Suicide prevention: developing a local action plan

The development of a local suicide action plan is recommended by government and supports the 2012 strategy ‘Preventing Suicide in England. A Cross Government Outcomes Strategy to save Lives’.

This document advises local authorities how to:

• develop a suicide prevention action plan
• monitor data, trends and hot spots
• engage with local media
• work with transport to map hot spots
• work on local priorities to improve mental health

Influenza: treatment and prophylaxis using anti-viral agents

Guidance from Public Health England on how to manage influenza (flu) using anti-viral agents.

GMC concerned about ‘state of unease’ in medical profession

The General Medical Council (GMC) has raised concerns that a ‘state of unease’ exists within the medical profession as services throughout the UK come under increased pressure.

The medical regulator’s warning that systems of healthcare and the health professionals working within them are struggling to cope with a range of issues – including the impact of health services under pressure and fragile social care services – appears in its annual report on The state of medical education and practice in the UK.

Policy changes to implement the NHS five year forward view: a progress report

In October 2014, NHS England and other arms-length bodies published the NHS five year forward view (Forward View). The Forward View set out a vision of how NHS services need to change to meet the needs of the population. In February 2015, The King’s Fund set out the main policy changes we thought were required to make a reality of the Forward View.​

Two years on from the Forward View, we assess what changes have been implemented and highlight what still needs to be done to align policies with the plan.

Final apprenticeship funding arrangements announced

The final funding arrangements for the apprenticeship levy have been published by the Department for Education.

The latest guidance sets out the final funding policy for 2017-18 for apprenticeships in England, which will come into effect from May 2017. It has taken into account feedback received from employers during the consultation phase.

Elbasvir–grazoprevir for treating chronic hepatitis C

New NICE Technology appraisal guidance on using Elbasvir–grazoprevir for treating chronic hepatitis C.

Cobimetinib in combination with vemurafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma

New NICE technology appraisal guidance on using Cobimetinib in combination with vemurafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma.

Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor

New NICE technology appraisal guidance on using certolizumab pegol (Cimzia) for treating severe active rheumatoid arthritis in adults who have had a tumour necrosis factor-alpha inhibitor.

Osimertinib for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer

New Technology Appraisal Guidance from NICE on using osimertinib (Tagresso) for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer in adults.

Templates for creating your Local Safety Standards for Invasive Procedures (LocSSIPs)

NHS Improvemt has developed two templates to support you in developing Local Safety Standards for Invasive Procedures (LocSSIPs) based on the National Safety Standards for Invasive Procedures

There’s no requirement to use these templates if you’ve developed your own or prefer a different approach.

Three hospital trust indicators published to aid research into seven-day NHS provision

The experimental statistics provide a starting point for discussions on how to effectively measure improvement and variation in care provision across the week.  

The report, published by NHS Digital, is presented at trust level and includes the following indicators for the period between 1 April 2015 and 31 March 2016:

• Mortality within 30 days of admission by week-part2 of admission to hospital
• Emergency readmissions within seven days of discharge from hospital by day of discharge
• Length of stay following an emergency admission to hospital by day of admission

Improve Patient Engagement with G.R.E.A.T.™ Communication

The Patient Experience Department at Edward-Elmhurst Health was charged to develop a system-wide service standard that would align their workforce culture with a methodology that would enhance patient experience, improve care quality and better engage staff.  They created an education program around the acronym G.R.E.A.T.™

Community triage for lower limb vascular concerns: reducing the burden on hospitals

New Quality and Productivity: Proven Case Study from Salford Royal NHS Foundation Trust on community triage for lower limb vascular concerns: reducing the burden on hospitals.

Influencing best practice in breast cancer

The Cancer Australia Statement – Influencing best practice in breast cancer is a summary of 12 practices that have been identified as appropriate or inappropriate for the provision of breast cancer care in Australia.

Needle-free arterial non-injectable connector

New NICE medtech innovation briefing (MIB) on the needle-free arterial non-injectable connector.

Absorb Bioresorbable Vascular Scaffold for coronary artery disease

New Medtech innovation briefing from NICE on the Absorb Bioresorbable Vascular Scaffold for coronary artery disease.

NHS England launches biggest upgrade to NHS cancer treatment in 15 years

NHS England has announced a £130m investment to kickstart the upgrade of radiotherapy equipment and transform cancer treatment across England.

Around 4 in 10 of all NHS cancer patients are treated with radiotherapy, which typically uses high-energy radiation from a machine called a linear accelerator (‘Linac’). Radiotherapy is one of the three main cancer treatments, alongside cancer surgery and chemotherapy.

Over the next two years older Linac radiotherapy equipment being used by hospitals across the country will be upgraded or replaced, ensuring patients get access to the latest leading edge technology regardless of where they live.

See RCR's response to this announcement.

Which opioids can be used in renal impairment?

New NHS Specialist Pharmacy Service Q&A focusing on opioids which can be used in renal imparment.

100% of NHS Trusts now research active

100% of NHS trusts in England are offering research to patients according to a league table published by the National Institute for Health Research (NIHR) Clinical Research Network (CRN).

The 2015/16 NIHR Research Activity League Table shows all NHS trusts in England are delivering clinical research, providing thousands more patients with access to better treatments and care.

Latest staff sickness absence figures - June 2016

The latest figures released by NHS Digital show that NHS staff sickness absence for June 2016 has remained the same as June 2015, when it was 3.94 per cent.

Modernising fitness to practise: changes to the Fitness to Practise Rules 2004

This consultation from the NMC seeks feedback on proposed changes to the NMC's fitness to practise processes. The proposed changes will allow the NMC to give advice, issue warnings and recommend undertakings. The consultation closes on 19 December 2016.

RCM launches new standards for midwifery

The RCM launched the UK’s first standards for high-quality midwifery services. The document outlines what the RCM sees as the key features that any midwifery service can use to measure its delivery of compassionate, well-led, professional evidence-based midwifery care.

RCR supports Choosing Wisely campaign

The Academy of Medical Royal Colleges, supported by The Royal College of Radiologists (RCR), has launched the Choosing Wisely campaign across the UK.  Choosing Wisely is aimed at encouraging patients and doctors to discuss the risks and benefits of available treatments and procedures to help choose and deliver the most appropriate and necessary treatment.

RCR’s recommendations are:

• In advanced cancer, the use of chemotherapy that is unlikely to be beneficial and may cause harm should be minimised
• In cases of a minor head injury, further imaging is not likely to be useful
• Back pain which is uncomplicated, that is not associated with 'red flags' or radiculopathy usually does not require imaging
• Where there is suspicion of a pulmonary embolus, further imaging should be guided by clinical scoring systems.
• After treatment for cancer, the use of routine scanning should only be used where this is beneficial to the patient.

Patient activation and why it is relevant to community pharmacy

Briefing from PSNC on patient activation.  Although it is aimed at community pharmacies, there are sections describing patient activation and its importance.

Involving patients and citizens: I Statements for research and innovation

This guidance from National Voices sets a standard for how patients and citizens should be involved in research and innovation. It was developed as part of the Department of Health's accelerated access review and this guidance aims to provide standards for how patients and the public are involved in research and innovation in medical technologies, diagnostic tools, drugs and digital health care.

Interactive Agenda for Change handbook launched online

The NHS terms and conditions of service handbook for Agenda for Change staff is now digital and has re-launched online. The handbook is now fully interactive, with new features that will help staff access information quicker, including:

• A new search function which enables users to find specific information easily.
• The ability to download individual PDF sections of the handbook.
• A new contents menu down the side of the handbook to enable quicker access to different areas of the terms and conditions.
• The ability to download the latest PDF version in full at the click of a button.

