorders, and specifies what extra assessments and support children born preterm might need during their growth and development.

It also says that neonatal physiotherapists should be helping to provide developmental support and surveillance assessments to prematurely born children, during the first two years of their lives.

Collagenase clostridium histolyticum for treating Dupuytren's contracture - guidance (TA459)

New Technology Appraisal Guidance from NICE on using collagenase clostridium histolyticum (Xiapex) for treating Dupuytren’s contracture in adults.

People who meet the inclusion criteria for the ongoing clinical trial (HTA-15/102/04), comparing collagenase clostridium histolyticum (CCH) with limited fasciectomy, are encouraged to participate in the study.

For people not taking part in the ongoing clinical trial, CCH is recommended as an option for treating Dupuytren's contracture with a palpable cord in adults only if all of the following apply:
  • There is evidence of moderate disease (functional problems and metacarpophalangeal joint contracture of 30° to 60° and proximal interphalangeal joint contracture of less than 30° or first web contracture) plus up to 2 affected joints.
  • Percutaneous needle fasciotomy (PNF) is not considered appropriate, but limited fasciectomy is considered appropriate by the treating hand surgeon.
  • The choice of treatment (CCH or limited fasciectomy) is made on an individual basis after discussion between the responsible hand surgeon and the patient about the risks and benefits of the treatments available.
  • One injection is given per treatment session by a hand surgeon in an outpatient setting.

Adalimumab and dexamethasone for treating non-infectious uveitis - guidance (TA460)

New NICE Technology Appraisal Guidance on using adalimumab (Humira) and dexamethasone (Ozurdex) for treating non-infectious uveitis in adults

Adalimumab is recommended as an option for treating non-infectious uveitis in the posterior segment of the eye in adults with inadequate response to corticosteroids, only if there is:
  • active disease (that is, current inflammation in the eye) and
  • inadequate response or intolerance to immunosuppressants and
  • systemic disease or both eyes are affected (or 1 eye is affected if the second eye has poor visual acuity) and
  • worsening vision with a high risk of blindness (for example, risk of blindness that is similar to that seen in people with macular oedema).

Roflumilast for treating chronic obstructive pulmonary disease - guidance (TA461)

New NICE Technology Appraisal Guidance on using roflumilast (Daxas) for treating chronic obstructive pulmonary disease (COPD) in adults with chronic bronchitis.

Roflumilast, as an add-on to bronchodilator therapy, is recommended as an option for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis, only if:
  • the disease is severe, defined as a forced expiratory volume in 1 second (FEV1) after a bronchodilator of less than 50% of predicted normal, and
  • the person has had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid.

Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma [TA462]

New NICE Technology Appraisal Guidance on using nivolumab (Opdivo) for treating relapsed or refractory classical Hodgkin lymphoma in adults.

Nivolumab is recommended, within its marketing authorisation, as an option for treating relapsed or refractory classical Hodgkin lymphoma in adults after autologous stem cell transplant and treatment with brentuximab vedotin, when the company provides nivolumab with the discount agreed in the patient access scheme.

Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane - guidance (TA458)

New Technology Appraisal Guidance on using trastuzumab emtansine (Kadcyla) for human epidermal growth factor receptor 2 (HER2)‑positive, unresectable, locally advanced or metastatic breast cancer in adults who have had trastuzumab and a taxane.

Patients should have either received prior therapy for locally advanced or metastatic disease or developed disease recurrence during or within 6 months of completing adjuvant therapy. Trastuzumab emtansine is recommended only if the company provides it in line with the commercial access agreement with NHS England.

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Carfilzomib for previously treated multiple myeloma (TA457)

New Technology Appraisal Guidance from NICE on using carfilzomib (Kyprolis) for treating multiple myeloma in adults.

Carfilzomib in combination with dexamethasone is recommended as an option for treating multiple myeloma in adults, only if:
  • they have had only 1 previous therapy, which did not include bortezomib and
  • the company provides carfilzomib with the discount agreed in the patient access scheme.

Parkinson’s disease in adults (NG71)

This new NICE guideline covers diagnosing and managing Parkinson's disease in people aged 18 and over. It aims to improve care from the time of diagnosis, including monitoring and managing symptoms, providing information and support, and palliative care. It includes recommendations on:

Bisphosphonates for treating osteoporosis [TA464]

New Technology Appraisal Guidance from NICE on the bisphosphonates alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid for treating osteoporosis.

