Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child

Cochrane Database of Systematic Reviews. DOI:10.1002/14651858.CD010224.pub2. November 2016. 

Exposure in the womb to certain antiepileptic drugs (AEDs) carried an increased risk of malformation in the foetus and may be associated with specific patterns of malformation. Based on current evidence, LEV and LTG exposure carried the lowest risk of overall malformation; however, data pertaining to specific malformations are lacking. Physicians should discuss both the risks and treatment efficacy with the patient prior to commencing treatment.

UHCW Research: Naghme Adab

Managing the stiff elbow

Orthopaedics and Trauma August 2016 Volume 30, Issue 4, Pages 329–335

Significant loss of the arc of elbow motion can cause difficulties with many activities of daily living. Elbow stiffness can be due to traumatic and atraumatic causes, and the osseous and soft tissue structures of the elbow can both contribute to the contracture. This article reviews the assessment of patients with elbow stiffness and highlights the importance of prevention of contracture after surgery or trauma. Non-operative options and operative techniques are discussed, and the outcomes after each are summarized. Non-operative treatment can be successful in patients with mild contractures and with symptoms that have been present less than 6 months. In patients with more severe contracture, open or arthroscopic arthrolysis may allow patients to regain a functional range of motion. An understanding of the anatomical structures that contribute to the contracture is essential to achieve a successful surgical outcome.

UHCW Research: Gev Bhabra, S. Modi Chetan and Tom Lawrence

Clinical Management of Pregnancies following ART

Clinical Management of Pregnancies following ART (Book) Springer International 978-3-319-42858-1 (e-Book)

Chapter 6: Early Pregnancy Support: Evidence-Based Management

UHCW Research: Siobhan Quenby

Updated advice on the diagnosis and treatment of women with premenstrual syndrome (PMS)

The timing of symptoms and degree of impact on daily activity determines a diagnosis of premenstrual syndrome (PMS), state revised guidelines for healthcare professionals published by the Royal College of Obstetricians and Gynaecologists (RCOG).

How nurses support families of intensive care patients towards the end of life

Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process.

Reviewers identified three main ways, or themes, in which families are supported. First, information and good communication, such as the focus on careful use of language, was seen commonly. Second, by careful management of treatment withdrawal itself, for example by clarifying the gradual change expected when medically focussed life-sustaining treatments are withdrawn and family centred end-of-life care begins. Lastly they described a common focus on making the nursing contribution more visible, such as using techniques to build lasting memories for families.

From the NIHR Dissemination Centre

OCS Heart system for heart transplant

New NICE medtech innovation briefing medtech innovation briefing (MIB) on OCS Heart system for heart transplant.

CytoSorb therapy for sepsis

New NICE medtech innovation briefing (MIB) on CytoSorb therapy for sepsis.

Impella 2.5 for haemodynamic support during high-risk percutaneous coronary interventions

New NICE medtech innovation briefing on Impella 2.5 for haemodynamic support during high-risk percutaneous coronary interventions.

Sternal Talon for sternal closure in cardiothoracic surgery

New NICE medtech innovation briefing on the Sternal Talon for sternal closure in cardiothoracic surgery.

South Somerset Symphony Programme – Leading the way in new models of care

South Somerset Symphony Programme(@Symphonyproj) are one of the vanguards showcasing areas of their work at the annual NHS Providers conference.

South Somerset is an integrated primary and acute care system vanguard.  Through vanguard funding, we have been able to develop our enhanced primary care model. This model focusses on prevention and education, as well as providing the specialist care that our patients with the most complex long-term health conditions need.

The State of the NHS Provider Sector: November 2016

This survey of NHS trust chairs and chief executives by NHS Providers has revealed rising concerns over the growing NHS workforce gap.

172 NHS leaders responded to the survey and only 27 per cent of these respondents reported confidence in having the right staff numbers, quality and skill mix to deliver high-quality care. The report provides examples of where trusts are improving quality of care and increasing productivity despite financial constraints and growing demand. The report highlights that trusts are able to deliver when given achievable tasks but warns that the sustainability of services is at risk.

Supported self-management improves quality of life and self-belief after stroke

Training people to take an active role in managing the consequences of their stroke improves their quality of life.

This Cochrane review pooled data from 14 trials comparing supported self-management with control interventions in people who had experienced a stroke one month to a year previously and lived in the community. Participants varied in their level of disability after stroke.

From the NIHR Dissemination Centre

High impact actions for service improvement and delivery by Transforming Care Partnerships

These high impact actions are intended to be complementary to the work on new models of care that is already underway and support Transforming Care Partnerships (TCPs).

These high impact actions are centred on the individual and can help TCPs make the biggest strides forward, in supporting children, young people and adults to have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives – thereby reducing the numbers of people in inpatient settings.

Fundamental facts about mental health 2016

This year’s Fundamental Facts follows the recent publication of the 2014 Adult Psychiatric Morbidity Survey (APMS). This highlights that, every week, one in six adults experiences symptoms of a common mental health problem, such as anxiety or depression, and one in five adults has considered taking their own life in the last year.

Nearly half of adults believe that, in their lifetime, they have had a diagnosable mental health problem, yet only a third have received a diagnosis. The APMS brings to the fore the widening gap between the mental health of young women and young men. Women between the ages of 16 and 24 are almost three times as likely (at 26%) to experience a common mental health problem as their male contemporaries (9%) and have higher rates of self-harm, bipolar disorder and posttraumatic stress disorder. This is clearly an issue that needs a deeper look and a strategy for addressing the factors that
are causing it.

NHS England sets out steps to improve mental health care for pregnant women and new mums and help those attending A&E in crisis

NHS England today sets out plans to provide more support for pregnant women and new mums suffering mental illness as well as to improve care for the many people with mental health problems attending A&E in crisis.

Simon Stevens, Chief Executive of NHS England will tell the Mind conference on Tuesday that £40m is to be allocated to 20 areas of the country to fund new specialist community mental health services for mums in the immediate run up to and after birth, and help reach 30,000 more women a year by 2021. A further £20m will be allocated next year.

2016 becomes worst year ever recorded for suicides in prisons

More than 100 people have lost their lives through suicide in prisons in England and Wales so far this year, an all-time record, it can be revealed today as two charities publish new research on how to make jails safer.

The Howard League for Penal Reform has been notified of 102 people dying by suicide behind bars since the beginning of 2016 – one every three days.

With five weeks remaining until the end of the year, it is already the highest death toll in a calendar year since current recording practices began in 1978. The previous high was in 2004, when 96 deaths by suicide were recorded.

How to avoid feeling depressed on Facebook

Comparing yourself with others on Facebook is more likely to lead to feelings of depression than making social comparisons offline.

That's one of the findings from a review of all the research on the links between social networking and depression by David Baker and Dr Guillermo Perez Algorta from Lancaster University.
They examined studies from 14 countries with 35,000 participants aged between 15 and 88.

Creative Activities Can Boost Well-Being

Everyday creative activity may lead to an “upward spiral” of increased well-being and creativity in young adults, according to new research.

For the study, researchers from the Department of Psychology at New Zealand’s University of Otago asked 658 university students to keep a daily diary of their experiences and emotional states over 13 days.

After analyzing the diaries, the researchers, led by Dr. Tamlin Conner, found a pattern of the participants feeling more enthusiasm and higher “flourishing” than usual following days when they were more creative.

