Improving access to psychological therapy services

NHS Improvement and NHS England have published Developing an outcomes-based payment approach for IAPT services (pdf). This guidance supports providers and commissioners to develop and implement an outcomes-based payment approach for improving access to psychological therapy services. For 2017/19, NHS Improvement has changed the local pricing rules to require commissioners and providers of IAPT services to adopt an outcomes-based payment approach from April 2018.

NHS England launches new measures to help GPs and patients access the care they need

A world-first nationally funded service to support GPs and GP trainees suffering mental ill-health and addiction goes live next week while 11 areas have been chosen to pilot new ways of retaining GPs who are considering leaving the profession so their skills can continue benefitting patients.

From Monday January 30, the NHS GP Health Service will provide confidential mental health support for GPs and GP trainees suffering from mental ill-health and addiction.

How psoriasis affects your mental health

For those living with chronic skin conditions, such as psoriasis, the impact is more than skin deep. A breakout of pimples here, blackheads there – we're all prone to some sort of skin complaint which leaves us feeling lousy, but for those living with chronic skin conditions, such as psoriasis, "feeling lousy" just doesn't cut it. This article explores how this may impact on mental health.

Falls in older people

Nice's Falls in Older People quality standard has been updated.

Transformational change through system leadership (TCSL)

The TCSL programme is for senior teams from health and care systems who are actively engaged in delivering system-wide transformational change. It offers the opportunity to build personal and team capabilities in transformational change whilst putting theory into practice.

Developing People - Improving Care

A webinar and online discussion about Developing People - Improving Care: the national framework for improvement and leadership development in NHS-funded services.

Eye surgery to remove the lens shows promise for treating early glaucoma

Lens extraction, a procedure usually used to remove cataracts, could be a better first choice for some people with one type of glaucoma than laser treatment.


From the NIHR Dissemination Centre

Following programmes to improve recovery after surgery linked to shorter hospital stays

Reduced compliance with enhanced recovery protocols was associated with more days in hospital after keyhole bowel surgery, an increased likelihood of readmission and complications. Enhanced recovery, also known as fast track access, is considered standard practice but there is considerable variation in what this means and how this is implemented locally.

From the NIHR Dissemination Centre

RCS responds to CCGs' plans to ration hip and knee surgery using Oxford score

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest CCGs are planning to decrease the eligibility threshold for patients requiring hip and knee replacements. The CCGs are using a scoring system, the Oxford score, designed to assess patients’ illness to reduce hip operations by 12 per cent and knee replacements by 19 per cent. They suggest the restriction could lead to 353 fewer surgeries and savings of up to £2.1m a year.

Registration update for vanguards and other new care models

The Care Quality Commission has published a registration update for vanguards and other new care models,

Reducing sepsis and saving lives

NHS Improvement spoke to Joan Pons Laplana, Transformation Nurse at James Paget University Hospitals NHS Foundation Trust, to find out how he has helped to reduce the incidents of death caused by sepsis at the trust by putting some simple and low-cost new measures in place.

Mental health conditions packs

NHS England - 
These packs contain data across a range of mental health and dementia services.  The packs are split into stages along a mental health pathway and enable local health economies to compare their performance with their ten most similar CCGs. Each stage also includes a combination of case studies, tools and guidance from around the country, helping to disseminate best practice to support CCGs wishing to introduce new and improved ways of working.

• Data packs

Improving access to social care for adults with autism

This guide helps people in the health and social care sector who work with adults with autism to increase their awareness, knowledge and understanding. Autism is a lifelong developmental disorder, referred to as a ‘spectrum condition’ since some people with autism have profound difficulties and require specialist support, while others live largely independent lives

LSD Helps Explain How Brain Makes Meaning

Emerging research with the psychedelic drug LSD has led to breakthroughs on our understanding of how the brain assigns meaning to particular experiences.

We all have unique remembrances of particular things — a favorite song, for example — that mean much more to us than others.

Now, investigators who have studied how perceptions of meaning change when people take the psychedelic drug known as LSD have traced that sense of meaningfulness to particular neurochemicals and receptors in the brain.

Delaying Pot Smoking Better for Teens’ Brains

The more teenagers delay smoking marijuana until they’re older, the better it is for their brains, according to new research.

