The Royal College of Physicians, in partnership with the UK’s medical specialty societies, has launched Medical Care, its first ever web-based planning resource for medical specialties.
The new website - www.rcpmedicalcare.org.uk - has been designed to help those involved in the planning and provision of services get a clearer picture of the specialty services that need to be in place to provide great patient care.
Friday, 29 July 2016
Framework sets out how to be a multispecialty community provider
A new framework outlines how place-based partnerships can replicate the successful work of the 14 multispecialty community provider (MCP) vanguards, when establishing their own programmes.
The MCP vanguards will move specialist care out of hospitals and into the community, removing divides between primary, community, mental health, social care and acute services to provide efficient, joined-up and preventative care.
Highlighted in the framework is primary care home, the joint programme between NHS Confederation and the National Association of Primary Care (NAPC), which redesigns primary care around the needs of local communities with the same goal of providing integrated, joined-up and person-centred care.
The MCP vanguards will move specialist care out of hospitals and into the community, removing divides between primary, community, mental health, social care and acute services to provide efficient, joined-up and preventative care.
Highlighted in the framework is primary care home, the joint programme between NHS Confederation and the National Association of Primary Care (NAPC), which redesigns primary care around the needs of local communities with the same goal of providing integrated, joined-up and person-centred care.
Five ways to help make health and care accessible
With the Accessible Information Standard coming into force on 31 July 2016, Healthwatch takes a look at how people's experiences across England have already helped to challenge barriers and improve accessibility in health and care.
1. The importance of making publications accessible
2. Improving access to health services for the Deaf community
3. Explaining things in a way people can understand
4. Improving GP services for Deaf patients
5. Helping people with communication support needs
Financial Forecasting In The NHS
Being able to produce an accurate operational and financial plan and then to estimate how the organisation will perform in financial terms against that plan is a key responsibility of NHS finance directors. This HFMA briefing focuses on how financial performance is estimated, predicted and reported within the NHS. It also includes a number of case studies to illustrate how the theory is applied in practice and how some organisations tackle the challenges of forecasting.
Please note that you need to register in order to download this publication.
Please note that you need to register in order to download this publication.
Creating a Culture of Family Satisfaction Assessment in Critical Care
Case study from Yale New Haven Hospital
Standard HCAHPS surveys currently provide limited insight into the experience of patients hospitalized in neuroscience intensive care units (ICUs) and their families. The HCAHPS survey (1) is meant to be filled out by patients only, when many brain injured patients are unable to do so reliably; (2) excludes patients who are discharged to skilled nursing facilities or hospice; where a substantial number of neuroscience ICU patients are transferred following hospitalization; and (3) does not contain questions to differentiate between a patient’s experience while in an ICU versus while on a regular inpatient floor. We thus sought to collect specific data on satisfaction with care from patients’ families in our neuroscience ICU for use in quality improvement initiatives.
Standard HCAHPS surveys currently provide limited insight into the experience of patients hospitalized in neuroscience intensive care units (ICUs) and their families. The HCAHPS survey (1) is meant to be filled out by patients only, when many brain injured patients are unable to do so reliably; (2) excludes patients who are discharged to skilled nursing facilities or hospice; where a substantial number of neuroscience ICU patients are transferred following hospitalization; and (3) does not contain questions to differentiate between a patient’s experience while in an ICU versus while on a regular inpatient floor. We thus sought to collect specific data on satisfaction with care from patients’ families in our neuroscience ICU for use in quality improvement initiatives.
Thursday, 28 July 2016
Medical management of secretory syndromes related to gastrointestinal neuroendocrine tumours
Endocr Relat Cancer. 2016 Jul 26. pii: ERC-16-0200. [Epub ahead of print]
Although recent epidemiological evidence indicates that the prevalence of non-functioning gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) is rising, a significant number of GEP-NETs still present with symptoms related to the secretion of biologically-active substances leading to the development of distinct clinical syndromes. In the past, these syndromes were associated with substantial morbidity and mortality due to the lack of specific therapies; however, since the introduction of long-acting somatostatin analogues and medications such as proton pump inhibitors, their control has been greatly improved. As a result, nowadays the main cause of morbidity and mortality in GEP-NETs is mostly directly related to tumour growth and the extent of metastatic disease. However, in some patients with functioning tumours and extensive disease, control of the secretory syndrome still remains problematic, necessitating the employment of several cytoreductive techniques which may not always be sufficient. Recently, new agents directed against tumour growth, or exerting increased binding activity to receptors expressed in these tumours, or interfering with the synthetic pathway of some of the compounds secreted by these tumours, have been developed. Since there are no specific guidelines addressing the totality of the management of the secretory syndromes related to GEP-NETs, this review aims at critically analysing the medical management of previously recognised secretory syndromes; it also addresses areas of uncertainty, assesses the newer therapeutic developments, and also addresses recently described but poorly-characterised secretory syndromes related to GEP-NETs.
UHCW Research - Dimitriadis GK and Weickert MO
Although recent epidemiological evidence indicates that the prevalence of non-functioning gastroenteropancreatic (GEP) neuroendocrine tumours (NETs) is rising, a significant number of GEP-NETs still present with symptoms related to the secretion of biologically-active substances leading to the development of distinct clinical syndromes. In the past, these syndromes were associated with substantial morbidity and mortality due to the lack of specific therapies; however, since the introduction of long-acting somatostatin analogues and medications such as proton pump inhibitors, their control has been greatly improved. As a result, nowadays the main cause of morbidity and mortality in GEP-NETs is mostly directly related to tumour growth and the extent of metastatic disease. However, in some patients with functioning tumours and extensive disease, control of the secretory syndrome still remains problematic, necessitating the employment of several cytoreductive techniques which may not always be sufficient. Recently, new agents directed against tumour growth, or exerting increased binding activity to receptors expressed in these tumours, or interfering with the synthetic pathway of some of the compounds secreted by these tumours, have been developed. Since there are no specific guidelines addressing the totality of the management of the secretory syndromes related to GEP-NETs, this review aims at critically analysing the medical management of previously recognised secretory syndromes; it also addresses areas of uncertainty, assesses the newer therapeutic developments, and also addresses recently described but poorly-characterised secretory syndromes related to GEP-NETs.
UHCW Research - Dimitriadis GK and Weickert MO
A simple breath test for tuberculosis using ion mobility: A pilot study.
Tuberculosis (Edinb). 2016 Jul;99:143-6. doi: 10.1016/j.tube.2016.05.005. Epub 2016 May 29.
A simple breath test for tuberculosis using ion mobility: A pilot study.
Tuberculosis (TB) remains one of the world's major health burdens with 9.6 million new infections globally. Though considerable progress has been made in reduction of TB incidence and mortality, there is a continuous need for lower cost, simpler and more robust means of diagnosis. One method that may fulfil these requirements is in the area of breath analysis. In this study we analysed the breath of 21 patients with pulmonary or extra-pulmonary TB, recruited from a UK teaching hospital (University Hospital Coventry and Warwickshire) before or within 1 week of commencing treatment for TB. TB diagnosis was confirmed by reference tests (mycobacterial culture), histology or radiology. 19 controls were recruited to calculate specificity; these patients were all interferon-gamma release assay negative (T.SPOT(®).TB, Oxford Immunotec Ltd.). Whole breath samples were collected with subsequent chemical analysis undertaken by Ion Mobility Spectrometry. Our results produced a sensitivity of 81% and a specificity of 79% for all cases of TB (pulmonary and extra-pulmonary). Though lower than other studies analysing pulmonary TB alone, we believe that this technique shows promise, and a higher sensitivity could be achieved by further improving our sample capture methodology.
UHCW Research - Sahota AS, Gowda R, and Arasaradnam RP
A simple breath test for tuberculosis using ion mobility: A pilot study.
Tuberculosis (TB) remains one of the world's major health burdens with 9.6 million new infections globally. Though considerable progress has been made in reduction of TB incidence and mortality, there is a continuous need for lower cost, simpler and more robust means of diagnosis. One method that may fulfil these requirements is in the area of breath analysis. In this study we analysed the breath of 21 patients with pulmonary or extra-pulmonary TB, recruited from a UK teaching hospital (University Hospital Coventry and Warwickshire) before or within 1 week of commencing treatment for TB. TB diagnosis was confirmed by reference tests (mycobacterial culture), histology or radiology. 19 controls were recruited to calculate specificity; these patients were all interferon-gamma release assay negative (T.SPOT(®).TB, Oxford Immunotec Ltd.). Whole breath samples were collected with subsequent chemical analysis undertaken by Ion Mobility Spectrometry. Our results produced a sensitivity of 81% and a specificity of 79% for all cases of TB (pulmonary and extra-pulmonary). Though lower than other studies analysing pulmonary TB alone, we believe that this technique shows promise, and a higher sensitivity could be achieved by further improving our sample capture methodology.
UHCW Research - Sahota AS, Gowda R, and Arasaradnam RP
Meningococcal: the green book, chapter 22
Chapter 22 of the Green Book on Meningoccocal disease has been updated.
Antibiotics for eczema that looks infected may be unnecessary in some cases
This trial found that when treating childhood eczema that clinically looked suspicious of moderate infection, adding antibiotic tablets or creams to the usual treatment of oils, lotions, creams and corticosteroids was not clearly beneficial.
From the NIHR Dissemination Centre
Two ways to reduce ovarian overstimulation during fertility treatment compared
This Cochrane review finds that the risk of over-stimulating the ovaries with gonadotrophin-releasing hormone (GnRH) antagonists is between 6% and 9% compared to about 11% with GnRH agonists. Both treatments resulted in similar live birth rates of around 29% for women undergoing fertility treatment.
From the NIHR Dissemination Centre
New methods to induce labour may increase chance of vaginal delivery, but safety questions remain
This review compared different methods for induction of labour. Misoprostol and oxytocin with amniotomy (membrane rupture), were most likely to lead to vaginal delivery within 24 hours. They were also expected to be most cost effective. There is limited information on the safety of misoprostol which may increase the risk of over-stimulating the uterus.
Current NICE guidance recommends induction by prostaglandin given vaginally. This guidance is under review and an update is expected to be available later this year.
This study highlights the need to continually review the effectiveness and costs of interventions, along with patient experience.
Current NICE guidance recommends induction by prostaglandin given vaginally. This guidance is under review and an update is expected to be available later this year.