The future of commissioning

NHS Clinical Commsioners has launched a new paper setting out our vision for the future of clinical commissioning.

In the future it is unlikely that there will be one single model of clinical commissioning, but at the heart sits the clinical leadership, expertise and local knowledge of the communities they serve and this must not be lost. The paper also calls on national bodies and policy-makers to support the local models of strategic commissioning that are emerging.

Commissioning For Value: Where To Look Packs

These packs from NHS RightCare provide local health economies with data to support service planning and to support initiatives such as sustainability and transformation plans (STPs). It is recommended that these data packs are used as part of annual planning cycles to support discussions about prioritising areas for change and utilising resources.

The framework for enhanced health in care homes

This framework is for local health and care systems, organisations, communities and patients, wishing to develop and implement new ways of working. It lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of in reach services. Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

The Health Service Medical supplies (Costs) Bill (Bill 72 of 2016-17)

This briefing from the House of Commons Library summarises the contents of the Health Service Medical Supplies (Costs) Bill 2016-17, the background on the issues and relevant comment. The bill is related to the control of medicine prices.

Treating low grade piles with a newer surgical technique leads to less recurrence than rubber band ligation

The new technique, called haemorrhoidal artery ligation requires an anaesthetic. In this trial it led to fewer episodes of recurrence than a single rubber band ligation of piles. The rubber band ligation, which can be done in the clinic, is less painful in the short-term and cheaper. This means that the decision over which treatment to offer or accept is a “trade-off”.

From the NIHR Dissemination Centre

Home-based cardiac rehabilitation may be a convenient alternative to centre-based rehabilitation

Home-based cardiac rehabilitation for people with heart failure is safe and effective. It improved exercise capacity slightly compared to care without cardiac rehabilitation, and may also be more convenient than centre-based rehabilitation as more people completed treatment.

From the NIHR Dissemination Centre

Accelerated Access Review: final report

The Accelerated Access Review (AAR) was commissioned by the government in November 2014. The final report makes recommendations to make it easier for NHS patients to access innovative medicines, medical technologies, diagnostics and digital products, improving efficiency and patient outcomes.

New treatment recommended for kidney cancer

NICE recommends nivolumab for people with advanced renal cell cancer (RCC) – a type of kidney cancer.

Nivolumab is a form of immunotherapy, a treatment that has been hailed as a an innovative way to battle cancer – it works by harnessing the power of the patient’s own immune system to destroy their cancer cells

Public Contracts Regulations 2015 for NHS commissioners

This summarises the Public Contract Regulations 2015 (PCR 2015) requirements for NHS commissioners and those supporting them with their procurement of healthcare services.

Coeliac disease Quality Standard

New NICE quality standard on coeliac disease.

Using benefit champions to promote staff rewards

Mid Yorkshire Hospitals NHS Trust share in a new case study how they recruited a network of staff, known as benefit champions, to help improve communication around reward and benefits.

NHS Employers

Revised model declaration forms and guidance for employers

Revised model declaration forms and guidance have been published by NHS Employers to support employers during recruitment when seeking a self-declaration from candidates.

Hospital Productivity Growth In The English NHS 2008/09 To 2013/14

This report from the Centre for Health Economics is concerned hospital productivity in the English NHS; the extent to which NHS hospital Trusts make better use of resources over time by increasing the number of patients they treat and the services they deliver for the same or fewer inputs

Unheeded warnings: health care in crisis: The UK nursing labour market review 2016

Report from the Royal College of Nursing on its review of the UK nursing labour market. It highlights risks to the future nursing supply in England as it finds that half of nurses are aged 45 or over and are within ten years of being eligible for early retirement.

The National Pregnancy in Diabetes Audit 2015

The National Pregnancy in Diabetes Audit 2015, published by NHS Digital, Diabetes UK and the Healthcare Quality Improvement Partnership (HQIP) found that few women with diabetes who become pregnant are well prepared, despite agreed national guidelines - resulting in increased risk of congenital abnormalities, stillbirth and large babies.

Dementia: policy, services and statistics

Briefing paper on dementia from the House of Commons Library.  It covers:

1. Dementia in England
2. Government policies to improve dementia care, support and research in England
3. Improving diagnosis rates
4. Improving support for carers
5. Services for people with dementia in England
6. Scotland, Wales and Northern Ireland
7. Statistics on dementia prevalence across the UK

LOCSU Annual Report shows optical sector 'building for breakthrough'

The increased number of primary care practices delivering care close to patient’s homes and so tackling capacity problems in the Hospital Eye Service is highlighted in the LOCSU Annual Report.

Health matters: reducing the burden of tuberculosis

This professional resource from Public Health England outlines the actions that can be taken to further reduce TB incidence and associated health inequalities.

Cross-distribution of age at diagnosis and stage of cancer diagnosed in England during 2012 to 2014

This workbook presents the number of tumours diagnosed in England during 2012 to 2014, by age at cancer diagnosis and stage of cancer. A cross-tabulation has been presented, to provide information on the interaction between the two factors.

How can the NHS use the new drugs for hepatitis C in a cost-effective way?

The new drugs for hepatitis C have the potential to take a large share of the NHS budget. These new drugs can cure more patients than the standard interferon-based treatments, but are much more costly at £25,000-£70,000 per treatment course.

The University of York's Centre for Health Economics (CHE) compared the costs and health benefits of the new drugs and the standard treatment in patients with advanced hepatitis C.

The CHE concluded that, for most types of hepatitis C, the new drugs should be reserved as second-line for those who are not cured with peginterferon and ribavirin.

Global tuberculosis report 2016

WHO has published a global TB report every year since 1997. The main aim of the report is to provide a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels.

RCoA Census 2015 - Final Report

Results of the 2015 RCoA workforce census have shown that SAS doctors make a significant contribution to the workforce, accounting for 21% of all UK anaesthetists.

Achieving better outcomes for musculoskeletal (MSK) conditions

In this blog, Roland Valori takes a closer look at some of the attempts to reduce variation in clinical outcomes and improve productivity of services for musculoskeletal conditions and diseases. These include using techniques such as ‘Audit and Feedback’, demonstration projects, whole service redesign and a variety of other quality improvement initiatives at local and national level.

Cold weather plan (CWP) for England

Includes plan and evidence summary on planning to protect health in cold weather. This plan is valid from October 2016 until further notice.

Flu vaccine reduces deaths for people with type 2 diabetes

Flu vaccination helps prevent some deaths, serious strokes, heart failure and pneumonia in people with type 2 diabetes. Vaccination is linked to less hospital admissions for these reasons, but there is no link to rates of admissions for heart attack.

The results come from a reliable population-based study that looked back at the general practice and hospital records of almost 125,000 adults with type 2 diabetes in England. Outcome rates were compared between those who had and hadn’t received the flu vaccine over seven successive flu seasons. The researchers carefully adjusted for things like the seasonal change in flu numbers.

From the NIHR Dissemination Centre

Flushing your nose with salt water may be moderately useful for symptoms of sinusitis

Nasal irrigation seems moderately effective for symptoms of sinusitis. People using nasal irrigation showed greater improvement in their sinus-related quality of life compared to people who didn’t use irrigation. They were also less likely to use over-the-counter medicines, and to have spent fewer days unwell with symptoms by six months.

From the NIHR Dissemination Centre

Acupuncture shows promise for preventing episodic migraines

Acupuncture was about as effective as long term medication in reducing the number of migraines. There were fewer adverse events amongst people receiving acupuncture (16-17%) compared to drug treatment (34%).

Migraines affect around one in seven people in the UK. Their unpleasant symptoms last between four and 72 hours and can impact on people’s ability to do everyday tasks, such as going to work.