The Université de Montréal study also suggests there may be little ill effect if they start after age 17.

Teens who smoke pot as early as 14 do worse by age 20 on some cognitive tests and drop out of school at a higher rate than non-smokers, according to the study, published in Development and Psychopathology, a Cambridge University Press journal.

The Health Foundation has selected eight projects for its new Evidence into Practice programme

The Evidence into Practice programme will enable the selected research teams to use their innovative and creative ideas and translate their findings from completed studies in improvement research, or more broadly in health services research, into actionable practical tools for practitioners in health services or health policy.

Each research team will receive £50,000 for the development of tools and resources to support the implementation of findings into practice. Each project will be funded for 15 months.

The eight projects are:

1. A short animated film and other visual resources to support recognition and response to eating disorders in the perinatal period
Organisation: King’s College London, Institute of Psychiatry, Psychology and Neuroscience

2. A hand-drawn animation exploring accelerating systems thinking in health care incident investigation
Loughborough University

3. On-line tools for GPs to help support new migrants in primary care
University of Sheffield

4. Online resource pack with infographics, videos and downloadable materials on REasonable adjustments to MAINstream diabetes and obesity care for adults with a learning disability (REMAIN)
Leeds Institute of Health Sciences, University of Leeds

5. Online platform dedicated to innovation in breathlessness management (E-Breathe)
King’s College London. Cicely Saunders Institute,

​6. A year in an hour: Quality Improvement through Interactive Simulations (QIIS)
Chelsea and Westminster Hospital

​7. Short videos outlining key messages for better tracheostomy care
University Hospital South Manchester

​8. In Control: a 40 minute theatre piece and workshop to challenge, empower and provoke conversations amongst adolescents with asthma and their peers
Barts and The London School of Medicine and Dentistry, Queen Mary, University of London

CEU Clinical Guidance: Contraception After Pregnancy

Contraception After Pregnancy aims to guide healthcare professionals to inform and support the women in their care to make planned choices about future pregnancies and improve maternal and child outcomes through optimum spacing between children.

Updated NHS Identity guidelines

The NHS Identity guidelines, which set out how to use the NHS brand on websites, in publications and elsewhere have been updated.

Building on the industrial strategy: Briefing for the NHS

The government published its long-awaited industrial strategy green paper on 23 January 2017. The forthcoming departure from the EU has given the industrial strategy added importance, with the 2016 referendum vote highlighting regional disparities in economic prosperity.

This briefing from the NHS Confederation focuses on the implications and opportunities for NHS organisations arising from the industrial strategy.

A new data-driven model for post-transplant antibody dynamics in high risk kidney transplantation

Mathematical biosciences, 284 pp. 3-11. http://dx.doi.org/10.1016/j.mbs.2016.04.008

The dynamics of donor specific human leukocyte antigen antibodies during early stage after kidney transplantation are of great clinical interest as these antibodies are considered to be associated with short and long term clinical outcomes. The limited number of antibody time series and their diverse patterns have made the task of modelling difficult. Focusing on one typical post-transplant dynamic pattern with rapid falls and stable settling levels, a novel data-driven model has been developed for the first time. A variational Bayesian inference method has been applied to select the best model and learn its parameters for 39 time series from two groups of graft recipients, i.e. patients with and without acute antibody-mediated rejection (AMR) episodes. Linear and nonlinear dynamic models of different order were attempted to fit the time series, and the third order linear model provided the best description of the common features in both groups. Both deterministic and stochastic parameters are found to be significantly different in the AMR and no-AMR groups showing that the time series in the AMR group have significantly higher frequency of oscillations and faster dissipation rates. This research may potentially lead to better understanding of the immunological mechanisms involved in kidney transplantation.