Social workers fear plan to commission out services will disrupt care, says union

Social workers in Northamptonshire fear the local authority’s plan to transfer its adult services to a new company will disrupt under-pressure teams, union leaders have warned.

Are stroke services in the NHS still improving?

The Sentinel Stroke National Audit Programme (SSNAP) has  launched findings from its 2016 Acute Organisational Audit showing that the way that care is provided for people with acute stroke continues to improve with more provision of weekend therapy and better access to early supported discharge (ESD) teams.

The 3rd SSNAP annual report 'Mind the Gap' is also published.

However, the SSNAP Acute Organisational Audit report highlights concerns about staffing levels, particularly consultants, with 40% of sites now with an unfilled stroke consultant post, increasing from 26% in 2014. Results also show that patient engagement is inadequate with almost 40% of hospitals carrying out formal surveys of patient and carer experience of stroke services less than once a year or not at all.

Management of Female Malignant Ovarian Germ Cell Tumours (Scientific Impact Paper No.52)

New scientific impact paper from the Royal College of Obstetricians and Gynaecologists.  This Scientific Impact Paper is confined to the management of non-paediatric cases of malignant ovarian germ cell tumours (MOGCTs), and examines the presentation, investigation, and surgery and chemotherapy options. 

Expensive IVF add-ons 'not evidence based'

"Nearly all costly add-on treatments offered by UK fertility clinics to increase the chance of a birth through IVF are not supported by high-quality evidence," BBC News reports, covering the findings of a review by experts in evidence-based medicine.

IVF "add-ons" include a wide variety of treatments such as pre-implantation genetic screening, where the chromosomes of conceived embryos are checked for genetic conditions, and transfer of a "mock" embryo, as well as various drug treatments for blood clotting and immunity.

The researchers reviewed 38 interventions offered by private clinics, and found most of them aren't supported by good evidence.  A systematic review of the evidence had been carried out for just under three-quarters of the procedures (27 out of 38).

Market structure, patient choice and hospital quality for elective patients

This research from the Centre for Health Economics examines the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England.

Challenges and opportunities in improving access to medicines through efficient public procurement in the WHO European Region

This WHO report reviews how different public procurement practices can influence prices and ensure supply security for pharmaceuticals. It discusses the use of increased collaboration as a means to improve procurement outcomes.

Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews

This study aims to summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity.  It concludes: Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity.
BMJ Open 2016;6:e011952 doi:10.1136/bmjopen-2016-011952

Redefining the Hospital Case Study Series: Part 2

The Triple Aim, a framework developed by the Institute for Healthcare Improvement, guides hospitals and health care systems to optimize care delivery by improving patient care and the community’s health while reducing the cost of health care. 

Redesigning care delivery requires hospitals and health systems to disrupt their conventional thinking and reimagine care from the patient’s perspective. Engaging clinicians, patients, volunteers, hospital executives, trustees and community members in the process helps hospitals consider a broader, holistic perspective to health care delivery.

These case examples highlight initiatives at hospitals and health systems that are redefining hospital care, or the “H.”

Hospitals in Pursuit of Excellence

Integrated care for older people with frailty: Innovative approaches in practice

A new joint report from the Royal College of GPs and the British Geriatrics Society has been published, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Data Quality Maturity Index (DQMI)

The DQMI is a quarterly publication from NHS Digital intended to raise the profile and significance of data quality in the NHS by providing data submitters with timely and transparent information about their data quality.

UHCW's DQMI is 98.7 for the period April-June 2016.  For the period Jan-Dec 2015 it was 99.6.

NHS staff from overseas: statistics

Research briefing from the House of Commons Library on people from overseas working for the NHS.

Bed Availability and Occupancy Data – Overnight

NHS England has published statistics which show that the percentage of beds occupied in wards open overnight has now reached over 89% in the second quarter (July-September) of 2016-17. Last year’s equivalent figure was 87%.

Health experts advise that occupancy levels should ideally be under 85% although this has become increasingly difficult to attain. Anything over this level is regarded as riskier for patients as this leads to bed shortages, periodic bed crises, and a rise in healthcare-acquired infections such as MRSA. 

Hip fracture in adults

NICE's quality standard on hip fracture has been updated:

• Statement 1 Adults with hip fracture are cared for within a Hip Fracture Programme at every stage of the care pathway. [2012, updated 2016]
• Statement 2 Adults with hip fracture have surgery on a planned trauma list on the day of, or the day after, admission. [2012, updated 2016]
• Statement 3 Adults with displaced intracapsular hip fracture receive cemented hemiarthroplasty or, if they are assessed as clinically eligible, a total hip replacement. [2012, updated 2016]
• Statement 4 Adults with trochanteric fractures above and including the lesser trochanter receive extramedullary implants. [2012, updated 2016]
• Statement 5 Adults with subtrochanteric fracture are treated with an intramedullary nail. [new 2016]
• Statement 6 Adults with hip fracture start rehabilitation at least once a day, no later than the day after surgery.[2012, updated 2016]

Multimorbidity – the biggest clinical challenge facing the NHS?

In this joint blog, Dawn Moody and David Bramley argue multimorbidity is becoming the norm. They take a look at the adverse impact this can have upon individual quality of life and examine its association with higher mortality, adverse drug events and greater use unplanned care.

The recent publication of the NICE guideline on multimorbidity offers clear direction in this complex area. It uses a tailored approach to put people at the heart of decisions about their care and helps professionals and commissioners to offer their best advice and support.  Here are six practical top tips to help make the most of the guideline in clinical practice:

Latest pharmacological technology briefings now available

NIHR Horizon Scanning Research and Intelligence Centre's latest batch of briefings on pharmacological technologies in development is now available:

• Anacetrapib in combination with a statin for patients with primary hypercholesterolaemia or mixed dyslipidaemia
• Anacetrapib in combination with a statin for the reduction of cardiovascular mortality and morbidity in patients at high risk of cardiovascular events
• Bococizumab for primary hyperlipidaemia and mixed dyslipidaemia – adjunctive to statin therapy and/or diet
• Cancer vaccine MUC-1 (CVac) for stage III or IV epithelial ovarian cancer — first or second remission after surgery and/or chemotherapy
• CTL019 for relapsed or refractory B-cell acute lymphoblastic leukaemia
• CTL019 for relapsed or refractory diffuse large B-cell lymphoma
• Dexamethasone intracanalicular insert (Dextenza) for pain and inflammation following cataract surgery
• Durvalumab for locally advanced or metastatic urothelial bladder cancer
• Ertugliflozin for type 2 diabetes mellitus
• Evolocumab (Repatha) for cardiovascular event prevention
• Intepirdine for Alzheimer’s disease
• Intepirdine for dementia with Lewy bodies
• Ixazomib (Ninlaro) with lenalidomide and dexamethasone for multiple myeloma
• Nivolumab (Opdivo) for relapsed small-cell lung cancer
• OTO-104 for Meniere's disease
• Pembrolizumab for locally advanced or metastatic gastric and gastroesophageal junction adenocarcinoma
• Plazomicin for complicated urinary tract infection
• Solanezumab for mild dementia due to Alzheimer’s disease
• VOLT-01 (zoledronic acid with prednisolone) for osteoarthritis

NICE reverses decision on CDF leukaemia drug after price drop

NICE has decided that ibrutinib can come off the Cancer Drugs Fund (CDF) and be routinely available to treat chronic lymphocytic leukaemia.