This systematic review looked at acupuncture delivered at least once a week for up to six sessions, similar to the NICE recommendation of up to ten sessions over five to eight - weeks.

From NIHR Dissemination Centre

Inactivated influenza vaccine information for healthcare practitioners

Guidance from Public Health England for healthcare practitioners about the inactivated influenza vaccine.

Fracture risk associated with melatonin and other hypnotics

New Medicines Evidence Commentary from NICE:

An observational cohort study has found that in people aged 45 years and over receiving 3 or more melatonin prescriptions was associated with an increased risk of fracture compared with no use of any hypnotic drugs. The study found that in a matched cohort receiving 2 or more prescriptions for ‘Z drug’ hypnotics was also associated with a similarly increased fracture risk.

Addition of or switch to insulin therapy in people treated with glucagon-like peptide-1 receptor agonists: A real-world study in 66 583 patients

Diabetes Obes Metab. 2016 Sep 15. doi: 10.1111/dom.12790. [Epub ahead of print]

Significant delay in intensification of treatment by addition of insulin is observed in patients with T2DM inadequately controlled with GLP-1RA. Earlier addition of insulin is associated with better glycaemic control, while switching to insulin is not clinically beneficial during 2 years of treatment. Non-responding patients on GLP-1RA would benefit from adding insulin therapy, rather than switching to insulin.

UHCW Research: S. Kumar

Inspiring improvement newsletter

NHS Improvement has published its October Inspiring Improvement newsletter. This edition contains:

• What is your fab idea for change?
• Bringing the joy back into care
• How can you help others to understand quality improvement?
• Getting things right from the start - about the Acute Medical Model (AMM) Programme

Agile conference hears about importance of person-centred care

A person-centred approach is vital for the successful physical rehabilitation of people with dementia.

This was one of the messages from specialist physiotherapist Jane Blakey to members of AGILE, the professional network for physiotherapists working with older people, at a conference held in Newcastle from 8-9 October.

Delegates discussed the importance of tapping into a patient’s long-term memory and of considering the rhythm and tone of their voice. Ms Blakey described how patients with dementia retain their hearing and are able to interpret facial expressions and non-verbal cues.

All types of communication should be used, she said, adding: ‘It is crucial that positive engagement techniques are used from the start of your communication with patients, even before your assessment begins.’

Tackling bullying and harassment in the NHS

NHS Employers has produced a new podcast, the first in a two-part series, discussing bullying and harassment in the NHS.

In this second edition you can listen to a discussion between staff at Birmingham and Solihull Mental Health NHS Foundation Trust and The Royal College of Nursing who are developing the cultural ambassadors project, which has helped increase fairness for BME staff in disciplinary hearings.

Why midwives leave - revisited

Midwives are leaving the profession and are being driven out by excessive workloads and poor staffing levels according to this report. The RCM report details a survey of over two-thousand midwives across the UK who have left the profession in the last two years or are intending to leave in the next two years. It also makes recommendations to prevent this flow of midwives out of the profession and the NHS.

Improving Access To Cochlear Implantation: Change Lives And Save Society Money

This report from the Ear Foundation calls for a review of the NICE guidelines on cochlear implants as new research shows that the UK has the most restrictive guidelines in Western Europe. It also shows that people with serious hearing loss often cost the NHS and other care services more by being denied an implant because of the greater risks of suffering from dementia and mental health problems when hearing loss is not addressed.

Preterm labour and birth

New quality standard from NICE on preterm labour and birth.

New RCP advice aims to reduce inpatient injury from trips and falls

The Royal College of Physicians (RCP) has produced Falls Prevention in Hospital: a Guide for Patients, their Families and Carers, a guide designed to help prevent serious injury and unnecessary cost to the NHS caused by older people tripping or falling when they are in hospital.

Aimed at older patients and their families and carers, the guide provides easy to follow advice on what patients and those in contact with them can do to help prevent inpatient falls.

Technical guidance for NHS planning 2017-19 updated

The guidance now includes joint technical definitions for performance and activity. In addition, changes have been made to Annex B – information on the quality premium. The final CQUIN document will be published in the week of 31 October 2016.

Understanding value in healthcare – the key to successful new care models

This workshop on 10 January on Birmingham will be of interest to commissioners and providers of primary care, community services and acute care, particularly those starting to plan for services across sustainability and transformation plan (STP) footprints.

New resource to record public interest concerns

A new template has been developed with employers, based on a spreadsheet the Wirral University Teaching Hospitals NHS Foundation Trust uses, to help managers and Freedom to Speak Up (FTSU) guardians record public interest raising concerns data. 

New guidance for the 2016/17 flu season

Immform, the influenza vaccine uptake monitoring programme from Public Health England, has released new guidance on how to report the number of flu vaccinations given to frontline healthcare workers. The uptake data given by trusts will be used to determine whether a trust is eligible for the flu component of the health and wellbeing CQUIN indicator.

Are there any complementary and alternative medicines that should be avoided in patients on cancer chemotherapy?

New NHS Specialist Pharmacy Service Q&A focusing on complementary therapies and alternative medicines (CAMs) with pharmacological activity such as herbal medicines, vitamins and minerals, and summarises information on common characteristics of CAMs that clinicians need to consider when using together with cancer chemotherapy. It includes recommendations on commonly used CAMs that should be avoided or used with caution in patients on cancer chemotherapy.

What are the equivalent doses of oral morphine to other oral opioids when used as analgesics in adult palliative care?

This NHS Specialist Pharmacy Service Q&A gives advice on converting between oral morphine and other oral opioids when they are used as analgesics in adult palliative care. In addition it gives details on the issues that need to be considered when switching a patient from morphine to an alternative opioid or vice versa.

NHS England accelerates national reviews of vital specialist services for children

NHS England has formally announced more details of its accelerated national reviews of both paediatric critical care, and specialised surgery for children.

Providing A 'Safe Space' In Healthcare Safety Investigations - Consultation

The DH proposal outlined in this consultation will legally ensure that information that staff provide as part of a health service investigation will be kept confidential except where there is an immediate risk to patient safety, or where the High Court makes an order permitting disclosure. This broadly mirrors the procedures followed in air accidents investigations. The closing date for comments is 16 December 2016.

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): djw050 doi: 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: C. J. Poole

Morphologic and angular planning for cam resection in femoro-acetabular impingement: value of the omega angle

International Orthopaedics October 2016, Volume 40, Issue 10, pp 2011–2017

This study showed that alpha angle, measured in one plane, was not a predictor of the radial extension of cam deformity. To achieve a full resection, it was frequently necessary to extend the femoral head osteoplasty over the retinacular area. Pre-operative determination of the omega angle and location of the vascular foramina helped improve cam resection safety and accuracy.

UHCW Research: Filipe S. Oliveira

Mutational signatures in esophageal adenocarcinoma define etiologically distinct subgroups with therapeutic relevance

Nature Genetics 48, 1131–1141(2016) doi:10.1038/ng.3659

Esophageal adenocarcinoma (EAC) has a poor outcome, and targeted therapy trials have thus far been disappointing owing to a lack of robust stratification methods. Whole-genome sequencing (WGS) analysis of 129 cases demonstrated that this is a heterogeneous cancer dominated by copy number alterations with frequent large-scale rearrangements. Co-amplification of receptor tyrosine kinases (RTKs) and/or downstream mitogenic activation is almost ubiquitous; thus tailored combination RTK inhibitor (RTKi) therapy might be required, as we demonstrate in vitro. However, mutational signatures showed three distinct molecular subtypes with potential therapeutic relevance, which we verified in an independent cohort (n = 87): (i) enrichment for BRCA signature with prevalent defects in the homologous recombination pathway; (ii) dominant T>G mutational pattern associated with a high mutational load and neoantigen burden; and (iii) C>A/T mutational pattern with evidence of an aging imprint. These subtypes could be ascertained using a clinically applicable sequencing strategy (low coverage) as a basis for therapy selection.