UHCW Research: Krishnan, Nithya and Higgins, Robert

Multi-Resolution Cell Orientation Congruence Descriptors for Epithelium Segmentation in Endometrial Histology Images

Medical Image Analysis. Available online 22 January 2017

It has been recently shown that recurrent miscarriage can be caused by abnormally high ratio of number of uterine natural killer (UNK) cells to the number of stromal cells in human female uterus lining. Due to high workload, the counting of UNK and stromal cells needs to be automated using computer algorithms. However, stromal cells are very similar in appearance to epithelial cells which must be excluded in the counting process. To exclude the epithelial cells from the counting process it is necessary to identify epithelial regions. There are two types of epithelial layers that can be encountered in the endometrium: luminal epithelium and glandular epithelium. To the best of our knowledge, there is no existing method that addresses the segmentation of both types of epithelium simultaneously in endometrial histology images. In this paper, we propose a multi-resolution Cell Orientation Congruence (COCo) descriptor which exploits the fact that neighbouring epithelial cells exhibit similarity in terms of their orientations. Our experimental results show that the proposed descriptors yield accurate results in simultaneously segmenting both luminal and glandular epithelium.

UHCW Research: Nasir M. Rajpoot

An altered endometrial CD8 tissue resident memory T cell population in recurrent miscarriage

Scientific Reports 7, Article number: 41335 (2017) doi:10.1038/srep41335

When trying to conceive 1% of couples have recurrent miscarriages, defined as three or more consecutive pregnancy losses. This is not accounted for by the known incidence of chromosomal aneuploidy in miscarriage, and it has been suggested that there is an immunological aetiology. The endometrial mucosa is populated by a variety of immune cells which in addition to providing host pathogen immunity must facilitate pregnancy. Here we characterise the endometrial CD8-T cell population during the embryonic window of implantation and find that the majority of cells are tissue resident memory T cells with high levels of CD69 and CD103 expression, proteins that prevent cells egress. We demonstrate that unexplained recurrent miscarriage is associated with significantly decreased expression of the T-cell co-receptor CD8 and tissue residency marker CD69. These cells differ from those found in control women, with less expression of CD127 indicating a lack of homeostatic cell control through IL-7 signalling. Nevertheless this population is resident in the endometrium of women who have RM, more than three months after the last miscarriage, indicating that the memory CD8-T cell population is altered in RM patients. This is the first evidence of a differing pre-pregnancy phenotype in endometrial immune cells in RM.

UHCW Research:, J. Brosens and S. Quenby

Are people experiencing problems accessing social care support?

Concerns raised by the public indicate services need better information to ensure timely support to those in need.

Social care has become one of the top issues that people tell their local Healthwatch about. We hear positive stories from people who are have been given vital help to regain or maintain their independence. However, local Healthwatch have also been told about the difficulty some people experience in accessing support in the first place.

Anxiety and depression linked to increased cancer death risk

"Depression linked to higher chance of dying from cancer," The Independent reports. Analysis of English and Scottish data found a link between mental distress and cancer mortality, which remained even after other factors such as smoking were taken into account.

However, you definitely should not assume this means lots of people with mental health problems will get cancer, or that mental distress causes cancer.

Read more about the science behind the headlines.

Fat shaming linked to greater health risks

Body shaming is a pervasive form of prejudice, found in cyber bullying, critiques of celebrities’ appearances, at work and school, and in public places for everyday Americans. People who are battling obesity face being stereotyped as lazy, incompetent, unattractive, lacking willpower, and to blame for their excess weight. The pain of these messages may take a toll on health and increase risk of cardiovascular and metabolic disease, according to a new study.

How the DoLS can give voice to people with minimal consciousness

Advocate Jakki Cowley reflects on three cases highlighting the value of the Deprivation of Liberty Safeguards for people with little consciousness

Service Pressures in Emergency Care

The AAGBI is aware that at present there are increasing, and at times unprecedented, demands for emergency care at acute hospitals.

AAGBI members have been requested to assist in areas outside their normal practice. In addition to a joint statement from the RCoA and AAGBI on the impact of such requests on trainees has been published recently, the AAGBI offers the following advice for consultants and other non-trainee members.

Giardia: guidance and data

Giardia is a parasite which can grow in the intestines of infected humans or animals and cause giardiasis. Diarrhoea is the most common symptom of giardiasis. Other symptoms include abdominal cramps, bloating and flatulence.

Mycobacterial infections associated with heater cooler units

Guidance and investigation updates from Public Health England concerning the risk of mycobacterial infections associated with heater cooler units used in cardiothoracic surgery.

Tuberculosis (TB) and other mycobacterial diseases: diagnosis, screening, management and data

Update from Public Health England on Tuberculosis (TB) diagnosis, screening, epidemiology and strategy.