PICANet Annual Report 2016

The PICANet (Paediatric Intensive Care Audit Network) Audit aims to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales.   This report summaries its audit for the period January 2013-December 2015.

Overall Patient Experience Scores: Supporting Information

NHS England has produced a Diagnostic Tool to help NHS managers and the general public understand what feeds in to the Overall Patient Experience Scores and to see how scores vary across individual NHS provider organisations.

Common Clinical Competency Framework for Ophthalmology

A new Ophthalmology Common Clinical Competency Framework has been launched by the Royal College of Ophthalmologists to provide standards of knowledge and skill required for non-medical eye healthcare professionals to deliver patient care.

NHS trust helps staff improve their confidence in conversational English

Barking, Havering and Redbridge University Hospitals NHS Trust have partnered with Creative English to develop and deliver a learning programme for their international staff, designed to improve confidence in conversational English.

The trust serves a large and diverse population, ranging from the elderly population of the East End of London, to those who have newly arrived from Eastern Europe with potentially few or no English language skills. This coupled with the changing demographic of staff increased the potential for difficulties in conversation between patients and staff.

Using scenarios inspired by hospital situations, the programme enabled staff to understand and practice the language they need in their day to day work in a relaxed and fun atmosphere.

Read the case study from NHS Employers to find out about the programme and the benefits to both staff and patients.

Advancing Healthcare Awards open for nominations

Nominations for the 2017 Advancing Healthcare Awards (AHA) are now open.

These awards are exclusively for healthcare scientists, allied health professionals – including podiatrists, dietitians, physiotherapists and radiographers - and those that work with them in support roles. This year NHS Employers is sponsoring a special award for apprentices, support workers and technicians.

The award for outstanding achievement aims to recognise the contribution these individuals make to providing high quality, creative care which enhances patients' quality of life. Nominations are welcome from the individual, their team, or by a patient, service user or carer.

The closing date for entries is Friday 13 January and the awards will take place on Friday 31 March 2017.

Building a culture of improvement at East London NHS Foundation Trust

In the past few years, East London NHS Foundation Trust has reduced incidents of inpatient violence, medication errors, waiting times for treatment in the community, and improved staff satisfaction and engagement, among other improvements. This report from the Institute for Healthcare Improvement looks at what made these achievements possible. Please note that registration is required before viewing this document.

How to complete winter daily situation reports (sitreps): 2016/17

The daily winter sitrep will indicate where there are winter pressures on the NHS around the country such as impact on A&E, cancelled operations and pressure on beds.

This guide outlines how to complete the sitrep using our new online portal and includes an annex outlining an example escalation framework. Trusts can see what submissions they need to make by looking at the trust submission requirements and following the promts within the portal.

Quality Champions

Wrightington, Wigan and Leigh NHS Foundation Trust has established a quality champions network which all of their staff are encouraged to get involved in to help the trust continue to be high-performing. With help from The Advancing Quality Alliance, the trust established an in-house QI course for staff and by August 2016, they had 349 champions and 143 improvement projects underway

Health Service Journal Awards - winners announced

The winners of the Health Service Journal (HSJ) Awards 2016 have been annoujnced. The awards celebrate excellence and innovation and the fantastic work and achievements that take place in healthcare across the country.

NHS Improvement's Efficiency Map

The efficiency map from NHS Improvement can help finance directors and professionals in NHS providers to:

• easily find best practice guidance on efficiency opportunities and processes for the NHS
• identify efficiency areas they haven’t considered yet, and consider where a different approach may yield increased benefits
• review their details on efficiency plans in the operational plans for 2017/18 and 2018/19

Best Practice in Clinical Audit

Updated guide from the Healthcare Quality Improvement Partnership on best practice in clinical audit.

See also:

• Guide to involving junior doctors in clinical audit and quality improvement.
• Clinical Audit – Statutory and Mandatory Requirements
• Developing a clinical audit policy
• Developing a clinical audit strategy
• Developing a clinical audit programme
• Documenting local clinical audit: A guide toreporting and recording

Individual Cognitive Therapy for PTSD Best for Active Duty Military

New research finds that although group and individual therapy are effective for PTSD among active-duty military service members, individual cognitive therapy relieves symptoms better and quicker.

Mental Health Foundation launches 'I'm Fine' campaign

A study of 2,000 adults commissioned by the Mental Health Foundation has found that the average adult will say "I'm fine" 14 times a week, though just 19% really mean it. Read more HERE.

Families Influence Gambling Behavior in Kids

New research finds that when family members gamble to relieve stress, it is a good chance that their children will also. However, adolescents do not always mimic parental behavior when family members find escape in alcohol or drugs.

Self-neglect: the tension between human rights and duty of care

Self-neglect was written into safeguarding procedures for the first time under the Care Act 2014, but has the change helped social workers? Read more HERE

Local authority pays damages after transgender boy’s privacy breached

A local authority has paid almost £5,000 to a transgender boy whose right to a private life was broken by an employee.

The 17-year-old, who was born a girl, was an adopted child but his relationship with his adoptive parents “completely broke down” after he told them he wanted to change sex.

Government publishes skills statement for achieving permanence

The government has published what it believes all social workers must know to help children in or entering care find permanent placements.
The Knowledge and Skills Statement for achieving permanence sets out how social workers should:

• Decide on the best permanence option
• Negotiate the legal process
• Help children find permanence without unnecessary delay
• Support children and families in transition and support the placement
• Manage disruption and breakdown

The final version was published last week following a consultation.

Underfunded child and adolescent mental health services: how much is spent in your region?

Our online tool can help you find out how much is spent on child and adolescent mental health services in your region.

New research from the Royal College of Psychiatrists shows there are huge differences across the country.

Royal College of Psychiatrists response to CQC report into how people are cared for when detained under the Mental Health Act

Registrar of the Royal College of Psychiatrists, Dr Adrian James said:
“The Royal College of Psychiatrists welcomes all attempts to safeguard the human rights of our patients. Better access to services across all levels of care will ensure that patients are cared for in the least restrictive environment and that effective care is given at the right time and in the right place. The report highlights many areas of good practice where mental health teams work positively with patients but support is needed to eradicate out of area placements - a key recommendation of Lord Crisp’s report on acute psychiatric care. However, in order to ensure full implementation across all areas it is essential that we train more mental health workers, including psychiatrists."

• Faster improvements needed in how people are cared for when detained under the Mental Health Act, warns CQC
• Mental Health Act 1983

Japanese encephalitis: the green book, chapter 20

Chapter 20 of the Green Book on Japanese encephalitis has been updated.

Intermittent inhaled steroids reduce asthma attacks in wheezing preschool children

Regular daily steroid inhalers reduce the number of severe asthma exacerbations requiring soluble tablets or injections in wheezing preschool children by about a third.

From the NIHR Dissemination Centre

Autumn Statement 2016 - the impact on employers

The main points from the Autumn Statement affecting the NHS workforce are:

Salary sacrifice:

• Tax and employer National Insurance advantages of salary sacrifice schemes will be removed from April 2017, except for arrangements relating to pensions, childcare, cycle to work and ultra-low emission cars. 
• Arrangements in place before April 2017 will be protected until April 2018.
• Arrangements for cars, accommodation and school fees will be protected until April 2021.