UHCW Research: Shamila Sothi and Sari Suortamo

Drug Safety Update

October's edition of the Drug Safety Update newsletter from MHRA.

Every Voice Matters - our Annual Report to Parliament 2015-16

Every Voice Matters, Healthwatch's Annual Report to Parliament for 2015/2016, outlines the ways in which the Healthwatch network has worked with people up and down the country to inform how services are being improved.

Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?

Nephrol Dial Transplant. 2016 Oct 13. pii: gfw345. [Epub ahead of print]

This study shows that haemodialysis deteriorates cardiac diastolic function indices and improves pulmonary circulation loading, while systolic function remains unchanged. High intradialytic volume removal may affect cardiac diastolic function.

UHCW Research: A. Saratzis

Pregnancy complications in older women are mostly due to multiple pregnancy or assisted conception

Women who give birth at a very advanced maternal age (48 years+) are at higher risk of pregnancy complications, however most can be explained by multiple pregnancy or the use of assisted conception, suggests a new study published in BJOG.

Agency, Bank And Overtime Spending In Maternity Units In England In 2015

This report from the Royal College of Midwives is derived from FOI requests sent to all NHS trusts in England with maternity services.  It found that in 2015, the NHS spent over £72 million on agency, overtime and bank midwives which is equivalent to the cost of over 3000 full-time midwives. The report highlights the need for improvement on workforce strategy within the NHS to ensure a more efficient use of resources and it also calls for the government to reconsider proposed plans to abolish nursing bursaries.

Improving the safety of maternity care in the NHS

The safer maternity care action plan, designed to dramatically improve the safety of maternity care in the NHS, has been announced by the Health Secretary today.

The new measures will provide resources for trusts to improve their approach to maternity safety, including £8 million for multi-disciplinary training, with at least £40,000 available to each NHS trust in England. They also will make sure lessons are learned from mistakes and shared openly and transparently across the NHS. We will also consult on how to change the litigation culture, which can prevent openness and transparency, by taking views on a new voluntary compensation scheme as an alternative to costly legal processes.

Second round of funding aims to improve maternity services through patient feedback

Maternity services are invited to put forward proposals on innovative ways of using patient feedback to improve services and the winning entries could receive up to £50,000 to help get their project up and running.

Maternity Challenge Fund’s second round projects will continue to look at ways to improve maternity services through patient feedback but will explore how individual feedback can be best used.

Agency caps one year on

The NHS has saved over £600 million in the first year of measures to curb spending on agency staff.

The measures were brought in after the NHS spent over £3 billion on agency staff in 2014/15. Some trusts requested help negotiating with agencies and bringing staff back into the NHS.

Almost three quarters of trusts (73%) have now successfully reduced their agency spend, and over half of these have reduced spend by more than a quarter.

The NHS partners with Twitter to help shed light on what it means to work or be a patient in the NHS

A pioneering new initiative to lift the lid on the NHS through the voices of the people on its frontline goes live today with the launch of the @NHS Twitter account.

A UK first, @NHS will see a different NHS patient or member of its 1.3 million staff become curator each week over a three month pilot and report first hand their experiences of the health service.

Molecular testing for familial hypercholesterolaemia-associated mutations in a UK-based cohort: development of an NGS-based method and comparison with multiplex polymerase chain reaction and oligonucleotide arrays

Annals of Clinical Biochemistry (ANN CLIN BIOCHEM), Nov2016; 53(6): 654-662. (9p)

Ion Torrent-based next-generation sequencing can deliver a suitable alternative for the molecular investigation of familial hypercholesterolaemia patients, especially when comprehensive mutation screening for rare or unknown mutations is required.

UHCW Research: Mike Khan and Sarojini Pandey

Enterovirus D-68: risk assessment

Enterovirus D-68 (EV-D68) was identified in 1962 and is one of more than 100 nonpolio enteroviruses. EV-D68 can cause mild to severe respiratory illness requiring ventilatory support and has been associated with cases and clusters of polio-like neurological symptoms including paralysis and meningo-encephalitis.

Clinicians should be aware of the community circulation of EV-D68 and of the need to submit appropriate samples in patients, particularly in children, where there is a severe acute respiratory infection and/or with unexplained neurological symptoms, the presence of acute flaccid paralysis or other presentations such as meningo-encephalitis.

Self Care Week 2016 Resources

Self Care Week is an annual national awareness week that focuses on embedding support for self care across communities, families and generations.

This year’s theme is health literacy and the strapline is Understanding Self Care for Life.  Self Care Week will take place from 14 to 20 November 2016.

Reasonable adjustments: the peer support service guide for members affected by disability in the workplace

New document from the Royal College of Nursing for members affected by disability in the workplace.  It aims to provide information about reasonable adjustments that enable members to make changes to their work and working environment so that they can work to the best of their ability.

Nursing Associates – a new member of the multi-disciplinary workforce – Jane Cummings

Blog post from the Chief Nursing Officer on the new Nursing Associate role within the nursing family.

Seasonal influenza frontline healthcare workers vaccine uptake survey: data collection guidance

This document from Public Health England informs local NHS England teams and NHS trusts how to collect data on flu vaccine uptake among frontline healthcare workers and how to upload it to the ImmForm website.

The Role of Family Caregivers throughout the Patient Experience

A new white paper by The Beryl Institute explores the value and impact caregivers have on the broader patient experience efforts in healthcare.

New specialised commissioning consultation launched

NHS England has launched a consultation on four related policies that describe how NHS England will make decisions on funding for treatments that are not currently routinely commissioned. The four policies are: in-year service developments, individual funding requests, funding experimental and unproven treatments, and continuing funding after clinical trials.

Health Education England announces training places for over 2,000 Nursing Associates

Health Education England (HEE) has announced the eleven partnership sites that will trial the new nursing associate role.

Over 1,000 nursing associates will start their training in December, aiming to provide quality hands on patient care, and support to nurses and support staff.

Referring influenza samples to respiratory virus unit, PHE Colindale

Guidance from Public Health England on how to refer flu samples to the respiratory virus unit (RVU) for diagnosis, subtyping, antiviral resistance testing and surveillance.

Burden of Disease Study for England

Estimates by Public Health England of the main causes of death and disability, attributable risk factors and the effect of deprivation, modelled for England and its regions.

Midwives' Voices, Midwives Realities: Findings From A Global Consulation On Providing Quality Midwifery Care

This WHO report outlines the findings of the first global survey of midwifery personnel and it reveals that too often midwives report their efforts are constrained by unequal power relations within the health system. It highlights the need to provide midwives with professional support (including better working conditions); stronger education and regulatory environments; and stronger advocacy around midwifery.

The state of health care and adult social care in England 2015/16

This annual assessment of the quality of health and adult social care in England by the CQC has found that most health and adult social care services in England are providing people with safe, high quality and compassionate care - but with pressures rising on demand, access and cost, this report raises concerns about how long this can last. The report also highlights the impact of the fragility of the adult social care market on those who rely on these services and on the performance of NHS care.

Delivering High Quality, Effective, Compassionate Care: Developing The Right People With The Right Skills And Right Values

This mandate outlines the government's objectives for Health Education England to provide health care education and training for 2016-2017. The document reflects strategic objectives around workforce planning, health education and training and development. The mandate looks at how the healthcare workforce can be developed to improve care for patients through education and training.

Monster-Filled Game App Aims to Make Patient Experience Less Scary

Throughout the summer, hospitals have been sharing how they've used Pokémon Go as a patient experience measure. Now, St. Joseph's Children's Hospital has taken that concept and improved upon it by creating a hospital-based game app to distract, educate, and assuage patients' fears.