International Guidelines for Management of Sepsis and Septic Shock

Revised guidelines on the management of sepis and septic shock by the Surviving Sepsis Campaign (SSC), Society of Critical Care Medicine (SCCM), and European Society of Intensive Care Medicine (ESICM)

Revised Guidance on health and character released

The Health and Care Professions Council (HCPC) has published revised guidance on health and character.

This revision includes several updates including the removal of any reference to ‘character reference’, updated terminology around the requirements on the declaration of cautions and convictions, and updates to legislative and legal language in general.

Outcome-focused Integrated Care: lessons from experience

This paper published by Oxford Brookes University's Institute of Public Care, captures some of the learning and experience from work on developing integrated practice. It aims to offer guidance to those embarking on a significant period of change on what they may need to consider.

Treat As One: Bridging The Gap Between Mental And Physical Healthcare In General Hospitals

This new NCEPOD report expresses concerns about a failure by general hospitals to integrate physical and mental healthcare services.

State of Child Health Report 2017

This report from the Royal College of Paediatrics and Child Health brings together data on a comprehensive list of 25 measures of the health of UK children, ranging from specific conditions such as asthma, diabetes and epilepsy, risk factors for poor health such as obesity and a low rate of breastfeeding, to child deaths.

Staying put: developing dementia-friendly care and support for people with a learning disability

Voluntary Organisations Disability Group 
 
This report, written by a partnership of voluntary sector organisations, calls for the needs of people with learning disabilities and dementia to be better addressed. It focuses on how best to support the growing numbers of people with the condition. It is based on recent work with care providers aiming to improve the quality of life of people with a learning disability and dementia, and the challenges to this goal.

• Report
• Voluntary Organisations Disability Group - press release

Treat as one: bridging the gap between mental and physical healthcare in general hospitals

National Confidential Enquiry into Patient Outcome and Death 

This report expresses concerns about a failure by general hospitals to integrate physical and mental healthcare services. It concludes that this is leading to poor care for patients with a physical illness who also happen to have a mental health condition.

• Report
• Summary report
• National Confidential Enquiry into Patient Outcome and Death - press release

An evidence review of the outcomes that can be expected of drug misuse treatment in England

Public Health England 

This review gives policy makers and local areas an objective assessment of what drug treatment outcomes are achievable, and compares outcomes in England to the evidence and to other drug treatment systems. It reviews the impact of housing problems, unemployment and social deprivation on treatment engagement and outcomes. The review also considers how drug treatment will need to be configured to meet future need and recommends an appropriate set of measures or indicator for treatment evaluation.

• Report
• Public Health England - publications

New rules on when mental health trusts should call police

Providers will be encouraged to sign up to a new agreement on when to use police interventions in mental health and learning disability settings.

The memorandum of understanding, published today, sets out what the police and healthcare professionals are expected to do and how to manage restraint and restrictive practices in mental health and learning disability inpatient units and places of safety.

The document sets out guidance that police should not be called to use restraint or restrictive measures in clinical interventions unless in exceptional circumstances. These include:

• healthcare professionals have been injured, compromising their ability to carry out restraint;
• there are not enough healthcare staff to carry out the restraint safely in a timely manner;
• an immediate risk to life or of serious harm;
• a risk of serious damage to property; or
• the patient is using an offensive weapon or has taken a hostage.

Brain Scan May Detect Antidepressant Response

New research suggests a brain scan can help predict which patients will respond positively to antidepressant therapy.

In the study, investigators at the University of Illinois at Chicago (UIC) and the University of Michigan performed functional magnetic resonance imaging (fMRI) scans on patients with major depressive disorder who were to begin antidepressant therapy.

Long-term oxygen therapy shows no benefit for moderate lung disease

Long-term oxygen therapy for 16 hours per day did not lengthen life or the time until hospital admission for people with stable chronic obstructive pulmonary disease (COPD) who experience a moderate drop in blood oxygen levels with exercise or at rest. Nor did it improve their quality of life, lung function or anxiety and depression scores.