This study highlights the need to continually review the effectiveness and costs of interventions, along with patient experience.
From the NIHR Dissemination Centre
RPS launches Research Resource Hub
The Royal Pharmaceutical Society has announced the launch of our new Research Resource Hub. The research hub offers members guidance and support on their research journey from developing an idea and defining appropriate methodology through to applying for funding, undertaking research and communicating findings.
Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation
New NICE Technology Appraisal Guidance on using Lumacaftor–ivacaftor for treating cystic fibrosis homozygous for the F508del mutation.
Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts - guidance (TA399)
New NICE Technology Appraisal Guidance on using Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts
Nivolumab in combination with ipilimumab for treating advanced melanoma
New NICE Technology Appraisal Guidance on using nivolumab (Opdivo) with ipilimumab (Yervoy) for treating advanced (unresectable or metastatic) melanoma in adults.
Percutaneous endoscopic laser balloon pulmonary vein isolation for atrial fibrillation
Evidence-based recommendations from NICE on percutaneous endoscopic laser balloon pulmonary vein isolation for atrial fibrillation in adults. This involves destroying the tissue causing atrial fibrillation using laser energy.
National Heart Failure Audit (reporting on April 2014-March 2015)
The eighth annual report for the National Heart Failure Audit presents findings and recommendations for patients with an unscheduled admission to hospital, who were discharged or died with a primary diagnosis of heart failure between 1 April 2014 and 31 March 2015. The report covers all NHS Trusts in England and Health Boards in Wales that admit patients with acute heart failure.
The audit report identifies serious gaps in the management of heart failure (HF), across England Wales, including specialist care, correct medication prescription and coordinated specialist care post-discharge.
The audit report identifies serious gaps in the management of heart failure (HF), across England Wales, including specialist care, correct medication prescription and coordinated specialist care post-discharge.
Rheumatoid and Early Inflammatory Arthritis 2nd Annual Report 2016
The National Rheumatoid and Early Inflammatory Arthritis Audit report reveals that nationally just 20 per cent of patients who see a GP with suspected rheumatoid and early inflammatory arthritis are referred to specialist services within the three-day limit recommended by the National Institute for Health and Care Excellence (NICE). For some health providers, this wait is over 20 weeks for a quarter of their patients. Nationally, fewer than half of patients who are referred, are seen by a specialist within the three-week time limit recommended by NICE. For some providers, a quarter of patients are waiting more than 12 weeks.
Wednesday, 27 July 2016
Ultroid 2.0 for internal haemorrhoids
NICE has developed a medtech innovation briefing (MIB) on the Ultroid 2.0 for internal haemorrhoids.
The technology described in this briefing is the Ultroid 2.0. It is a direct current electrotherapy system intended for use in people with internal haemorrhoids (grades I to III).
The technology described in this briefing is the Ultroid 2.0. It is a direct current electrotherapy system intended for use in people with internal haemorrhoids (grades I to III).
Lutonix drug-coated balloon for peripheral arterial disease
NICE has developed a medtech innovation briefing (MIB) on the Lutonix drug-coated balloon for peripheral arterial disease.
The technology described in this briefing is the Lutonix drug-coated balloon (DCB; also known as the Lutonix 035). It is a paclitaxel-coated percutaneous transluminal angioplasty (PTA) catheter. It is indicated for treating peripheral arterial disease (PAD).
The technology described in this briefing is the Lutonix drug-coated balloon (DCB; also known as the Lutonix 035). It is a paclitaxel-coated percutaneous transluminal angioplasty (PTA) catheter. It is indicated for treating peripheral arterial disease (PAD).
Latest staff sickness absence figures - March 2016
The latest figures released by the Health and Social Care Information Centre (HSCIC) show that NHS staff sickness absence has increased slightly from March 2015, when it was 4.18 per cent, to 4.21 per cent in March 2016.
QTUG for assessing falls risk and frailty
NICE has developed a medtech innovation briefing (MIB) on the Quantitative Timed Up and Go (QTUG).
The technology described in this briefing is the Quantitative Timed Up and Go (QTUG). It uses body-worn sensors and a mobile software app to assess mobility, falls risk and frailty. It is used during the standard Timed Up and Go (TUG) test.
The technology described in this briefing is the Quantitative Timed Up and Go (QTUG). It uses body-worn sensors and a mobile software app to assess mobility, falls risk and frailty. It is used during the standard Timed Up and Go (TUG) test.
Stretta System for gastro-oesophageal reflux disease
NICE has developed a medtech innovation briefing (MIB) on the Stretta System for gastro-oesophageal reflux disease.
The technology described in this briefing is the Stretta System. It applies radiofrequency (RF) energy to the lower oesophageal sphincter and gastric cardia to improve symptoms of gastro-oesophageal reflux disease (GORD).
Transforming Care (Must Knows)
Published by the Local Government Association this document says that too many people are still living in hospitals who should be living in the community, and gives recommendations for action to make this happen.
New and emerging angioplasty technologies in development for severe lower limb ischaemia
HSRIC has completed a review of new and emerging angioplasty-related technologies for arterial revascularisation in patients with severe lower limb ischaemia due to femoro-popliteal artery disease (PAD). Peripheral artery disease (PAD) is a condition in which the peripheral arteries of the body, particularly those in the legs, are narrowed or blocked by a build-up of fatty deposits (atheroma). The most common initial symptom of lower limb PAD is leg pain, usually in the calf, while walking (intermittent claudication). Severe or critical limb ischaemia is a seriously disabling, life and limb threatening, condition. It is characterised by severely diminished circulation, ischaemic pain at rest and tissue loss (ulceration and/or gangrene).
We identified thirty-one new and emerging technologies; 22 thought to be emerging and 9 that we believed to have been CE marked since 2015 and logged links to clinical trials and other key sources.
We identified thirty-one new and emerging technologies; 22 thought to be emerging and 9 that we believed to have been CE marked since 2015 and logged links to clinical trials and other key sources.
Tuesday, 26 July 2016
How outcome prediction could affect patient decision making in knee replacements: a qualitative study
BMC Musculoskeletal DisordersBMC series – open, inclusive and trusted201617:304
DOI: 10.1186/s12891-016-1165-x
This research suggest that an outcome prediction tool would have most effect targeted towards people at the start of their treatment pathway, with a “bottom line” prediction of outcome. However, any effect on expectation and decision making of a poor outcome prediction is likely to be blunted by the optimism bias. These findings merit replication in a larger sample size.
UHCW Research - Timothy Barlow, Patricia Scott and Damian Griffin
DOI: 10.1186/s12891-016-1165-x
This research suggest that an outcome prediction tool would have most effect targeted towards people at the start of their treatment pathway, with a “bottom line” prediction of outcome. However, any effect on expectation and decision making of a poor outcome prediction is likely to be blunted by the optimism bias. These findings merit replication in a larger sample size.
UHCW Research - Timothy Barlow, Patricia Scott and Damian Griffin
Accuracy of clinical diagnosis of benign eyelid lesions: Is a dedicated nurse-led service safe and effective?
Orbit. 2016 Aug;35(4):193-8. doi: 10.1080/01676830.2016.1176209. Epub 2016 Jun 20.
This article compares an independent nurse-led benign lesion service with a doctor-led one, and assesses the impact of clinician seniority on diagnostic accuracy rates.
Request this article from the Library
UHCW Research - Mohite AA, Johnson A, Rathore DS, Bhandari K, Mehta P and Ahluwalia HS
This article compares an independent nurse-led benign lesion service with a doctor-led one, and assesses the impact of clinician seniority on diagnostic accuracy rates.
Request this article from the Library
UHCW Research - Mohite AA, Johnson A, Rathore DS, Bhandari K, Mehta P and Ahluwalia HS
Active appearance pyramids for object parametrisation and fitting
Med Image Anal. 2016 Aug;32:101-14. doi: 10.1016/j.media.2016.03.005. Epub 2016 Apr 1.
Object class representation is one of the key problems in various medical image analysis tasks. We propose a part-based parametric appearance model we refer to as an Active Appearance Pyramid (AAP).
AAPs achieve a higher segmentation and reconstruction precision. Moreover, AAPs have a significant improvement in efficiency, consuming about half the memory and less than 10% of the training time and 15% of the testing time.
UHCW Research - Dickenson E and Hutchinson C
Object class representation is one of the key problems in various medical image analysis tasks. We propose a part-based parametric appearance model we refer to as an Active Appearance Pyramid (AAP).
AAPs achieve a higher segmentation and reconstruction precision. Moreover, AAPs have a significant improvement in efficiency, consuming about half the memory and less than 10% of the training time and 15% of the testing time.
UHCW Research - Dickenson E and Hutchinson C
PD-L1 testing for lung cancer in the UK: recognizing the challenges for implementation
Histopathology. 2016 Aug;69(2):177-86. doi: 10.1111/his.12996. Epub 2016 Jun 30.
This article reviews the current knowledge about PD-L1 testing, and identifies current research requirements. Key factors to consider include the source and timing of sample collection, pre-analytical steps (sample tracking, fixation, tissue processing, sectioning, and tissue prioritization), analytical decisions (choice of biomarker assay/kit and automated staining platform, with verification of standardized assays or validation of laboratory-devised techniques, internal and external quality assurance, and audit), and reporting and interpretation of the results. This review addresses the need for integration of PD-L1 immunohistochemistry with other tests as part of locally agreed pathways and protocols.
UHCW Research - Cree IA
This article reviews the current knowledge about PD-L1 testing, and identifies current research requirements. Key factors to consider include the source and timing of sample collection, pre-analytical steps (sample tracking, fixation, tissue processing, sectioning, and tissue prioritization), analytical decisions (choice of biomarker assay/kit and automated staining platform, with verification of standardized assays or validation of laboratory-devised techniques, internal and external quality assurance, and audit), and reporting and interpretation of the results. This review addresses the need for integration of PD-L1 immunohistochemistry with other tests as part of locally agreed pathways and protocols.
UHCW Research - Cree IA
Improving diagnosis and quality of care for people with IBS across Somerset
Quality and Productivity Proven Case Study on improving diagnosis and quality of care for people with IBS.
Transition Toolkit for Providers
In March 2015 the Yorkshire & Humber Strategic Clinical Network for Children established a Task and Finish Group (T&FG) for Transition [from Childhood to Adulthood] as part of its work programme.