Other key points for employers:

• Employee and employer National Insurance thresholds to be aligned at £157 per week from April 2017, with a maximum cost to business of £7.18 per employee per year.
• National living wage to rise from £7.20 an hour to £7.50 from April next year.
• Tax-free personal income allowance will be raised to £11,500 in April 2017, from £11,000 now.
• Personal allowance will be raised to £12,500, and the threshold for the higher tax rate to £50,000, by the end of this parliament.
• Insurance premium tax to rise from 10 per cent to 12 per cent next June.
• Fuel duty remains frozen, with the scheduled fuel duty rise cancelled.
• Tax-free childcare will be rolled out in early 2017.

Nivolumab for previously treated advanced renal cell carcinoma

NICE technology appraisal guidance on nivolumab (Opdivo) for previously treated advanced renal cell carcinoma in adults.

Apremilast for treating moderate to severe plaque psoriasis

New NICE technology appraisal guidance on apremilast (Otezla) for treating moderate to severe plaque psoriasis in adults.

Testing Times to Come? An Evaluation of Pathology Capacity Across the UK

This report from Cancer Research UK finds that pathology services in the UK are struggling to cope with the increasing number of patient samples that need to be tested. A growing and ageing UK population means that more people than ever before are being referred for cancer tests; however, pathology staff numbers are not growing to meet the rising demand for tests.

Infections associated with heater cooler units used in cardiopulmonary bypass and ECMO

Evidence to date suggests heater cooler units used in cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) may generate potentially infectious aerosols containing bacteria, including mycobacteria and legionella.

This guidance from Public Health England explains what healthcare providers need to do to mitigate risks associated with these devices.

Capital regime, investment and property business case approval guidance for NHS trusts and foundation trusts

Guidance from NHS Improvement setting out the overarching principles relating to the capital regime and the business case approval process.  It also sets out other useful information for trusts including:

• development of business cases in the five case model
• a business case core checklist for use by trusts in the production of business cases and NHS Improvement in the review and approval of business cases
• further technical guidance including information specific to NHS trusts and details for foundation trusts that are not in financial distress
• advice on post-project evaluations
• roles and responsibilities of trusts and NHS Improvement in the preparation and approval of capital investment and property business cases

Incidental finding of giant pericardial lipoma

BMJ Case Rep. 2016 Nov 21;2016. pii: bcr2016218143. doi: 10.1136/bcr-2016-218143.

We describe a patient with an incidental finding of a large mass adjacent to the heart detected on a screening CT scan. The differential diagnosis included primary and secondary tumours of the heart. Subsequent investigation with trans-thoracic echocardiogram and cardiac MRI confirmed a diagnosis of a giant pericardial lipoma, one of the common benign primary cardiac tumours.

UHCW Researchers: Salim H, Anand DV, Tapp L

Latest staff sickness absence figures - July 2016

The latest figures released by NHS Digital show that NHS staff sickness absence has increased to 4.04 in July 2016, from 3.98 in July 2015.

NICE reviews multiple myeloma drug and approves for routine use

Pomalidomide – a type of biological therapy – is used to treat patients whose cancer has come back after 3 previous treatments, including both lenalidomide and bortezomib. Around 620 patients would be eligible for treatment with this drug a year.

NICE originally looked at pomalidomide in 2015 and published guidance not recommending the drug for patients who have had 2 previous treatments.

Dapagliflozin in triple therapy for treating type 2 diabetes

New NICE technology appraisal guidance on dapagliflozin (Forxiga) given with 2 other drugs for treating type 2 diabetes in adults.

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy for treating morbid obesity

New NICE Interventional Procedure Guidance on single-anastomosis duodeno-ileal bypass with sleeve gastrectomy for treating morbid obesity. This involves reducing the size of the stomach and small intestine to reduce the amount of food absorbed.

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice

Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers.


The purpose of this statement from the American Heart Association is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research.

Percutaneous insertion of craniocaudal expandable implants for vertebral compression fracture

New NICE intervantional procedure guidance on percutaneous insertion of craniocaudal expandable implants for vertebral compression fracture in adults. This involves inserting an implant into the spine to restore the vertebral height.

Endoscopic transluminal pancreatic necrosectomy

New NICE interventional Procedure Guidance on endoscopic transluminal pancreatic necrosectomy in adults. This involves removing dead tissue from the pancreas.

Sorting The Plans

Some sustainability and transformation plans (STPs) do not include enough substance to prove they are tackling the problems realistically, according to this report.

In the report, CIPFA has analysed nine published STPs out of the 44 that are being developed in England to improve services while reducing costs. It found that although the plans set out proposals to close the widening financial gap, which the NHS estimates to be £30bn by 2020, some fail to set out a credible case for the deliverability of their savings plans.

Meeting The Need: What Makes A 'Good' JSNA For Mental Health Or Dementia?

This research from the Centre for Mental Health outlines how mental health needs assessments can prompt concerted action to improve wellbeing and life chances in local communities. It explores how five local councils across England went about understanding the mental health needs of their communities and taking action to meet them more effectively.

Self care nation: self care attitudes and behaviours in the UK

This research from the Proprietary Association of Great Britain (PAGB) explores how people use GP and A&E services and finds that if they understood their own NHS ‘footprint’, 80 per cent would be more likely to seek advice from pharmacists and use over-the-counter remedies for coughs, colds and other self-treatable conditions.

STP checklist for governance and engagement

Sustainability and Transformation Plans (STPs) are the latest mechanism to drive system-wide collaboration and planning and bring with them an important opportunity to improve the way the whole system works together to deliver high quality and sustainable services across a place. Since STPs do not change the statutory responsibilities of individual organisations they raise important questions for how governance and engagement will be managed to support collective decision-making.

This checklist is for CCG lay members, provider non-executive directors (NEDs), councillors, local Healthwatch organisations, the voluntary sector, and other key community partners. It provides a series of questions that can be asked locally and within boards to support effective dialogue and decision-making within ‘STP footprints’.

Prescribing costs in hospitals and the community

The report from NHS Digital presents summary cost figures relating to medicine use through prescribing in hospitals and the community in England in 2015/16, which includes the estimated prescribing cost of prescriptions in millions of pounds from 2010/11 to 2015/16 for primary care prescribing dispensed in the community, hospital prescribing dispensed in the community and for medicines issued from hospital pharmacy departments. It also shows the proportions of the total cost for each sector and the corresponding annual percentage change between each year.

Male breast patient imaging: what is an appropriate pathway?

The aims of the retrospective study outlined on this poster were

1. To audit the male breast imaging service at UHCW using corresponding clinical examination scoring(Pvalue)and radiological imaging scoring(Rvalue).
2. To identify ifany current pathway strategy is being used and whether this works to classify likelihood of benign vs malignant pathology.
3. To propose a new male breast imaging pathway which may make better use of the breast imaging services.

UHCW Research: M. Sreenivas

Monitoring Response in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy—A Single Institution Study

The aims of this poster were:

1. To identify pre-treatment MRI and tumour features which are predictive of response to NAC.
2. To evaluate the correlation between residual disease on post-NAC MRI with residual disease on final pathology.

UHCW Research: Dr Muthyala Sreenivas

Exit Interviews for Junior Drs- What Can We Learn? The Pope-I Project

Emerg Med J 2016;33:930 doi:10.1136/emermed-2016-206402.55

Organisations which conduct exit interviews are known to create more promoters in people who leave than organisations that do not. Despite this and the valuable feedback gained, exit interviews are uncommon in medicine.
                                

Our objectives were to develop an exit interview programme which was brief, gave the opportunity to say positives and negatives and guaranteed anonymity. Further to this we wished to evaluate the information that we received and how useful it was felt to be by those taking part.