The game—called UnMonsters—is set inside the Tampa, FL-hospital, and invites young patients to wrangle four silly monsters. Players can earn medical "power ups" along the way by answering simple health related questions, like "Do you know how many servings of dairy you should be eating in a single day?" and "What is a stethoscope used for?"

Conn. hospital upgrades patient experience with 'luxury' family suites

Forget about sleeping on an uncomfortable pull-out sleep sofa or chair. Family members who don't want to leave their loved ones alone during an overnight stay at a Connecticut hospital can now opt for an upgrade and sleep in an adjoining private room more like one found at a luxury hotel.

New virtual reality program for young cancer patients aims to lift their spirit

The USC Norris Comprehensive Cancer Center has teamed with a nonprofit on a virtual reality initiative for patients in the Adolescent and Young Adult Cancer program at USC (AYA@USC).

The initiative aims to provide a library of curated cinematic and interactive VR experiences using the most advanced media technology available to lessen a patient’s discomfort and anxiety with quality entertainment.

A Whole Hospital Approach to Patient Engagement

How every department, from HR to HIM, influences patient satisfaction scores.

From the Beryl Institute.

The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy

BMJ Open 2016;6:e012678 doi:10.1136/bmjopen-2016-012678

Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy.

UHCW Research: Joanna Skillman

Understanding the distribution of A&E attendances and hospital admissions for the case managed population: A single case cross sectional study

Applied Nursing Research.  http://dx.doi.org/10.1016/j.apnr.2016.10.005

Aim: To describe the characteristics of case-managed patients presenting at accident and emergency (A & E) and to explore the distribution of their attendances and admissions.

Conclusion: The high level of A&E conversion could indicate case-managed patients are presenting appropriately with acute clinical need. However, inadequate provision in primary-care could drive decisions for admitting vulnerable patients.

UHCW Research: Mark Radford

How one trust used the Electronic Staff Record to support revalidation

Read this new NHS Employers' case study from Peterborough and Stamford Hospitals NHS Foundation Trust to find out how it is supporting nurses and midwives to revalidate using functionality within the Electronic Staff Record (ESR).

Case studies' library at NHS England's Learning Environment

NHS England continues to expand the NHS England Learning Environment with more than 25 new case studies added in the past month, including examples of CCG engagement with young people, initiatives to tackle antibiotic resistance and consultations on primary care strategy.   

Development areas covered include:

• Collaboration and commissioning
• Leadership development
• Delivering transformational change
• Organisational development
• Communications, patient, public and member engagement
• Strategic and operational planning

Over four in five line managers are not trained in supporting people with long term conditions such as cancer

Four in five (87%) line managers are not given any training on how to support people with long term conditions including cancer, according to new research by Macmillan Cancer Support.

A YouGov survey of 1,010 line managers also revealed a misconception, a quarter (26%) thought making reasonable adjustments to allow someone with cancer to keep working would be difficult. However over two thirds (69%) of those who had had to make reasonable adjustments said it was easy to do.

Single-incision short sling mesh insertion for stress urinary incontinence in women

Evidence-based recommendations from NICE on single-incision short sling mesh insertion for stress urinary incontinence in women. This involves putting 2 short slings around the tube that carries urine from the bladder to support it.

Organisation patient safety incident reports

Data based on incidents that occurred in England and Wales from 1 October 2015 to 31 March 2016 and were submitted to the National Reporting and Learning System (NRLS) by the 31 May 2016.

Understanding patient flow in hospitals

The aim that 95% of patients attending A&E should be admitted, discharged or transferred within four hours is one of the highest profile NHS targets, yet it is being consistently missed across England. 

Previous Nuffield Trust work has argued that although the target can be over-emphasised, struggles in meeting it are associated with deeper problems in the capacity to move patients into hospital wards. This briefing draws on theories about congestion to look at why this has become more difficult, and what can be done about it. It aims to be useful to the hospital managers and people involved in Sustainability and Transformation Plans who tackle these problems on the front line, as well as to the policymakers who oversee them.

Scottish Cancer Patient Experience Survey 2015/16: Analysis of the Free-Text Comments

This report presents the results and analysis of free-text comments provided in Scotland’s first Cancer Patient Experience Survey (SCPES). Of the 4,835 patients who took part, 2,663 (55%) left at least one free-text comment. The survey included seven free-text comment boxes relating to different aspects of cancer treatment, from the lead up to diagnosis, to the overall experience of cancer care.

Mental Health at Work Report 2016

Business in the Community has published a survey into mental health at work which gives employers, by listening to the voices of employees and managers the ability to fundamentally change the way that they approach mental wellbeing in the workplace.

Se also BIC's Mental Health Toolkit for Employers.

Improving patient-practitioner communication

The NHS in Wales has run a nationwide campaign to improve dialogue between patients and healthcare practitioners on the issue of “do not attempt cardiopulmonary resuscitation” (DNACPR) orders among patients with a terminal illness.

This case study is most relevant to acute trusts, ambulance trusts, foundation trusts and NHS trusts.

New figures reveal running cost of NHS estate

NHS Digital has released figures detailing the costs of building, maintaining and servicing parts of the NHS estate - from how much is spent on feeding patients, to how many car parking spaces hospitals have.

Validity of Exercise Measures in Adults with Anorexia Nervosa: The EDE, Compulsive Exercise Test and Other Self-Report Scales

International Journal of Eating Disorders. 3 October 2016. DOI: 10.1002/eat.22633

Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample.

UHCW Research: Caroline Meyer

Presentation of neurogenic shock within the emergency department

Emerg Med J doi:10.1136/emermed-2016-205780

Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings.

Neurogenic shock is variable and unpredictable. It can present in the prehospital environment and without warning in a patient with previously normal vital signs. The medical team should be aware of it in all patients with spinal cord injury regardless of injury level.

UHCW Research: Paul Wrenn

Step in time: exploration of synchrony and timing correction in response to virtual reality avatars for gait re-training

The 11th International Conference on Disability, Virtual Reality and Associated Technologies: Proceedings

This study investigates the use of virtual reality avatars as exercise cues for retraining gait. A
feasibility test was conducted by asking participants to step in time with the avatar viewed through
a virtual reality headset. We observed that a temporal perturbation (a speeding up or slowing down
of one step cycle) applied to the avatar resulted in a significant corrective response in participants’
own step timing. If this response can extend to spatial perturbations, we suggest that virtual reality
avatars have the potential to assist in the targeted rehabilitation of neuromuscular or other
disorders and retraining of gait post-surgery.

UHCW Research: I Ahmed and M Rahhal

New care models: Emerging innovations in governance and organisational form

New report from the King's Fund looking at the different approaches being taken by MCP and PACS vanguards to contracting, governance and other organisational infrastructure. It focuses on developments at five sites: Dudley; Sandwell and West Birmingham (Modality Partnership); Salford; Northumberland; and South Somerset (Symphony Project).

Patient Safety Update - April - June 2016

Patient safety update from the Royal College of Anaesthetists for the period April - June 2016, including learning from reported incidents.

Sexual health promotion and contraceptive services in local authorities: A systematic review of economic evaluations 2010-2015

Since 2013, health commissioners in England’s local authorities have been responsible for sexual health services, including contraception, HIV testing, STI testing and treatment, health education and specialist sexual health services. Effective commissioning requires information to indicate which interventions may, or may not, be cost-effective. However, current UK guidance and recent research on the cost-effectiveness of sexual health services provides patchy and fragmented evidence. This study aims systematically to review the evidence available on the cost-effectiveness of OECD-based interventions relevant to UK local authority-commissioned sexual health services.