The T&FG have developed a generic toolkit and guidance for transition which can be used by Providers and Commissioners to provide evidence based high quality care and improve outcomes for children, young people (CYP) and their families.
The T&FG have developed a generic toolkit and guidance for transition which can be used by Providers and Commissioners to provide evidence based high quality care and improve outcomes for children, young people (CYP) and their families.
5,700 new cases of FGM during 2015/16
Cases of female genital mutilation continue to grow, with 5,700 more recorded in the year to March 2016, according to figures from the Health and Social Care Information Centre
English language requirements for public sector workers published
The Immigration Act 2016 creates a duty for employers to ensure that all public sector staff working in customer-facing roles speak English to an appropriate standard. The government has published an early draft of the code of practice, ahead of the requirements coming into force in October 2016 to help employers meet their obligations.
Monday, 25 July 2016
Understanding of a negative bowel screening result and potential impact on future symptom appraisal and help-seeking behaviour: a focus group study
Health Expect. 2016 Jul 14. doi: 10.1111/hex.12484. [Epub ahead of print]
Objective of this study was to explore (i) understanding of a negative FOBt and (ii) the potential impact of a negative FOBt upon future symptom appraisal and help-seeking behaviour.
UHCW Research - Smith S
Objective of this study was to explore (i) understanding of a negative FOBt and (ii) the potential impact of a negative FOBt upon future symptom appraisal and help-seeking behaviour.
UHCW Research - Smith S
A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)(®) for awake oral tracheal intubation
Anaesthesia (ANAESTHESIA), Aug2016; 71(8): 908-914. (7p)
We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients.
Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.
UHCW Research - Mendonca C
We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients.
Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.
UHCW Research - Mendonca C
Sentinel Lymph Node Biopsy in Endometrial Cancer
Scientific Impact Paper no. 51 from the Royal College of Obstetrics and Gynaecology on Sentinel Lymph Node Biopsy in Endometrial Cancer.
Reproductive Outcomes after Local Treatment for Preinvasive Cervical Disease
Scientific Impact Paper no. 21 from the Royal College of Obstetrics and Gynaecology on Reproductive Outcomes after Local Treatment for Preinvasive Cervical Disease.
Quality, safety and clinical governance in ophthalmology: an overview
This document from the Royal College of Ophthalmologists aims to provide a simple overview of the principles and systems which
currently exist in the UK for quality and safety (Q&S) in ophthalmology.
Ophthalmic Pathology
New service guidance from the Royal College of Ophthalmologists on ophthalmic pathology.
Managing an outbreak of postoperative endophthalmitis
New service guidance from the Royal College of Ophthalmologists on managing an outbreak of postoperative endophthalmitis.
Raising awareness of end of life care
Case study from Shrewsbury and Telford Hospital NHS Trust on raising awareness if end of life. The Trust recruited an end of life care facilitator who:
- created individual end of life care plans for patients in collaboration with other health services across Shropshire
- delivered training on the plan to 1500 staff
- implemented the swan scheme
Also see NHS Employers end of life care training top tips.
Planning Successful International recruitment a Guide for Employers
This short guide from NHS Employers will help you plan your approach to an international recruitment campaign. It provides prompt questions and gives suggestions which you will want to discuss and agree locally to ensure your campaign meets your objectives.
Professional Standards for Cosmetic Surgery
New professional standards for cosmetic surgery from the Royal College of Surgeons.
Slow growing mycobacteria: procedure for testing heater cooler units
This protocol from Public Health England provides guidance on how best to perform and process environmental water and air sampling, from heater-cooler units and environments where these units are in operation, in order to recover slow growing mycobacterial species.
NHS procurement standards
New guidance form the Department of Health on NHS procurement and Standards for assessing NHS procurement performance.
Newcastle Hospitals halves the time it takes to hire new staff
Newcastle Upon Tyne Hospitals NHS Foundation Trust has significantly reduced the time it takes to recruit new staff by simplifying the employment checks process. See the case study at NHS Employers.
Maternity Transformation Programme Early Adopters
NHS England are seeking expressions of interest from local areas that are willing to test out new models of care as outlined by the Maternity Transformation Programme. The experiences of the early adopters will pave the way for national roll-out of initiatives that deliver safer, more personalised care for all women and every baby, improve outcomes, and reduce inequalities. The closing date for applications is 19 September 2016.
Improving the quality of care in the last days of life
This document from NHS London Clinical Networks identifies best practice in the way medications should be managed in the last days of life.
It sets out practical, high level, evidence-based recommendations to help guide those responsible for care to review their processes and consider ways to make change where necessary.
It sets out practical, high level, evidence-based recommendations to help guide those responsible for care to review their processes and consider ways to make change where necessary.
Nasogastric tube misplacement: continuing risk of death and severe harm
This alert from NHS Improvement highlights patient safety incidents involving the misplacement of nasogastric and orogastric tubes.
Fair Training Pathways For All: Understanding Experiences Of Progression
This GMC report examines the progression of doctors from different ethnicities and backgrounds through exams and recruitment. It shows that white UK medical graduates remain more likely to pass specialty exams than their black and minority ethnic (BME) counterparts, while doctors whose primary qualification was gained outside the UK or European Economic Area (EEA) are even less likely to do well in exams or recruitment.
Friday, 22 July 2016
SMI V 44: Syphilis serology
UK Standards for Microbiology Investigations (SMIs) V 44: Syphilis serology from Public Health England
Sulfonylureas can be considered safe for those with type 2 diabetes
This large review finds that sulfonylurea drugs are not associated with an increased risk of death, heart attack or stroke when compared with placebo, diet control or other diabetes drugs.
Sulfonylureas are commonly used in the treatment of adults with type 2 diabetes. The drugs in this class are relatively cheap and have been available for many decades, but there have been conflicting views on their safety. The trials in this review were large enough and sufficiently long to pick up relatively rare harmful events like death. Therefore the researchers were confident that, even if there is a small risk, less than one in 200 people treated with sulfonylureas are likely to be harmed.
These findings provide reassuring evidence for continued use of sulfonylureas. Clinically, the benefits and low costs of sulfonylureas in treating type 2 diabetes need to be weighed against their potential risks of leading to very low blood sugar levels or weight gain. The evidence needs to be considered alongside the benefits and safety of newer drugs now available for treatment.
From the NIHR Dissemination Centre
Sulfonylureas are commonly used in the treatment of adults with type 2 diabetes. The drugs in this class are relatively cheap and have been available for many decades, but there have been conflicting views on their safety. The trials in this review were large enough and sufficiently long to pick up relatively rare harmful events like death. Therefore the researchers were confident that, even if there is a small risk, less than one in 200 people treated with sulfonylureas are likely to be harmed.
These findings provide reassuring evidence for continued use of sulfonylureas. Clinically, the benefits and low costs of sulfonylureas in treating type 2 diabetes need to be weighed against their potential risks of leading to very low blood sugar levels or weight gain. The evidence needs to be considered alongside the benefits and safety of newer drugs now available for treatment.
From the NIHR Dissemination Centre
PHE publishes new advice on vitamin D
PHE is advising that 10 micrograms of vitamin D are needed daily to help keep healthy bones, teeth and muscles.
New and emerging non-invasive glucose monitoring technologies
The NIHR Horizon Scanning Research and Intelligence Centre has published a horizon scanning review on new and emerging non-invasive glucose monitoring technologies in development for people with diabetes.
Plans for changing healthcare education funding
Following a consultation on reforms to the education funding for nursing, midwifery and allied health professional (AHP) students, the government has set out its plans to keep healthcare courses accessible for all.
Strengthening financial performance and accountability in 2016/17
This document from NHS Improvement sets out action to stabilise NHS finances in 2016/17, provides further detail on access to the Sustainability and Transformation Fund (STF) in 2016/17, outlines the proposed basis for assessing the financial performance of provider organisations and introduces new programmes of financial special measures for providers and commissioners that are unable to ensure sufficient financial discipline.
NHS sets out plan to road test maternity services of the future
NHS England has laid out new plans to improve maternity services and is calling on local areas to road test new ways of working.
The Maternity Transformation Programme has now identified nine working areas to take forward implementation of the recommendations set out in the report of the national maternity review, Better Births. These include:
The Maternity Transformation Programme has now identified nine working areas to take forward implementation of the recommendations set out in the report of the national maternity review, Better Births. These include:
- Supporting Local Transformation
- Promoting good practice for safer care
- Increasing Choice and Personalisation
- Improving access to perinatal mental health service
- Transforming the workforce
- Sharing data and information
- Harnessing technology
- Reforming the payment system
- Improving prevention
Thursday, 21 July 2016
Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section
This Cochrane Systematic Review concludes that there was no clear difference between irrigation and intravenous antibiotic prophylaxis in reducing the risk of post-caesarean endometritis. For other outcomes, there is insufficient evidence regarding which route of administration of prophylactic antibiotics is most effective at preventing post-caesarean infections. The authors advise caution in the interpretation and generalisability of the results. Future studies should evaluate the more recently available antibiotics, elaborating on the various available routes of administration, and exploring potential neonatal side effects of such interventions
Anti-Microbial Resistance (AMR) CQUIN
To support the delivery of the national AMR CQUIN, NHS England (NHSE) has been working with NHS Improvement (NHSI) and Public Health England (PHE) to develop FAQs and data collection forms.
Transfer of some hospital outpatient services to general practice is effective, but costs are unclear
This NIHR funded review strengthens evidence that transferring some hospital outpatient services to general practice is beneficial and liked by patients. It highlights a number of promising service configurations that could make NHS outpatient care more efficient. These include giving GPs direct access to some diagnostic tests and investigations giving specialist advice to GPs by phone or email. Where expertise is available, the report found that GPs performing minor surgery and providing long term follow up for chronic diseases were also effective.
This was an update to a 2006 review, which had similar findings. However, economic evaluations of the strategies were rarely reported, and community care may not necessarily be cheaper. If care is transferred to the community, the views of patients and the effect on overall costs are also important considerations.
This was an update to a 2006 review, which had similar findings. However, economic evaluations of the strategies were rarely reported, and community care may not necessarily be cheaper. If care is transferred to the community, the views of patients and the effect on overall costs are also important considerations.
From the NIHR Dissemination Centre
Decontamination of surgical instruments (HTM 01-01)
Health Technical Memorandum (HTM) 01-01: management and decontamination of surgical instruments (medical devices) used in acute care.