From the NIHR Dissemination Centre

Daily aspirin reduces pre-eclampsia for ‘at-risk’ women

Starting daily low-dose aspirin before 16 weeks of pregnancy in women at risk reduces pre-eclampsia, severe pre-eclampsia and foetal growth restriction. Aspirin started after 16 weeks is less beneficial, giving smaller risk reduction for pre-eclampsia and no effect on other outcomes. Defining who is ‘at risk’ remains challenging.

From the NIHR Dissemination Centre

Cervical screening: laboratory testing for human papillomavirus

This document from Public Health England is for use in laboratories performing human papillomavirus (HPV) testing as part of the NHS Cervical Screening Programme

Mepolizumab for treating severe refractory eosinophilic asthma

New Technology Appraisal guidance on using mepolizumab (Nucala) for treating severe refractory eosinophilic asthma in adults.

Sofosbuvir–velpatasvir for treating chronic hepatitis C

New Technology Appraisal guidance from NICE on using sofosbuvir–velpatasvir (Epclusa) for treating chronic hepatitis C in adults.

Antimicrobial stewardship: changing risk-related behaviours in the general population

New NICE guidance on making people aware of how to correctly use antimicrobial medicines (including antibiotics) and the dangers associated with their overuse and misuse. It also includes measures to prevent and control infection that can stop people needing antimicrobials or spreading infection to others. It aims to change people’s behaviour to reduce antimicrobial resistance and the spread of resistant microbes.

Cerebral palsy in under 25s: assessment and management

New NICE guidance on diagnosing, assessing and managing cerebral palsy in children and young people from birth up to their 25th birthday. It aims to make sure they get the care and treatment they need for the developmental and clinical comorbidities associated with cerebral palsy, so that they can be as active and independent as possible.

Ibrutinib for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation

New Technology Appraisal Guidance from NICE on ibrutinib (Imbruvica) for treating chronic lymphocytic leukaemia in adults.

Staying Put: Developing Dementia-Friendly Care and Support for People with a Learning Disability

This paper from the Voluntary Organisations Disability Group explores how best to develop support, services and treatments for the growing number of people with a learning disability and dementia.

Falls And Fracture Consensus Statement: Supporting Commissioning For Prevention

This guidance was produced by the National Falls Prevention Coordination Group (NFPCG).  The guidance is aimed at local commissioning and strategic leads in England with a remit for falls, bone health and healthy ageing.

Latest NHS sickness absence figures - September 2016

The latest figures released by NHS Digital show that NHS staff sickness absence has decreased from 4% in September 2015 to 3.99% in September 2016.

NMC agrees to regulate new nursing associate role

The Nursing and Midwifery Council (NMC) has formally agreed to a request from the Department of Health to be the regulator for the new nursing associate role.

Saving Babies’ Lives: A care bundle for reducing stillbirth

NHS England’s National Clinical Director for the Maternity Review and Women’s Health evaluates the Saving Babies’ Lives Care Bundle for reducing stillbirths.

Clinical Excellence Awards 2017

The Advisory Committee on Clinical Excellence Awards has announced the Clinical Excellence Awards 2017 will be open for application on 28 February 2017 and will close on Tuesday 25 April 2017.

The ACCEA website is yet to be updated for the 2017 round so please keep checking, however there is to be no change on the forms used for 2016 so you can start to prepare now.

New Confidentiality guidance published by the GMC

The General Medical Council (GMC) has published revised, expanded and reorganised guidance on confidentiality for all doctors practising in the UK. The guidance – Confidentiality: good practice in handling patient information – comes into effect from Tuesday 25 April 2017.

Mindfulness meditation training lowers biomarkers of stress response in anxiety disorder

Mindfulness meditation is an increasingly popular treatment for anxiety, but testing its effectiveness in a convincing way has been difficult. Now a rigorously designed, NIH-sponsored clinical trial led by a Georgetown University Medical Center researcher has found objective physiological evidence that mindfulness meditation combats anxiety.

Area of brain linked to bipolar disorder pinpointed

A volume decrease in specific parts of the brain's hippocampus -- long identified as a hub of mood and memory processing -- was linked to bipolar disorder in a study led by researchers at The University of Texas Health Science Center at Houston (UTHealth). The research was published today in Molecular Psychiatry, part of the Nature Publishing Group.

