'There are many millions of papers of clinical research — approximately 1 million papers from clinical trials have been published to date, along with tens of thousands of systematic reviews — but most of them are not useful.'
This is the central message of an essay by John Ioannidis in the open-access journal PLoS Medicine. Below are two extracts, citation, and abstract.
CITATION: Ioannidis JPA (2016) Why Most Clinical Research Is Not Useful. PLoS Med 13(6): e1002049. doi:10.1371/journal.pmed.1002049. Published: June 21, 2016
Thursday, 30 June 2016
British Social Attitudes Survey 33
This British Social Attitudes report from the National Centre for Social Research aims to uncover the consequences of seven years of austerity for social and political attitudes in Britain. The chapter on the NHS explores levels of dissatisfaction with the NHS and how this has changed over time and in relation to trends in NHS funding. It examines new data identifying the reasons for NHS dissatisfaction and satisfaction.
New edition of HCPC In Focus
In this issue of In Focus, the HCPC takes an in depth look at standard seven of our recently revised Standards of conduct, performance and ethics, and explain our expectations of registrants in terms of reporting and escalating concerns.
We also provide an update on the government's intention to create a new body for social work and take an initial look at an upcoming consultation to reform health and care professional regulation.
We also provide an update on the government's intention to create a new body for social work and take an initial look at an upcoming consultation to reform health and care professional regulation.
More than a million alcohol-related hospital admissions in 2014-15
There were an estimated 1.09 million hospital admissions for which an alcohol-related disease, injury or condition was the primary reason for admission or a secondary diagnosis, in 2014-15, compared to 1.06 million in 2013-14.
The figures, released today by the Health and Social Care Information Centre, also show that men account for the majority of these admissions (65 per cent) compared to women (35 per cent).
The figures, released today by the Health and Social Care Information Centre, also show that men account for the majority of these admissions (65 per cent) compared to women (35 per cent).
SMI B 14: Investigation of pus and exudates
UK Standards for Microbiology Investigations B 14: Investigation of pus and exudates.
Health care is a people business but is the NHS approach to workforce fit for purpose?
The Health Foundation’s report, Fit for Purpose? provides an overview of NHS workforce policy in England and calls for an overhaul in how the NHS plans, trains, regulates, pays and, most importantly, supports its people.
Supporting integration through new roles and working across boundaries
This new report from the King's Fund, commissioned by NHS Employers and the Local Government Association, looks at the evidence on new roles and ways of spanning organisational workforce boundaries to improve the delivery of integrated health and social care.
NMC updates guidance on language tests
The Nursing and Midwifery Council (NMC) has updated its guidance on how the international English language testing system requirements can be achieved by nurses and midwives trained outside of the European Economic Area (EEA).
All overseas applicants are still required to achieve a level of at least seven (out of a possible nine) in all categories - listening, reading, writing and speaking - of the academic version of the IELTS test.
Getting young people involved with health research
Up and down the country, local Healthwatch are finding new ways to make sure people get to share their views of health and care. This case study looks at Healthwatch Dudley’s award winning approach to listening to young people.
New draft guideline AAGBI Guidelines: Safer pre-hospital anaesthesia
A new draft guideline on pre-hospital anaesthesia is in its final draft stage and comments are invited from members. Please read the draft below and submit comments to workingparties@aagbi.org.
New evidence-based practice resource for AHPs goes online
Evidence for Everyday Allied Health, a series of resources from the research organisation Cochrane UK has been launched.
Waiting Time Policies In The Health Sector
The main purpose of this briefing from the Office for Health Economics is to discuss waiting time policies in the health sector from an international perspective and to highlight which policies have worked in the last decade in OECD countries. It also looks at how to compare waiting times internationally and where the UK stands in those international figures.
The future of pathology services
The future of pathology services finds well-established opportunities for pathology to make substantial improvements in care for patients, and deliver savings estimated at £200m. Yet despite major reviews identifying these possibilities in 2006 and 2008, progress has been patchy
Wednesday, 29 June 2016
Mobi-C for cervical disc replacement
New NICE medtech innovation briefing (MIB) on Mobi-C for cervical disc replacement.
Mobi-C is a prosthetic device used for 1- or 2-level cervical disc replacement. It is designed for people with cervical disc degeneration. The evidence from 1 systematic review and 3 additional studies summarised in this briefing includes 1,675 individual patients and is of mixed quality. The systematic review concluded that Mobi-C is non inferior to anterior cervical discectomy and fusion (ACDF). The studies found that Mobi-C (at 1 or 2 levels) was more effective than ACDF for overall success and for reducing limitations of daily activity as a result of neck pain, and allowed a greater range of motion with less adjacent segment degeneration and less need for subsequent surgery. Each Mobi-C prosthesis costs £1,750 (excluding VAT).
Mobi-C is a prosthetic device used for 1- or 2-level cervical disc replacement. It is designed for people with cervical disc degeneration. The evidence from 1 systematic review and 3 additional studies summarised in this briefing includes 1,675 individual patients and is of mixed quality. The systematic review concluded that Mobi-C is non inferior to anterior cervical discectomy and fusion (ACDF). The studies found that Mobi-C (at 1 or 2 levels) was more effective than ACDF for overall success and for reducing limitations of daily activity as a result of neck pain, and allowed a greater range of motion with less adjacent segment degeneration and less need for subsequent surgery. Each Mobi-C prosthesis costs £1,750 (excluding VAT).
Cellvizio confocal endomicroscopy system for characterising pancreatic cysts
New NICE medtech innovation briefing (MIB) on the Cellvizio confocal endomicroscopy system for characterising pancreatic cysts.