Needlestick injuries and blood-borne viruses: decisions about testing adults who lack the capacity to consent
This new guidance from the BMA provides advice on what to do in situations where the patient lacks the capacity to consent to testing for blood-borne viruses when a health professional has sustained needlestick injury.
Raising concerns e-learning module now available
Health Education England's e-Learning for Healthcare team (HEE e-LfH) has developed a new online resource for healthcare staff to equip them with the necessary knowledge and confidence to raise public interest concerns.
An investigation report by the Parliamentary and Health Service Ombudsman into how the NHS failed to properly investigate the death of a three-year old child
The report on an investigation into a child's death, found that the local NHS investigation processes were not fit for purpose, and not sufficiently independent, inquisitive, open or transparent, properly focused on learning, or able to span organisational and hierarchical barriers, and they excluded the family and junior staff in the process.
Wednesday, 20 July 2016
Non-Hodgkin’s lymphoma: diagnosis and management
New NICE guideline covering diagnosing and managing non-Hodgkin's lymphoma in people aged 16 years and over. It aims to improve care for people with non-Hodgkin's lymphoma by promoting the best tests for diagnosis and staging and the most effective treatments for 6 of the subtypes. Tests and treatments covered include excision biopsy, radiotherapy, immunochemotherapy and stem cell transplantation.
Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
Evidence-based recommendations on ataluren (Translarna) for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene in people aged 5 years and older who can walk.
NHS National Tariff Payment System 2016/17
The NHS National Tariff Payment System 2016/17 has been updated.
Improving the quality of care for men with lower urinary tract symptoms: shared decision making
The primary aim of the initiative was to prevent inappropriate
referrals and raise the quality of patient referrals by improving the
decisions made by clinicians and their patients with lower urinary tract symptoms (LUTS). The use of patient decision aids (PDAs)
and shared decision-making (SDM) would help facilitate the
quality of referrals and the better use of resources.
What is the appropriate management for incidental finding of endometrial fluid (EF) in postmenopausal women?
Answer to the question, What is the appropriate management for incidental finding of endometrial fluid (EF) in postmenopausal women? posted to the RCOG Query Bank.
The safer management of controlled drugs
THE CQC's report for 2015 highlights local and national initiatives to promote the safe use of controlled drugs and to reduce harm from their misuse.
Safe data, safe care
This thematic review published by the CQC of data security was conducted to establish whether personal health and care information is being used safely and is appropriately protected in the NHS. The review found that across the NHS there is widespread commitment to keeping data secure, but effective action is not always being taken where necessary.
Diabetes UK surveying healthcare professionals and carers about research priorities
Diabetes UK is looking for the Top 10 research priorities of people with Type 2 diabetes, carers and healthcare professionals. Whether you are a research expert or not, you can take part. The survey outcomes has great potential to influence future research investment.
Diabetes UK want ideas and thoughts from people with lots of different experiences and backgrounds and to hear about their experiences of Type 2 diabetes.
Diabetes UK want ideas and thoughts from people with lots of different experiences and backgrounds and to hear about their experiences of Type 2 diabetes.
Reducing Inequalities, Improving Society: an evaluation of the Widening Digital Participation programme
A report published by the Tinder Foundation shows an NHS programme to train vulnerable people to use the internet has led to over half feeling more confident to manage their health, 21% making fewer calls or visits to their GP and 6% making fewer trips to A&E.
New National Commissioning Framework for Hearing Loss Services launched
A new guide to help organisations responsible for planning and commissioning local hearing services for deaf people and those with diminishing hearing is launched by NHS England.
The Commissioning Services for People with Hearing Loss – a Framework for Clinical Commissioning Groups establishes what effective commissioning looks like for CCGs by:
The Commissioning Services for People with Hearing Loss – a Framework for Clinical Commissioning Groups establishes what effective commissioning looks like for CCGs by:
- Ensuring CCGS are supported when choosing good value services for their local populations
- The needs of local people are met by high quality integrated care
- Addressing access and outcome inequalities
- Improving patient choice when it comes to selecting services
- Contracting and monitoring outcomes and referrals from all providers to ensure consistency
Almost two thirds of patients with muscular dystrophy can’t get specialist physio
The report from Muscular Dystrophy UK found that 60 per cent of people with muscle-wasting conditions were unable to access appropriate physiotherapy; short-term provision of physiotherapy meant patients were receiving little or no benefit from it; 20 per cent of patients were paying privately for their physiotherapy; and 40 per cent of UK neuromuscular centres said they urgently needed increased physio capacity.
Tuesday, 19 July 2016
Extrauterine Mirena - conservative or laparoscopic removal?
Answer to the question, A 54 years old asymptomatic postmenopausal patient has missing threads of a Mirena IUS inserted over 9 years ago for heavy periods. Recent ultrasound showed no intrauterine device and plain X-ray showed IUS in pelvis suggesting perforation. Should management be conservative or laparoscopic removal of the device?, posted to the RCOG Query Bank.
Is there any evidence that noise exposure in utero can harm the fetus?
Answer to the question, Is there any evidence that noise exposure in utero can harm the foetus?, posted to the RCOG Query Bank.
Guidance on the Provision of Services for Anaesthetic Care in the Non-theatre Environment
New guidance from the RCoA on the Provision of Services for Anaesthetic Care in the Non-theatre Environment.
Is there any evidence to support the use of prostaglandins before syntocinon for induction of labour in low risk women with prelabour rupture of membranes?
Answer to the question, Is there any evidence to support the use of prostaglandins before syntocinon for induction of labour in low risk women with prelabour rupture of membranes?, posted to the RCOG Query Bank.
In nulliparous women in second stage of labour, should the use of oxytocin (Syntocinon) be considered if contractions are inadequate?
Answer to the question, In nulliparous women in second stage of labour, should the use of oxytocin (Syntocinon) be considered if contractions are inadequate?, posted to the RCOG Query Bank.
Is there any evidence that women with uncomplicated polyhydramnios need induction of labour after 37 weeks?
Answer to the question, Is there any evidence that women with uncomplicated polyhydramnios need induction of labour after 37 weeks?, posted to the RCOG Query Bank.
What is the evidence for intermittent auscultation for twin pregnancies in labour?
Answer to the question, What is the evidence for intermittent auscultation for twin pregnancies in labour?, posted to the RCOG Query Bank.
When a decision for trial of instrumental delivery is made either for failure to progress and/or non-reassuring fetal status, does a delay in performing the instrumental delivery affect the outcome?
Answer to the question, When a decision for trial of instrumental delivery is made either for failure to progress and/or non-reassuring fetal status, does a delay in performing the instrumental delivery affect the outcome?, posted to the RCOG Query Bank.
Is there any evidence for advocating home birth for twin pregnancies?
Answer to the question, Is there any evidence for advocating home birth for twin pregnancies?, posted to the RCOG Query Bank.
Delivering An Equal Right To Sight
This report from SeeAbility examines current evidence and examples of good practice to advocate for people with learning disabilities about what is important to them in the provision of eye care and sight tests. It finds that people with learning disabilities are at high risk of developing sight problems but that support is lacking in assisting this group in accessing the services needed to prevent sight loss. The report highlights examples of projects and initiatives to improve access to eye care for those with learning disabilities.
State of the nation 2016: time to take control of diabetes
This report from Diabetes UK brings together evidence from recent national diabetes audit reports covering care processes and treatment targets, inpatient care, pregnancy and foot care. It sets out actions to improve the delivery support, care and prevention of diabetes in England.
Guide will help physios tackle malnutrition in COPD patients
Physiotherapists can now access a practical, evidence-based guide to managing malnutrition in adults with chronic obstructive pulmonary disease (COPD). The resource aims to help healthcare professionals identify and manage people with the condition who are malnourished or at risk of disease-related malnutrition.
Monday, 18 July 2016
Congenital Heart Disease: NHS England takes action to deliver consistent and high quality services now and for the future
The changes announced by NHS England are being introduced to ensure core standards of quality and sustainability apply across all specialist congenital heart disease services. NHS England has set out a number of actions it intends to take subject to necessary engagement and service change process.
Physio involvement is vital to the NHS’s digital journey
Involving clinicians and patients is vital to developing IT to support better health services. - This was the message from digital experts at the King’s Fund digital health and care congress, held in London on 6 July.
Building on our vision of the future – Dr Peter Lanyon
The President of the British Society for Rheumatology calls for “all hands on deck” to tackle rheumatic and musculoskeletal diseases: I am very excited to be serving the British Society of Rheumatology (BSR) as its President – a role I took up just two months ago. Our members are front-line clinicians, nurses and allied health professionals […]
A clear road ahead: creating a coherent quality strategy for the English NHS
A clear road ahead is the result of a project by a team from the Health Foundation, working with Professor Sheila Leatherman – whose previous work on a national quality programme fed into Lord Darzi’s NHS Next Stage Review – to recommend how the different parts of the NHS should work together to support and accelerate improvements in quality of care.
Be Clear on Cancer respiratory symptoms campaign launches
First national Be Clear on Cancer campaign to raise awareness of symptoms of lung cancer, lung disease and heart disease begins.
Preterm babies do not benefit from a new IV feeding regimen - NIHR Signal
Intravenous feeding solutions with a higher dose of amino acids or solutions containing fish oils do not provide better outcomes for preterm infants.
Many preterm babies can’t feed normally for the first few weeks after birth so they are given a mixture of protein, carbohydrate and lipid (oil or fat) intravenously. There is wide variation across the UK in terms of the type, composition and regimen of intravenous feeds.
This NIHR-funded NEON trial looked at infants born before 31 weeks. It tested the theory that increasing the amount of amino acids provided in IV feeding fluids may improve lean body mass and that giving more fish oils rather than plant oils may reduce liver problems. The trial findings provide no evidence that higher intakes of amino acids or emulsions containing fish oils are beneficial compared to a standard approach, where the dose of amino acids is slowly increased and soya oil is used.
Many preterm babies can’t feed normally for the first few weeks after birth so they are given a mixture of protein, carbohydrate and lipid (oil or fat) intravenously. There is wide variation across the UK in terms of the type, composition and regimen of intravenous feeds.
