RCOG - Antenatal CTG and IUGR (query bank)

Question
Is there any role for antenatal cardiotocography (CTG) in a confirmed intrauterine growth-restricted (IUGR) fetus?
Answer
This clinical query answer was produced by RCOG Library staff following the clinical query protocol.

Alcohol and drug prevention, treatment and recovery for adults: planning interventions

Public Heath England -
Good practice prompts for planning comprehensive interventions in 2016 and 2017, to be used by local healthcare commissioners.

JCVI statement on the nasal spray flu vaccine

Using the nasal spray flu vaccine for the UK childhood influenza immunisation programme: advice from JCVI

What is the available evidence for the use of statins in patients with renal impairment?

Specialist Pharmacy Service - 

This Q&A evaluates the evidence for the use of statins in renal impairment and discusses current guidance for using statins in this population.

Bias in leadership: What's your story?

As the diversity and inclusion annual conference on 21 September approaches we will be publishing blogs from our keynote speakers.

In the first of the blogs, Dan Robertson the Director of Diversity and Inclusion at the Employers Network for Equality and Inclusion, talks about bias in leadership and his own experience of it in both the private and public sector. Dan is a highly respected expert on workplace diversity & inclusion management, unconscious bias and inclusive leadership.

RCOpth - NICE Macular Oedema (Branch Retinal Vein Occlusion) Final Technology Appraisal

The Royal College of Ophthalmologists - 

This is a response to NICE announcing their positive final guidance for Eylea® for the treatment of adult patients with visual impairment due to macular oedema secondary to branch retinal vein occlusion (BRVO)

The Golden Ticket: Primary care takes the lead in improving dementia care

The Golden Ticket is a new approach to the management of dementia in primary care, piloted by the Buxted Medical Centre in East Sussex. By working with a range of partner agencies to provide a coordinated package of support for patients and their carers within the community, the project is already showing a significant reduction in acute admissions, while also reducing reliance on GP consultations and improving patient experience. - See more at The Health Foundation

Four tools to enhance significant event analysis in primary care

Significant event analysis (SEA) is a collective learning technique used to investigate patient safety incidents (circumstances where a patient was or could have been harmed) and other quality of care issues.

About the project
The project team at NHS Education for Scotland (NES) had more than 15 years’ experience of working on SEA in primary care. They identified limitations in how SEA was being used and set about investigating and developing a new approach during a project funded by our SHINE 2012 programme.

See more at The Health Foundation

Chart: how stressful GPs in the UK find their job

In our report Under Pressure, we looked at the satisfaction of GPs, as well as care coordination and use of electronic medical records in general practice. The report is UK-focused analysis by the Health Foundation of the Commonwealth Fund’s 2015 survey of primary care physicians across 11 countries, which included several UK-specific questions funded by the Health Foundation. - 

See more at The Health Foundation

Emergency care departments miss waiting-time targets

Waiting-time targets for Welsh emergency care departments have been missed again, according to the latest statistics.
A total of 83.2 per cent of patients spent less than four hours in emergency care in July – before being admitted, transferred or discharged – missing the Welsh Government target of 95 per cent.
This is a slight decline from June's figure of 83.3 per cent.

NHS Workforce Statistics - 2016

This report shows provisional monthly figures for headcount and full-time equivalent of NHS Hospital and Community Health Service (HCHS) staff groups working in Trusts and CCGs in England (excluding primary care staff).   
This data is an accurate summary of the validated data extracted from the NHS's HR and Payroll system. It has a provisional status as the data may change slightly over time where trusts make updates to their live operational systems.

NHS England statement on Sustainability and Transformation Plans

Commenting on stories today on local Sustainability and Transformation Plans, a spokesperson for NHS England said: “We need an NHS ready for the future, with no one falling between the cracks. To do this, local service leaders in every part of England are working together for the first time on shared plans to transform health and care in the communities they serve, and to agree how to spend increasing investment as the NHS expands over the next few years.

Joint inspections for vulnerable children and young people to focus on domestic abuse

Joint Targeted Area Inspections (JTAI) examine how well agencies work together in a local area to help and protect children.

The next series of inspections, starting in September, will look at how well children affected by domestic abuse are protected. They will include children living where there are incidents of domestic abuse, or where there is a risk of domestic abuse taking place.

Comment on the Department of Health's proposal to enable us to rate more types of provider

The Department of Health has launched a consultation on proposals to extend the types of provider registered with us that we are able to rate following inspection.

We already rate NHS trusts, general practices, care homes, hospices, home care and other types of community adult social care, and private hospitals. The Department of Health is proposing that we publish ratings for a number of types of provider that we already regulate but currently don't rate.

CQC Workforce Race Equality Standard (WRES) response shows improvement

Today sees the publication of our submission against the Workforce Race Equality Standard (WRES) for 2015/16.

The standard sets out indicators of race equality in the workplace, enabling organisations to measure progress and decide what action they need to take to ensure equality of opportunity and fair treatment. Our submission uses the same format and questions as are used in NHS trusts.

RCN Competences: an education and training competence framework for peripheral venous cannulation in children and young people

This education and training competence framework for peripheral venous cannulation in children and young people was first published in 2005. It has been revised in 2013 and again in 2016 and addresses a number of political and professional issues and initiatives.

RCN Competencies: Capillary blood sampling and venepuncture in children and young people.

Developing skills in performing capillary blood sampling and venepuncture can facilitate holistic care and timely treatment. For nurses working with children and young people this is usually regarded as an extended role. Before starting a programme of education and training, practitioners should becompetent and confident to care for children and young people

Carilion Clinic Uses TeamSTEPPS To Train Emergency Department Nurses in Virginia

Carilion Clinic, a not-for-profit health care system based in Roanoke, Virginia, uses the TeamSTEPPS® patient safety training program as part of its trauma crash course curriculum. All nursing staff working in trauma settings must complete this education prior to achieving trauma nurse academy status.

Kimbrough Ambulatory Care Center Uses TeamSTEPPS To Boost Patient Safety

Kimbrough Ambulatory Care Center at Fort George C. Meade in Maryland introduced the TeamSTEPPS® patient safety training program to its 650-member workforce in 2011. By 2015, employee teamwork at Kimbrough had improved by 12 percent.

Denver Hospital Uses AHRQ’s TeamSTEPPS Training To Enhance Teamwork

Porter Adventist Hospital, a 368-bed facility in Denver, Colorado, has used AHRQ’s TeamSTEPPS® patient safety training program to improve workflow between perioperative and intensive care units (ICU). As a result of the training, the 123 participants’ perceptions of the hospital’s teamwork improved in several areas, with a marked improvement in the “mutual support” category.

AHRQ Health Literacy Toolkit Supports Better Health Communication in Tasmania

The State of Tasmania’s Department of Health and Human Services (DHHS) has used elements of AHRQ’s Health Literacy Universal Precautions Toolkit in its plan to help patients better understand health information. Addressing health literacy in Tasmania, an island south of mainland Australia, is a priority for both policymakers and service providers because a national survey found that only 37 percent of people in Tasmania had adequate health literacy.

NICE set to recommend device to help spot heart disease using 3D models of blood vessels

Provisional recommendations from the NICE medical technology advisory committee support using the new software called HeartFlow FFRCT in patients with stable recent chest pain that’s thought to be heart-related and who have an intermediate risk of heart disease.

Using HeartFlow FFRCT, data from standard cardiac CT scans are sent to a processing centre where virtual 3D models of the patient’s blood vessels are created, identifying any areas of narrowing that may require treatment.

Alcohol consumption: advice on low risk drinking

UK Chief Medical Officers’ guidelines on how to keep health risks from drinking alcohol to a low level.

Weight loss surgery is value for money in selected people with severe obesity

NIHR Signal - 

Surgery is a cost-effective method of weight loss for severely and morbidly obese people. 

This study of general practice data compared health costs and outcomes for people with severe or morbid obesity who underwent surgery and those who did not...

Helping staff find their 'VOICE'

Read how Bolton NHS Foundation Trust helped staff to find their 'VOICE' by including them in the creation of the trust's new organisational values.