Cellvizio is a confocal laser endomicroscopy (CLE) system with a fibre-optic probe for real-time imaging of tissues. It is designed for use as an adjunct to the standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedure, to characterise pancreatic cysts and provide additional information to help guide therapeutic decisions. The evidence summarised in this briefing comes from 2 feasibility and 3 pilot studies with a total of 138 adult patients. The diagnostic accuracy for Cellvizio was reported to be between 71% and 87% in 3 studies compared with histopathology, EUS-FNA or a committee consensus. In 2 studies, images were successfully obtained in all patients. In another study, images were successfully obtained in most (17 of 18) patients. The device was used to identify and validate new diagnostic criteria for pancreatic cyst types in 4 studies. The numbers of safety incidents in 2 Cellvizio studies were higher than reported in a previous EUS-FNA-only study. The main capital component of the Cellvizio system costs £79,000 with installation, commissioning and initial training costs of £2,145. Each fibre-optic miniprobe (AQ-Flex 19) can be used up to 10 times and costs £4,000. All costs are excluding VAT.
Cellvizio is a confocal laser endomicroscopy (CLE) system with a fibre-optic probe for real-time imaging of tissues. It is designed for use as an adjunct to the standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedure, to characterise pancreatic cysts and provide additional information to help guide therapeutic decisions. The evidence summarised in this briefing comes from 2 feasibility and 3 pilot studies with a total of 138 adult patients. The diagnostic accuracy for Cellvizio was reported to be between 71% and 87% in 3 studies compared with histopathology, EUS-FNA or a committee consensus. In 2 studies, images were successfully obtained in all patients. In another study, images were successfully obtained in most (17 of 18) patients. The device was used to identify and validate new diagnostic criteria for pancreatic cyst types in 4 studies. The numbers of safety incidents in 2 Cellvizio studies were higher than reported in a previous EUS-FNA-only study. The main capital component of the Cellvizio system costs £79,000 with installation, commissioning and initial training costs of £2,145. Each fibre-optic miniprobe (AQ-Flex 19) can be used up to 10 times and costs £4,000. All costs are excluding VAT.
Telehealth may help some people be more active after a heart attack
A variety of “telehealth” approaches may be worth considering for encouraging physical activity after a heart attack or heart surgery, suggests a review of published research. Cardiac rehabilitation and exercise programmes are well known to be effective in improving survival following a heart attack.
Typical cardiac rehabilitation programmes offer exercise classes, education about heart disease and healthier lifestyle, and approaches to reduce stress. Although rehabilitation is usually provided as group sessions in hospital settings, in the UK only about 45% of those eligible join schemes and many drop out. This review looked at 11 studies of telehealth from around the developed world that included telephone contact, text messages, email reminders or exercise-related phone apps for use at home compared with rehabilitation delivered at a centre.
Overall, the review found few studies comparing telehealth delivered programmes directly with centre-based rehabilitation, and the evidence was not strong enough to be confident of any difference on exercise levels or fitness outcomes. There was a modest benefit over usual care. People using telehealth delivered programmes appear to complete more sessions. There was no evidence to compare costs.
The study population, at an average age of 58, was young. Whether telehealth works for people who are older or less likely to use technology is yet to be tested.
From the NIHR Dissemination Centre
Typical cardiac rehabilitation programmes offer exercise classes, education about heart disease and healthier lifestyle, and approaches to reduce stress. Although rehabilitation is usually provided as group sessions in hospital settings, in the UK only about 45% of those eligible join schemes and many drop out. This review looked at 11 studies of telehealth from around the developed world that included telephone contact, text messages, email reminders or exercise-related phone apps for use at home compared with rehabilitation delivered at a centre.
Overall, the review found few studies comparing telehealth delivered programmes directly with centre-based rehabilitation, and the evidence was not strong enough to be confident of any difference on exercise levels or fitness outcomes. There was a modest benefit over usual care. People using telehealth delivered programmes appear to complete more sessions. There was no evidence to compare costs.
The study population, at an average age of 58, was young. Whether telehealth works for people who are older or less likely to use technology is yet to be tested.
From the NIHR Dissemination Centre
Positive and Proactive Care
New document form the Royal college of Nursing about reducing the need for restrictive interventions,
New single oversight framework launched to help NHS providers improve services
NHS Improvement has launched a consultation on a single oversight and improvement framework which is designed to help identify the support needs of both NHS trusts and foundation trusts.
Candida auris: laboratory investigation, management and infection prevention and control
Guidance from Public Health England for the laboratory investigation, management and infection prevention and control for cases of Candida auris (C. auris).
NICE: Suspected Cancer Recognition and Referral: Symptom Desk Easel
This resource from Cancer research UK summarises NICE’s 2015 referral guidelines for suspected cancer (NG12).
Revolutionising UK lung cancer management
An innovative method of carrying out lung biopsies at Barnet Hospital could free up hundreds of hospital beds and provide earlier lung cancer diagnosis by increasing tenfold the number of potentially life-saving tests carried out each year. Chest radiologist Dr Sam Hare explains why his team’s ambulatory lung biopsy method should be rolled out across the NHS
Tuesday, 28 June 2016
Promoting staff version of the friends and family test
NHS England has produced two video resources to support the promotion of the friends and family test for NHS staff.
Making an important space for hearing loss
The Ear Foundation has launched a website which brings together a wide range of practical resources and information available on hearing loss in one place.
SoundSpace Online aims to gather accessible information for people of all ages with hearing loss, their families, professionals ,policy makers and funders of services in the sector - or anyone interested in learning more about hearing loss.
Diabetic Eye Screening: Consent And Cohort Management
This document provides guidance on patient consent and cohort management within the NHS diabetic eye screening programme. It includes information about the provision and management of information; consent for screening; and consent for use of information throughout the screening pathway.
Hospital acquired foot ulcers reduced by 50 per cent since diabetes inpatient audit launched
Clinical audit shows a significant fall in foot ulcers but few changes in other patient harms and a continuing lack of specialist staff in many hospitals. Only 1.1 per cent of inpatients with diabetes developed a new foot lesion during their admission to hospital, a significant decrease from 2.2 per cent when inpatient auditing began in 2010.