This NIHR-funded NEON trial looked at infants born before 31 weeks. It tested the theory that increasing the amount of amino acids provided in IV feeding fluids may improve lean body mass and that giving more fish oils rather than plant oils may reduce liver problems. The trial findings provide no evidence that higher intakes of amino acids or emulsions containing fish oils are beneficial compared to a standard approach, where the dose of amino acids is slowly increased and soya oil is used.
A statin drug during admission for heart surgery did not prevent an irregular heart beat - NIHR Signal
The statin, rosuvastatin, taken by adults before and after heart surgery, did not prevent atrial fibrillation or heart muscle injury compared to placebo. Acute kidney injury was more common for adults who received rosuvastatin.
Friday, 15 July 2016
Stepping up to the place: Integration self-assessment tool
This self-assessment tool from the Local Government Association and the NHS Confederation is designed to
support local health and care leaders through
health and wellbeing boards (HWBs) to
critically assess their ambitions, capabilities and capacities to integrate services to
improve the health and wellbeing of local
citizens and communities.
Make time to talk performance
NHS Employers' popular people performance management toolkit has been refreshed to include links to new guidance and useful resources.
This toolkit encourages NHS managers to make time to talk about performance with staff. It provides practical support and aims to increase managers’ knowledge about what good performance management is, and give them confidence to deal with some of the key management challenges, such as:
This toolkit encourages NHS managers to make time to talk about performance with staff. It provides practical support and aims to increase managers’ knowledge about what good performance management is, and give them confidence to deal with some of the key management challenges, such as:
- How do you review performance on an ongoing basis?
- What to do if a member of your team is underperforming?
- How do you give constructive feedback?
- How can you support staff to achieve their best?
GMC training surveys data published for local action
The General Medical Council (GMC) has published the latest results of its annual surveys into medical education and training across the UK.
The national training survey (NTS) sought views from around 55,000 doctors undergoing postgraduate training. In addition around 44,000 trainers – senior doctors responsible for developing the next generation of consultants and GPs – were also surveyed for their views from the education frontline.
The national training survey (NTS) sought views from around 55,000 doctors undergoing postgraduate training. In addition around 44,000 trainers – senior doctors responsible for developing the next generation of consultants and GPs – were also surveyed for their views from the education frontline.
New competency framework for all prescribers
Developed by the Royal Pharmaceutical Society in collaboration with NICE, the Framework sets out competencies central to effective performance needed by all prescribers, regardless of their professional background.
NICE draft guidance recommends non-invasive prenatal testing (NIPT) for fetal rhesus-D status
NICE is recommending a new test in pregnancy that could mean up to 40,000 women could avoid unnecessary medicines.
The test analyses the baby’s DNA found in its mother’s bloodstream to establish what blood group it is – if it’s different to that of its mother it can cause serious complications.
The test analyses the baby’s DNA found in its mother’s bloodstream to establish what blood group it is – if it’s different to that of its mother it can cause serious complications.
Diabetes in children and young people
New NICE Quality Standard covering the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. This quality standard will not cover care for children and young people with other forms of diabetes mellitus (such as monogenic diabetes or cystic fibrosis-related diabetes).
Maternal health project - It's better to ask and Three Ps in a pod
Preventing maternal mortality: It’s ok to ask reminds maternity professionals about the indirect causes of maternal death during pregnancy and in the postnatal period. More information can be found here.
The Maternal Health project has also produced an animated video about the physical, neurological and mental health conditions that can have an effect on pregnancy. View this short video on YouTube, and the Three Ps in a Pod poster.
The Maternal Health project has also produced an animated video about the physical, neurological and mental health conditions that can have an effect on pregnancy. View this short video on YouTube, and the Three Ps in a Pod poster.
Women with short or long birth spacing face a greater risk of preterm birth
Women who conceive less than 11 months after giving birth have a higher chance of going into labour or being medically induced before 37 weeks of gestation. In addition, the odds of a premature birth are also increased for those who wait three years to have another baby, suggests a new study published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).
Sepsis: recognition, diagnosis and early management
This new NICE guideline covers the recognition, diagnosis and early management of sepsis for all populations.
NICE draft guidance extends treatment options for thousands of people with severe rheumatoid arthritis
The draft guidance increases the number of people who will be eligible for Certolizumab pegol (Cimzia, UCB Pharma), on its own or with another drug, methotrexate, when other drugs haven’t worked or aren’t suitable.
NICE already recommends certolizumab pegol for treating severe rheumatoid arthritis which has not responded to intensive therapy with a combination of conventional disease-modifying anti-rheumatic drugs (DMARDs).
NICE already recommends certolizumab pegol for treating severe rheumatoid arthritis which has not responded to intensive therapy with a combination of conventional disease-modifying anti-rheumatic drugs (DMARDs).
Thursday, 14 July 2016
Building Bridges, Breaking Barriers
This report follows the CQC's review of integrated care for older people. It looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers. It finds that some older people are being denied personalised, effective and responsive care due to poor integration across local systems and makes various recommendations to make improvements
Clinical Commissioning: GPs In Charge?
Clinically led approaches to planning and designing health services are more likely to be both innovative and effective. For this reason, CCGs were set up to put GPs at the heart of NHS planning decisions. This King's Fund report looks at what has been learnt – including strategies to overcome challenges and identification of the main barriers to effective involvement – and makes recommendations for the future.
Bleeding risk with anticoagulants in atrial fibrillation or venous thromboembolism
New Eyes on Evidence from NICE:
A systematic review and meta-analysis found that, compared with warfarin, non-vitamin K antagonist oral anticoagulants were associated with a reduction in fatal bleeding in people with atrial fibrillation or venous thromboembolism.
A systematic review and meta-analysis found that, compared with warfarin, non-vitamin K antagonist oral anticoagulants were associated with a reduction in fatal bleeding in people with atrial fibrillation or venous thromboembolism.
Modified Valsalva manoeuvre for supraventricular tachycardia
New Eyes on Evidence from NICE:
A UK randomised controlled trial found that using a modified version of the Valsalva manoeuvre, where the patient was laid flat and raised their legs immediately after the move, was more effective than the standard manoeuvre at restoring normal heart rate in people who presented to emergencydepartments with an abnormally fast heart rate.
A UK randomised controlled trial found that using a modified version of the Valsalva manoeuvre, where the patient was laid flat and raised their legs immediately after the move, was more effective than the standard manoeuvre at restoring normal heart rate in people who presented to emergencydepartments with an abnormally fast heart rate.
Effects of calcium intake on bone mineral density and fracture risk
New Eyes on Evidence from NICE:
Two meta-analyses have found that increasing calcium intake, either through diet or using supplements, did not have a consistent effect on bone mineral density and incidence of fracture in people aged over 50 years
Two meta-analyses have found that increasing calcium intake, either through diet or using supplements, did not have a consistent effect on bone mineral density and incidence of fracture in people aged over 50 years
Urgent referral for suspected cancer
New Eyes on Evidence from NICE:
The study found that use of the urgent referral pathway by general practices was associated with lower mortality rates among their patients who were subsequently diagnosed with cancer.
A flexible approach to end-of-life care
Case study from NHS Employers on how applying a flexible approach to training can have a positive impact on patient care. By delivering more than 850 training sessions to staff in dispersed locations, Kent Community Health NHS Trust has:
- improved the end-of-life care service being delivered to patients
- increased staff confidence in having end-of-life care conversations.
Clinicians rise to the social media challenge
Patients often look for information about their condition in isolation, often resorting to Google or joining Facebook groups that have been created by other patients - with no idea of who is providing the content for the discussions or moderating the groups. These can often be more trouble than they are worth, directing people down paths that are not appropriate for them.
To address this issue, healthcare teams at Royal Stoke Hospital have started supporting patients by developing self-care videos and Facebook groups where clinicians can provide accurate, valuable, self-care information to patients in a closed environment.
Part of a person-centred care project launched by the West Midlands Academic Health Science Network across the region, the closed clinical Facebook groups now include atrial fibrillation, multiple sclerosis, asthma and cardiac rehabilitation care and are supported by public facing pages which are used to communicate valuable self-care information to the wider population.
To address this issue, healthcare teams at Royal Stoke Hospital have started supporting patients by developing self-care videos and Facebook groups where clinicians can provide accurate, valuable, self-care information to patients in a closed environment.
Part of a person-centred care project launched by the West Midlands Academic Health Science Network across the region, the closed clinical Facebook groups now include atrial fibrillation, multiple sclerosis, asthma and cardiac rehabilitation care and are supported by public facing pages which are used to communicate valuable self-care information to the wider population.
Resources to support safer care of the deteriorating patient (adults and children)
A stage two resource alert has been issued by NHS Improvement to support the timely identification, response and management of the deteriorating patient (adults and children).
Acute Pain Management: Scientific Evidence (4th Edition)
Acute Pain Management: Scientific Evidence is published every five years by ANZCA and FPM ANZCA and covers a wide range of clinical topics, combining a review of the best available evidence for acute pain management with current clinical and expert practice.
Alair bronchial thermoplasty system for adults with severe difficult to control asthma
NICE has developed a medtech innovation briefing (MIB) on the Alair bronchial thermoplasty system for adults with severe, difficult to control asthma.
The Alair bronchial thermoplasty system is designed to reduce the amount of smooth muscle in the airway walls, with the aim of improving symptoms in people with severe, difficult to control asthma. Evidence from 3 systematic reviews (reporting on 3 randomised controlled trials of mixed quality) suggests that use of the Alair system is associated with some patient benefits (such as improved quality of life, and morning peak expiratory flow), but not all benefits were considered to be clinically significant. There is mixed evidence in relation to other outcomes (including asthma exacerbations, hospitalisations and emergency department visits).
The procedure must be done 3 times, once every 3 weeks. The device cost for 3 procedures is up to £6,930 (for 3 single-use catheters), with a capital cost of up to £31,500 for the radiofrequency controller. Additional costs include more detailed pre-bronchoscopy assessments, increased patient monitoring and treating short-term adverse events.
The Alair bronchial thermoplasty system is designed to reduce the amount of smooth muscle in the airway walls, with the aim of improving symptoms in people with severe, difficult to control asthma. Evidence from 3 systematic reviews (reporting on 3 randomised controlled trials of mixed quality) suggests that use of the Alair system is associated with some patient benefits (such as improved quality of life, and morning peak expiratory flow), but not all benefits were considered to be clinically significant. There is mixed evidence in relation to other outcomes (including asthma exacerbations, hospitalisations and emergency department visits).