Bolton NHS Foundation Trust has implemented a new set of organisational values and engaged its staff in the process.
The scheme, which was launched to boost staff morale and engagement after the trust was moved out of special measures in 2015, aimed to help the trust move forward and align itself better with the NHS constitution.

GMC appoints new Director of Education and Standards

The General Medical Council (GMC) has announced that Dr Colin Melville will become its new Director of Education and Standards from January 2017...

Health Foundation response to NHS Improvement’s quarterly report on the performance of the provider sector

Figures published today by NHS Improvement show that NHS providers posted a net deficit of £461m for the first quarter of 2016/17, better than the planned net deficit of £466m. This is a dramatic improvement on the £930m deficit at the same point last year. Yet there are concerns about trusts missing their Cost Improvement Plans (CIPs) by £45m...

Brexit: Implications for anaesthesia and healthcare

Royal College of Anesthetist's -

The President's Statement from Bulletin (99, September 2016) is now available

NICE Advice [MIB76] - Axxent electronic brachytherapy system for early stage breast cancer

NICE has developed a medtech innovation briefing (MIB) on Axxent electronic brachytherapy system for early stage breast cancer.

The technology described in this briefing is the Axxent electronic brachytherapy (eBx) system.

NICE advice [MIB77] - OSNA for colon cancer staging

NICE has developed a medtech innovation briefing (MIB) on OSNA for colon cancer staging.

• The technology described in this briefing is the OSNA in vitro diagnostic molecular assay system. It is used for detecting lymph node metastases in people with colon cancer.

Promoting staff benefits through events: case study for employers

You can now download, read and share a case study with Dorset Healthcare University NHS Foundation Trust, on how they raised awareness of their staff benefits through a series of interactive roadshows.

Read how the trust planned the events and how they communicated them to staff across the trust's large geographical area. The trust shares how the events helped increase the trust bank and reduce agency spend by more than 50 per cent. The case study also includes top tips for trusts looking to run similar awareness raising events.

Sustainability and transformation plans (STPs) explained

Sustainability and transformation plans (STPs) were announced in the NHS planning guidance published in December 2015. NHS organisations in different parts of the country have been asked to come together to develop ‘place-based plans’ for the future of health and care services in their area. Draft plans were submitted in June 2016, and final plans are expected to be completed in October. 

But what do STPs really mean? And what will they mean for the NHS?

Guidance to support health and social care commissioners in joint market shaping

The Institute of Public Care has developed tools and guidance to help local commissioners understand market shaping.

These include a database of market position statements and general guidance on market shaping.
The guidance was developed at the request of the Department of Health, Local Government Association and the Association of Directors of Adult Social Service, working with the Care Provider Alliance. One of the six resources aimed at health and social care commissioners explores the importance of developing a place-based approach to shaping the care market.

NHS providers are ‘up for the challenge’ after making a strong start with finances

The number of NHS providers showing a financial deficit fell by 20% during the first quarter of 2016/17.

Our figures show that of the 214 providers who have signed up to control totals, 185 have met their commitments in full.
Despite it being early in the financial year, our analysis of the latest financial performance shows that NHS providers are ahead of the financial plan for the first time in over 3 years.

Southampton NHS Trust physios digitise workbook for newly-qualified colleagues

A respiratory physiotherapy team at a major teaching trust has pushed training into the digital age by creating an electronic workbook for its band 5 members.

The team co-produced the e-workbook with IT staff at University Hospitals Southampton NHS Trust. It went live on the trust’s virtual learning environment this summer, after an eight-month pilot.

Becoming One Of Us: Reforming The UK's Citizenship System For A Competitive, Post-Brexit World

Institute for Public Policy Research (IPPR) -
This report calls for a reform of citizenship rules to avoid harm to the British economy and workforce following Brexit. 

Home Office figures show a rise of 14 per cent in EU nationals applying for British citizenship in the past year, reflecting the uncertainty of the result of the referendum.

The report notes that one in ten doctors is from the EU and that this uncertainty would have implications for the NHS workforce and on service provision.

Drugs that stimulate bone marrow might save lives in critically ill trauma patients

NIHR Signal - 

Erythropoiesis stimulating agents (ESAs) might improve survival of critically ill patients after trauma. These drugs are synthetic versions of erythropoietin, a natural hormone produced by the kidneys.

This systematic review of trials in critical trauma patients found the survival benefit occurred without an increase in adverse effects, such as blood clots in the leg veins.

Existing drugs for rheumatoid arthritis may also improve associated fatigue

NIHR Signal -
Biological treatments work by reducing the joint inflammation and destruction associated with the condition, but to date it has been uncertain if this could affect fatigue.
Fatigue was not a main outcome in any of the included studies in this Cochrane review. The way it was measured and reported varied between studies, making it harder to compare findings.

NICE [TA401] - Bosutinib for previously treated chronic myeloid leukaemia

Evidence-based recommendations on bosutinib (Bosulif) for previously treated chronic myeloid leukaemia in adults.

NICE [TA403] - Ramucirumab for previously treated locally advanced or metastatic non-small-cell lung cancer

Evidence-based recommendations on ramucirumab (Cyramza) for locally advanced or metastatic non-small-cell lung cancer in adults who have had platinum-based chemotherapy.

NICE [TA405] - Trifluridine–tipiracil for previously treated metastatic colorectal cancer

Evidence-based recommendations on trifluridine–tipiracil (Lonsurf) for previously treated metastatic colorectal cancer in adults.

NICE [TA402] - Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin

NICE [TA404] - Degarelix for treating advanced hormone-dependent prostate cancer

Evidence-based recommendations on degarelix (Firmagon) for advanced hormone-dependent prostate cancer in adults with spinal metastases.

Patient choice: support for CCGs

NHS England and NHS Improvement have co-developed a CCG choice, planning and improvement guide to assess how well choice is working in the services they commission.

The guide can be found here...

NHS England agrees to consider package of support for GPs

NHS leaders have promised to address unsustainable pressures affecting GPs – including looking at safe working, length of appointments and time-consuming bureaucracy.

Judge finds rating review process fair, factual accuracy improved

SPP Health Ltd is a GP provider in the North-West with approximately 40 locations. They requested a rating review of the location Seaforth Village Surgery. As the request did not meet the grounds for review as set out in the Provider Handbook, CQC’s Rating Review Manager declined to consider the request. SSP was granted permission to seek a judicial review of this decision.

In a judgment handed down on 12 August 2016, Mrs Justice Andrews does not find that CQC’s rating review process is unfair, nor that it was applied unfairly in this case.

NICE [IPG564] - Extracorporeal carbon dioxide removal for acute respiratory failure

Evidence-based recommendations on extracorporeal carbon dioxide removal for acute respiratory failure in adults. This involves reducing the level of carbon dioxide in the blood to reduce the risk of lung injury with mechanical ventilation.

This guidance replaces NICE interventional procedures guidance on extracorporeal membrane carbon dioxide removal (IPG428).

RCOphth Consultation on Professional Standards in Refractive Surgery

The College has been working with some of the UK’s leading refractive surgeons, RCOphth Council members and patient and optometry representation to develop improved standards for the practice of refractive surgery in the UK.
We have produced a series of consultations on the outputs of the Group summarised here...

Health In A Hurry: The Impact Of Rush Hour Commuting On Our Health And Wellbeing

Royal Society for Public Health (RSPH) -
This report highlights the impact of passive commuting (via rail, bus or car) on the public's health and wellbeing. The report outlines how longer commute times are associated with increased stress, higher blood pressure and BMI and contributes to reduced time available for health promoting activities such as cooking, exercise and sleeping. The report calls for a greater adoption of flexible and remote working and greater restrictions on unhealthy food and drinks outlets in stations.

The Eatwell Guide

The Eatwell Guide is a policy tool used to define government recommendations on eating healthily and achieving a balanced diet.

SMI B 59: Detection of Enterobacteriaceae producing extended spectrum β lactamases

UK Standards for Microbiology Investigations B 59: Detection of Enterobacteriaceae producing extended spectrum β lactamases.