What are the priorities for health and social care?

As the dust settles on the first weeks of the new parliament and ahead of the party conference season, The King's Fund assesses the state of health and social care and set out the big issues facing the government.

Wednesday, 9 August 2017

Updates to the Single Oversight Framework: share your views

NHS Improvement is updating the Single Oversight Framework (SOF) to reflect feedback, changes in national policy priorities and developments in their oversight approach.

Tell them what you think of our proposed updates and whether they are clear, reasonable and practicable.

1,500 extra medical undergraduate places confirmed

DH has published the government response to the recent consultation on expanding undergraduate medical education.

The government will increase the number of student places at medical schools in England by 1,500.

NHS hospitals to be assessed on how they use their resources from the autumn

Earlier this year and together with NHS Improvement, we sought your views on our joint plans to assess how NHS hospital (non-specialist acute) trusts use their resources.

The framework sets out the key lines of enquiry, prompts and rating characteristics that both CQC and NHS Improvement will use to review how effectively trusts are using their resources to provide high quality, efficient and sustainable care. As well as finance, it will include a review of workforce, estates and facilities.

The 'use of resources' assessments will be introduced from the autumn and will be carried out by NHS Improvement alongside scheduled inspections looking at the quality and safety of care, led by CQC. Following the assessment, NHS Improvement will produce a report with recommendations for improvement, if required and it will propose a 'use of resources' rating of outstanding, good, requires improvement or inadequate to CQC.

See the assessment framework from NHS Improvement.

Her2 Challenge Contest: A Detailed Assessment of Automated Her2 Scoring Algorithms in Whole Slide Images of Breast Cancer Tissues

Histopathology. 2017 Aug 3. doi: 10.1111/his.13333. [Epub ahead of print]

This paper presents a benchmark for comparing the performance of automated algorithms for scoring of Her2. It also demonstrates the enormous potential of automated algorithms in assisting the pathologist with objective IHC scoring. 

UHCW Research: D. Snead, N. Raipoot

Issues to consider when implementing pharmacy access to local electronic health records (EHRs)

This briefing, from the Pharmaceutical Services Negotiating Committee (PSNC), outlines a list of issues to be considered by Local Pharmaceutical Committees (LPCs) and community pharmacy contractors when pharmacy access to local electronic health record systems is being planned.

Conflicts of interest joint statement

Today, the Chief Executives of the statutory regulators of health care professionals have issued a joint statement on ‘conflicts of interest’. It sets out expectations of nurses and midwives as well as other health and care professionals in relation to avoiding, declaring and managing conflicts of interest across healthcare settings.

Intermediate Care

This paper, from SCIE, sets out evidence to guide the growth of intermediate care. It looks at why the development of intermediate care requires fresh impetus, sets out learning points that can guide its development and provides case studies covering reablement and bed-based intermediate care.

Quality assurance for apprenticeships confirmed

The Institute for Apprenticeships (IfA) has confirmed the arrangements for the delivery of external quality assurance (EQA) of apprenticeship end-point assessments to ensure they are effective, consistent and fit for purpose.

Integrating care: contracting for accountable models NHS England

NHS England has published information on contractual arrangements for accountable care organisations.

This package clarifies how accountable models may be contracted for, how local areas would approach procurement questions and the application of the new Integrated Support and Assurance Process, run by NHSE and NHSI in relation to the award of all novel or complex procurements by commissioners. It sets out the funding model including the details of integrated budget approaches, a new Improvement Payment Scheme to replace current incentive schemes and gain/loss sharing across the local health economy to align incentives. Finally, the package describes implications for the commissioning system of new models of whole population provision.

Equality and diversity mapping exercise 2017

NHS Employers is working with NHS England to gather information from trusts to:
  • understand what the capacity is within NHS organisations to deliver against the various equality and diversity standards and mandates across England
  • identify key trends, developments, issues and gaps
  • assess how we can better support you to meet your requirements under the Equality Act 2010.

General Data Protection Regulation - will you be ready?

From 25 May 2018, all health organisations and arm's-length bodies will need to demonstrate compliance with new General Data Protection Regulation (GDPR) requirements. GDPR will replace the Data Protection Directive (1995).