UHCW Research:  C Turner,  V Lee-Shrewsbury and N Hill

Solitary Pulmonary Hyalinizing Granuloma (A rare cause of

BJR| case reports, 2016

A pulmonary nodule is a common incidental finding on chest imaging which includes a wide variety of differential diagnosis. Pulmonary hyalinizing granuloma (PHG) is a rare disease etiology of pulmonary nodule/nodules. We report a 74 year old female who was referred to respiratory clinic with incidental finding of solitary pulmonary nodule on chest X-ray . Computed tomography confirmed 1.2cm solitary pulmonary nodule in the left upper lobe with no lymphadenopathy. She underwent wedge resection and histology of the lesion confirmed pulmonary hyalinising granuloma. In most previously reported cases, patients had multiple lesions on chest radiography. Solitary pulmonary lesion is an uncommon presentation of this clinical entity and only few cases have been reported in the literature.

UHCW Research: B. B. Sinha

High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation

BMJ Open 2016;6:e012843 doi:10.1136/bmjopen-2016-012843

Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the ‘modern’ patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes.

UHCW Research: G. McGregor, S. Ennis, R. Powell and P. Banerjee

Resus Estimated Times of Arrival – Just How Accurate Are They?

Emerg Med J 2016;33:922-923 doi:10.1136/emermed-2016-206402.42

Effective use of staff and facilities is one of the cornerstones of good Emergency Departments (EDs). An accurate estimated time of arrival (ETA) at the point of the alert call to the ED allows us to prepare efficiently prior to patients arriving.

If the patient arrives too early the receiving team may not be fully assembled and specialist equipment not readily available; too late and team members are inadvertently wasting time that could have been allocated to other tasks, or leave the Resuscitation Area (Resus).

We aimed to compare estimated versus actual time of arrival (ATA) of patients to Resus at UHCW ED in order to determine and quantify any difference.

UHCW Research: C Turner, H Patten and M Williams

Lifelike model of child’s skull and brain created using 3D printing, heralding breakthrough in surgical training

Experts at the Royal College of Surgeons have used 3D printing and advanced modelling techniques to create a realistic model of a toddler’s skull and brain. The brain has been designed to simulate the dimensions, feel and consistency of an infant’s.

Trainees will be able to use the portable model paediatric heads to become skilled at a paediatric neurosurgery operation, before performing it for the first time. They will also be able to use it in the operating theatre, before an operation, to become familiar with a procedure and the correct instruments, under the supervision of their consultant surgeon trainer.

Financial sustainability of the NHS

This is the National Audit Office's fifth report on the financial sustainability of the NHS. The health service must be financially sustainable to provide high-quality services for patients both now and in the future. Health is an area of public spending that has been protected in recent years. However, finances have become increasingly tight.

How can contingency management support treatment for substance use disorders? A systematic review

Contingency management (CM) is a general behavioural intervention technique used in the treatment of drug dependence to systematically arrange consequences and it is designed to weaken drug use and strengthen abstinence.

The main elements of CM interventions are behavioural reinforcers and monitoring, which aim to promote social reintegration by sustaining compliance, abstinence and/or attendance at work. A systematic review was performed of studies on the effectiveness of CM alongside pharmacological treatment of dependence.

Pearson and RCS explore virtual reality training for surgeons

Pearson, the world's learning company has announced a new partnership with the Royal College of Surgeons (RCS) to explore the use of immersive technology to help train and support a new generation of surgeons.

Describing variation in numbers of people with psychosis and their access to care in England

The ‘Five Year Forward View for Mental Health’ has made the case for transforming mental health care in England, and ‘Implementing the Five Year Forward View for Mental Health’ drives forward delivery of this programme including enhanced action on Early Intervention in Psychosis (EIP) access and wait standards. This report from Public Health England aligns with ambitions within these documents, aiming to assist in the move towards improved access to quality care for people at risk of, or living with psychosis. It also seeks to encourage continuous quality improvement through better data collection and reporting of information on mental health to service users, clinical teams and the wider health and social care system.

Valuing therapeutic alliances with people experiencing acute psychosis

• Mental health professionals must value the therapeutic relationship as central to providing recovery focused nursing care to people experiencing acute psychosis on acute mental health wards.
• Therapeutic alliances can be maintained by skilled mental health professionals even when containment measures are required.
• Further research focused on detailed accounts of therapeutic interactions could provide the basis for the development of practice guidance, measurement of outcomes and enhanced education of mental health professionals.

Evid Based Nurs 2016;19:116 doi:10.1136/eb-2016-102367.  Access with your Athens username and password.

Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults

The objective of this study was to assess the efficacy and acceptability of psychological therapies versus pharmacological interventions for panic disorder, with or without agoraphobia, in adults.  It concludes that the evidence in this review was often imprecise. The superiority of either therapy over the other is uncertain due to the low and very low quality of the evidence with regard to short-term efficacy and treatment acceptability, and no data were available regarding adverse effects.


From the Cochrane Database of Systematic Reviews

It is unclear if combined motivational interviewing and cognitive behavioural therapy improve medication adherence

• Interventions in motivational interviewing (MI) and cognitive behavioural therapy (CBT) to enhance self-care and healthy behaviours, including the appropriate use of medication, should be implemented in practice.
• Future research should separately consider MI and CBT and their effect on medication adherence, ensuring the utilisation of a skilled cognitive behavioural therapist.

Evid Based Nurs 2016;19:124 doi:10.1136/eb-2016-102370.  To access, use your Athens username and password. 

Current evidence does not support the widespread use of collaborative care for PTSD, but it is limited by not evaluating context

Posttraumatic stress disorder (PTSD) is a common disorder that affects many patients in the primary care (PC) setting. There are multiple evidence-based treatments for PTSD, and some of which could easily be delivered in a PC setting. Collaborative care (CC) models have been used to improve depression care in PC. In comparison to depression, PTSD is less commonly treated in PC. There have been several attempts to examine CC models for PTSD; however, the results have been inconclusive. This study seeks to examine the effectiveness of CC for PTSD in Federally Qualified Health Centers (FQHCs).


Evid Based Med 2016;21:176 doi:10.1136/ebmed-2016-110482.  Access using your Athens username and password.

‘Time for self’ appears to be a proactive strategy for the prevention of postpartum depression

• Encouraging women and their partners to take time for self at least once a week in the first 6 months postpartum may promote positive parental mental health.
• Future research examining the relationship between co-parenting and time for selfholds potential in the effort to prevent postpartum depression.

Evid Based Nurs 2016;19:114 doi:10.1136/eb-2016-102391.  Access using your Athens username and password.

Antibiotics of no benefit to children with eczema and features of cutaneous infection but controversy remains unresolved

Eczema poses substantial adverse impact on the quality of life of patients and their families. Although most patients have cutaneous Staphylococcus aureus colonisation, the relationship between S. aureus and eczema flares remains unclear. Oral and topical antibiotics are widely prescribed to treat clinically infected eczema despite the lack of high-quality evidence to justify this practice. This multicentre randomised, double-blind, placebo-controlled trial (RDBPCT) examined whether antibiotics confer benefits to these patients.


Evid Based Med 2016;21:179 doi:10.1136/ebmed-2016-110457. Access using your Athens username and password.