Click here for standards from Public Health England

SMI B 41: Investigation of urine

UK Standards for Microbiology Investigations SMI B 41: Investigation of urine.

Click here for Public Health England documentation

Appointment of new Audit and Risk Assurance Committee Chair/Non Executive Director

Joanne Shaw has been appointed by the Secretary of State as a Non-Executive Director, who will also chair the Audit and Risk Assurance Committee, at NHS England for four years from 1 October 2016.

She is a non executive director and Chair of Audit at the National Audit Office, a position which she will hold until 30 September 2016. Joanne’s previous roles include:...

We must make the most of Alzheimer’s disease research

 – Professor Alistair Burns and Professor Martin Rossor

"We recently wrote about the challenge for dementia clinical services if immunotherapy for Alzheimer’s disease proves to be successful.It is important to plan for the future but there is some thinking and planning to be done before we arrive there.
The focus of research has shifted significantly away from established and moderately severe Alzheimer’s disease to the much earlier stages of the illness and in some cases when symptoms are very mild or even absent. People have called this “Prodromal” Alzheimer’s disease or “Asymptomatic” Alzheimer’s disease..."

Lung density associates with survival in alpha 1 antitrypsin deficient patients.

Lung density associates with survival in alpha 1 antitrypsin deficient patients.

Respir Med. 2016 Mar;112:81-7

CT density correlates with quality of life (QOL) scores and impaired upper zone lung density associates with higher mortality in alpha one antitrypsin deficiency (A1ATD). We hypothesised that decline in CT densitometry would relate to survival or deterioration in QOL in A1ATD.

UHCW Research - Parr D

Skin antisepsis for reducing central venous catheter-related infections

This review concludes that it is not clear whether cleaning skin around CVC insertion sites with antiseptic reduces catheter related blood stream infection vs. no skin cleansing. 

Very low quality evidence suggests chlorhexidine may reduce rates of infection and catheter colonisation vs. povidone iodine.
Editorial Group: Cochrane Wounds Group

MTRAC commissioning support guidance for sacubitril-valsartan (Entresto) for heart failure

MTRAC commissioning support guidance for sacubitril-valsartan (Entresto) for heart failure from the Midlands Therapeutics Review and Advisory Committee.

MTRAC commissioning support guidance for safinamide (Xadago) for management of mid- to late-stage Parkinson’s disease

MTRAC commissioning support guidance for safinamide (Xadago) for management of mid- to late-stage Parkinson’s disease.

CSP says make Paralympic athletes a priority, following budget cuts to Rio games

The CSP has expressed concern at ‘last minute’ changes to the venues, workforce and transport for athletes and their teams, at the Paralympics in Rio.

CSP chief executive Karen Middleton said: ‘As physios we know the tremendous effort put in by Paralympians and their support teams. Changes at this late date can be a significant challenge. It is vital the organising committee prioritise the needs of the athletes.

Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes.

Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes.

Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2923-35. doi: 10.1007/s00167-015-3573-0. Epub 2015 Mar 19.

The primary aim of this systematic review was to examine the hypothesis that meniscal allograft transplantation is chondroprotective by identifying and appraising studies that have assessed the progression of osteoarthritis following meniscal allograft transplantation. The secondary aim was to identify and appraise radiological measures of meniscal allograft integrity following surgery.

UHCW Research - Smith NA, Parkinson B, Hutchinson CE, Costa ML and Spalding T.

Learning disability services monthly statistics, July 2016

The latest data from NHS Digital relates to patients with learning disabilities and/or autism spectrum disorder receiving inpatient care commissioned in England.

This statistical release makes available the most recent data relating to patients with learning disabilities and/or autism spectrum disorder receiving inpatient care commissioned in England.

Terrorism attacks: mental health check and treatment

The Department of Health has launched a mental health check for those adversely affected by the 2015 and 2016 attacks in Paris and Brussels, including those present and their close...

Palliative care in patients with heart failure

This review summarises the current literature on the role of palliative care for people with heart failure. It considers how it can be integrated into routine care and how collaboration between the palliative care and heart failure disciplines can be developed.

RCOG/BMS response to Breast Cancer Now Generations Study on HRT use and breast cancer risk

The Breast Cancer Now Generations study, published today in the British Journal of Cancer, suggests that previous studies may have underestimated the increased risk of breast cancer associated with HRT use.

Dr Heather Currie, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG) and Chair of the British Menopause Society (BMS), said:

“The findings of this prospective study reconfirm that some previous studies may have underestimated the risk of breast cancer associated with combined oestrogen-progestogen HRT use...."

Demand Management Good Practice Guide

NHS England -
This guidance is aimed at commissioners and providers in order to support effective management of demand for NHS services. It provides an overview of regional benchmarking of demand in England alongside a summary of actions and initiatives that can be taken to manage demand on a sustainable basis.

Understanding The Basic Economics Of Tobacco Harm Reduction

Institute of Economic Affairs (IEA) -
This report examines the economics behind smoking cessation policies and argues that minimising taxes on low-risk tobacco products (e-cigarettes or smokeless tobacco) has the potential to improve public health.

Government announces successful bids to £15 million mental health fund

Forty-one projects will benefit from a share of £15 million to improve provision of mental health places of safety, the government announced today.

The Department of Health funding is supporting the creation of new places of safety and the refurbishment of existing sites, to prevent people experiencing a mental health crisis, who have committed no crime, from being placed in a police cell.

The Hospital At Home Model: Bringing Hospital-Level Care To The Patient

The Commonwealth Fund -
This case study is one in an ongoing series examining programmes that aim to improve outcomes and reduce the cost of care for patients with complex needs, who account for a large share of U.S. health care spending. This case study looks at an initiative that offers patients the option of receiving hospital-level care at home rather than in-hospital.

AAA screening: protocol for reporting deaths

Public Health England -
The quality assurance process within the AAA screening programme includes monitoring mortality rates in patients with abdominal aortic aneurysms.

Who is eligible for the shingles vaccine beyond 2016?

Department of Health - 

Shingles eligibility poster for GP surgeries.

Scope Of Performance Assessments Of Providers Regulated By The Care Quality Commission (CQC)

Department of Health (DH) -
CQC currently regulate and inspect providers of health and social care and the ratings are limited to NHS trusts, NHS foundation trusts, GP practices, adult social care providers and independent hospitals. The government would like CQC to develop ratings for other sectors and is seeking views on these proposed changes. The consultation closes on 14 October 2016.

Physios help develop new commissioning guidance for lymphoedema services and easy read leaflets

Chartered Society of Physiotherapy -
Transforming Cancer Services Team produced the guidance, which was developed by Karen Robb, a specialist cancer physiotherapist. The team is part of a collaboration between clinical commissioning groups and NHS England known the Healthy London Partnership.

Monitor - FOI release: FOI National Data Validation Programme

NHS Improvement explained that it holds this information and has decided to release the information, subject to redaction of certain material under sections 40 and 42 of the Freedom of Information Act 2000.

Note and supporting documentation sent to NHS Improvement’s board on the National Elective Data Validation Programme.

GPs need guidance and further training to help them assess people with neurological conditions...

This is according to a report from UK charity the Neurological Alliance, published on 15 August.
The Neurology and Primary Care report presents the results of a survey of 1,001 GPs from across the UK.
‘This report is highlighting what we already know,’ said Jakko Brouwers, chair of the Association of Chartered Physiotherapists Interested in Neurology (ACPIN). ‘Namely, GPs are facing challenges in the early identification of specific patient groups and referring them onto pathways designed to fast-track appropriate care.

Sexual intercourse and placenta praevia (query bank)

Royal College of Obstetricians & Gynaecologists -
Question
Is there any role for sexual intercourse causing bleeding in a known placenta previa?
Answer
This clinical query answer was produced by RCOG Library staff following the clinical query protocol.

Induction in GBS +ve women with PROM (query bank)

Royal College of Obstetricians & Gynaecologists -
Question:
How should a women who is group B streptococcus (GBS) positive and has prelabour spontaneous rupture of membranes (PROM) at term be induced?
Answer:
This clinical query answer was produced by RCOG Library staff following the clinical query protocol.