Magnesium sulfate injection: converting between millimoles, milligrams and percentage w/v
Various methods of stating the concentration of magnesium sulfate injection on the labels of ampoules or vials are currently used and these may differ from the units used for stating doses. This Medicines Q&A aims to help minimise the risks involved with administering intravenous (IV) magnesium sulfate, by providing equivalences between the different units used for expressing doses and concentrations.
Manual for prescribed specialised services 2016/17
NHS England has published a revised version of the manual for prescribed specialised services, the technical document that sets out what NHS England and what CCGs commission in respect of specialised services.
The document has been updated to reflect services where commissioning responsibility has transferred from NHS England to CCGs and vice versa. A number of areas have also been clarified following feedback from stakeholders.
The document has been updated to reflect services where commissioning responsibility has transferred from NHS England to CCGs and vice versa. A number of areas have also been clarified following feedback from stakeholders.
NHS Innovation Accelerator 2016
NHS England has launched the NHS Innovation Accelerator 2016, a partnership programme which looks for the best national and international healthcare innovators.
NIA 2016 will focus on three challenges: prevention, early intervention and long-term conditions management. The deadline for submissions is 1 August 2016.
Latest staff sickness absence figures - February 2016
The latest figures released by the Health and Social Care Information Centre (HSCIC) show that NHS staff sickness absence for February 2015 and 2016 has remained the same at 4.42 per cent.
Preventing Maternal Mortality: It's Okay To Ask
This animation was produced by the RCOG in conjunction with the Royal College of Physicians and Surgeons of Glasgow and it aims to help doctors assess unwell pregnant or post-partum women. The video is accompanied by a poster which highlights the main causes of maternal death and provides doctors and midwives with advice for assessing pregnant and post-partum women who are feeling unwell.
Award-winning lung cancer service helping even more patients
An NHS Challenge Prize winning lung cancer service is already making an even bigger difference to patients, and helping doctors all over England develop the same innovative techniques.
Patients at Barnet Hospital are now able to have small lung tumours diagnosed and cells destroyed in a single hospital visit without surgery, after Royal Free Hospitals NHS Foundation Trust was awarded the £100,000 Cancer Challenge Prize for its innovative 30-minute lung biopsy service.
Patients at Barnet Hospital are now able to have small lung tumours diagnosed and cells destroyed in a single hospital visit without surgery, after Royal Free Hospitals NHS Foundation Trust was awarded the £100,000 Cancer Challenge Prize for its innovative 30-minute lung biopsy service.
Friday, 24 June 2016
Transforming community neurology
Thames Valley Strategic Clinical Network (SCN) has launched a new commissioning brief for local commissioners, to help them to improve the services provided in community settings to people diagnosed with a long-term neurological condition.
Commissioning through Competition and Cooperation
This Policy Research Unit in Commissioning and the Healthcare System (PRUComm) project aimed to investigate how commissioners in local health systems managed the interplay of competition and cooperation in their local health economies, looking at acute and community health services (CH).
New model of care for frail older people
Sutton Homes of Care's vanguard site will develop a care home provider network to support training across local care homes, and a new model of health and social care locally, which will include telehealth and expanded in-reach services, providing the right care at the right time where patients need it.
This means a patient who has three in-patient hospital stays in a month will now get the care they need from hospital specialists at home, enabling them to stay close to their family and friends.
This means a patient who has three in-patient hospital stays in a month will now get the care they need from hospital specialists at home, enabling them to stay close to their family and friends.
Statins: modelling study suggests lifespan benefits are not evenly distributed and that people may not choose the mathematically optimal option for benefit
New Medicines Evidence Commentary from NICE:
A 3-part study has found that, according to a model based on UK population data, starting preventive therapy in people at risk of cardiovascular disease produces greater mean gain in lifespan in people aged 50–54 years than in older people (although quality of life was not modelled). It also suggests that the actual lifespan gain is not evenly distributed: most people gain no lifespan whereas a few gain a great deal, with a greater proportion of people benefiting among those at greater baseline risk. Finally, members of the public were asked to choose between the option of a 1 year gain in healthy life span for sure or a certain percentage chance (2%, 5%, 10%, 20% or 50%) to gain 10 years healthy lifespan. Although in each comparison the majority chose the option with the greatest mean gain, substantial proportions of people preferred the ‘sure thing’ over percentage options that offered a greater mean gain. This study should help to inform shared decision-making and elicitation of individual preferences, in terms of communicating risk in practice and in guideline development.
A 3-part study has found that, according to a model based on UK population data, starting preventive therapy in people at risk of cardiovascular disease produces greater mean gain in lifespan in people aged 50–54 years than in older people (although quality of life was not modelled). It also suggests that the actual lifespan gain is not evenly distributed: most people gain no lifespan whereas a few gain a great deal, with a greater proportion of people benefiting among those at greater baseline risk. Finally, members of the public were asked to choose between the option of a 1 year gain in healthy life span for sure or a certain percentage chance (2%, 5%, 10%, 20% or 50%) to gain 10 years healthy lifespan. Although in each comparison the majority chose the option with the greatest mean gain, substantial proportions of people preferred the ‘sure thing’ over percentage options that offered a greater mean gain. This study should help to inform shared decision-making and elicitation of individual preferences, in terms of communicating risk in practice and in guideline development.
Local steroid injections may help sciatica
Steroid injections into the opening where nerves exit the spine (transforaminal injections) are slightly more effective than local anaesthetic or a salt solution (saline) injection at reducing pain for adults with sciatica.
This study found that all three techniques reduced pain for three months by over three points on a 0 to 10 point scale. It is unclear what effect they have on disability at three months or need for spinal surgery at 12 months.
There are other options which may be used when conservative treatment with physiotherapy and medication has failed or if the pain is severe. These include a midline injection of steroid and local anaesthetic into the epidural layer. This review did not find trials which compared all of these options with one another which limits the ability to decide which approach is best and any immediate implications for practice.