Brivaracetam (Brivioact®)

The Midlands Therapeutics Review and Advisory Committee's advice on the use of Brivaracetam for the adjunctive treatment of focal seizures in epilepsy.

Corticosteroid injections provide only short term relief for rotator cuff disorders

A corticosteroid steroid injection into the shoulder provides some short-term pain relief for adults with rotator cuff disorders.

This review compared injection of corticosteroids (‘steroids’) with injection of local anaesthetic or placebo. The average improvement in pain relief at two months was calculated as moderate using standardised techniques. The effect wore off by three months.

From the NIHR Dissemination Centre

Surgery to remove the thymus gland improves weakness for people with myasthenia gravis

Having a thymectomy (surgery to remove the thymus gland) improves various measures of weakness and reduces the need for other treatment in people with myasthenia gravis. When combined with standard steroid treatment, surgery gives a meaningful, but small, improvement compared with steroids alone. Importantly it also reduced the requirement for steroids or immune suppressing drugs and their side effects.

From the NIHR Dissemination Centre

Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck

NEJM October 9, 2016DOI: 10.1056/NEJMoa1602252

The recurrence and metastasis of squamous-cell carcinoma of the head and neck are facilitated by immune evasion,7 which is mediated in part by expression of the programmed death ligands (PD-L1 and PD-L2) of the T-cell–suppressive immune-checkpoint receptor programmed death 1 (PD-1).8-11Nivolumab, a fully human IgG4 anti–PD-1 monoclonal antibody, has shown antitumor efficacy in multiple tumor types.12,13 We designed a randomized trial to investigate whether overall survival would be longer with nivolumab therapy than with standard therapy, among patients with platinum-refractory squamous-cell carcinoma of the head and neck.

Record levels of workplace stress put staff and patients at risk

A TUC study published published today on World Mental Health Day shows that stress is the top health and safety concern in UK workplaces.

The TUC’s biennial survey of more than 1,000 health and safety reps around the UK asks them to pick out the hazards at work that most trouble them and their workforces.

Stress was at the top of the list in this year’s survey, with seven in 10 reps (70 per cent) citing it as a problem – an increase since 2014, when 67 per cent did so, and a higher proportion than in any previous TUC study.

Guidance on commissioning medicines optimisation services from community pharmacy

The University of Manchester and PCC have launched a toolkit to support commissioners to plan, design and evaluate services provided by community pharmacies for patients requiring medicines.

By integrating a medicines optimisation service into the patient pathway, the patient can access the expertise of a pharmacist and their team in community pharmacy, which can improve their medicines taking, reduce unplanned hospital admissions and reduce pressure on the wider health and social care system.

Caring for patients with pregnancy loss

The Miscarriage Association hears from thousands of women – and some men – who have been though pregnancy loss. Some are going through it when they get in touch – from home, from A&E, from the Early Pregnancy Unit waiting room.  They talk to us about their feelings and their fears. They ask questions – often about the terminology they have heard or the procedures they may face.

They also talk about the care they received from the variety of health professionals they have met along the way. And it is very clear that the kind of care that they receive can make a significant difference to how they cope with their experience of pregnancy loss.

Along with that, women and their partners tell us how much the human aspects of care matter. Kindness, understanding, clear information and sensitive language are just some of the ways that health professionals can help them cope with their experience.

Of course most health professionals work hard to provide good and sensitive care. What’s more, many of them will have been through pregnancy loss themselves and know how important this is.
Limited training budgets, staff time and cover mean that it is increasingly difficult for staff to access training, whether on or off site. The Miscarriage Association’s new online learning resources aim to fill some of those gaps.

The changing face of cardiovascular disease 2000–2012: An analysis of the world health organisation global health estimates data

International Journal of Cardiology December 1, 2016Volume 224, Pages 256–264

The pattern and global burden of disease has evolved considerably over the last two decades, from primarily communicable, maternal, and perinatal causes to non-communicable disease (NCD). Cardiovascular disease (CVD) has become the single most important and largest cause of NCD deaths worldwide at over 50%. The World Health Organisation (WHO) estimates that 17.6 million people died of CVD worldwide in 2012. Proportionally, this accounts for an estimated 31.43% of global mortality, with ischaemic heart disease (IHD) accounting for approximately 7.4 million deaths, 13.2% of the total. IHD was also the greatest single cause of death in 2000, accounting for an estimated 6.0 million deaths. The global burden of CVD falls, principally, on the low and middle-income (LMI) countries, accounting for over 80% of CVD deaths. Individual populations face differing challenges and each population has unique health burdens, however, CVD remains one of the greatest health challenges both nationally and worldwide.

UHCW Research: C. J. McAloon, F. Osman and S. A. Hayat

An inducer of glyoxalase 1 improves insulin resistance and glycaemic control in overweight and obese non-diabetic subjects

Diabetologia (2016) 59 (Suppl 1):S1–S581  Abstracts of 52nd EASD Annual Meeting No. 278

The aim of this study was to validate target pharmacology of an optimised Glo1 inducer formulation in Phase 1 clinical trial in overweight and obese subjects and assess effect on insulin resistance and glycaemic control.

UHCW Research: M. O. Weickert and S Qureshi

Discrimination between advanced glycation endproducts of endogenous and dietary origin in overweight and obese non-diabetic subjects

Diabetologia (2016) 59 (Suppl 1):S1–S581  Abstracts of 52nd EASD Annual Meeting No. 487

The aim of this study was to assess the correlation of urinary AGE free adducts with flux of pyrraline and explore regression with extrapolation of AGE flux to zero pyrraline content to thereby deduce the mean endogenous formation of AGEs in overweight and obese subjects. This was then validated for the methylglyoxal (MG)-derived AGE, MG-H1, by therapeutic intervention with an inducer of glyoxalase 1 (Glo1) that decreased endogenous MG and MG-H1 formation

UHCW Research: M. O. Weickert and S Qureshi

Validation of circulating Wnt1 inducible signalling pathway protein 1 (WISP1) as a novel biomarker of visceral obesity and associated diseases

Diabetologia (2016) 59 (Suppl 1):S1–S581  Abstracts of 52nd EASD Annual Meeting No. 628

The secreted extracellular matrix protein WISP1 (WNT1 inducible signaling pathway protein 1) is a novel adipokine that induces a pro-inflammatory response in macrophages. Our aims were 1) to assess the WISP1 reliability, as expressed by intraclass correlation coefficient (ICC), over a 4-month period of time in a population-based sample of healthy individuals (n=207 ) within the European Prospective Investigation into Cancer and Nutrition (EPIC) -Potsdam Cohort (2007- 2008) and 2) to evaluate its suitability as a circulating marker for visceral adiposity and associated diseases in individuals with different stages of glucose tolerance (n=172).

UHCW Research: M. O. Weickert

An inducer of glyoxalase 1 down regulates inflammatory gene expression in overweight and obese non-diabetic subjects

Diabetologia (2016) 59 (Suppl 1):S1–S581  Abstracts of 52nd EASD Annual Meeting No. 631

Glo1 deficiency was identified as a driver of cardiovascular disease in a large integrative genomics study. Induction of glyoxalase 1 (Glo1) expression is a novel strategy to prevent inflammatory signalling and decrease risk of cardiovascular disease in overweight and obese populations. Increasing Glo1 expression is unaddressed by current therapy. Glo1 is part of the glyoxalase metabolic pathway which catalyses the metabolism of the reactive metabolite and glycating agent, methylglyoxal (MG), and thereby prevents formation of advanced glycation endproducts (AGEs). We previously described a regulatory antioxidant response element in the GLO1 gene which, when bound by transcription factor Nrf2, increases basal and inducible expression of Glo1. We screened dietary bioactive compounds for Glo1 inducer activity, confirmed hits and improvement of cell function in human cell primary cultures. The aim of this study was to validate target pharmacology of an optimised Glo1 inducer formulation in Phase 1 clinical trial in overweight and obese subjects and assess inflammatory gene expression in peripheral blood mononuclear cells (PBMCs)

UHCW Research: M. O. Weickert and S Qureshi

Patients’ decision making in total knee arthroplasty: a systematic review of qualitative research

Bone and Joint Research DOI: 10.1302/2046-3758.410.2000420 Published 8 October 2015 

A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty.