HIV and cord clamping (query bank)

Royal College of Obstetricians & Gynaecologists -
Question:
Should HIV positive women with an undetectable viral load have delayed cord clamping at the time of delivery?
Answer:
This clinical query answer was produced by RCOG Library staff following the clinical query protocol.

Antibiotics for GBS +ve women with PROM (query bank)

Royal College of Obstetricians and Gynaecologists -
Question:
When should antibiotics be started in a woman who is group B streptococcus (GBS) positive and has prelabour spontaneous rupture of membranes at term (PROM)?
Answer:
This clinical query answer was produced by RCOG Library staff following the clinical query protocol.

New Drugs for Dementia

Parliamentary Office Of Science and Technology:
This POSTnote provides an overview of dementia, current treatments andpotential new drugs. It examines the challenges involved in developing new drugs and in ensuring patient access. Finally, it considers prevention strategies.

Maternal hydration and amniotic fluid volume (query bank)

Royal College of Obstetricians and Gynaecologists -
Question:
Is there any evidence for increasing maternal hydration to improve amniotic fluid volume?
Answer:

This clinical query answer was produced by RCOG Library staff following the clinical query protocol.

Guidance on anticoagulant care

The interdisciplinary group for stroke prevention in atrial fibrillation (iSPAF), part of the London stroke clinical network, has just published guidance on anticoagulant care, which describes the components of an...

Better mental health provision in primary care

The London Mental Health Clinical Network has published guidance on improvements to access, training and education for mental health in primary care settings.

This document supports people to improve access and understand the key components of good primary care mental health training and education.

It provides: 1.) Workforce training and education framework; 2.) competency checklist; 3.) summary of education and training in London.

Concerns for child health as paediatric units struggle to fill rotas

The Royal College of Paediatrics and Child Health has published an annual survey on paediatric staffing.

Children’s doctors have expressed serious fears for the future of paediatric services as a new workforce survey shows gaps on rotas are increasing. Doctors say the service is at breaking point, sustained by existing junior doctors and consultants struggling to plug vacancies.

Annual NHS stop smoking service figures published

NHS Digital has published the latest statistics on NHS stop smoking services. They are for April 2015 to March 2016, including some time series data for the last 10 years.

Hepatitis C treatment decisions

This study aimed to inform Hepatitis C (HCV) treatment by (1) better understanding the nexus of factors physicians consider when making HCV treatment decisions; (2) investigating the comparative influence and importance of specific factors and the trade-offs implicated in the decision making process; and (3) examining how much thrombocytopenia impacts treatment decisions and how it impacts treatment.

NHS England kickstarts programme to help 30,000 more new or expectant mums with serious mental illness

The NHS is kick starting a new programme that will each year help an extra 30,000 new or expectant mums who experience serious mental ill health, offering them the right care at the right time in a bid to reduce even further the rare tragedies that can occur when it is left untreated.

Poverty and mental health

The Mental Health Foundation has published Poverty and mental health: a review to inform the Joseph Rowntree Foundation's anti-poverty strategy. 

This paper presents a conceptual framework for understanding the relationship between poverty and mental health and offers recommendations to improve the situation across the life course

Neurology and primary care: improving the transition from primary care for people with neurological conditions

Neurological Alliance -
This report finds that GPs in England lack confidence in the primary care pathway for people with neurological conditions. In a poll of GPs, respondents reported low levels of confidence in the ability of local services and systems to manage neurology patients effectively and widespread concern over unnecessary delays. 

The report also sets out eight recommendations aimed at improving the primary care pathway for people with neurological conditions, including a call for the development of a pan-neurological ‘watch list’ of the ten signs and symptoms GPs should be aware of during patient interactions in primary care settings.

CCG Inequality Indicators

Centre for Health Economics (CHE) -
Indicators developed by CHE have been adopted by the NHS to help local areas reduce potentially avoidable A&E admissions arising from social inequality. The indicators focus on emergency admissions for patients with long-term conditions and they highlight variations between CCGs on inequality performance. Between April 2015 and April 2016, there were 264,000 excess hospitalisations associated with socioeconomic inequality. CHE have developed an online tool which allows you to explore inequalities within CCGs.

The medicine needed for the emergency care service

Royal College of Emergency Medicine (RCEM) - 

This report, written jointly with the Royal College of Nursing, outlines key recommendations from both organisations on reducing the pressures on emergency medical services in the UK. The report calls for a commitment for education funding, provision of training time and a realistic workforce planning strategy for emergency care. It also highlights the need for a change in culture to enable emergency departments to be more collaborative and to adopt a hub structure.

NICE recommends crizotinib for lung cancer

New draft guidance from NICE means hundreds of people will now have access to crizotinib, a twice-a-day pill for lung cancer.

Professor Carole Longson, director of the health technology evaluation centre at NICE said: “We are pleased that we have been able to work with Pfizer to secure a positive recommendation for crizotinib. As crizotinib is available as an oral treatment, it's a really valuable option for people with untreated lung cancer that will now be routinely available on the NHS.”

Recommendations for the determination of measurement uncertainty for assays performed in the H&I laboratory

G152 - Recommendations for the determination of measurement uncertainty for assays performed in the histocompatibility and immunogenetics (H&I) laboratory.

- The Royal College of Pathologists

Ebola: overview, history, origins and transmission - Guidance

Ebola guidance from Public Health England.

The history of Ebola virus disease, animal reservoirs, routes of transmission and an overview of diagnosis and management.

Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®)

General information about childhood brain and spinal cord tumors from the National Cancer Institute.
Click here for the Health Professional Version

Neuroblastoma Treatment (PDQ®)

General information about neuroblastoma from the National Cancer Institute
Click here for the Health Professional Version

Unusual Cancers of Childhood Treatment (PDQ®)

General information about unusual cancers of childhood from the National Cancer Institute.
Click here for the Health Professional Version

Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment

General Information about ovarian epithelial cancer, fallopian tube cancer (FTC), and primary peritoneal cancer (PPC) from the National Cancer Institute.

Click here for the Health Professional Version

Childhood Ependymoma Treatment (PDQ®)–

General information about childhood ependymoma from the National Cancer Institute.

Click here for the Health Professional Version

Colon Cancer Treatment (PDQ®)

General information on the topic of colon cancer treatment from the National Cancer Institute.

Click here to view the Health Professional Version

Rectal Cancer Treatment (PDQ®)

General information about rectal cancer from the National Cancer Institute.

Click here for the Health Professional Version

Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®)

General Information About Childhood Kidney Tumors from the National Cancer Institute.

Click here to view the Health Professional Version

National Cancer Drugs Fund (CDF) List August 2016

Click this link for the list - NHS England

Do NSAIDs increase the risk of severe skin reactions in children with chickenpox?

This Q&A evaluates the limited published evidence investigating an association between Non-steroidal anti-inflammatory drugs (NSAIDs) and severe skin reactions in children with chickenpox.

- Specialist Pharmacy Service

What factors need to be considered when prescribing for lactose intolerant adults?

This Medicines Q&A discusses the types of lactose intolerance people may suffer from, how to determine the lactose content of medicines, and what factors healthcare professionals should consider when prescribing for lactose intolerant patients.

- Specialist Pharmacy Service

What are the risks of using antidepressants together with NOACs and how should these risks be managed?

Article from South West Medicines Information and Training

Gene patterns may explain brain's Alzheimer's vulnerability

"Scientists say they have discovered a possible explanation for how Alzheimer's disease spreads in the brain," The Guardian reports.

Gene patterns in specific areas may explain why the disease tends to start in these regions, before spreading through the brain

Sudden infant death advice 'being ignored' due to flat head worries - NHS Choices

A review of parental attitudes found some were ignoring advice about sudden infant death syndrome (SIDS) by letting them sleep with pillows.

Supporting nurses to prepare for the OSCE

Find out how Cambridge University Hospitals is supporting nurses recruited from overseas to prepare to work in the UK in our new blog.