Karen Lumley mental health summit forges path for Redditch sufferers

A MENTAL health summit set to be hosted by Redditch MP Karen Lumley went ahead last Friday (January 20), despite Mrs Lumley being too ill to attend.

The meeting, at Grosvenor House in Redditch, came as a result of concerns for mental health provision in Worcestershire and involved representatives from a number of local stakeholders including NHS England, Redditch & Bromsgrove Clinical Commissioning Group, Worcestershire Health and Care NHS Trust, Redditch Borough Council, West Mercia Police and others.

Care home funding gap will result in divide between rich and poor areas

A shortfall in English council funding for care homes, which leaves providers reliant on private-paying residents, is creating a “postcode lottery” in care quality, the head of representative body Care England has said.

Data released today by researchers LaingBuisson suggests the average fee per resident paid to care homes by local authorities falls short of service provision costs by more than £100 a week.

Integrating health and social care across the UK: toolkit for nursing leaders

This integration toolkit is designed to be a personal support for senior nurses and RCN representatives working in strategic decision-making roles or forums around integrated care. 

It is intended to support you to provide confident nursing leadership as you shape, deliver and monitor safe, quality and local integrated services.

National Lung Cancer Audit report 2016

A new report from the Royal College of Physicians (RCP) shows a 7% increase in the number of people diagnosed with lung cancer surviving for longer than 1 year, compared with results from 2010.

In addition, the National Lung Cancer Audit report 2016 reveals that 60% of lung cancer patients received anti-cancer treatment such as chemotherapy, radiotherapy or surgery, meeting the target set out in the 2015 annual audit report.

‘Putting Patients First’ is the key aim for new hospital food report

The Patients Association has released an independent report that identifies in-patient food, drink and meal service preferences while in hospital. The report entitled ‘Putting Patients First’ provides a patient-centred insight into the experience of patient meals, which is supported by a series of recommendations for food service providers and hospitals to help ensure patients are getting what they want and need.

Delivering high value health care

The King’s Fund has published the presentations from a conference held on 10 January 2017 on Delivering high value health care.

• International evidence and experience on reducing wasteful spending on health care
• Tackling overuse and underuse of health care services
• Right Care
• Stories from the hospital setting: KT framework to minimise opportunity loss
• Improving safety and reducing harm and error
• Patient safety improvement
• Helping patients choose wisely
• Five Year Forward View: a new relationship with patients

Time to move: Get up, get dressed, keep moving

Older people, whether in hospitals, care homes or at their own homes, who do not get enough opportunity to mobilise, can have an increased risk of reduced bone mass and muscle strength, reduced mobility, increased dependence, confusion and demotivation. These problems can be attributed to the phenomenon of what can be termed as ‘Deconditioning Syndrome’

Preventing Deconditioning Syndrome requires a broader strategic approach that includes physical therapy, maintenance of nutrition, medical management, and psychological support including addressing loneliness; essentially addressing elements of the Comprehensive Geriatric Assessment.

Health matters: combating high blood pressure

This professional resource published by Public Health England outlines how providers and commissioners can reduce the population average blood pressure through improved prevention, detection and management.

Defining And Measuring Unmet Need To Guide Healthcare Funding: Identifying And Filling The Gaps

Budget allocations to CCGs include adjustments for meeting unmet health care needs and tackling health inequalities. This literature review from the Centre for Health Economics aims to identify and understand the available evidence regarding unmet health need. The study found that whilst there was evidence to support identifying unmet health need, there was a gap in the evidence on how budget allocations are best used to reduce unmet need.

A competency framework for nurses working in Parkinson’s disease management

This revised competency framework describes professional criteria in the form of competencies required by experienced nurses when caring for a person with Parkinson’sand atypical Parkinsonian syndromes.

Exploring new approaches to improve hand hygiene monitoring in healthcare

Infection, Disease & Health, Available online 18 January 2017

Hand-mediated transmission of micro-organisms is a major factor for the spread of healthcare associated infections. Ensuring that optimal hand hygiene (HH) practices are followed remains a challenge and monitoring remains a key activity in measuring healthcare professional's adherence to HH protocols. This paper describes the role that methods from engineering, specifically Morphological Analysis (MA), can play in developing and improving the efficacy of HH monitoring in healthcare.