UHCW Research: T. Barlow and A Realpe

Man or machine? An experimental study of prehospital emergency amputation

Emerg Med J 2016;33:641-644 doi:10.1136/emermed-2015-204881

Prehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation.

UHCW Research: C Leech. Published June 2016, Revised October 2016

An interesting case report of vertebral artery dissection following polytrauma

Int J Surg Case Rep. 2016 Oct 3;28:196-199. doi: 10.1016/j.ijscr.2016.09.055. [Epub ahead of print]

The authors present an interesting case of a 19-year-old male who presented as a polytrauma patient following a fall from a height.

UHCW Research: Acharya V, Chandrasekaran S, Nair S

Keeping safe when working alone

New guidance from the Royal College of Nursing on Keeping Safe When Working Alone.

Funding available to use research findings to improve health service delivery

The Health Foundation has £300,000 available to help research teams bridge the gap between academic research and actionable information for people practicing in the field. 

This new programme will help fund the development of tools and resources, based on completed research studies, to support the implementation of findings into practice. We are looking for ideas that appear innovative and likely to have impact.

If you are interested in applying, visit www.health.org.uk/programmes/evidence-practice for further information. Deadline for applications is 12 noon on 16 November 2016.

Discordance between patients' stated values and treatment preferences for end-of-life care: results of a multicentre survey

Background: Medical orders for the use of life-supports should be informed by patients' values and treatment preferences. The purpose of this study was to explore the internal consistency of patients' (or their family members') stated values, and the relationship between these values and expressed preferences. 

Conclusions: Decision-making regarding medical treatments at the EOL is inadequate. To reduce decisional conflict, patients and their families need more support to clarify their values and ensure that their preferences are grounded in adequate understanding of their illness and treatment options.

BMJ Support Palliat Care bmjspcare-2015-001056. Published Online First: 6 October 2016 

Request full article from the library.

Using appreciative inquiry to implement person-centred dementia care in hospital wards

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

Dementia October 6, 20161471301216663953

Request full article from the library.

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. 

In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specific subgroups of patients with cancer.

Request article form the library.

Corticosteroid injections provide only short term relief for rotator cuff disorders

A corticosteroid steroid injection into the shoulder provides some short-term pain relief for adults with rotator cuff disorders.

This review compared injection of corticosteroids (‘steroids’) with injection of local anaesthetic or placebo. The average improvement in pain relief at two months was calculated as moderate using standardised techniques. The effect wore off by three months.

From the NIHR Dissemination Centre

Options for structuring foundation groups

Guidance for NHS foundation trusts considering forming a foundation group and for any providers who are considering participating.

Core set of NHS products to be used by all NHS providers

A set of standardised products selected to help NHS trusts and foundation trusts save money through better procurement.

To achieve the savings that are clearly possible through better procurement, NHS Improvement is working with the NHS to standardise specifications and product catalogues. This will help to reduce the range and ensure best value prices are secured using our collective purchasing power.

It has identified a set of products that account for around £100m of NHS trust and foundation trusts' annual expenditure and we anticipate savings of up to 25% on current costs depending on market circumstances.

Legionnaires' disease: guidance, data and analysis

The symptoms, diagnosis, management, surveillance and epidemiology of Legionnaires' disease. From Public Health England.

HPV vaccination pilot for men who have sex with men (MSM)

Detailed guidance, training material, leaflet and vaccination card from Public Health England for use in selected clinics involved in the human papillomavirus (HPV) pilot programmes for men who have sex with men (MSM).

NHS screening programmes: duty of candour

Guidance from Public Health England on applying duty of candour responsibilities and disclosing audit results in NHS screening programmes.

Choice in end of life care: government response

This report details the 6 commitments that the government has made to the public to end variation in end of life care across the health system by 2020.

RPS Launches Guidance on the Additional Monitoring of Medicines

Working with the APBI Pharmacovigilance Expert Network, RPS has produced a Quick Reference Guide and a more detailed Advice for Pharmacists document on the EU wide scheme for the additional monitoring of medicines, commonly known in the UK as the black triangle. 

This guidance highlights the importance of the additional monitoring scheme (the black triangle), and discusses the ways in which pharmacists and other healthcare professionals can contribute to medicines’ safety by reporting any adverse reactions to medicines with the black triangle symbol.

Common Principles of Rehabilitation for Adults in Audiology Services

New practice guidance from the British Society of Radiology on common principles of rehabilitation for adults in audiology services.

Diabetes commissioning pack

This comprehensive commissioning pack from NHS London Clinical Networks aims to ensure excellent type 1 diabetes services for all Londoners. There are three parts:

• Service specification – aimed at commissioners
• Clinical management: Optimal pathway – aimed at providers
• Implementation guide – This document provides the tools for both commissioners and providers to measure, analyse and develop improvement plans for their local diabetes service. 

New guide on Patient Reported Outcome Measures

The aim of this guide from NHS England is to highlight PROMs related resources available, and explain to provider trusts & clinical commissioning groups (CCGs) how national PROMs data can be used to monitor performance, understand and investigate variation, and inform commissioning decisions and conversations with provider trusts.

No hospital is an island: new models of acute collaboration in the NHS

Encouraged in recent years through the NHS Five Year Forward View, the Dalton and Carter reviews and now Sustainability and Transformation Plans (STPs), hospitals are looking for creative solutions to clinical and financial challenges that they can’t solve on their own.

NHS England recently brought together the 13 acute care collaboration vanguards, who are exploring this issue as part of the new care models programme, in a ‘community of practice’ hosted by the Nuffield Trust and The King’s Fund.

These 13 are a diverse bunch at first glance. Certainly the scope of their collaboration appears different. The four emerging foundation groups, Royal Free London, Salford, Northumbria and Guy’s and St Thomas’, are looking at bringing together full hospitals. Other models focus on single service lines, like EMRAD’s radiology consortium or Moorfield’s network of eye services. But at closer inspection, it looks more like a continuum of collaboration across acute services. The hospital groups are all considering tiered membership options, in which other hospitals could gain some of the group benefits through more limited collaboration options. Meanwhile, other partnerships such as Working Together and Developing One NHS in Dorset are specifically looking at collaborating on a defined cluster of clinical and back office services.

CTAS: a CT score to quantify disease activity in pulmonary sarcoidosis

Thorax. 2016 Jul 27. pii: thoraxjnl-2016-208833. doi: 10.1136/thoraxjnl-2016-208833. [Epub ahead of print]

CTAS provides a concept for an objective and reproducible CT scoring method to quantify disease activity in sarcoidosis. The score can potentially be used to stratify patients according to disease activity, determine response to treatment and establish if fibrotic sarcoidosis is active.