The trust's innovative programme for internationally recruited nurses helps them to prepare for their new role in the UK and ensures a better first-time pass rate.

CQC inspections uncover concerns at Marie Stopes International clinics

The Care Quality Commission (CQC) and NHS England are working with Marie Stopes International to make sure that patients are protected from potential harm when undergoing pregnancy terminations.

Following CQC’s inspections of Marie Stopes International’s services and its corporate headquarters in England, the regulator has raised concerns about the provider’s corporate and clinical governance arrangements and patient safety protocols in specific areas.

CQC inspectors highlight outstanding and good care as reports are published on 108 more GP practices

In the past week, CQC has published a further 108 reports on the quality of care provided by GP practices that have been inspected by specialist teams of inspectors.

Under CQC’s new programme of inspections, all of England’s GP practices are being given a rating according to whether they are safe, effective, caring, responsive and well led.

Tailored end-of-life care training

A case study from NHS Employers outlines how the palliative care and end-of-life care specialists at Leeds Teaching Hospitals offered bespoke departmental teaching and focused interventions to improve care within specific clinical areas.

Staff at the trust reported an improvement in their skills and confidence in symptom management, facilitating end-of-life care at home, recognising end of life, and knowledge of community services. 

HIV, Sexual and Reproductive Health project announced by RCGP

The one-year project will focus on enhancing sexual and reproductive health services, and HIV care in primary care.
The project will initially focus on developing strategies for increasing HIV testing in primary care using online access to HIV tests as part of a broader health screen for those at greater risk of HIV. It will also signpost to existing excellence in sexual health education for primary care and develop educational resources, such as e-learning, where there are gaps.

Diabetes in adults - NICE Quality Standard

The quality standard for diabetes in adults has been updated.

Childhood obesity plan unlikely to lead to drastic change

England’s childhood obesity strategy has been published following a delay of more than 8 months.

Karin Orman, Professional Practice Manager at the College of Occupational Therapists said:
“The action plan is not as proactive as we were led to expect and is unlikely to drastically reduce England’s rate of obesity within the next ten years..."

New blog on what it means to be a Freedom to Speak Up guardian - NHS Employers

Read Wayne Walker's first blog in a series that will describe what it means to him to be a Freedom to Speak Up guardian.

Wayne is a multi-skilled technician at Torbay and South Devon NHS Trust. In this post he highlights the importance of raising concerns and instilling confidence in staff to speak up, describes his interview process, requirements of the role and some of the obstacles he faced.

Childhood obesity: a plan for action - Department of Health

The government’s plan to reduce England’s rate of childhood obesity within the next 10 years by encouraging:

• industry to cut the amount of sugar in food and drinks
• primary school children to eat more healthily and stay active

Click here for the Department of Health plan

Perfect painkiller? Safe alternative to opiates may have been found

The Independent has claimed: "Scientists discover what could be a 'perfect' painkiller without side effects".

New research suggests that a newly identified compound, PZM21, could be more effective at longer-lasting pain relief than morphine, without any of the attendant drawbacks.

- NHS Choices - 

BJOG release: Ethnicity can affect fertility treatment outcomes

The ethnicity of women undergoing fertility treatment such as In-Vitro Fertilisation (IVF) or Intra Cytoplasmic Sperm Injection (ICSI) can affect live birth rates suggests a new study published today  (19 Aug) in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).

The turnaround has begun – Dr Arvind Madan

Prior to joining NHS England my focus was on growing a group of GP practices across London, mainly comprised of over a dozen struggling practices we turned around.

Each one came with its own history and needed its own unique support package including clinical, financial and operational solutions. It was much harder and took far longer than expected, often because of the prevailing culture in the practice. Only when everybody involved engaged with the plan did we make progress.

High-performing foundation trusts to support others in improving patient services - NHS Improvement

We've accredited the first four foundation trusts in the country to lead groups of NHS providers.
By linking together hospitals, the aim is to improve their clinical and financial viability, creating better and more sustainable services for patients.
The foundation group leaders will help to improve efficiency and the quality of clinical services by sharing excellent practice.

Transforming care for people with MSK conditions – Jill Firth

Over the past 20 years of working as a specialist nurse, I have witnessed first-hand the changing face of care for people with Musculoskeletal conditions (MSK) – particularly Rheumatoid Arthritis – leading to better outcomes for patients...

Quality assurance report: NHS cervical screening programme Southport and Ormskirk Hospitals NHS Trust visit on 18-19 May 2016

Public Health England (PHE) -
This document presents an executive summary of a quality assurance visit to Southport and Ormskirk hospitals and it sets out observations and recommendations on the cervical screening programme there.

ECDC roadmap for integration of molecular typing into European level surveillance and epidemic preparedness

This roadmap Version 2.1, 2016–19 presents the recommended priority list of pathogens/diseases and technical implementation options for the medium-term integration of molecular/genomic typing into EU-level surveillance and epidemic preparedness. It is meant as a strategic framework to guide the consolidation of ECDC activities in relation to molecular typing of human pathogens and to focus the development of genomic-typing-enhanced surveillance over the next four years. It builds upon and synthesises evidence and the opinion of experts in Member States and at ECDC.

Guide for Clinical Audit Leads

Guide for Clinical Audit Leads from the Healthcare Quality Improvement Partnership.

HIV Infection in the United Kingdom

House of Lords In Focus on HIV in the United Kingdom.

New regional chief nurses appointed to support frontline NHS staff

The first two regional chief nurses have been appointed. Sue Doheny has for the South and Professor Oliver Shanley, OBE for London.

In their joint roles, they will provide professional leadership to all members of the nursing and midwifery professions in their region, bringing greater clarity for front line staff.

Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances

This document from the Novel Psychoactive Treatment UK Network (NEPTUNE) provides guidance on the clinical management of harms resulting from acute intoxication and from the harmful and dependent use of club drugs andNPS. It categorises club drugs broadly according to their clinical effects:

• depressant; 
• stimulant; 
• hallucinogenic. 

In addition, the synthetic cannabinoids are treated as a separate category. The guidance is based on available evidence and clinical consensus.

Costing Standards Improvement Guide

This draft set of healthcare costing standards from NHS Improvement will help to ensure consistency in costing processes.

MERS-CoV Referral Pathways

MERS-CoV: referral of samples to PHE public health laboratories

MERS-CoV: referral pathway of positive samples to the NRL Respiratory Virus Unit

The interplay between heart failure, metabolism and body composition

The interplay between heart failure, metabolism and body composition

Br J Hosp Med (Lond). 2016 Jun;77(6):362-4. doi: 10.12968/hmed.2016.77.6.362.

A complex interplay exists between heart failure, metabolic status and body composition. The idiosyncrasies of these relationships are poorly understood, but they offer prognostic value and potential clinical utility. Current understanding of this relationship and known clinical value are discussed in this article.

UHCW Research - McAloon CJ, O'Hare P, Osman F, Randeva HS

Does malalignment affect patient reported outcomes following total knee arthroplasty: a systematic review of the literature

Does malalignment affect patient reported outcomes following total knee arthroplasty: a systematic review of the literature

Springerplus. 2016 Jul 28;5(1):1201. doi: 10.1186/s40064-016-2790-4. eCollection 2016.

When considering malalignment in an individual parameter, there is an inconsistent relationship with PROMs scores. Malalignment may be related to worse PROMs scores, but if that relationship exists it is weak and of dubious clinical significance. However, this evidence is subject to limitations mainly related to the methods of assessing alignment post operatively and by the possibility that the premise of traditional mechanical alignment is erroneous. Larger longitudinal studies with a standardised, timely, and robust method for assessing alignment outcomes are required.

UHCW Research - Hadi M, Barlow T, Ahmed I, Dunbar M, Griffin D

Healthcare education and training tariff: 2016 to 2017

Sets out what the tariffs cover, how to use the tariffs and also in what circumstances the national tariffs may be varied.

Defining volunteering in hospice and palliative care in Europe: an EAPC White Paper

A White Paper published by the European Association for Palliative Care, exploring the role, position, value and identity of volunteering in hospice and palliative care.