The procedure must be done 3 times, once every 3 weeks. The device cost for 3 procedures is up to £6,930 (for 3 single-use catheters), with a capital cost of up to £31,500 for the radiofrequency controller. Additional costs include more detailed pre-bronchoscopy assessments, increased patient monitoring and treating short-term adverse events.
New cancer dashboard
NHS England are publishing local data from the Cancer Patient Experience Survey side-by-side with data on other outcomes in the new Cancer Dashboard.
From September, the Dashboard will help Cancer Alliances – made up of local clinical leaders, commissioners and providers – to quickly identify areas for improvement across the whole cancer pathway, including patient experience.
NHS England announces provisional investment decisions for specialised services
NHS England has set out the results of its annual process for deciding which new treatments and services it will make available to patients.
Staffing Matters; Funding Counts: An Analysis Of Workforce Profile And Trends In The English NHS
This report from the Health Foundation examines the profile and features of the NHS workforce in England, including; health labour market trends; relevant international data and comparisons from other countries; and a series of specific ‘pressure points’. The report concludes that the greatest threats to the delivery of the NHS five year forward view are funding constraints and workforce shortages.
37 areas to lead rollout of tool to deliver person-centred care
People with long-term conditions in 37 areas across England are next in line to receive person-centred support to manage their own care, thanks to the roll-out of an evidence-based tool over the next five years.
The Patient Activation Measure (PAM) is a validated tool which captures the extent to which people feel engaged and confident in taking care of their health and wellbeing, helping professionals tailor support to better meet their needs.
The Patient Activation Measure (PAM) is a validated tool which captures the extent to which people feel engaged and confident in taking care of their health and wellbeing, helping professionals tailor support to better meet their needs.
Improvements needed for how newborn babies and infants with complex health problems are cared for
This CQC review looks at how risks for newborn babies are identified and managed and at the care for infants in the community who need respiratory support.
Data on written complaints in the NHS, Q4 2015/16
This new quarterly collection from HSCIC (annual prior to 2015/16) is a count of written complaints made by or on behalf of patients.
Data is for complaints about NHS hospital and community health services in England.
Data is for complaints about NHS hospital and community health services in England.
Deficits in the NHS 2016
This King's Fund report indicates that NHS commissioners (clinical commissioning groups and NHS England) and providers in aggregate ended 2015/16 in deficit for the second year running.
Not seen, not heard: a review of the arrangements for child safeguarding and health care for looked after children in England
This CQC report looks at how effective health services are in providing early help to children in need, the health and wellbeing of looked-after children and how these services identify and protect children at risk of harm.
It concludes that health professionals have improved the way they assess risk and recognise safeguarding concerns, but that services are not consistently protecting and promoting the health and welfare of children. It urges a whole system response to do more to listen to and involve children in need in their care.
Delayed Discharges And Hospital Type: Evidence From The English NHS
This Centre for Health Economics study investigated how delayed discharges vary by hospital type (acute, specialist, mental health, teaching), and the extent to which such differences can be explained by demography, case-mix, the availability of long-term care and hospital governance as reflected in whether the hospital has foundation trust status, which gives greater financial autonomy and flexibility in staffing and pay.
Congenital Heart Disease: NHS England takes action
Congenital heart disease (CHD) services have been the subject of a number of reviews since the public inquiry at Bristol Royal Infirmary in 2001.
As a result of these assessments, and following further verification with providers, NHS England intends – subject to necessary engagement and service change process in relation to this assessment – to take action to ensure all providers comply with the set standards.
In 2015, NHS England published new commissioning standards for CHD servicesfollowing extensive consultation with patients and their families, clinicians and other experts. Since then, hospital trusts providing CHD services have been asked to assess themselves against the standards, which came into effect from April 2016, and report back on their plans to meet them within the set time frames.
NHS England successfully negotiates access to new drug treatment for children with duchenne muscular dystrophy
NHS England and the manufacturer, PTC Therapeutics, have successfully negotiated a managed access agreement (MAA) for ataluren (brand name Translarna) for the treatment of children aged 5 and over with Duchenne muscular dystrophy (DMD) caused by a nonsense mutation.
NICE approves first drug from old Cancer Drugs Fund
NICE has approved bosutinib (Bosulif, Pfizer) which treats some people chronic myeloid leukaemia (CML).
Friday, 8 July 2016
Johanson-Blizzard syndrome
Update on Johanson-Blizzard Syndrome (JBS) from Orphanet, the portal for rare diseases and orphan drugs.
Johanson-Blizzard syndrome (JBS) is a multiple congenital anomaly characterized by exocrine pancreatic insufficiency, hypoplasia/aplasia of the nasal alae, hypodontia, sensorineural hearing loss, growth retardation, anal and urogenital malformations, and variable intellectual disability.
Johanson-Blizzard syndrome (JBS) is a multiple congenital anomaly characterized by exocrine pancreatic insufficiency, hypoplasia/aplasia of the nasal alae, hypodontia, sensorineural hearing loss, growth retardation, anal and urogenital malformations, and variable intellectual disability.
Care Quality Commission reviews how NHS acute trusts are learning from serious incidents
CQC has published the findings of its review of how acute NHS trusts report on investigations into serious incidents, and the extent to which they identify learning that can be used to improve practice when things go wrong.
The review – Learning from serious incidents in NHS acute hospitals: A review of the quality of investigation reports – was based on a sample of 74 investigation reports from 24 NHS acute hospital trusts.
The findings of the review have been published in a briefing paper which highlights a variation in the quality of investigations, and also provides a number of good practice examples and identifies the following five opportunities for improvement for NHS acute trusts:
The review – Learning from serious incidents in NHS acute hospitals: A review of the quality of investigation reports – was based on a sample of 74 investigation reports from 24 NHS acute hospital trusts.
The findings of the review have been published in a briefing paper which highlights a variation in the quality of investigations, and also provides a number of good practice examples and identifies the following five opportunities for improvement for NHS acute trusts:
- Prioritising serious incidents that require full investigation and developing alternative methods for managing and learning from other types of incident.
- Routinely involving patients and families in investigations.
- Engaging and supporting the staff involved in the incident and investigation process.
- Using skilled analysis to move the focus of investigation from the acts or omissions of staff, to identifying the underlying causes of the incident.
- Using human factors principles to develop solutions that reduce the risk of the same incidents happening again.
Workplace human rights
Each month, to celebrate diversity in the NHS, NHS Employers focuses on one of the key topics in the equality, diversity and human rights calendar.
This month it's workplace human rights. Workplace human rights are the fundamental rights and freedoms that protect and allow us to choose how we live our life, and be treated with dignity and respect.
For more information visit the workforce human rights web page and building a diverse workforce in the NHS.
This month it's workplace human rights. Workplace human rights are the fundamental rights and freedoms that protect and allow us to choose how we live our life, and be treated with dignity and respect.
CCEHC publish Primary Eye Care Framework
Demand is growing for busy hospital eye services (HES) because of the ageing population and new treatments. Patients risk losing sight because of delayed appointments and radical change is needed. The Clinical Council for Eye Health Commissioning (CCEHC) has designed a Primary Eye Care Framework to help commissioners tackle this problem.
NHS Financial Temperature Check - July 2016
This HFMA briefing sets out finance directors’ views on the financial issues facing the NHS in the UK. It provides a national picture of NHS finance directors’ and CFOs’ views of the financial outlook and main challenges NHS finance staff are facing. Please note that registration is required to access this publication.
Treat the Cause: A review of the quality of care provided to patients treated for acute pancreatitis
This NCEPOD report examines the quality of care received by patients admitted to hospital with a primary diagnosis of acute pancreatitis during the first 6 months of 2014. My first impression was that this report was a good news story, since a sizeable proportion of these patients received good care during a time when our daily press had started to regularly identify stories about how badly the NHS is handling patients, due to reduced resources. However, as with most NCEPOD reports, more detailed scrutiny reveals that the true picture is more complex and as a result my second impression is that there are many aspects of care in which we could be doing better. Our report has been able to identify these and make some practical recommendations to improve the situation.
Thursday, 7 July 2016
NHS Indicators: England, July 2016
Latest statistical data including:
- Waiting times for routine treatment
- Cancer waiting times
- Cancelled operations
- Delayed transfer of care
- Diagnostic tests: activity and waiting times
- Hospital activity
- Bed availability and occupancy
Cirrhosis in over 16s: assessment and management
This new NICE guideline covers assessing and managing suspected or confirmed cirrhosis in people who are 16 years or older. It aims to improve how cirrhosis is identified and diagnosed. It recommends tools to assess the severity of cirrhosis and gives advice on monitoring people with cirrhosis to detect and manage complications early, and referral criteria for tertiary care.
Non-alcoholic fatty liver disease (NAFLD): assessment and management
This new NICE guidance covers how to identify the adults, young people and children with non-alcoholic fatty liver disease (NAFLD) who have advanced liver fibrosis and are most at risk of further complications. It outlines the lifestyle changes and pharmacological treatments that can manage NAFLD and advanced liver fibrosis.
Thousands of cancer patients to benefit from early supportive care
An innovative programme to improve the care and experience of patients with incurable cancer is being rolled out across the country. ‘Enhanced Supportive Care’ was developed by specialists at The Christie NHS Foundation Trust, and will now be used by at least 21 more cancer centres across England, supported by incentives from NHS England.
New standards to keep your patient data secure
A new report published by the National Data Guardian sets out recommendations for how patient's health and care information should be used within the NHS.
'Review of Data Security, Consent and Opt-out', produced by the National Data Guardian Dame Fiona Caldicott, was commissioned by the Department of Health and received evidence from Healthwatch England and local Healthwatch about the public's views on consent and data security.
'Review of Data Security, Consent and Opt-out', produced by the National Data Guardian Dame Fiona Caldicott, was commissioned by the Department of Health and received evidence from Healthwatch England and local Healthwatch about the public's views on consent and data security.
Changes to cervical cancer screening
The process of cervical screening is to be changed to allow women to benefit from more accurate tests.
At the moment, cervical screening samples are first tested using the cytology test. The sample is examined for abnormal cells that could go on to develop into cancer. However, the cytology test leaves room for abnormal cells to be missed, as they sometimes look similar to normal cells. Normal cells can also be misdiagnosed as abnormal.