Acceptance and commitment therapy: an appropriate treatment option for older adults with chronic pain

• Acceptance and commitment therapy (ACT) shows benefit for older adults managing chronic pain.
• Research is needed around which components of different psychotherapies are most suitable for individuals.
• Research with a larger population is needed to show clinical significance of ACT and/or cognitive-behavioural therapy in adults with chronic pain.  

Evid Based Nurs 2016;19:123 doi:10.1136/eb-2016-102368. Access using your Athens username and password. 

Hidden in plain sight: The unmet mental health needs of older people

Many older people live with both physical and mental health conditions, yet almost 40% of mental health trusts do not have a specific policy or strategy for supporting comorbidities (i.e. the presence of more than one long-term condition). Often, physical and mental health needs are inter-related and failing to address them together can severely undermine an older person’s ability to recover from an illness or deterioration in their health. Furthermore, figures for older people detained in police stations and hospitals under the Mental Health Act suggest that mental health crisis care is not always adequately dealing with their needs.

In light of these findings, Age UK makes a number of recommendations to build on progress already made and ensure that older people’s mental health gains not only parity of esteem with physical health concerns but parity with other age groups as well.

Funding of Mental Health Services: Do Available Data Support Episodic Payment?

The results indicate that if a new cluster-based episodic payment system were introduced it would have different financial impacts across providers as there is variation in the activity they perform


within clusters and the costs they report for them. However remaining under block contract incurs a risk of mental health services experiencing disinvestment. There is thus a need to invest in improving the quality of data collection, and refining the cluster classification system to facilitate sustainable payment system reform.

Entry level occupational therapy core knowledge and practice skills

This document sets out the scope of occupational therapists’ core professional knowledge and practice skills to inform commissioners of health, social care and other public services, wider stakeholders, education providers and members of the general public.

S-adenosyl methionine (SAMe) for depression in adults

Given the absence of high quality evidence and the inability to draw firm conclusions based on that evidence, the use of SAMe for the treatment of depression in adults should be investigated further. Future trials should be in the form of large randomised controlled clinical trials of high methodological quality, with particular attention given to randomisation, allocation concealment, blinding and the handling of missing data. Comparator antidepressants from all classes should be used. Adverse events should be detailed for each participant, bearing in mind that induction of mania is of particular interest.






From the Cochrane Database of Systematic Reviews

Simpler, cheaper therapy (behavioural activation) can be as good as CBT for treating depression

A simpler therapy called behavioural activation can be as effective at treating adults with depression as cognitive behavioural therapy (CBT). Also, it is delivered more cheaply, by trained junior mental health workers.




From the NIHR Dissemination Centre

Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review

The aim of this review was to determine whether or not automated computerised tests could accurately identify patients with progressive cognitive impairment in MCI and dementia and, if so, to investigate their role in monitoring disease progression and/or response to treatment.


Health Technology Assessment 20:(77) 2016

Hypovitaminosis D predicts more rapid and severe cognitive deterioration in ethnically diverse older adults with and without dementia

• Hypovitaminosis D precedes and predicts incident declines in episodic memory and executive function in older adults with and without baseline dementia.
• This finding encourages testing the efficacy of vitamin D supplementation to slow down, prevent or even improve cognitive decline.
• These findings should encourage clinicians to correct hypovitaminosis D in elderly patients.

Evid Based Nurs 2016;19:127 doi:10.1136/eb-2016-102357.  Access with your Athens username and password. 

Children’s attachment quality standard

This quality standard from NICE covers the identification, assessment and treatment of attachment difficulties. It focuses on children and young people up to age 18

Psychological therapies for children and adolescents exposed to trauma

Children and adolescents who have experienced trauma are at high risk of developing post-traumatic stress disorder (PTSD) and other negative emotional, behavioural and mental health outcomes, all of which are associated with high personal and health costs. A wide range of psychological treatments are used to prevent negative outcomes associated with trauma in children and adolescents.  This systematic review assesses the effects of psychological therapies in preventing PTSD and associated negative emotional, behavioural and mental health outcomes in children and adolescents who have undergone a traumatic event.


From the Cochrane Database of Systematic Reviews

Hyperbaric oxygen therapy for people with autism spectrum disorder (ASD)

The rising prevalence of autism spectrum disorder (ASD) has increased the need for evidence-based treatments to lessen the impact of symptoms. Presently, no therapies are available to effectively treat individuals with all of the symptoms of this disorder. It has been suggested that hyperbaric oxygen therapy may alleviate the biochemical dysfunction and clinical symptoms of ASD.




from the Cochrane Database of Systematic Reviews

Hope for parents of children with cancer-development and evaluation of a group-based and web-based self-management intervention for parents of children with cancer

Pediatric Blood and Cancer. Conference: 48th Congress of the International Society of Paediatric Oncology, SIOP 2016. Ireland. Conference Start: 20161019. Conference End: 20161022. 63 (pp S232), 2016. Date of Publication: November 2016.

Every day in the UK 10 children are diagnosed with cancer. Parents of children with cancer often face despair, grief, shock, isolation and long term financial and psychological consequences following diagnosis. There is a need to provide parents and caregivers with a specialised support intervention to help them address these challenges. Interventions aimed at similar population groups, such as parents of children with autism have shown positive outcomes, providing parents with the skills, and resilience to support a positive environment for the family. The aim of this project is to develop and evaluate a group-based (HOPE) and web-based (iHOPE) self-management programme to meet the psychosocial needs of parents of children with cancer.

UHCW Research: Polanco A.

Haemolytic uraemic syndrome associated with docetaxel in breast cancer

International Journal of Gynecological Cancer. Conference: 16th Biennial Meeting of the International Gynecologic Cancer Society. Portugal. Conference Start: 20161028. Conference End: 20161031. 26 (pp 258), 2016. Date of Publication: October 2016.



Haemolytic uraemic syndrome (HUS) is a potentially fatal condition with no recognised association with docetaxel. We present the first documented case of HUS associated with docetaxel in a patient who had tolerated 5 prior cycles of adjuvant chemotherapy without major toxicity, developing HUS after the final cycle of docetaxel



UHCW Research: Allos B., Dunn V., Walji N. and Short A.

Molecular Imaging of Late Somatostatin Receptor–Positive Metastases of Renal Cell Carcinoma in the Pancreas by Radiolabeled 111In SRS Octreotide Scan: A Rare Differential Diagnosis to Multiple Primary Pancreatic Neuroendocrine Tumors

Abstracts of the 13th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease. March 9-11, 2016, Barcelona, Spain.  Abstract I9

Somatostatin-Receptor Scintigraphy (SRS) has a sensitivity and specificity for pancreatic NETs (pNETs) of 90 and 80% respectively. SRS is indicated as first staging procedure and one of the
most sensitive imaging modalities for well-differentiated neuroendocrine tumors, based on imaging of somatostatin receptors (SSRTs).  The aim was to report 111In SRS scan ability in detecting lesions of RCC origin.

UHCW Research: Dimitriadis G., Davies L., Randeva H.S., Weickert M.O.

Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment

Eur Arch Otorhinolaryngol 273(12) pp. 4543-4547

Voice symptoms are frequently reported early after thyroidectomy, even in the absence of laryngeal nerves injury. We evaluated the short-term outcomes of these functional alterations.

UHCW Research: Chakrabarti, S and Weickert, M. O.