What If Antibiotics Were To Stop Working?

The NHS if is a collection of essays that explores hypothetical scenarios and their impact on the future of health and care. 

The aim is to encourage new thinking and debate about possible future scenarios that could fundamentally change health and care. This essay, by Professor Dame Sally Davies and Rebecca Sugden, explores a future in which antimicrobial resistance changes the face of medicine and health care.

Resources to support the care of patients with acute kidney injury

A stage two alert has been issued to support NHS providers in diagnosing, treating and managing acute kidney injury.

Walsall physios give stroke survivors better access to post-hospital rehab

A multidisciplinary community service in the West-Midlands is using a goal-focused approach to help people recovering from stroke to reach their full rehab potential.

New Drugs For Dementia

This briefing from the Parliamentary Office of Science and Technology (POST) outlines the challenges in developing new drugs to treat dementia, and provides an overview of UK and international research activities to accelerate progress in this field.

Paediatric Rota Gaps And Vacancies 2016

This annual workforce survey compiles data and evidence on paediatric staffing levels.  The survey found that more than half of paediatric units is not meeting recommended staffing standards and to keep services running, consultants are increasingly providing unplanned cover in addition to covering their own roles.

Dementia Atlas

This interactive map of England allows people to make comparisons about the quality of dementia care in their area, on issues such as prevention, diagnosis and support. 

Progesterone-Dependent Induction of Phospholipase C-Related Catalytically Inactive Protein 1 (PRIP-1) in Decidualizing Human Endometrial Stromal Cells

Progesterone-Dependent Induction of Phospholipase C-Related Catalytically Inactive Protein 1 (PRIP-1) in Decidualizing Human Endometrial Stromal Cells

Endocrinology. 157 (7) (pp 2883-2893), 2016

Decidualization denotes the transformation of endometrial stromal cells into specialized decidual cells. In pregnancy, decidual cells form a protective matrix around the implanting embryo, enabling coordinated trophoblast invasion and formation of a functional placenta. Continuous progesterone (P4) signaling renders decidual cells resistant to various environmental stressors, whereas withdrawal inevitably triggers tissue breakdown and menstruation or miscarriage. Here, we show that PLCL1, coding phospholipase C (PLC)-related catalytically inactive protein 1 (PRIP-1), is highly induced in response to P4 signaling in decidualizing human endometrial stromal cells (HESCs).

UHCW Research: Muter J.; Brighton P.J.; Lucas E.S.; Lacey L.; Shmygol A.; Quenby S.; Blanks A.M.; Brosens J.J.

RCOphth Publish Corneal Cross-Linking Data Set

The purpose of the Royal College of Ophthalmologists' Corneal Cross-Linking Data Set is to represent an agreed set of clinical information which can be collected on patients being considered for corneal cross-linking.

Type 2 diabetes: liraglutide reduces cardiovascular risk in people at high risk of having a cardiovascular event

New Medicines Evidence Commentary from NICE:

A randomised controlled trial has compared the GLP-1 mimetic liraglutide with placebo, as an add-on to standard care, in people with type 2 diabetes who had established cardiovascular disease or were at high risk of developing it. Liraglutide reduced the risk of cardiovascular events and death from any cause, over the average 3.5 years of the study. NICE guidance on type 2 diabetes recommends that GLP-1 mimetics are used as an alternative to insulin in people who meet certain criteria relating to body weight or for whom insulin therapy would have significant occupational implications.

How to encourage staff to choose well and stay well

Barkering, Havering and Redbridge University Hospitals NHS Trust (BHRUHT) have been empowering staff to make informed wellbeing choices by implementing a number of health and wellbeing pledges, including:

• Physical activity sessions
• Healthy food options
• Staff health checks
• Smoking cessation and respiratory health.

Feeling the Wait

Annual Report on Elective Surgery Waiting Times from The Patients Association

Benign male genital dermatoses

Benign male genital dermatoses 

BMJ 2016;354:i4337

Males with genital skin disease may present to clinicians in primary care, dermatology, genitourinary medicine, or urology clinics. Male genital dermatoses encompass a wide variety of skin lesions and rashes, some of which are limited to the genital area whereas others, such as psoriasis, can be part of a more generalised skin disorder. Genital skin disease can impact on the physical, psychological, and sexual wellbeing of men. Some dermatoses are precancerous, and cancer of the penis is associated with morbidity and mortality and litigation.1 This clinical update provides a guide to normal anatomical variations of the penis, how to recognise and manage common benign male genital dermatoses, and when to refer for specialist opinion.

UHCW Research: Tang Hgee Shim

Hepatitis E: symptoms, transmission, prevention, treatment

Update on this guidance from Public Health England on the symptoms, means of transmission, best means of prevention and treatment of Hepatitis E.

Latest guidance issued on apprenticeship levy

The Department for Education (DfE) has issued new guidance on the apprenticeship levy, which is due to be introduced on 6 April 2017. The latest set of guidance includes:

• information about the proposed funding bands
• an update on how employers will be able to access the levy funds
• information about how employers can become training providers. 

Devo-health: what and why?

This booklet from the Institute for Public Policy Research (IPPR) sets out the context of devolution and the questions which will be addressed in IPPR's programme of work on this area. It also sets out some initial hypotheses about devolution and health care which will be tested in the course of this research programme.

CSP launches updated Falls Prevention Economic Model online

The latest version of the Falls Prevention Economic Model, with fresh data and research, is now live on the CSP’s website.

Thousands to benefit as NICE set to recommend drug to prevent heart attacks and strokes

NICE has published draft guidance recommending anti-clotting drug ticagrelor 60 mg with aspirin for people who have had a heart attack.

SMI B 59: Detection of Enterobacteriaceae producing extended spectrum β lactamases

UK Standards for Microbiology Investigations B 59: Detection of Enterobacteriaceae producing extended spectrum β lactamases

Zika virus: epidemiology and cases diagnosed in the UK

Historical and current epidemiology of Zika virus infections, including cases in UK travellers.

Combined cognitive-behavioural and mindfulness programme for people living with dystonia: a proof-of-concept study

Objective is to design and test the delivery of an intervention targeting the non-motor symptoms of dystonia and pilot key health and well-being questionnaires in this population.

BMJ Open. 2016 Aug 5;6(8):e011495. doi: 10.1136/bmjopen-2016-011495.

UHCW Research - Lindahl A

New data demonstrates benefits to patients from a range of elective surgeries

Annual data for Patient Reported Outcome Measures shows patients who have undergone elective inpatient surgery for four common elective procedures – hip and knee replacement, varicose vein surgery and groin hernia surgery – are reporting significant health gains.

A Report on CQC Inspection Reports and Regulation of the Duty of Candour

This study by Action Against Medical Accidents finds that CQC inspections of NHS trusts in 2015 were inconsistent and often superficial in how they assessed compliance with the duty. The report calls on the CQC to make urgent improvements to how it regulates the duty of candour and makes several recommendations to that end.

One type of drug for depression during pregnancy may be linked to a small increase in pre-term births

Women who are depressed during pregnancy and who take selective serotonin inhibitors (SSRIs) may be more likely to have a pre-term birth than those who do not take SSRIs. Pre-term birth occurred in 6.8% of women with depression during pregnancy treated with SSRIs compared to 5.8% of depressed women who were treated with talking therapies alone.

However, because this is a review of observational (cohort) studies rather than randomised controlled trials it is not possible to say that SSRIs cause pre-term birth. For example, it is possible that women who had worse depression were more likely to be prescribed SSRIs, and it may have been the greater severity of depression rather than the SSRIs that caused pre-term birth.

The benefits of drugs for depression during pregnancy need to be weighed against potential harms. This information does not suggest a change in practice, but may help the discussion between doctor and patient.

From the NIHR Dissemination Centre

Creating Effective Hospital-Community Partnerships To Build A Culture Of Health

This HPOE guide argues that effective and sustainable hospital-community partnerships are critical to building a culture of health. This means creating a society that gives all individuals an equal opportunity to live the healthiest life they can, whatever their ethnic, geographic, racial, socioeconomic or physical circumstances may be. This guide focuses on how hospitals and communities can develop and sustain partnerships.