Testing for HPV is used as a secondary measure for samples needing further investigation. In the new process, the sample will be tested for HPV first.
At the moment, cervical screening samples are first tested using the cytology test. The sample is examined for abnormal cells that could go on to develop into cancer. However, the cytology test leaves room for abnormal cells to be missed, as they sometimes look similar to normal cells. Normal cells can also be misdiagnosed as abnormal.
Testing for HPV is used as a secondary measure for samples needing further investigation. In the new process, the sample will be tested for HPV first.
Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time
The National Quality Board (NQB) has published an updated safe staffing resource for NHS provider boards to assure the delivery of compassionate, effective, safe, sustainable high quality patient care.
Project to improve management of painful bowel condition wins 2016 Shared Learning Award
In Somerset, NICE’s recommendations on IBS were not being carried out in several areas. This was leading to unnecessary referrals to hospital outpatient clinics, inconveniencing patients and wasting money.
Consequently, Somerset Gastroenterology Flexible Healthcare Team decided to improve the diagnosis and management by better aligning practice with NICE guidance. After 3 years, the team found that there was a 5% reduction in appointments among 16 to 45 year olds likely to have IBS.
Consequently, Somerset Gastroenterology Flexible Healthcare Team decided to improve the diagnosis and management by better aligning practice with NICE guidance. After 3 years, the team found that there was a 5% reduction in appointments among 16 to 45 year olds likely to have IBS.
What staff need to know - An infographic from the Working Longer Group
NHS Employers Working Longer Group has published a new infographic for staff, highlighting the important facts about the ageing workforce in the NHS, including things staff should consider regarding their retirement and some of the common misconceptions.
A healthier life for all: the case for cross-government action
The Health Foundation and the All-Party Parliamentary Health Group have jointly published a comprehensive, accessible collection of essays setting out the current and emerging threats to health and wellbeing and what we know about what works to address them.
The essay collection concludes that addressing the wider determinants of health is critical to ensuring the prosperity and wellbeing of British society as well as easing pressure on the NHS. The essays support the view that a more proactive approach to tackling poor health across all policy areas is urgently needed, to help ensure individuals, families and communities can thrive.
The essay collection concludes that addressing the wider determinants of health is critical to ensuring the prosperity and wellbeing of British society as well as easing pressure on the NHS. The essays support the view that a more proactive approach to tackling poor health across all policy areas is urgently needed, to help ensure individuals, families and communities can thrive.
Just launched: a nationwide drive to digitise outpatient services
NHS Improvement has launched a nationwide drive to digitise outpatient services to improve patient experience and care quality – which could also help save the NHS up to £2.9 billion.
Its Digital Outpatients programme aims to help NHS providers accelerate work from first principles, support the sharing of best practice, unblock barriers to uptake and deliver solutions that have been built with patients and clinicians from the start.
Its Digital Outpatients programme aims to help NHS providers accelerate work from first principles, support the sharing of best practice, unblock barriers to uptake and deliver solutions that have been built with patients and clinicians from the start.
The value of knowing and knowing the value: improving the health technology assessment of complementary diagnostics
This White Paper from the
Office of Health Economics (OHE) and the European Personalised Medicine Association
(EPEMED) addresses key issues in the health technology assessment (HTA) of complementarydiagnostics. In particular, it develops a more comprehensive framework for assessing the
potential value contribution of complementary diagnostics.
End of life care for infants, children and young people
NICE are consulting on draft guidance on end of life care for infants, children and young people. The consultation closes on 12 August 2016
Wednesday, 6 July 2016
Research shows patient-centred outcome measures improve emotional wellbeing of patients
Research conducted at the Cicely Saunders Institute shows strong evidence that feedback from patient-centred outcome measures affects the process of care delivery, enabling more positive and holistic care.
End of Life Care CPD
NHS Employers in co-operation with Health Education England have launched a new programme of work which aims to support organisations to invest in the continuing professional development (CPD) and capacity building of staff in order to deliver high quality end of life care.
Compassion in Dying launches free website for advance care planning
Compassion in Dying has launched a free website to help people plan ahead for their future treatment and care. It includes information on living wills, advance decisions and lasting power of attorney.
Better Ways to Pay for Health Care
Report from the OECD on paying for health care
Payers for health care are pursuing a variety of policies as part of broader efforts to improve the quality and efficiency of care. Payment reform is but one policy tool to improve health system performance that requires supportive measures in place such as policies with well-developed stakeholder involvement, information on quality, clear criteria for tariff setting, and embedding evaluation as part of the policy process. Countries should not, however, underestimate the significant data challenges when looking at price setting processes. Data access and ways to overcome its fragmentation require well-developed infrastructures. Policy efforts highlight a trend towards aligning payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting. There are signs of increasing policy focus on outcomes to inform price setting. These efforts could bring about system-wide effects of using evidence along with a patient-centred focus to improve health care delivery and performance in the long-run.
Payers for health care are pursuing a variety of policies as part of broader efforts to improve the quality and efficiency of care. Payment reform is but one policy tool to improve health system performance that requires supportive measures in place such as policies with well-developed stakeholder involvement, information on quality, clear criteria for tariff setting, and embedding evaluation as part of the policy process. Countries should not, however, underestimate the significant data challenges when looking at price setting processes. Data access and ways to overcome its fragmentation require well-developed infrastructures. Policy efforts highlight a trend towards aligning payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting. There are signs of increasing policy focus on outcomes to inform price setting. These efforts could bring about system-wide effects of using evidence along with a patient-centred focus to improve health care delivery and performance in the long-run.
Cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death
New guidance from the Resuscitation Council (UK), British Cardiovascular Society and National Council for Palliative Care on cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death.
Exploring the Value of Patient Experience
New post to the Beryl Institute Patient Experience Blog exploring the value of patient experience.
Government commits to high quality end of life care
The government has made 6 commitments to the public to end variation in end of life care across the health system by 2020. These are:
- honest discussions between care professionals and dying people
- dying people making informed choices about their care
- personalised care plans for all
- the discussion of personalised care plans with care professionals
- the involvement of family and carers in dying people’s care
- a main contact so dying people know who to contact at any time of day
Patient Safety Collaborative teams reduce harm to patients nationwide
'Patient Safety Collaboratives: making care safer for all’ updates on the work of the 15 teams (known as Patient Safety Collaboratives) to improve patient safety, spread examples of success and influence system leaderships.
National Emergency Laparotomy Audit
The Second Patient Report of the National Emergency Laparotomy Audit has been published. It covers patients who
underwent emergency bowel surgery between December 2014 and November 2015, and describes the care received by these patients within English and Welsh NHS hospitals as well as hospital-level patient
mortality.
The NHS if...
A collection of essays published by the King's Fund exploring hypothetical scenarios for the future of health and care.
Beyond Maternal Death: Improving The Quality Of Maternal Care Through National Studies Of 'Near-Miss' Maternal Morbidity
Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.
This NIHR study aimed to estimate the incidence of near-miss morbidities; describe different interventions and their impact on outcomes and costs; and compare an external confidential enquiry or a local review approach for investigating the quality of care for affected women.
National Cancer Patient Experience Survey Results 2015 - Local Data
Hospital trusts and clinical commissioning groups have opportunities to improve cancer patients experience of care by looking at the variation highlighted by a national survey published by NHS England.
The annual survey of how cancer patients are cared for in the NHS has undergone an extensive review to ensure it is a better tool to help deliver the national cancer strategy, and follows consultation involving patients, clinicians and other stakeholders to ensure it best represents patient experience.
The annual survey of how cancer patients are cared for in the NHS has undergone an extensive review to ensure it is a better tool to help deliver the national cancer strategy, and follows consultation involving patients, clinicians and other stakeholders to ensure it best represents patient experience.
Mental Capacity Act
The Social Care Institute for Excellence has release a new online resource Using the Mental Capacity Act. The video aims to explain the Mental Capacity Act and how it can protect the right to make choices for people who need the Act, their carers, and others. Split into sections it explains the five key principles of the Act and how they work in practice.
Updated CPR advice aims to support decisions
Guidance on doctors’ responsibilities in relation to decisions concerning CPR (cardiopulmonary resuscitation) has been reviewed in light of recent statutory changes and a high court ruling.
The BMA, the Royal College of Nursing and the Resuscitation Council (UK) have produced updated joint guidance on the ethical principles that should inform how decisions about CPR are made and communicated.
The BMA, the Royal College of Nursing and the Resuscitation Council (UK) have produced updated joint guidance on the ethical principles that should inform how decisions about CPR are made and communicated.
Situation awareness in hospitals
A new resource to introduce and improve situation awareness in hospitals is now available on the Royal College of Paediatrics and Child Health’s website. This free, online resource pack aims to improve communication, build a safety-based culture and deliver better health outcomes for children and young people.
Tuesday, 5 July 2016
Disclosure UK database
This database from the APBI brings together and makes publicly available the details of payments or benefits in kind - made to doctors, nurses and pharmacists, as well as other health professionals and healthcare organisations in the UK.
A Spectrum Of Obstacles: An Inquiry Into Access To Healthcare For Autistic People
Following a seven-month inquiry and a consultation of over 900 people, the Westminster Commission on Autism launches its inquiry report and calls for improved access to healthcare for all autistic people. It calls for greater training of health professionals to increase awareness of the health care needs of autistic people; the implementation of annual health checks for autistic people; and also that CQC should establish autism-specific inspection questions into their inspection framework.
Patients As Partners: Building Collaborative Relationships Among Professionals, Patients, Carers And Communities
This King's Fund report calls for all NHS organisations to commit to working more closely with patients to meet the requirements of a new relationship with patients and communities outlined in the NHS five year forward view. The paper looks at what can be achieved by NHS professionals working with patients and looks in detail at case studies drawn from the Fund’s ground-breaking national collaborative pairs programme, which supported patients and health professionals to work together on a wide range of local initiatives. The paper is a helpful guide for people who are interested in working with patients and sets out five practical ways to develop collaborative relationships among NHS, patient and community partners.
SMI ID 3: Identification of Listeria species, and other non sporing Gram positive rods, except Corynebacterium
UK Standards for Microbiology Investigations SMI ID 3: Identification of Listeria species, and other non sporing Gram positive rods, except Corynebacterium.
Infant feeding: commissioning services
Information from Public Health England to support commissioning of local infant feeding services.