This study found that all three techniques reduced pain for three months by over three points on a 0 to 10 point scale. It is unclear what effect they have on disability at three months or need for spinal surgery at 12 months.
There are other options which may be used when conservative treatment with physiotherapy and medication has failed or if the pain is severe. These include a midline injection of steroid and local anaesthetic into the epidural layer. This review did not find trials which compared all of these options with one another which limits the ability to decide which approach is best and any immediate implications for practice.
NIHR Dissemination Centre
Trametinib in combination with dabrafenib for treating unresectable or metastatic melanoma
New NICE technology appraisal guidance:
Evidence-based recommendations on trametinib (Mekinist) with dabrafenib (Tafinlar) for adults with unresectable or metastatic melanoma that has a BRAF V600 mutation.
Evidence-based recommendations on trametinib (Mekinist) with dabrafenib (Tafinlar) for adults with unresectable or metastatic melanoma that has a BRAF V600 mutation.
Ceritinib for previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer
New NICE technology appraisal guidance:
Evidence-based recommendations on ceritinib (Zykadia) for treating advanced anaplastic lymphoma kinase positive non‑small‑cell lung cancer in adults who have had crizotinib.
Evidence-based recommendations on ceritinib (Zykadia) for treating advanced anaplastic lymphoma kinase positive non‑small‑cell lung cancer in adults who have had crizotinib.
Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
New NICE technology appraisal guidance:
Evidence-based recommendations on alirocumab (Praluent) for treating primary hypercholesterolaemia or mixed dyslipidaemia in adults.
Evidence-based recommendations on alirocumab (Praluent) for treating primary hypercholesterolaemia or mixed dyslipidaemia in adults.
Adalimumab for treating moderate to severe hidradenitis suppurativa
New technology appraisal guidance from NICE:
Evidence-based recommendations on adalimumab for treating active moderate to severe hidradenitis suppurativa in adults whose disease has not responded to conventional systemic therapy.
Evidence-based recommendations on adalimumab for treating active moderate to severe hidradenitis suppurativa in adults whose disease has not responded to conventional systemic therapy.
Belimumab for treating active autoantibody-positive systemic lupus erythematosus
New NICE technology appraisal guidance:
Evidence-based recommendations on belimumab (Benlysta) as an add-on treatment for active autoantibody-positive systemic lupus erythematosus in adults.
Evidence-based recommendations on belimumab (Benlysta) as an add-on treatment for active autoantibody-positive systemic lupus erythematosus in adults.
Stomach (Gastric) Cancer Prevention
Evidence summary from the National Cancer Institute on preventing stomach cancer.
Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia
New NICE technology appraisal guidance:
Evidence-based recommendations on evolocumab (Repatha) for treating primary hypercholesterolaemia or mixed dyslipidaemia in adults.
Evidence-based recommendations on evolocumab (Repatha) for treating primary hypercholesterolaemia or mixed dyslipidaemia in adults.
Wednesday, 22 June 2016
Coroners statistics 2015
The Ministry of Justice has published its annual statistical bulletin on deaths reported to coroners across England and Wales. These include inquests and post-mortems held, inquest conclusions recorded and finds reported to coroners under treasure legislation.
New measures to prevent maternal deaths
More needs to be done to prevent maternal deaths from causes not directly linked to pregnancy and childbirth, say leading experts from the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Obstetricians and Gynaecologists (RCOG).
As part of a collaborative project led by leadership fellow Dr Rebecca Northridge, the Royal Colleges, in partnership with other medical organisations, have produced an animated video to help doctors assess unwell pregnant or post-partum women. The video, titled It's better to ask: working together to prevent maternal mortality, aims to help reduce the number of maternal deaths in the UK.
As part of a collaborative project led by leadership fellow Dr Rebecca Northridge, the Royal Colleges, in partnership with other medical organisations, have produced an animated video to help doctors assess unwell pregnant or post-partum women. The video, titled It's better to ask: working together to prevent maternal mortality, aims to help reduce the number of maternal deaths in the UK.
The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69)
For this guideline, nausea and vomiting of pregnancy (NVP) is defined as the symptom of nausea and/or vomiting during early pregnancy where there are no other causes, and hyperemesis gravidarum (HG) is the severe form of NVP.
There is variation in the management of women who have NVP or HG with an occasional lack of understanding of its severity and options for treatment and support. The aim of this guideline is to provide evidence-based or best clinical practice information regarding the diagnosis and subsequent management of NVP and HG across community, ambulatory daycare and inpatient settings. It gives advice for multidisciplinary professionals involved in the care of women with these conditions, including how to counsel and support women before, during and after their pregnancies.
There is variation in the management of women who have NVP or HG with an occasional lack of understanding of its severity and options for treatment and support. The aim of this guideline is to provide evidence-based or best clinical practice information regarding the diagnosis and subsequent management of NVP and HG across community, ambulatory daycare and inpatient settings. It gives advice for multidisciplinary professionals involved in the care of women with these conditions, including how to counsel and support women before, during and after their pregnancies.
Microstructural scaffold (patch) insertion without autologous cell implantation for repairing symptomatic chondral knee defects
New NICE Interventional Procedure guidance:
Evidence-based recommendations on microstructural scaffold (patch) insertion without autologous cell implantation for repairing symptomatic chondral knee defects in adults and young people. This involves stimulating growth of new cartilage in the knee.
Evidence-based recommendations on microstructural scaffold (patch) insertion without autologous cell implantation for repairing symptomatic chondral knee defects in adults and young people. This involves stimulating growth of new cartilage in the knee.
Transcervical extracorporeal reverse flow neuroprotection for reducing the risk of stroke during carotid artery stenting
New NICE Interventional Procedure guidance:
Evidence-based recommendations on transcervical extracorporeal reverse flow neuroprotection for reducing the risk of stroke during carotid artery stenting in adults. This involves reversing blood flow away from the brain and filtering the blood to remove any debris.