Employers are encouraged to plan ahead for the operational changes and consider how they will raise awareness of the new requirements and evidence they meet them. This will include:
  • Planning and resourcing the appointment of a data protection officer whose job description is compliant with GDPR requirements.
  • Revising information governance and related policies, addressing accountability, data protection officer reporting arrangements and statutory reporting requirements.
  • Creating an action/project plan which includes a set of measures to meet the requirements, ideally endorsed by the board.

Diabetes drug may be helpful for Parkinson's disease

"A drug commonly used to treat diabetes could help those living with Parkinson's disease," The Guardian reports. A small study suggests a drug called exenatide may have a modest beneficial effect on motor (movement) symptoms in people with Parkinson's disease.

Exenatide is known as a GLP-1 agonist, used to help regulate blood sugar levels in people with diabetes. Previous, early-stage research also suggests it may help protect nerves against damage, which is the root cause of Parkinson's.

The study looked at changes to people's movement ("motor") ability when given either an injection of exenatide or a placebo injection. The people in the study had their motor ability assessed by a well-validated scoring tool before taking the drug, at various points during the trial, and 12 weeks after they were last treated.

New framework for eye health

The Clinical Council for Eye Health Commissioning (CCEHC), which represents the major clinical professions and charity organisations in the eye-care sector, has launched a new low vision, habilitation and rehabilitation framework for adults and children.

The framework – mainly aimed at commissioners and providers in health and social care – calls for more joined-up commissioning and provision of appropriate equipment.

A journey to improved staff engagement

A new case study, from NHS Employers, looking at how Imperial College Healthcare NHS Trust has significantly improved their staff engagement levels using new and innovative methods.

Through engaging with staff to understand more about how they are feeling at work, engagement levels have improved from the 2015 score of 3.71 to 3.8 in 2016, which was the largest year-on-year increase of all acute trusts in London.

Screening consultation on rare but serious condition in babies

Consultation launched on whether screening for Severe Combined Immune Deficiency (SCID) in babies should be tried within the NHS.

Mid Yorks NHS Trust adopts physio-designed training to prevent falls

Mid Yorkshire Hospitals NHS Trust has launched falls prevention training for staff which recreates real-life situations in allocated sections of actual wards and clinics.

The aim of the training is to reduce preventable falls and improve staff confidence in managing people who have fallen.

GIRFT: national general surgery report

The report found that reducing unwarranted variations between hospitals in areas such as effective procedures, length of stay, infection rates and procurement costs will improve patient outcomes and help the NHS save £160 million in efficiencies each year.

Pancreatic cancer patients to have routine access to life extending drug after new deal

NICE has recommended nab-paclitaxel for routine NHS use after the company agreed a confidential price discount and provided more evidence on its effectiveness.

NHS England announces world’s largest single PrEP implementation trial to prevent HIV infection

NHS England has announced the start of a pioneering implementation trial to provide HIV prevention drugs to people at high risk of HIV infection.

From September, pre-exposure prophylaxis (PrEP) will now be provided by the NHS through the initial three year trial to an estimated 10,000 people, in what will be the largest single study of its type in the world. Whilst HIV infection rates in England are falling due to increased prevention, diagnosis and treatment programmes, this major new NHS-England funded intervention will now assess the full additional potential of PrEP, by gathering clinical evidence on optimal targeting, uptake and implementation on a large scale.

NIHR research and impact annual data for UHCW

NIHR annual data for the period 2016/17 for UHCW

Knee Replacement; New study recommends alternative pain relief for knee replacement patients

Biotech Week; Atlanta (Aug 9, 2017): 200.

A new study led by researchers at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust and the University of Warwick has recommended an alternative method of pain relief for patients undergoing knee replacement surgery.

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

The Breast, Volume 35, October 2017, Pages 182-190

The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK.