UHCW Research: Cole SL

Pre-exposure prophylaxis of HIV in adults at high risk: Truvada (emtricitabine/tenofovir disoproxil)

New Evidence Summary: New Medicine from NICE:

This evidence summary reviewed 4 randomised trials of Truvada (emtricitabine/tenofovir disoproxil 200 mg/245 mg) for pre-exposure prophylaxis (PrEP) of HIV in either HIV-negative men or transgender women who have sex with men, or HIV-negative individuals in a heterosexual partnership with a person already infected with HIV. In these trials, Truvada reduced the relative risk of acquiring HIV infection by between 44% and 86% compared with placebo or no prophylaxis, which is equivalent to approximate numbers needed to treat of between 13 and 68 per year. In all trials, Truvada was given in addition to a comprehensive package of prevention services including HIV testing, risk-reduction counselling, condoms and sexually transmitted infection management. In addition to efficacy, issues relating to uptake, adherence, sexual behaviour, drug resistance, safety, prioritisation for prophylaxis and cost-effectiveness are also important to consider, especially at a population level.

New cancer ratings published by NHS England

Nearly nine in 10 clinical commissioning groups (CCGs) are failing cancer patients, according to data from NHS England.

The ratings reveal that, of the 209 CCGs in England, only 14% are considered to be providing good quality cancer care.

UrgoStart for chronic wounds

New Medtech Innovation Briefing on the use of UrgoStart for chronic wounds.

Woundchek Protease Status for assessing elevated protease status in chronic wounds

New Medtech Innovation Briefing from NICE on the use of the Woundchek Protease Status for assessing elevated protease status in chronic wounds.

The Handbook of Peri-Operative Medicines

Until now there has been no national guideline in existence for the use of medicines in the peri-operative period. This has resulted in varying practices across the country for the management of patients’ regular medicines during this time. The Handbook aims to provide guidance on the management of medicines in the peri-operative period.

ACR appropriateness criteria: Adjuvant Management of Early Stage Endometrial Cancer

Updated/New guidance from the American College of Radiology:

Summary of Recommendations

• Early-stage endometrial cancer patients are a heterogeneous group of patients with different recurrence rates and treatment approaches. 
• Consider observation in patients with low-grade, early-stage endometrial adenocarcinoma without risk factors.
• Vaginal brachytherapy or WPRT can be considered in early-stage patients with risk factors such as high grade, deep myometrial invasion, or LVSI. 
• 3D conformal radiation therapy and IMRT are reasonable treatment techniques for adjuvant radiation therapy.

User feedback in maternity services

Patient feedback is an important tool for tracking the experience of those who use NHS services and, through this, the quality of care they receive. It also plays a key role in identifying problem areas and shaping service improvements. Maternity services are using a variety of feedback mechanisms, in addition to national tools, to help them understand women’s experience of maternity services.

This report from the King's Fund looks at what maternity services are doing locally to collect, analyse and act on user feedback. It describes the challenges of adopting the different approaches and highlights the features of organisations that are successful in user feedback activities.

Calibrating how doctors think and seek information to minimise errors in diagnosis

Information gathering is a foundational step of the diagnostic process. However, evidence over the last several decades suggests that failures in information gathering are common and feature prominently in analyses of diagnostic errors. 

In this issue of BMJ Quality and Safety, Sheringham et al used simulated patient vignettes to understand the role that patient characteristics (including demographics and symptomatology) play in physicians' decisions to investigate for possible diagnosis of lung cancer.

RCPCH to launch first ever quality improvement measures for children

The Royal College of Paediatrics and Child Health (RCPCH) has launched a programme of work to develop a set of much needed quality improvement measures specifically for children and young people.

Service Level Quality Improvement Measures for Acute General Paediatric Services, is the first step in a process that will see the development of a set of measures designed to support acute paediatric services following last year’s RCPCH publications of two sets of acute service standards,

‘Dignity therapy’, a promising intervention in palliative care: A comprehensive systematic literature review

Evidence suggests that dignity therapy is beneficial. One randomized controlled trial with patients with high levels of psychological distress shows DT efficacy in anxiety and depression scores. Other design studies report beneficial outcomes in terms of end-of-life experience. Further research should understand how dignity therapy functions to establish a means for measuring its impact and assessing whether high level of distress patients can benefit most from this therapy.

Published in Palliative Medicine.

Optimal value pathway on cardiovascular disease prevention

NHS RightCare has published an optimal value pathway on cardiovascular disease (CVD) prevention which commissioners are asked to consider during the “what to change” phase of their RightCare work.

More CCGs urged to apply for ‘delegated’ status

NHS England is encouraging CCGs to apply for full delegation from April 2017.

Giving CCGs more control and say over primary medical services is part of a wider strategy to support the development of place-based commissioning and is a key enabler of the development of new care models.

Always open, always ready

Dr Juliane Kause – lead consultant, out of hours care and seven day services blogs on the journey University Hospital Southampton NHS Foundation Trust (UHS) is on as it progresses at pace towards delivering quality services, seven days a week, 24 hours a day.

NICE recommends new drug osimertinib for hundreds of people with lung cancer

Osimertinib which was only licensed in February this year is recommended in new NICE draft guidance to treat a particularly aggressive form of lung cancer.

Adult native knee extensor mechanism ruptures

Injury (INJURY), Oct2016; 47(10): 2065-2070.

Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery.

UHCW Research: I.P. Pengas and T. Spalding

National Clinical Guidelines for Stroke

The national clinical guideline for stroke has been updated by the Royal College of Physicians.

Up to 1,500 extra medical training places announced

The number of medical training places available to students each year will be expanded to ensure the NHS has enough doctors to continue to provide safe, compassionate care in the future, Health Secretary Jeremy Hunt has announced.

From September 2018, the government will fund up to 1,500 additional student places through medical school each year. Students will be able to apply for the extra places from next year in order to take them up from the academic year 2018/19.

Final episode in Workforce 2020 podcast series

Listen to the final episode in the Workforce of 2020 podcast series, recorded by NHS Employers for Capsticks HR Advisory Service.

In this edition, Kelvin Cheatle discusses the workforce of the future with Deborah Tarrant, director of people and organisational development at Barking Havering and Redbridge Hospitals NHS Trust. They discuss HR strategies, rostering and quality of care for patients.

For other epiodes in the series.

Gloucestershire Receives Award for Improvements in Cancer Diagnosis

NHS Gloucestershire Clinical Commissioning Group (CCG) has received an award from the All Party Parliamentary Group on Cancer for its work to improve early diagnosis and one-year cancer survival rates.

Its initial focus was on delivering a large-scale education programme across GP services, and together with Macmillan, held a series of 17 very successful masterclasses. They subsequently developed a range of online resources, and have executed a quality improvement project which has given us useful learning through an audit of cancer diagnoses.

World Alzheimer Report 2016: Improving Healthcare for People Living with Dementia - Coverage, Quality and Costs Now and in The Future

This report from Alzheimer's Disease International reviews research evidence on the elements of healthcare for people with dementia, and, using economic modelling, suggests how it should be improved and made more efficient. It argues that current dementia healthcare services are over-specialised, and that a rebalancing is required with a more prominent role for primary and community care which could increase capacity, limit the increased costs associated with scaling up coverage of care, and, coupled with the introduction of care pathways and case management, improve the coordination and integration of care.

Awareness and understanding of EHRC guidance on the Public Sector Equality Duty

The Public Sector Equality Duty (PSED) is a duty on public authorities to consider how their policies or decisions affect people who are protected under the Equality Act. This research from the Equality and Human Rights Commission explores the effectiveness of some of the guidance the Commission has produced on the PSED.

Latest pharmacological technology briefings available

The Horizon Scanning Research & Intelligence Centre has published its latest set of pharmacological technology briefings.  October's briefing covers:

• Cancer
• Emergency care
• Endocrine, nutritional and metabolic
• Mental Health, drug abuse and learning difficulties
• Neurology & neurosurgery
• Ophthalmology
• Renal Disease and Urology
• Respiratory Disease and Thoracic Surgery
• Skin Disease, Burns and Wound Care