What If People Controlled Their Own Health Data?

Health data offers the opportunity to develop a better health system for the future, but people need to believe their data is in safe hands. 

In its latest collection of essays from the King's Fund, Matthew Honeyman explores hypothetical scenarios for the future of health and care, and discusses how to realise the full potential of using this data.

Make time to talk performance

This toolkit from NHS Employers 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?

HEE extends whistleblowing protection for doctors in training

Health Education England (HEE) has acted to address concerns expressed by junior doctors about their ability to make protected disclosures without fear of detriment.

HEE has agreed with the BMA, NHS Employers organisation and Department of Health that in order to address this potential barrier to junior doctors raising concerns about patient safety, HEE will place into its contracts with local employers a provision that protects junior doctors making disclosures.

Patients undergoing four common NHS operations rate their recovery

NHS Digital has published findings of patient surveys taken before and after four common surgical procedures performed by the NHS, to measure patients' health gain.

Latest pharmacological technology briefings

NIHR's Horizon Scanning Research and Intelligence Centre's latest batch of briefings on pharmacological technologies in development is now available. These include briefings in the following specialties:

• Anaesthetics, pain relief & ITU
• Cancer 
• Cardiovascular disease 
• Endocrine, nutritional and metabolic 
• Haematology & blood products 
• Mental health, drug abuse & learning difficulties 
• Neurology & neurosurgery 
• Orthopaedics, rheumatology & podiatry 
• Pregnancy & childbirth 
• Respiratory disease & thoracic surgery 

Feeling the crunch: NHS finances to 2020

As recognised by the NHS’s Five Year Forward View, by 2020 the NHS will need to find savings of around £22 billion in order to balance its books. But there has been no clear articulation of how that gap is expected to be closed. The options for doing so include NHS providers becoming more efficient; NHS commissioners reducing the pace at which NHS activity is increasing each year, either through reducing demand or limiting access to care; more funding for the NHS; or some combination of these. This analysis from the Nuffield Trust examines different scenarios to determine exactly what it would take to close the gap.

RCS publishes document on how to avoid unconscious bias

The Royal College of Surgeons has published a guide for surgeons on how to avoid unconscious bias.

Everyone has unconscious biases - where our judgements and thought processes are influenced, often without us realizing, by personal experiences, our background and societal expectations. The guide – ‘Avoiding unconscious bias’ - aims to encourage surgeons to be aware of this, and sometimes adjust their behavior so that their trainees and fellow staff do not misinterpret their actions.

MSK outcome measure heralded as ‘a deal breaker’

A single musculoskeletal (MSK) outcome measure, available online and free of charge to physiotherapists, has the potential to revolutionise physiotherapy professional practice.

Is there a future for smaller hospitals in the NHS?

In the second podcast of our Daring to Ask debate series, the NHS Confederation’s director of external affairs, Helen Birtwhistle, asks Nuffield Trust CEO Nigel Edwards and former NHS England CEO Sir David Nicholson, whether there is a future for smaller hospitals in the NHS.

Comparisons in childhood obesity and cardiometabolic risk factors among urban Saudi Arab adolescents in 2008 and 2013.

Comparisons in childhood obesity and cardiometabolic risk factors among urban Saudi Arab adolescents in 2008 and 2013.

Child: care, health and development42.(September 2016): 652-657.

We aimed to compare the prevalence of childhood obesity and other cardiometabolic risk factors from two independent cohorts (2008 and 2013) in Riyadh, Saudi Arabia.

UHCW Research - Kumar, S

Comparing Breast Cancer Multiparameter Tests in the OPTIMA Prelim Trial: No Test Is More Equal Than the Others

Comparing Breast Cancer Multiparameter Tests in the OPTIMA Prelim Trial: No Test Is More Equal Than the Others

JNCI J Natl Cancer Inst (2016) 108(9): djw050doi: 10.1093/jnci/djw050

Existing evidence on the comparative prognostic information provided by different tests suggests that current multiparameter tests provide broadly equivalent risk information for the population of women with estrogen receptor (ER)–positive breast cancers. However, for the individual patient, tests may provide differing risk categorization and subtype information.


UHCW Research -Christopher J.Poole

A longitudinal study of asymptomatic rectocoele

The aim of this study was to reassess symptomsand signs of asymptomatic rectocoele in women five or more years post initial diagnosis and to determine any factors associated with a worsened condition.

UHCW Research - Jacqueline R Woodman

Open with your Athens username and password.

Safety Notice: Air embolism following CVC port being left open

NHS Improvement have been alerted via the coroner’s court to an incident where a patient died following a clamp on a central venous catheter port being briefly left open, resulting in air embolisation and cerebral infarction. The coroner was particularly concerned that:

• nursing staff were not aware of the risk of air embolisation when leaving a central venous catheter port uncapped and unclamped
• they were unable to locate any literature or guidance regarding the risk of air entry if the clamp is left open during use of the catheter.

PLACE assessments published

Patient-Led Assessments of the Care Environment (PLACE) have for the first time the assessments have considered how well healthcare environments support the provision of care for those with a disability. The first PLACE Disability assessment focuses on issues of access including wheelchair, mobility (e.g. handrails), signage and provision of visual/ audible appointment alert systems, hearing loops, and aspects relating to food and food service.

PLACE assessments also evaluate the quality of the patient environment and provide information on non-clinical services such as food, hydration, the extent to which the provision of hospital care with privacy and dignity is supported and whether the premises are equipped to meet the needs of people with dementia against a specified range of criteria.  

These assessments have been published by NHS Digital.

2015 UK Parkinson's Audit findings

The 2015 UK Parkinson’s Audit of the care provided to nearly 9,000 people with the condition found that for 15 per cent of patients the physiotherapist used no outcome measures.

One in four people with Parkinson’s said they were not assessed for blood pressure, pain and bone health in neurology services. Only 28 per cent of those with advanced Parkinson's had any recorded discussion about end of life care.

The SITS-UTMOST: A registry-based prospective study in Europe investigating the impact of regulatory approval of intravenous Actilyse in the extended time window (3–4.5 h) in acute ischaemic stroke

European Stroke Journal,  Vol 1, Issue 3, 2016

The SITS-UTMOST (Safe Implementation of Thrombolysis in Upper Time window Monitoring Study) was a registry-based prospective study of intravenous alteplase used in the extended time window (3–4.5 h) in acute ischaemic stroke to evaluate the impact of the approval of the extended time window on routine clinical practice..

UHCW Research: Anthony Kenton

Readers’ panel - Should personal use of illegal drugs be decriminalised?

Article published in the Nursing Standard on the decriminalisation of personal illegal drug use, one of whose contributors works at University Hospitals Coventry and Warwickshire NHS Trust.

Request this article from the library.

UHCW Research - Daniel Athey

The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction

Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the procedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these techniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are challenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design and conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR.

Pilot and Feasibility Studies20162:41 DOI: 10.1186/s40814-016-0085-8

UHCW Research - Joanna M Skillman

Obesity-related metabolic and reproductive dysfunction: Variations between the sexes

Obesity prevalence remains at epidemic levels globally and is showing no signs of abating in either adult or child populations. Areas covered: Obesity-associated metabolic and reproductive diseases appear to be sexually dimorphic. Polycystic Ovary Syndrome (PCOS) and male obesity-associated secondary (hypogonadotrophic) hypogonadism (MOSH) represent two of the most common obesity associated endocrinopathies with sex-specific metabo-reproductive aberrations. These two diseases have entirely separate pathogeneses, with characteristic sex-specific clinico-pathological findings. These differences result from effects of sex-specific hormones, including estrogens and androgens. Such differences in sex-hormones also influence patterns of body-fat distribution. Expert Commentary: This article focuses on sex-specific obesity-related metabolic and reproductive dysfunction. To illustrate key sex-related differences in the mechanisms by which obesity contributes towards metabolic and reproductive dysfunction, two common obesity-related conditions affecting women and men are considered: respectively, Polycystic Ovary Syndrome (PCOS) and Male Obesity-associated Secondary Hypogonadism (MOSH).