Evidence-based recommendations on transcervical extracorporeal reverse flow neuroprotection for reducing the risk of stroke during carotid artery stenting in adults. This involves reversing blood flow away from the brain and filtering the blood to remove any debris.
Ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules - guidance (IPG562)
New NICE guidance:
Evidence-based recommendations on ultrasound-guided percutaneous radiofrequency ablation for treating benign thyroid nodules in adults. This involves using heat energy to destroy tissue in the nodules.
This guidance does not cover the treatment of malignant (cancerous) thyroid nodules.
Evidence-based recommendations on ultrasound-guided percutaneous radiofrequency ablation for treating benign thyroid nodules in adults. This involves using heat energy to destroy tissue in the nodules.
This guidance does not cover the treatment of malignant (cancerous) thyroid nodules.
Vaccination of individuals with uncertain or incomplete immunisation status
One-page summary for health professionals and immunisation practitioners giving vaccinations, from Public Health England.
Moderate to severe acute post-operative pain: fentanyl transdermal system (ESNM77)
New NICE advice:
The fentanyl transdermal system, Ionsys, is a patient‑controlled analgesia (PCA) system that delivers fentanyl in a non‑invasive way across the skin using iontophoresis. It is licensed for the management of acute moderate to severe post‑operative pain in adults.
The fentanyl transdermal system has comparable efficacy to IV morphine PCA. Its adverse event profile is as expected for an opioid used in post‑operative pain, and is similar to that of IV morphine PCA. In randomised controlled trials, the fentanyl transdermal system had better user satisfaction than IV morphine PCA, mainly because of improved mobilisation, and more favourable ease of care scores reported by nurses and physiotherapists. However, the clinical significance of these differences is unclear.
The fentanyl transdermal system, Ionsys, is a patient‑controlled analgesia (PCA) system that delivers fentanyl in a non‑invasive way across the skin using iontophoresis. It is licensed for the management of acute moderate to severe post‑operative pain in adults.
The fentanyl transdermal system has comparable efficacy to IV morphine PCA. Its adverse event profile is as expected for an opioid used in post‑operative pain, and is similar to that of IV morphine PCA. In randomised controlled trials, the fentanyl transdermal system had better user satisfaction than IV morphine PCA, mainly because of improved mobilisation, and more favourable ease of care scores reported by nurses and physiotherapists. However, the clinical significance of these differences is unclear.
Good clinical practice for clinical trials
Good clinical practice (GCP) is a set of internationally-recognised ethical and scientific quality requirements that must be followed when designing, conducting, recording and reporting clinical trials that involve people.
How to improve ‘do not resuscitate’ decisions in England
This review has highlighted some variations in how ‘do not attempt cardiopulmonary resuscitation’ decisions are made across NHS hospitals. By describing the literature and giving examples where things have gone well and less well in the past it begins to surface promising areas for improvement. These include the designing and implementing of structured forms to record decisions, talking sensitively about the decisions with patients and their families early and letting other health professionals know what has been decided.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
Administering subcutaneous methotrexate for inflammatory arthritis
RCN guidance containing evidence-based guidance
to support practitioners in the safe and confident
administration of subcutaneous methotrexate in a variety of
primary and secondary care settings, including community
and managed care environments
Inequalities experienced by children across the UK accessing the right care, at the right time, in the right place
RCN briefing document:
There are wide variations in waiting times for a range of health care services. This means that children face unacceptable delays in receiving the right care and have different access to services, depending on where they live. To address child health inequalities, children, young people and their families must have access to quality services, delivered in a timely manner, by the right professional with appropriate skills and in a setting that meets the needs of the child. The three aspects of right care, right time and right place are inextricably linked together. Failure to achieve one represents a barrier to achieving the others
There are wide variations in waiting times for a range of health care services. This means that children face unacceptable delays in receiving the right care and have different access to services, depending on where they live. To address child health inequalities, children, young people and their families must have access to quality services, delivered in a timely manner, by the right professional with appropriate skills and in a setting that meets the needs of the child. The three aspects of right care, right time and right place are inextricably linked together. Failure to achieve one represents a barrier to achieving the others
Using Trust-level national clinical audit data to support quality assurance and quality improvement
The purpose of the workshop was to describe the progress of a collaborative endeavour between
HQIP and CQC to systematically optimise the use of National Clinical Audit (NCA) data for both quality assurance and quality improvement.
Latest pharmacological technology briefings now available
The Horizon Scanning Research and Intelligence Centre's latest batch of briefings on pharmacological technologies in development is now available. These include briefings in the following specialties:
- Cancer and Palliative Care
- Endocrine, Nutritional and Metabolic
- Eye Disease
- Gastrointestinal, Pancreatic and Liver Disease
- Haematology and Blood Products
Cutting unnecessary emergencies
This case study is from the South London Health Innovation Network which is working to reduce catheter-associated urinary tract infections by 30 per cent by 2017 and to improve patient wellbeing and recovery.
Tuesday, 21 June 2016
The Foundation Programme Curriculum 2016
The foundation programme curriculum 2016 (the curriculum) sets out the framework for
educational progression that will support the first two years of professional development,
following graduation from medical school.
This edition of the curriculum updates the curriculum published in 2012 and includes minor revisions from the 2014 and 2015 editions.
This edition of the curriculum updates the curriculum published in 2012 and includes minor revisions from the 2014 and 2015 editions.
Procurement E-Learning Tool
The Competition and Markets Authority with the Crown Commercial Service has worked with Builtintelligence to produce a procurement e-learning tool.
It is designed to help procurers and supply chain professionals understand why bid-rigging is harmful, learn how to spot tell-tale signs that suggest a bid may be illegal, deal with suspect bids and know where to go for further help.