UHCW Research: Joanna M. Skillman

Athletic identity, compulsive exercise and eating psychopathology in long-distance runners

Eating Behaviors (EAT BEHAV), Aug2017; 26: 129-132

Having a high athletic identity is thought to increase vulnerability for compulsive exercise and Eating Disorder (ED) psychopathology. This study examined whether there is an association between athletic identity and levels of compulsive exercise and ED psychopathology in long-distance runners. A sample of 501 long-distance runners completed the Athletic Identity Measurement Scale (AIMS), Compulsive Exercise Test (CET) and Eating Disorders Examination Questionnaire (EDEQ). There was a significant positive association between participants' AIMS and total CET scores (moderate effect size; r=0.34 for males and 0.33 for females). BMI did not influence the relationship between AIMS and CET scores in males. However, for females, AIMS scores were positively associated with levels of Weight Control Exercise when covarying for BMI (small to moderate effect size, r=0.22). No significant associations with EDEQ scores were found (negligible to small effect sizes; r=0.06 for males and r=0.14 for females). Following replication, coaches might need to be vigilant to the welfare of endurance runners that have a strong athletic identity, since this could be linked to them exercising compulsively. Future work should examine whether having a strong athletic identity predicts ED psychopathology when this identity is challenged (e.g., due to injury).

UHCW Research: Caroline Meyer

Bipolar Employees Can Face Major Challenges In The Workplace

New research finds that workplace environments may be unsupportive for people with bipolar disorder who may find themselves unemployed due to exclusion, stigma and stereotypes.

These workers had to disclose their condition to co-workers and employers to receive special accommodations or more support, but often the outcomes were negative, say researchers at the University of Michigan and the University of California, Los Angeles.

“Our findings suggest disclosure may risk job security,” said Lisa O’Donnell, the study’s lead author and a former doctoral student at U-M’s School of Social Work.

The study examined the relationship between social stressors at work such as isolation, conflict with others and stigmas, and how a person functions on the job.

Mood Stabilizing Medications an Effective Option for Older Adults with Bipolar Disorder

Two standard medications for bipolar disorder were effective in controlling symptoms at doses tailored to older people in a clinical trial of treatment in adults over age 60. The findings are an important step towards filling an existing gap in evidence-based guidance for treatment of bipolar disorder in older adults.

People with bipolar disorder experience marked shifts in mood and energy; manic episodes are a hallmark of the illness. Mania is associated with severe disability and can be life-threatening. The disorder affects an estimated 2.6 percent of Americans, including older adults. While mood stabilizing drugs can be very effective in treating mania, changes accompanying aging and co-occurring illness can make some older adults more susceptible to side effects of medications. Lithium, one of the medications tested in this study, is a mainstay drug for bipolar disorder, but older patients may not tolerate the doses used in younger individuals. This study sought to provide information on the effectiveness of lithium or a traditional alternative, divalproex, in older adults.

Increased brain acidity in psychiatric disorders

Decreased brain pH in the patients with schizophrenia and bipolar disorder has been considered to be the result of secondary factors associated with the diseases, such as medication and agonal state. However, the researchers of the present study suggest that decreased brain pH is a primary feature of the diseases themselves, based on the current findings from systematic investigation using five animal models, which are devoid of such secondary factors.Read more HERE

Friday, 4 August 2017

Wellbeing in mental health: applying All Our Health

Evidence and guidance from Public Health England to enable healthcare professionals to make improvements against wider factors that affect health and wellbeing in mental health.

Dementia: applying All Our Health

Evidence and guidance from Public Health England to help healthcare professionals maximise their contribution to supporting the health, wellbeing and independence of people with dementia.

Mental health patients stranded in units for years

Mental health patients across the UK are spending years stranded in acute units awaiting discharge, figures show.

Over the past two years, at least 91 patients have waited more than a year to be discharged, with at least seven patients waiting more than two years.

At least 320 patients had to wait at least 100 days to be discharged, BBC Freedom of Information requests show.

Experts say a lack of suitable accommodation and wrangling over budgets are to blame for the delays.

15 year old leads campaign to improve mental health services in Worcestershire

Darian found that his friends and peers were struggling with their mental health and didn't know where to go for support. Concerned, he decided to do something about it.

Along with the Worcestershire Youth Cabinet he chaired, Darian developed a campaign to find out more about people’s experiences of mental health and how health and care services can improve to meet people's needs.

Flexibility For Who? Millennials and mental health in the modern labour market

Younger workers face a future employment landscape that could damage their mental health and wellbeing unless we take action.