Expert Review of Endocrinology & Metabolism  DOI: 10.1080/17446651.2016.1220301

UHCW Research - Georgios K. Dimitriadis and Thomas M Barber

UK SMI updates

The following UK standards for microbiology investigations have been updated:

• SMI B 11: Investigation of swabs from skin and superficial soft tissue infections
• SMI B 14: Investigation of pus and exudates

Drug Safety Update - August 2016

Latest monthly drug update newsletter from the MHRA

National tariff proposals for 2017/18 and 2018/19

Deadline for submissions 26th August

MHN is seeking member views on the tariff engagement document published last week by NHS England and NHS Improvement.

The engagement document seeks views on certain proposals by the national bodies for changes to the national tariff, along with other proposals relating to the pricing system.

The proposals – include four new best practice tariffs, the introduction of new innovation and technology tariff, and changes to local payment rules for mental health.

Accuracy of staff who read mammograms doesn’t decline over time

Changing the order in which readers examine screening mammograms has no effect on breast cancer detection rates, rates of recall for further tests or rates of disagreement between re

Integrating health and social care

Briefing note from the Parliamentary Office of Science and Technology on integrating health and social care.

Revised DH contract will benefit researchers and patients

The Department of Health (DH) and the Health Research Authority (HRA) have been working together to review the standard DH contract for NIHR funded research. 

Research funded by an NIHR research programme will be able to receive payments for start-up in advance of ethical approval. This enables more rapid, efficient and streamlined set-up of research and quicker translation of research into patient benefit. This change will enable the appointment of skilled research staff earlier in the project leading to better quality applications for HRA Approval, fewer protocol amendment applications early on in the project, and a quicker and more efficient start up process.

View a copy of the standard DH contract. 

Are your right to work checks consistent and fair?

To avoid any challenge from individuals following employment checks, it is crucial your right to work checks are carried out consistency and fairly for everyone. One way of ensuring this is to enforce a uniform right to work policy, requiring all short-listed applicants provide the necessary documentation that needs to be checked to avoid any civil penalty.

NHS Employers have updated its Background information on the employment checks standards section to highlight some of the key steps employers can take to avoid discrimination and ensure all potential staff are treated the same.

Diabetic eye screening programme: pathway standards

This document presents the revised national standards for the NHS diabetic eye screening programme that come into effect in April 2017.

Latest MedTech alerts

The following Medtech Alerts on innovative new and emerging medical diagnostics have recently been uploaded to the Horizon Scanning Research and Intelligence Centre website:

• Vivistim® System for upper-limb deficit after a stroke
• LightPath™ Imaging System for intra-operative tumour assessment
• Chordate System S100 for chronic non-allergic rhinitis
• Neurally Adjusted Ventilatory Assist (NAVA)
• Navilas® 577 laser system for retinal laser photocoagulation

Altered fibrinolysis in autosomal dominant thrombomodulin-associated coagulopathy

Thrombomodulin-associated coagulopathy (TM-AC) is a newly recognised dominant bleeding disorder in which a p.Cys537Stop variant in the thrombomodulin (TM) gene THBD, results in high plasma TM levels and protein C-mediated suppression of thrombin generation. Thrombin in complex with TM also activates thrombin activatable fibrinolysis inhibitor (TAFI). However, the effect of the high plasma TM on fibrinolysis in TM-AC is unknown. Plasma from TM-AC cases and high-TM model control samples spiked with recombinant soluble TM showed reduced tissue factor-induced thrombin generation. Lysis of plasma clots from TM-AC cases was significantly delayed compared to controls, but was completely restored when TM/thrombin-mediated TAFI activation was inhibited. Clots formed in blood from TM-AC cases had the same viscoelastic strength as controls but also showed a TAFI-dependent delay in fibrinolysis. Delayed fibrinolysis was reproduced in high-TM model plasma and blood samples. Partial restoration of thrombin generation with rFVIIa or aPCC did not alter the delayed fibrinolysis in high-TM model blood. Our finding of a previously unrecognised fibrinolytic phenotype indicates that bleeding in TM-AC has a complex pathogenesis and highlights the pivotal role of TM as a regulator of haemostasis.

Blood. 2016 Jul 19. pii: blood-2016-05-716092. [Epub ahead of print]

UHCW Research - Chapman O G

Chronic tarsal conjunctivitis

Toxicity is rarely considered in the differential diagnosis of conjunctivitis, but we present here a new form of toxic conjunctivitis with unusual clinical features. Between 2010 and 2013, a new clinical presentation of chronic conjunctivitis unresponsive to normal treatment was noted within a Primary Care Ophthalmology Service.

The presentation, appearances, histological features are consistent with a contact allergen-driven chronic conjunctivitis. Steroid treatment provided good relief of symptoms and patients were advised to avoid potential contact allergens. Management remains difficult. Further research into contact allergies of mucous membranes and identification of its allergens is required.

BMC Ophthalmol. 2016 Jul 29;16(1):130. doi: 10.1186/s12886-016-0294-1.

UHCW Research -  Leitner C and Cree I A

Progress and potential of RAS mutation detection for diagnostics and companion diagnostics

This paper is restricted to RAS testing in cancer, and highlights papers relevant to current practice. Expert Commentary: Multiple laboratory methods are available for RAS gene analysis. PCR is commonly used to determine RAS status, providing a robust and inexpensive technology for clinical use. Next generation sequencing (NGS) platforms are changing the way in which mutation status is determined, though they require considerable expertise. Pre-analytical issues affect both methods and should be considered. The interpretation and reporting of results is not simple, particularly for NGS. External quality assurance is a pre-requisite for success, and is mandated by most laboratory accreditation schemes. The use of RAS testing is now extending beyond biopsy material to include the detection of mutations in circulating cell-free DNA and tumour cells.

Expert Rev Mol Diagn. 2016 Aug 5. [Epub ahead of print]

UHCW Research - Cree I A

MRI assessment of prolapse

Answer to the question 'Compared to clinical examination, does MRI assessment of the pelvic floor in women with symptoms of genital prolapse improve the outcome of corrective surgery?' posted to the RCOG Query Bank.

Timing of oxytocin for third stage of labour

Answer to the question 'What is the ideal time to administer Syntometrine/Syntocinon in the active management of the third stage of labour?', posted to the RCOG Query Bank.

Misoprostol for second trimester abortion

Answer to the question 'What is the safe dose and frequency of misoprostol for mid trimester termination of pregnancy?', posted to the RCOG Query Bank.

Vaginal mesh and prolapse surgery

Answer to the question 'Is there any role for vaginal mesh for primary prolapse surgery?', posted to the RCOG Query Bank.

Updated Zika Virus guidance

Updated Zika Virus guidance from Public Health England:

• Zika virus congenital infection: Interim guidance for neonatologists and paediatricians
• Algorithm: Recommendations for neonates whose mother has travelled to an area with active Zika transmission during pregnancy or within 4 weeks before conception
• Zika virus infection: guidance for primary care
• Zika virus: interim algorithm for assessing pregnant women with a history of travel during pregnancy

Obesity Quality Standards

NICE has published a new quality standard on obesity clinical assessment and management.

UK NSC Screening Decisions

The UK NSC has decided not to recommend systematic population screening to the following:

• Kernicterus screening in newborns
• Adolescent Idiopathic Scoliosis screening
• Toxoplasmosis screening in pregnancy

End-of-life care guide for older LGBT people

The National Council for Palliative Care (NCPC) has published a guide on end of life care for older LGBT people.  The publication, “Being Accepted Being Me: Understanding the end of life care needs for older LGBT people” is intended to help health and social care staff and volunteers to learn more about listening, understanding and responding to the unique needs of LGBT people

New framework to support transformation of care for people with learning disabilities

A new Learning Disabilities Core Skills Education and Training Framework has been launched by Health Education England to help improve the care health and social care staff deliver to people with learning disabilities.

Improvement directory

A list of websites that provide online improvement tools, resources or networks on health and social care from NHS Improvement.