Public Perceptions Of The NHS
The BMA commissioned BritainThinks to conduct an online survey of 1240 adults living in England to question their perceptions of the NHS as of June 2016. The survey concentrates on general perceptions of the NHS, public health and seven-day services. It shows:
- Growing discontent with the way the NHS is being run. 37% are dissatisfied with the running of the NHS, compared with 21% this time last year.
- The public are far more pessimistic about the future of the NHS this year. 53% of the public think it is going to get worse, and only 29% think it will get better.
- There are also strong indications that the public do not trust the government's motivations in the way it runs the NHS, nor its ability to do so effectively. 58% say they they do not trust the government with the management of the NHS.
- 48% disagree that this government genuinely cares about the NHS.
- A large majority (81%) say that ring-fencing NHS funding is not enough, and that the government should increase the amount of money received by the NHS.
Epilepsy in Pregnancy (Green-top Guideline No.68)
This RCOG guideline summarises the evidence on maternal and fetal outcomes in women with epilepsy (WWE), and provides recommendations on the care of WWE during the prepregnancy, antepartum, intrapartum and postpartum periods.
Stereotactic radiosurgery and radiotherapy (SRS/SRT) contracts
NHS England has now announced the award of new contracts for stereotactic radiosurgery and radiotherapy (SRS/SRT) – specialist forms of radiotherapy that can be used to treat patients with intracranial conditions, such as benign and malignant brain tumours.
NHS healthy workforce programme - new leadership resources
Two new role descriptors have been developed to help NHS organisations identify skilled leaders, to drive and champion staff wellbeing across the organisation.
The job roles covered in the descriptors are for a senior/board lead and a clinical lead. These resources form part of the NHS England healthy workforce programme, where the health and wellbeing team is working together with board and clinical leads to establish what senior leaders need to do to ensure that their staff are looked after.
Plasmid-mediated colistin resistance in Enterobacteriaceae
Self-transferable plasmid-borne colistin resistance gene (mcr-1) poses a substantial public health risk to the EU/EEA because it further limits treatment options in patients with infections caused by multidrug-resistant gram-negative bacteria. It can spread colistin resistance more easily between bacteria and humans than chromosomal mutation.
MDR gram-negative bacteria, including carbapenem-resistant Enterobacteriaceae strains that acquire the mcr-1 gene, remain susceptible to only a few antimicrobial agents, which means that infections caused by these strains are very difficult to treat.
MDR gram-negative bacteria, including carbapenem-resistant Enterobacteriaceae strains that acquire the mcr-1 gene, remain susceptible to only a few antimicrobial agents, which means that infections caused by these strains are very difficult to treat.
New end-of-life care resources
NHS Employers has developed a range of information and tools to support organisations to train their staff in end-of-life care.
Discharging older patients from hospital
The health and social care system’s management of discharging older patients from hospital does not represent value for money, according to the National Audit Office. The spending watchdog estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million.
Their report found that, while some efforts to rectify the situation have been made, an ageing population and more older people being admitted to hospital means there needs to be a step change in performance to resolve the problem.
Their report found that, while some efforts to rectify the situation have been made, an ageing population and more older people being admitted to hospital means there needs to be a step change in performance to resolve the problem.
Updated UK standards for microbiology investigations
Q 7: Good practice when undertaking serology assays for infectious diseases
B 17: Investigation of tissues and biopsies from deep seated sites and organs
B 17: Investigation of tissues and biopsies from deep seated sites and organs
Published by Public Health England
New infection prevention measures get UK-wide launch
A new tool which will help surgical teams prevent infection has been launched following pioneering work by a senior Betsi Cadwaladr University Health Board nurse.
Tracey worked with other leading professional organisations to develop the clinical tool, which encourages surgical staff to assess their everyday work and the way they care for patients.
Tracey worked with other leading professional organisations to develop the clinical tool, which encourages surgical staff to assess their everyday work and the way they care for patients.
NHS Chief launches new fast track funding so NHS patients get treatment innovations faster
The head of NHS England has announced the launch of a new programme to fast-track cutting-edge innovations from across the globe to the NHS frontline.
In his keynote speech at the NHS Confederation Conference in Manchester, Simon Stevens has announced that for the first time the NHS will provide an explicit national reimbursement route for new medtech innovations. This will accelerate uptake of new medtech devices and apps for patients with diabetes, heart conditions, asthma, sleep disorders, and other chronic health conditions, and many other areas such as infertility and pregnancy, obesity reduction and weight management, and common mental health disorders.
In his keynote speech at the NHS Confederation Conference in Manchester, Simon Stevens has announced that for the first time the NHS will provide an explicit national reimbursement route for new medtech innovations. This will accelerate uptake of new medtech devices and apps for patients with diabetes, heart conditions, asthma, sleep disorders, and other chronic health conditions, and many other areas such as infertility and pregnancy, obesity reduction and weight management, and common mental health disorders.
Friday, 17 June 2016
Flu fighter: guidance for acute Trusts
Tips from NHS Employers for acute trusts to improve uptake of flu jabs by staff.
Chronic kidney disease: increased risk with proton pump inhibitors
New NICE Medicines Evidence Commentary:
An observational study found the use of proton pump inhibitors (PPIs) was associated with a20% to 50% increased relative risk of chronic kidney disease (CKD). The increase in absolute risk was 1.7% to 3.3% over 10 years. PPIs are widely prescribed for the management of dyspepsia and gastro-oesophageal reflux disease (GORD), and to reduce the gastrointestinal side effects of non-steroidal anti-inflammatory drugs (NSAIDs). However, the NICE guideline on GORD and dyspepsia recommends that reviewing the need for long-term use of PPIs is important for the management of these conditions, as are more general discussions with patients about the safe and effective use of medicines (see the NICE guideline on medicines optimisation).