As a result of the evolution of the UK labour market over the past 25 years, today’s generation of younger workers - millennials and centennials (those born during or after 1982) – risk losing out on access to permanent, secure and fulfilling work. Compared to previous generations, they are more likely to be in work characterised by contractual flexibility (including part-time work, temporary work and self-employment). Relatedly, they are also more likely to be underemployed (and so be working fewer hours than they would like) and/or overqualified (being a graduate in a non-professional or managerial job).

Fair shares - a guide to NHS allocations

This set of infographics summarises data on NHS England's funding allocations to CCGs and commissioning areas in a digestible format. The slides also outline the rationale behind the funding formula used to calculate funding allocations.

HCPC publishes Education annual report 2016

The Health and Care Professions Council (HCPC) has published its Education annual report covering the period of 1 September 2015 to 31 August 2016. This report provides statistical information and analysis and is designed to highlight key trends and what caused them, in particular important developments in the education sector.

Re-employment of staff in receipt of NHS pension scheme benefits

This DH document provides guidance on how to consider applications from staff wishing to retire and return to work for the NHS. It aims to help employers put in place policies and procedures so that decisions to re-employ staff can be justified in terms of service need and value for money.

Seven day hospital services: autumn 2017 survey (clinical standard 2 only)

The spring 2017 survey showed that providers are making progress towards meeting all four priority clinical standards for seven day hospital services.

As clinical standard 2 remains the most challenging to implement, for the autumn 2017 survey we'll only measure you on this standard. The data collection will run between 20 September and 18 October 2017 and the submission deadline is midnight, Wednesday 29 November 2017.

Developing trusted assessment schemes: ‘essential elements’

Through the use of a trusted assessor, we can reduce the numbers and waiting times of people awaiting discharge from hospital and help them to move from hospital back home or to another setting speedily, effectively and safely.

This guide from NHS Improvement describes how local systems could implement trusted assessment. It is for each local system, including all parties involved in a trusted assessor scheme, to agree how that scheme will operate and be funded and implemented.

Nasogastric tube misplacement: continuing risk of death and severe harm

A stage two alert has been issued to support providers of NHS-funded care to prevent the risk of severe harm or death caused by the misplacement of nasogastric tubes (NG tubes).



RCoA/NIHR Research Awards 2017

The RCoA is pleased to announce three joint awards in conjunction with the National Institute for Health Research (NIHR) Clinical Research Network (CRN). The awards are designed to recognise NHS clinicians (consultants and trainees) who are making outstanding contributions to clinical research, particularly in relation to NIHR CRN portfolio research studies.

Applicants must be NHS clinicians (clinical academics are not eligible) and must be a fellow or member of the RCoA. Clinicians can enter under one of three categories: consultant (including SAS), trainee (individual) and a new trainee network category.

Each award carries a £1,000 prize. Complete this short application form to apply. The deadline for applications is midnight on Friday 3 November 2017.

The State of Patient Experience 2017: A Return to Purpose

The full research report from the Beryl Institute's latest benchmarking study provides insights into trends in structure and practice, leadership and measurement and offers core considerations for organizations looking to lead in experience excellence. The largest research of its kind, the study engaged almost 1,700 respondents from 26 countries representing six continents sharing the challenges and opportunities they are facing and the steps they are taking to address the patient experience.

According to the research:
  • Experience efforts are expanding and are now an integral part of the fabric of our healthcare efforts.
  • Patient experience remains a top priority with a focus on employee engagement now seen as a central driver in experience efforts.
  • Leadership and culture are now the significant motivators versus the historic focus on mandates and requirements, and there is a recognition of the impact that patient/family voice and caregiver engagement has on the work of healthcare.
  • Patient experience itself continues to establish presence with the role of patient experience leaders, experience team size and the use of a formal definition on the rise.
  • Patient experience is now being recognized as an integrated effort touching on much of what we do in healthcare and one that drives clear and measurable outcomes.

Immigration health surcharge: removal of assisted conception services

Amendments to the NHS (Charges to Overseas Visitors) Regulations 2015 were introduced into Parliament on 19 July 2017.

As a result, from 21 August 2017, assisted conception services will no longer be included in the scope of services available for free for those who pay the immigration health surcharge. CCGs should update their online and publicly available policies in this area, to ensure potential users of these services are aware of the changes. Further information can be found in the explanatory memorandum for these regulations. 