Tracheal Extubation of Patients With Cervical Spine Injury: A Case Report and Review of Literature

A & A case reports 2016

In patients with cervical spine injuries, emergence from anesthesia and tracheal extubation can prove as challenging to the anesthesiologist as the tracheal intubation. We report a case of a patient with a potentially unstable cervical spine injury who presented for a nonspinal surgery and experienced agitation on emergence from anesthesia. The use of an intravenous sedative was necessary to ensure cervical spine immobilization but was complicated by severe respiratory depression and the need for reintubation and admission to intensive care. The case report is followed by a review of literature relating to safe extubation of patients with cervical spine injuries. Possible complications during emergence and various methods to prevent these complications are discussed.

UHCW Research: Nowicka, Aleksandra

Combined Acute Haemolytic and Secondary Angle Closure Glaucoma following Spontaneous Intraocular Haemorrhages in a Patient on Warfarin

Case Rep Ophthalmol 2016;7:233–238 (DOI:10.1159/000452440)

To report the first described case of combined haemolytic and acute angle closure glaucoma secondary to spontaneous intraocular haemorrhages in a patient on excessive anticoagulation. To the best of our knowledge, this is the first case reported in the literature presenting with raised intraocular pressure due to both mechanisms.

UHCW Research: Andreatta W.,  Boukouvala S. and Bansal A.

Neuromyelitis Optica in HIV: A Case Report and Literature Review

J Neurol Neurosurg Psychiatry 2016 87:e1. doi:10.1136/jnnp-2016-315106.122

Neuromyelitis optica (NMO) is a rare autoimmune condition that preferentially causes inflammation of the optic nerves and spinal cord. There are scanty reports of NMO occurring in the setting of patients with Human immunodeficiency virus (HIV). We present a case and review the literature.

UHCW Research: Jason P Appleton and Anthony Kenton

The RCN’s Working Longer Project/Valuing Older Workers

In April 2015, the RCN was granted funding from the Union Learning Fund, for a one-year project to consider how unions and employers could work together, to develop learning strategies that could address some of the challenges that staff face as they work to their pension age.

The RCN has published this report along with Valuing Older Workers: A 10 Step Action Plan for Partnership Working. The action plan, includes steps to challenge perceptions, demonstrate commitment, understand learning needs and implement effective learning strategies, based around the key learning and resources identified during the project. It includes a list of tools, resources and activities that can support organisations to create a positive culture that values older workers and supports staff to prepare for working to retirement age.

Monitoring the Mental Health Act: 2015 to 2016

The seventh annual report by the Care Quality Commission on its monitoring activities of the Mental Health Act 1983 (MHA).  It highlights concerns that patients are not receiving the support they need to be involved in their care and that some staff are not following the revised Code of Practice.

Core principles for Continuing Professional Development

The Academy of Medical Royal Colleges (AoMRC) has published guidance on the Core Principles for Continuing Professional Development (CPD).

Who Shares Wins: Efficient, Collaborative Radiology Solutions

The Royal College of Radiologists (RCR) has published Who shares wins: efficient, collaborative radiology solutions, where diagnostic images and their reports are shared between interconnected networks of trusts.

ER-WCPT Dublin dean talks of tool to help with wearable tech pilots

In a debate, at the ER-WCPT conference in Dublin, about how technologies can enhance healthcare education and clinical practice, Professor Caulfield said that, over the past 10 years, personal sensors had massively increased the capacity to measure human performance.

But he cautioned that, particularly in relation to consumer products, there was a lack of scientific evidence and huge variations in the accuracy of data they produced.

CQC publishes urgent and emergency care pilot reports for two local areas

These CQC reports on the pilots focus on UEC systems in South Warwickshire and in Airedale, Wharfedale, Craven & Bradford. In each area we looked at the contribution of the services that support people with urgent and emergency care needs, including NHS 111, A&E departments, ambulance services, GP practices, GP out of hours services and care homes – and how well they worked together for the benefit of the local population.

New central contact for apprenticeship trailblazers

Health Education England and Skills for Health have launched a new, centralised place of contact for any organisation wishing to develop apprenticeship standards for the health sector.

A series of groups have been set up to develop the new standards, which are known as 'trailblazers'. If you are thinking about becoming involved with a trailblazer you can now ask questions, seek advice or submit suggestions by contacting Healthcare.Trailblazer@skillsforhealth.org.uk.

Maintaining and improving staff engagment in demanding times

Over the last four years the NHS has secured sustained improvement in staff engagement.  This NHS Employers briefing provides different approaches and methods that will help to maintain this improvement in the current context.

Online calculator that tries to predict IVF success released

"Couples can find out their chances of having a baby over multiple cycles of IVF treatment using a new online calculator," BBC News reports.

The calculator is designed to predict the success of in vitro fertilisation (IVF) – often used when a woman has a fertility problem – or intracytoplasmic sperm injection (ICSI), which is used when a man has a fertility problem.

Exploring the case for seven-day services

The evidence for and against seven-day NHS services is explored in a new report from the NHS Confederation.

Commissioning and delivering enhanced seven-day NHS services looks at the ongoing debate, analysing what is already known about seven-day provision and exploring what the evidence tells us about the case for an enhanced seven-day.

Taking on board evidence around issues such as workforce planning, the analysis looks to determine what is best for the NHS, arguing that local decision makers are best placed to decide what is needed to meet the changing health and care needs of their local communities.

Monthly announcement on national dementia diagnosis rate

Alistair Burns, NHS England’s national clinical director for dementia has written to CCGs outlining priorities for treating dementia.

Research suggests 'missed opportunities' to prescribe drugs for stroke prevention

An analysis of the records of UK patients who had experienced a stroke has found that over half of those who should get drugs to prevent strokes were not prescribed them.

Across the UK, that amounts to 33% of all stroke and ‘mini-stroke’ (transient ischaemic attack, or TIA) patients having a ‘missed opportunity’ for preventative treatment.

English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report

The ESPAUR report includes national data on antibiotic prescribing and resistance, and hospital antimicrobial stewardship implementation.

Accident and Emergency Statistics: Demand, Performance and Pressure, Waits and Health Expenditure

From the House of Commons Library:

• Accident and Emergency Statistics: Demand, Performance and Pressure
• Waiting times in England, Wales & Scotland
• Health expenditure in England and the UK
• NHS staff in England

New £112 million investment in clinical research facilities

The DoH has announced funding for specialist research nurses and new facilities to support clinical research and trials.It will be given to 23 NHS organisations, including UHCW, and will pay for specialist research nurses and technical staff, as well as providing cutting-edge facilities to support clinical research and trials.

GOLD 2017: Global Strategy for the Diagnosis, Management and Prevention of COPD

The GOLD report from the Global Initiative for Chronic Obstructive Lung Disease is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems.

The risk of myocardial infarction with antipsychotics

New Medicines Evidence Commentary from NICE:

A systematic review and meta-analysis of 9 observational studies found that taking antipsychotic medicines almost doubled the risk of having a myocardial infarction (MI). The risk was greatest within the first 30 days of exposure to an antipsychotic medicine. Despite its limitations, the review highlights the importance of continuing to follow current advice that these medicines should be used with caution in people with cardiovascular disease. The NICE guideline on psychosis and schizophrenia in adults, recommends that various cardiovascular assessments should be carried out before starting an antipsychotic medicine and that ongoing monitoring should continue during treatment. The guideline on dementia, produced jointly by NICE and the Social Care Institute for Excellence (SCIE), advises against using antipsychotic medicines for non-cognitive symptoms or challenging behaviour of dementia unless the person is severely distressed or there is an immediate risk of harm to them or others.