Making staff experts in end-of-life care
Case study from the Salford Royal NHS Foundation Trust on making staff experts in delivering end of life care.
Depression and anxiety common in people with heart disease
This multi-part NIHR study found that depression and anxiety were more common in people with coronary heart disease, than the general population. Anxiety increased people’s risk of a future heart attack. The people included in the study were generally older, white males, so the findings may not apply to everyone.
Patients considered a nurse-led intervention to personalise care was acceptable. The intervention included optimising medicines and facilitating referrals for psychological support. When asked, people with depression and coronary heart disease generally favoured non-medical treatments. These findings provide an insight into the scale of depression and anxiety amongst people with coronary heart disease. Overall costs of NHS care were increased in people with coronary heart disease and depression, compare with those who were not depressed. This was mainly due to coronary heart disease related inpatient care. The link between mental and physical health indicates the necessity of addressing both.
The insights into why people feel depressed provide a framework for starting conversations with potentially depressed people.
Patients considered a nurse-led intervention to personalise care was acceptable. The intervention included optimising medicines and facilitating referrals for psychological support. When asked, people with depression and coronary heart disease generally favoured non-medical treatments. These findings provide an insight into the scale of depression and anxiety amongst people with coronary heart disease. Overall costs of NHS care were increased in people with coronary heart disease and depression, compare with those who were not depressed. This was mainly due to coronary heart disease related inpatient care. The link between mental and physical health indicates the necessity of addressing both.
The insights into why people feel depressed provide a framework for starting conversations with potentially depressed people.
From the NIHR Dissemination Centre
Nexgen found to be best value for total knee replacement
This economic analysis, using routinely collected National Joint Registry data from 2003 to 2012, found that Nexgen was the most cost-effective brand of prosthesis for total knee replacement. The cheapest brand was AGC Biomet, but Nexgen gave greater quality of life improvement, and the additional cost for the benefit - £2,300 per quality-adjusted life-year - was well within usual willingness to pay thresholds. Nexgen also had the lowest rates of revision surgery.
The study is the first to compare commonly-used prostheses for patient outcomes, costs and revision rates (how soon the replacement knee needed replacing). The comparisons relied on non-randomised, routinely collected data, and although the authors made every effort to correct for possible bias, the results should be treated cautiously. Prosthesis design improves over time, and so procurement decisions will need to be periodically re-examined.
The study is the first to compare commonly-used prostheses for patient outcomes, costs and revision rates (how soon the replacement knee needed replacing). The comparisons relied on non-randomised, routinely collected data, and although the authors made every effort to correct for possible bias, the results should be treated cautiously. Prosthesis design improves over time, and so procurement decisions will need to be periodically re-examined.
From NIHR Dissemination Centre
Management and decontamination of flexible endoscopes (HTM 01-06)
Health Technical Memorandum (HTM) 01-06 from the DoH offers guidance on the management and decontamination of flexible endoscopes.
Achieving World-Class Cancer Outcomes: The Vision for Therapeutic Radiography
This guidance from the Society and College of Radiographers (SCoR) is intended to be a vision for the radiography profession as these roles continue to change and develop in the future in response to technical, operational and political influences. It also aims to assist radiotherapy managers in making informed decisions about their local service needs.
Monday, 4 July 2016
Intravenous nutrition is more costly than feeding by stomach tube, with few added benefits
Critically ill people need some form of feeding to give them protein and energy. The NIHR funded this multicentre trial to compare the costs and effects of early intravenous nutritional support with enteral feeding, feeding by tube into the stomach or the intestine. Death rates and other important outcomes were similar when using either route. The intravenous route was associated with lower rates of stomach overfilling, diarrhoea and low blood sugar, but the benefits gained were not great enough to justify the higher costs.
The findings support current practice across NHS critical care units where delivery of early nutritional support is predominantly given via stomach tube.
From the NIHR Dissemination Centre
The findings support current practice across NHS critical care units where delivery of early nutritional support is predominantly given via stomach tube.
From the NIHR Dissemination Centre
Single therapy an option for adults with suppressed HIV
For adults with HIV who have achieved a low level of the HIV virus after initial treatment, further treatment with a protease inhibitor alone instead of standard triple drug therapy does not reduce future drug options. It is also cost-effective for long-term management of HIV.
In this large NIHR funded trial, switching to single therapy after the virus level is suppressed did not lead to treatment resistance compared to triple therapy, as earlier evidence had suggested. A return to detectable levels, called a rebound increase, was ten-fold higher on single therapy but this was managed with a change in drug regime. There was no difference between the groups in terms of quality of life, disease complications or side effects up to five years.
Single therapy for suppressed HIV is not yet recommended in the guidelines but is being increasingly used in the UK.
From the NIHR Dissemination Centre
In this large NIHR funded trial, switching to single therapy after the virus level is suppressed did not lead to treatment resistance compared to triple therapy, as earlier evidence had suggested. A return to detectable levels, called a rebound increase, was ten-fold higher on single therapy but this was managed with a change in drug regime. There was no difference between the groups in terms of quality of life, disease complications or side effects up to five years.
Single therapy for suppressed HIV is not yet recommended in the guidelines but is being increasingly used in the UK.
Mechanical clot removal may offer better outcomes for people with stroke
Mechanical clot removal alongside standard clot-busting drug treatment may offer better functional outcomes for people who have suffered a stroke caused by a blood clot than drug treatment alone. This review found that 44% of patients receiving mechanical clot removal had a good functional outcome after 90 days, compared to 33% of those who didn’t.
However, these benefits only apply to a subset of patients. Prior brain scan is essential in order to identify if the clot is amenable to mechanical removal. Also, newer technology was associated with better outcomes.
Given these implementation challenges, the cost-effectiveness of the approach remains unknown. Mechanical clot removal is a highly skilled operation that should be performed within six to eight hours after the stroke. Patients would need early access to stroke units with the necessary diagnostics, technology and specialist expertise. Therefore a pragmatic NHS trial and cost-effectiveness analysis would be informative.
However, these benefits only apply to a subset of patients. Prior brain scan is essential in order to identify if the clot is amenable to mechanical removal. Also, newer technology was associated with better outcomes.
Given these implementation challenges, the cost-effectiveness of the approach remains unknown. Mechanical clot removal is a highly skilled operation that should be performed within six to eight hours after the stroke. Patients would need early access to stroke units with the necessary diagnostics, technology and specialist expertise. Therefore a pragmatic NHS trial and cost-effectiveness analysis would be informative.
From the NIHR Dissemination Centre
A newer sedative agent may shorten length of stay in intensive care units
Adults needing mechanical ventilation who were sedated with dexmedetomidine had reduced length of stay in intensive care and reduced duration of ventilation.
Various sedative drugs are available for use in England although it is unclear if one is better than the others. This review compared two alpha-2 agonist drugs (clonidine and dexmedetomidine) to other commonly used sedative drugs: propofol and the benzodiazepines midazolam and lorazepam for adults on mechanical ventilation.
A 2014 survey reported that, while clonidine is used in about a third of units, dexmedetomidine is not frequently used. The latter drug is expensive, and this review did not consider cost-effectiveness which will be an important factor if the drug is to be used more widely.
This review’s findings on dexmedetomidine support best practice guidelines which suggest modest benefits for non-benzodiazepines compared to benzodiazepines.
Various sedative drugs are available for use in England although it is unclear if one is better than the others. This review compared two alpha-2 agonist drugs (clonidine and dexmedetomidine) to other commonly used sedative drugs: propofol and the benzodiazepines midazolam and lorazepam for adults on mechanical ventilation.
A 2014 survey reported that, while clonidine is used in about a third of units, dexmedetomidine is not frequently used. The latter drug is expensive, and this review did not consider cost-effectiveness which will be an important factor if the drug is to be used more widely.
This review’s findings on dexmedetomidine support best practice guidelines which suggest modest benefits for non-benzodiazepines compared to benzodiazepines.
From the NIHR Dissemination Centre
Care Act 2014: Guidance for occupational therapists - Prevention
This is one of a series of guides to the Care Act 2014 that has been developed by the College of Occupational Therapists. This one covers prevention and will assist occupational therapy practitioners, to understand and deliver some of the key concepts and duties within the Act.
Five big issues for health and social care after the Brexit vote
Health is not an area of significant EU competence; its role is by and large limited to supporting member states in their health endeavours.
Nevertheless, the impact of the UK’s vote to leave the EU could have major implications for health and social care, not least because it has ushered in a period of significant economic and political uncertainty at a time when the health and care system is facing huge operational and financial pressures. While the impact on health and social care services of leaving the EU is impossible to forecast, it is clear that a number of important issues will need to be resolved, five of which we set out in this King's Fund report..
Nevertheless, the impact of the UK’s vote to leave the EU could have major implications for health and social care, not least because it has ushered in a period of significant economic and political uncertainty at a time when the health and care system is facing huge operational and financial pressures. While the impact on health and social care services of leaving the EU is impossible to forecast, it is clear that a number of important issues will need to be resolved, five of which we set out in this King's Fund report..
E-Learning resource for ophthalmologists about certifying visually impaired patients
RNIB has developed an online E-Learning resource for ophthalmologists to highlight the importance of working proactively with eligible patients to certify them as sight impaired (partially sighted) or severely sight impaired (blind) using The Certificate of Vision Impairment (CVI).
Applications open for nursing associate role test sites
Health Education England (HEE) is inviting partnership applications from organisations in health care settings who are interested in becoming test sites for the new nursing associate role.
Computerised Tomography (CT) scanners in Nuclear Medicine facilities; use by nuclear medicine practitioners from both radiographic and technologist backgrounds
The Society and College of Radiographers recognises that the developing use of multi-detector computerised tomography
(MDCT) scanners within nuclear medicine facilities provides a challenge to the non-medical
workforce to assure high quality patient services. The Nuclear Medicine Advisory Group (NMAG) of
the SCoR has developed this statement to support the non-medical workforce in delivering safeservices.
Census of the Radiotherapy Radiographic Workforce in the UK, 2015
This report from the Society and College of Radiographers provides a summary of the UK radiotherapy radiographic workforce in the National
Health Service (NHS) and private/independent healthcare sector.
Storage of Drugs in Anaesthetic Rooms
New guidance on the storage of drugs in anaesthetic rooms from the RCoA and the AAGBI
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