New case study - how trust wide engagement has encouraged speaking up

NHS Employers has worked with York Teaching Hospital NHS Foundation Trust to find out how by engaging with staff across multiple sites, they've successfully promoted awareness about raising concerns and the role of their Freedom to Speak Up guardian, Lisa Smith.

Find out how Lisa used flu clinics and inductions to speak to staff, and how alongside her trust, she plans to introduce Schwartz rounds in our new shared learning example.

New case study on improving new starter turnover

NHS Employers has published a new case study looking at how East Kent Hospitals University NHS Foundation Trust teams has worked to improve experience for staff in their first year of employment.

The team improved the overall on-boarding experience including starting induction to the role before day one and introducing an online portal for new starters. This work has resulted in an improvement in new starter turnover of nearly 20 per cent.

Gene editing used to repair diseased genes in embryos

"Deadly gene mutations removed from human embryos in landmark study," reports The Guardian. Researchers have used a gene-editing technique to repair faults in DNA that can cause the often-fatal heart condition, hypertrophic cardiomyopathy.

This inherited heart condition is caused by a genetic change (mutation) in one or more genes. Babies born with hypertrophic cardiomyopathy have diseased and stiff heart muscles, which can lead to sudden unexpected death in childhood and in young athletes; often because they don't realise they have the condition and so put their heart under strain when exercising.

In this latest study researchers used a technique called CRISPR-cas9 to target and then remove faulty genes. CRISPR-cas9 acts like a pair of molecular scissors, allowing scientists to cut out certain sections of DNA. The technique has attracted a great deal of excitement in the scientific community since it was released in 2014. But as yet, there have been no practical applications for human health.

Position Statement: breastfeeding in the UK

This guidance, from the RCPCH gives advice on how long women should consider breastfeeding. It also sets out the health benefits of breastfeeding for mother and child, and the cost savings to families and health services.

Barometer on change 2017

This report, from Morehouse Consulting, examines the challenges faced by service leaders and finds that the pressure for organisations to meet customer demands is at a high. Technological innovation has changed the expectations of customers and also raised the bar for quality of services and products. The report looks across all sectors of the service market and highlights industry-specific challenges for the health and care sector and the pharmaceutical sector.

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Breast. 2017 Jul 30;35:182-190. doi: 10.1016/j.breast.2017.07.016. [Epub ahead of print]

The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK.

The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored.

UHCW Research: Skillman JM

A playbook for fostering hospital-community partnerships to build a culture of health

This guidance, from the American Hospital Association, outlines a range of methods, tools and strategies to help create and sustain partnerships between hospitals and communities in order to create a culture of health. The guidance also uses insights from cohorts of a pilot programme on how to manage, strengthen and accelerate collaborations effectively.

Improving the working environment for safe surgical care

This discussion paper from the Royal College of Surgeons of Edinburgh, outlines a number of critical recommendations to government to greatly improve safety in the delivery of surgical treatment and patient care. The report notes factors adversely affecting morale, including a lack of team structure, poor communication, high stress levels, and limited training opportunities. The report also records how staff, at times, feel diverted away from the patient-centred care they strive to deliver because of administrative and IT issues, and believe that being more innovative and efficient with existing resources could make a positive difference.

Hexavalent 6-in-1 vaccine to be made available to newborn babies

All babies born on or after 1 August 2017 will be offered protection against hepatitis B as part of our universal childhood immunisation programme, Public Health England has announced. This is in addition to continued protection against diphtheria, tetanus, pertussis, polio and Hib.

Member briefing: Brexit

This briefing from National Voices explains the priority areas of concern for the health and care sector as Britain leaves the European Union, and explains the role the Brexit Health Alliance is seeking to play.

See also Patients 'at risk' in Brexit negotiations, from the Brexit Health Alliance.  It has five collective 'asks' as the UK negotiates to exit the EU:
1. Maximum levels of research and innovation collaboration
2. Regulatory alignment for the benefit of patients and population health
3. Preservation of reciprocal healthcare arrangements
4. Robust coordination mechanisms on public health and wellbeing
5. A strong funding commitment to the health and public health sectors

See also What impact will Brexit have on the health and social care workforce? from The King's Fund