New payment approaches for mental health services

As part of NHS England's consultation on the 2017/18 and 2018/19 national tariff they require mental health providers and commissioners to adopt transparent and robust payment approaches linked to outcomes. This page sets out the different approaches that providers and commissioners can adopt.

Tariff Metrics engine

The metrics engine is a tool that NHS England has developed to explain how tariff prices change as we move through the price modelling process.

Antibiotic Guardian and Awareness

Antibiotic Guardian and Antibiotic Awareness: key messages on antibiotic use
This document explains how to use antibiotics responsibly for patients, animal keepers and pet owners, and prescribers.

Antibiotic awareness: toolkit for healthcare professionals in England
How to use antibiotic awareness resources to support the Antibiotic Guardian campaign and local initiatives.

Antimicrobial resistance

Antimicrobial Resistance Empirical and Statistical Evidence-Base
Provides an overview of the current situation of antimicrobial resistance in bacteria, viruses and fungi that can cause disease in humans.

Management of Asthma

SIGN has published the following summary guidance on the British Guideline on the Management of Asthma:

• Summary of management - adults
• Table 9: Categorisation of inhaled corticosteroids by dose - adults
• Table 10: Categorisation of inhaled corticosteroids by dose - children

The Digital Patient: Transforming Primary Care?

This report from the Nuffield Trust argues that digital technology for patients and staff in primary care holds great potential for the NHS but that the impact of this new digital capability is far from certain. It reviews the evidence on digital technology and its impact on patients and finds that patient-facing technology is already showing promise, particularly for people with long-term conditions.

How can we do Better? Improving blood pressure management

Using data from the Quality and Outcomes Framework (QOF), Hospital Episode Statistics (HES), Office for National Statistics (ONS) and PHE, this resource, How can we do better?, from the British Heart Foundation summarises care across the nation, but also provides recommendations for improving care, both at a CCG and practice level.

Includes localised data alongside practical tips from healthcare professionals on how you can improve detection and management of BP.

ER-WCPT: Physios should give patients a voice and listen to their stories

Physiotherapists should be listening to patients’ stories and working with them to improve research, education and clinical practice. This was one of the ideas debated during an ER-WCPT conference discussion panel about how physical therapists can make better use of patients’ views and experiences.

 Jonathan Harvey, a research fellow at the University of Southampton, suggested that physiotherapists could benefit from the insights provided by patients’ accounts. 'The patient voice offers an alternative and important perspective on physiotherapy provision. It offers a perspective which encourages the clinician to evaluate their practice and imagine how things could be otherwise.’

Dasatinib (Sprycel, Bristol-Myers Squibb) approved for two indications of Philadelphia-chromosome-positive chronic myeloid leukaemia (CML)

NICE is currently reappraising 11 drug indications in the first group of the CDF, and of the nine looked at so far, seven have been approved at draft or final guidance stage. None have yet been rejected in final guidance, with the remaining two currently in the process.

The seventh drug was approved in draft guidance published on Thursday 16 November.

Dasatinib (Sprycel, Bristol-Myers Squibb) was approved for two indications of Philadelphia-chromosome-positive chronic myeloid leukaemia (CML), which means it can come off the CDF and be available to patients routinely on the NHS.

Price discount helps give green light for breast cancer drug pertuzumab

The recommendation follows a discount to the price of pertuzumab (also called Perjeta and made by Roche Products) agreed with the company.  The draft guidance looks at pertuzumab in combination with trastuzumab (Herceptin) and docetaxel (a type of chemotherapy) to treat HER2-positive breast cancer that is locally advanced, inflammatory, or early-stage and at high risk of coming back.

NICE says pancreatic cancer treatment considered not cost effective for routine NHS use

The drug pegylated liposomal irinotecan, was not clinically effective enough in treating pancreatic cancer, to justify its high cost, NICE says a statement.

Some treatments for abnormal cervical cells increase risk of preterm birth

Women who receive the more radical treatments (like loop excisions) for abnormal cells on the cervix are more likely to experience preterm birth and other adverse pregnancy outcomes than those receiving more local treatments or those not needing treatment at all. Abnormal cells – termed cervical intraepithelial neoplasia (CIN) – can be picked up on cervical screening. These non-cancerous changes can develop into cancer in the future if left untreated. Various treatment options are available to either cut away or destroy the problem cells. The benefits of treatments need to be considered too.

From the NIHR Dissemination Centre

Exercise therapy may still improve balance when started a long time after a stroke

Exercise therapy may improve balance for people in the chronic phase of recovery six or more months after stroke. The most effective training regimens seem to be those that focus on balance, weight shifting and gait training. Though significant, the improvements in function may still be small.

From the NIHR Dissemination Centre

Breast screening: clinical guidelines for screening assessment

NHSBSP Publication No 49: clinical guidelines for healthcare professionals screening women for breast cancer.

The aim of assessment is to obtain a definitive and timely diagnosis of all potential abnormalities detected during screening.

This is best achieved by using ‘triple assessment’, comprising:

• imaging (usually mammography and ultrasound)
• clinical examination
• image guided needle biopsy for histological examination if indicated

Cytology should no longer be used alone to obtain a non-operative diagnosis of breast cancer.

Early diagnosis and specialist care needed for twins who share the same placenta

The purpose of this new RCOG guideline is to describe and, if possible, quantify the problems associated with monochorionic placentation and to identify the best evidence to guide clinical care, including routine fetal surveillance and treatment of complications at secondary and tertiary levels.

Code of Practice: provision of information for postgraduate medical training

NHS Employers, the British Medical Association (BMA) and Health Education England (HEE) have been working together on a programme of work aimed to improve the experience of doctors and dentists in training.

As part of this joint work, the Code of practice: provision of information for postgraduate medical training, which sets out the information employers should provide to doctors and dentists in training during the recruitment process, has been updated.

Updated CVI form and explanatory notes: Consultation

The Department of Health has today  the consultation to the revised Certificate of Vision Impairment form and the Explanatory Notes for Consultant Ophthalmologists and Hospital Eye Clinic Staff in England. They have been revised to clarify who should be certified severely sight impaired and sight impaired.

This consultation seeks views on the revised CVI form and explanatory notes and suggestions on how they can be improved further.

This consultation will close on 3rd January 2017.

Study looks at nursing assistants' effect on patient outcomes

This latest research into 243 hospitals across Europe found those with more professional nurses, compared to nursing assistants, had lower death rates after surgery and were rated more highly by nurses and patients.

However, analysis of the data is complicated by differences from country to country and interpreting it is more complex than media headlines suggest. It is unclear whether training for nursing assistants was equivalent in all countries studied. In England, the Department of Health plans to introduce "nursing associates", who would have 18 months' training and work alongside professional nurses and existing, less well-trained health care assistants.

Additionally, the study does not prove that more qualified nurses are the reason for the differences in death rates and quality of care. The research is based on one "snapshot" of what was happening in hospitals at one point in time (2009 to 2010). Other factors, such as local doctor staffing levels, may also have an effect on outcomes.

Choice in the Presence of Experts: The Role of General Practitioners in Patients' Hospital Care

This paper from the Institute for Fiscal Studies (IFS) presents an analysis of patients' hospital choice for elective medical procedures when their choice set is pre-selected by a GP. The study found that patients defer to GPs when assessing hospital quality and tangible attributes such as hospital ameneties and that GPs, in turn, as patients' agents present choice options based on quality, but as agents of health authorities also consider their financial implications.