An observational study found the use of proton pump inhibitors (PPIs) was associated with a20% to 50% increased relative risk of chronic kidney disease (CKD). The increase in absolute risk was 1.7% to 3.3% over 10 years. PPIs are widely prescribed for the management of dyspepsia and gastro-oesophageal reflux disease (GORD), and to reduce the gastrointestinal side effects of non-steroidal anti-inflammatory drugs (NSAIDs). However, the NICE guideline on GORD and dyspepsia recommends that reviewing the need for long-term use of PPIs is important for the management of these conditions, as are more general discussions with patients about the safe and effective use of medicines (see the NICE guideline on medicines optimisation).
Tackling bullying and harassment in the NHS
NHS Employers' Health, Safety and Wellbeing Partnership Group (HSWPG) has launched new resources and an infographic to support NHS organisations to develop cultures where staff are free from the fear of intimidating behaviour.
NHS guidance aims to cure sickness absence
NHS England has published guidance offering financial incentives to improve the health and wellbeing of NHS staff in England., Today
Proposals to reduce the impact of our investigations on doctors – workshop report published
The GMC has published a report from the workshop held to discuss draft proposals aimed at reducing the stress that our processes can have on doctors.
Thursday, 16 June 2016
An anticoagulant, bivalirudin, may not be safer than the alternative, heparin, when unblocking arteries in the heart
Bivalirudin is currently recommended as an alternative option to heparin to prevent clotting during percutaneous coronary intervention. This is a common procedure to unblock the heart’s arteries. It is more costly but may have advantages relative to heparin, such as a more rapid action and less risk of lowering the platelet count.
This review found that bivalirudin reduced risk of major bleeding compared with heparin. However, this was only when heparin was combined with a higher dose of another anti-clotting drug, a glycoprotein platelet IIb/IIIa inhibitor. When there was equivalent use of these inhibitors, there was no difference in bleeding. Bivalirudin was also associated with very small increased risks of heart attack and re-blockage of the blood vessel being treated.
For now, bivalirudin remains an alternative option to heparin, but individual patient characteristics should guide the best drug to use.
From the NIHR Dissemination Centre
This review found that bivalirudin reduced risk of major bleeding compared with heparin. However, this was only when heparin was combined with a higher dose of another anti-clotting drug, a glycoprotein platelet IIb/IIIa inhibitor. When there was equivalent use of these inhibitors, there was no difference in bleeding. Bivalirudin was also associated with very small increased risks of heart attack and re-blockage of the blood vessel being treated.
For now, bivalirudin remains an alternative option to heparin, but individual patient characteristics should guide the best drug to use.
From the NIHR Dissemination Centre
Topical steroids better than vitamin D for treating scalp psoriasis
Topical steroids applied to the scalp were more effective and safer for treating psoriasis than topical vitamin D alone.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
Evaluation of the Care Assistant Development Programme: Learning from early implementation – SCIE evaluation report for HC-One
HC-One’s Care Assistant Development Programme (CADP) aims to develop senior carers into nursing assistants, trained up to assist with medication and care planning. The Programme enables newly-trained nursing assistants to support registered nurses and improves the quality of care provided to residents.
This report presents the findings from SCIE’s independent evaluation – commissioned by HC-One – of the early implementation of the Programme.
This report presents the findings from SCIE’s independent evaluation – commissioned by HC-One – of the early implementation of the Programme.
First annual report from Each Baby Counts programme
The Royal College of Obstetricians and Gynaecologists has published the first annual report of Each Baby Counts.
This quality improvement programme aims to halve the number of stillbirths, neonatal deaths and severe brain injuries by 2020. The report uses 2015 data to argue for improvement in the quality of local investigations into cases of death or injury occurring during term labour.
This quality improvement programme aims to halve the number of stillbirths, neonatal deaths and severe brain injuries by 2020. The report uses 2015 data to argue for improvement in the quality of local investigations into cases of death or injury occurring during term labour.
Six Principles For Engaging People And Communities: Putting Them Into Practice
This document from National Voices is about creating person-centred, community-focused approaches to health, wellbeing and care. It builds on the proposed new relationship with patients and communities set out in the NHS Five Year Forward View. It aims to complement a wider suite of products to be produced by national bodies for the health and care system as it moves forward with the implementation of innovations in care delivery.
Securing health returns: realising the financial value of sustainable development
This research from the NHS Sustainable Development Unit has calculated that the NHS and wider health sector could save up to £414m and cut one million tonnes of carbon emissions every year by 2020. The analysis selected 35 areas and calculated their financial and environmental benefits. This report outlines areas that offer potential cash savings and environmental benefits.
New Care Models and Staff Engagement: All Aboard
NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association, have published a handy guide to the work vanguards are doing to engage their staff in the design and delivery of new care models.
Patients suffering due to delays in accessing medical images by doctors
A survey by the Royal College of Radiologists (RCR) shows that systems for sharing X-ray and scan images and reports between hospitals are inadequate, leading to harm for patients.
The RCR report, It’s good to share: medical image and report exchange between UK health care providers reveals that problems with sharing vital X-rays and scans between doctors and hospitals are commonplace across the NHS.
The RCR report, It’s good to share: medical image and report exchange between UK health care providers reveals that problems with sharing vital X-rays and scans between doctors and hospitals are commonplace across the NHS.
Wednesday, 15 June 2016
What progress has been made since Boorman?
NHS Employers' health and wellbeing team has launched an interactive timeline to show work in the NHS, that has taken place nationally, in relation to key recommendations from the Boorman report.
The timeline allows users to see where the NHS is in terms of staff health and wellbeing, since the review was published in 2009. The product enables health and wellbeing leads to reflect on their local strategy by plotting work and initatives against the national progress.
The timeline allows users to see where the NHS is in terms of staff health and wellbeing, since the review was published in 2009. The product enables health and wellbeing leads to reflect on their local strategy by plotting work and initatives against the national progress.
Stepping up to the place: the key to successful health and care integration
This briefing aims to describe what a fully integrated, transformed system should look like based on evidence. It outlines a whole-system vision for integration based on forming care around the needs of individuals in a society with increasingly chronic and complex health needs.
The report also identifies challenges, including an unprecedented pressure on funding that has put plans to improve patient care and the sustainability of the whole health and social care sector at risk.
The report also identifies challenges, including an unprecedented pressure on funding that has put plans to improve patient care and the sustainability of the whole health and social care sector at risk.
Toolkit on the risks of valproate medicines in female patients
Information from the MHRA about the toolkit to ensure female patients are better informed about the risks of taking valproate medicines during pregnancy.
Leadership in the NHS
Marcus Powell, Director of Leadership and Organisational Development, shares his initial observations about leadership in the NHS.
GreenLight XPS for treating benign prostatic hyperplasia - guidance (MTG29)
New Nice Medical Technology guidance:
The case for adopting GreenLight XPS for treating benign prostatic hyperplasia is supported in non‑high‑risk patients. GreenLight XPS is at least as effective in these patients as transurethral resection of the prostate (TURP), but can more often be done as a day‑case procedure, following appropriate service redesign.
The case for adopting GreenLight XPS for treating benign prostatic hyperplasia is supported in non‑high‑risk patients. GreenLight XPS is at least as effective in these patients as transurethral resection of the prostate (TURP), but can more often be done as a day‑case procedure, following appropriate service redesign.
A scan may help decide if surgery is required as follow-on treatment for head and neck cancer
People with head and neck cancer in the UK usually receive chemotherapy and radiotherapy followed by surgery. Using a scan to assess cancer status after this first line chemoradiotherapy and only suggesting surgery to those with a clear indication led to similar survival rates, complications and fewer operations compared with planned cancer surgery for everyone.
After receiving similar initial treatment, this trial compared routine neck dissection surgery to surgery only if the scan showed residual cancer 12 weeks after chemoradiotherapy.
Head and neck surgery can be invasive and disfiguring, so doctors and patients alike want to minimise unnecessary operations, this potentially saves money.
The scanning tested was PET-CT scanning, a newer type of highly detailed CT scanning. This scan guided surveillance is not currently covered by NICE guidance. These findings suggest there may be a place for it and that by saving surgery for some people it could also save costs, compared to planning surgery for everyone without a surveillance scan.
From the NIHR Dissemination Centre
Visual impairment due to myopic choroidal neovascularisation: aflibercept
New Evidence Summary from NICE:
Intravitreal aflibercept is a vascular endothelial growth factor (VEGF) inhibitor that is already licensed for several ophthalmic indications. In 1 randomised controlled trial (RCT) involving 122 adults with myopic choroidal neovascularisation (myopic CNV), aflibercept was more effective than sham injections at improving best corrected visual acuity over 24 weeks' treatment. People in the aflibercept group were on average able to read 14 more letters on a standard vision chart compared with the sham group, an improvement considered clinically relevant by the European Public Assessment Report (EPAR) for aflibercept. More people in the aflibercept group gained 15 letters or more than in the sham group at week 24 (38.9% compared with 9.7% respectively, number needed to treat=4). Most ocular adverse events reported were mild. There are no published comparisons with other active treatments for myopic CNV.
Intravitreal aflibercept is a vascular endothelial growth factor (VEGF) inhibitor that is already licensed for several ophthalmic indications. In 1 randomised controlled trial (RCT) involving 122 adults with myopic choroidal neovascularisation (myopic CNV), aflibercept was more effective than sham injections at improving best corrected visual acuity over 24 weeks' treatment. People in the aflibercept group were on average able to read 14 more letters on a standard vision chart compared with the sham group, an improvement considered clinically relevant by the European Public Assessment Report (EPAR) for aflibercept. More people in the aflibercept group gained 15 letters or more than in the sham group at week 24 (38.9% compared with 9.7% respectively, number needed to treat=4). Most ocular adverse events reported were mild. There are no published comparisons with other active treatments for myopic CNV.
GPhC survey provides a useful picture of experiences of pharmacist prescribers
A survey of pharmacist prescribe has been published by the pharmacy regulator. Respondents highlighted that the organisational culture as well as the more immediate environment can play an important role both in enabling and acting as a barrier to prescribing practice.
Other findings of the report include:
Funding for training as a pharmacist prescriber or to offer services in that role can be challenging and there is a lack of financial incentives in taking on an enhanced role with increased responsibilities.
Some respondents expressed a lack of confidence in their clinical assessment skills and felt this could be addressed through greater multi-disciplinary working.
Interaction with peers is seen as a powerful tool used by pharmacist prescribers to keep their knowledge and skills up to date.
Other findings of the report include:
Guidance on conduct and ethics
The Health and Care Professions Council (HCPC) has published revised Guidance on conduct and ethics for students.
Tuesday, 14 June 2016
Hiding who I am: exposing the reality of end of life care for LGBT people
Marie Curie has published 'Hiding who I am: exposing the reality of end of life care for LGBT people'. This report looks at the barriers that prevent lesbian, gay, bisexual and trans (LGBT) people from accessing end of life care and highlights their real-life experiences.
Consultation on changes to the NHS Patient Survey Programme
The CQC is consulting on proposed changes to the NHS Patient Survey Programme. The survey programme is used to collect feedback on the experiences of people using a range of NHS healthcare services.
Capacity and consent: tool for health professionals
The General Medical Council has launched an interactive online tool to help health professionals determine a patient's capacity to make a decision about their treatment. The tool draws on principles in GMC guidance and includes downloadable resources including guidance, a flowchart setting out all the steps in the tool, case studies and a record to help the health professional reflect on skills and understanding.
Developing a patient and public involvement panel for quality improvement
The Healthcare Quality Improvement Partnership has published two new guides dealing with patient and public involvement in health care: one of them being, Developing a patient and public involvement panel for quality improvement - an updated step-by-step guide to developing an effective patient led panel. It is suitable for patients, the public, and staff working in quality improvement in NHS healthcare provider organisations
See also Patient and public involvementin quality improvement
See also Patient and public involvementin quality improvement
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