UHCW Research: Carolyn Dawson

A Qualitative Exploration of the Lived Experiences of Patients Before and After Ileostomy Creation as a Result of Surgical Management for Crohn's Disease

Ostomy Wound Manage. 2017 Jan;63(1):34-39.
Patient experiences pre- and post-ileostomy creation as a result of severe Crohn's Disease are underresearched. A qualitative phenomenological design involving a purposeful sampling approach was used to capture the lived physical and psychosocial transition of patients with Crohn's Disease before and after ileostomy formation.

UHCW Research: A. Morris

Confirmation of traumatic cardiac arrest in children

New from BestBETs

In [paediatric patients in (traumatic) cardiac arrest], [palpation of pulses] OR [auscultation of heart sounds] or [ultrasound] (or combinations of these) most accurately [confirms cardiac arrest].

Palpation of pulses is the only universally available method for which evidence exists, but this is unreliable – ensuring that the operator has sufficient clinical experience is essential. POCUS may increase diagnostic accuracy when available. Further work is needed in this area to be able to determine the optimal method or combination of methods for assessing cardiac arrest. In clinical settings, these methods are likely to be combined with other elements including clinical examination and physiological measurements in order to decide whether a cardiac arrest protocol should be initiated.

Markers of futility of resuscitation for paediatric patients following a traumatic cardiac arrest:: a literature review to inform the PERUKI (PTCA) consensus study

New from BestBETs

In [paediatric patients (<18years)] with a [traumatic cardiac arrest] what are the [markers of futility for starting and terminating the resuscitation?]

Prolonged resuscitation beyond 15 minutes, fixed pupils, asystole and an absent pulse are all associated with a very poor outcome in terms of survival and neurological outcome in survivors. Despite this however, there are case reports of small numbers of children having a good outcome despite prolonged resuscitation.

Peripheral Metaraminol Infusion in the Emergency Department

New from BestBETs

In [adult patients presenting to the Emergency Department with sepsis resulting in persistent hypotension not responding to fluid replacement] is a [peripheral metaraminol infusion as effective as central noradrenaline infusion] for [maintaining a blood pressure capable of effective organ perfusion]

There is currently insufficient evidence to support the use of peripheral metaraminol as vasopressor support in the emergency department. A randomised multi-centre controlled trial should be performed with adult patients to establish definitively whether the use of a peripheral metaraminol infusion is safe and feasible as vasopressor support in patients who attend the emergency department with persistent hypotension secondary to sepsis unresponsive to adequate fluid resuscitation.

Can the value of end tidal CO2 prognosticate ROSC in patients coming into ED with an out of hospital cardiac arrest (OOHCA)?

New from BestBETs

A 60-year old gentleman is brought into the Emergency Department with an OOHCA. All monitoring is attached whilst ALS protocol is ongoing, including CO2 monitoring. You want to assess whether the patient is going to survive and thereby achieve a return of spontaneous circulation (ROSC) and you wonder whether the patient’s ETCO2 level can prognosticate this.

Current literature suggests that: 1) Our current ETCO2 aim of 10-20mmHg may be inadequate and should be modified to 25mmHg. 2) A 3-5 minute ETCO2 level of ≤10mmHg is associated with bad prognosis and as such, it may be beneficial to consider stopping patient resuscitation should this be the clinical case. 3) It is important to see the trend of ETCO2 rather than making a decision solely on one specific value, as sometimes an abrupt increase in ETCO2 could be a sign of impending ROSC. 4) More robust prospective data on the optimal ETCO2 value that is associated with ROSC would be helpful in defining a more accurate future target for intervention.

Trendelenburg Position helps to cardiovert patients in SVT back to sinus rhythm

New from BestBETs

In [adult patients with supraventricular tachycardia] does [putting them in trendelenburg position] help [in cardioverting to sinus rhythm]?


Using the modified valsalva manoeuvre appears to increase the success rates of reverting patients in SVT back to sinus rhythm compared to the sitting/standing position.

Inhaler Standards and Competency Document

Using an inhaler is the most common and effective way to take respiratory medications and remains the cornerstone for treating airways diseases such as asthma and COPD.

Concerned that people are still unable to use their devices and that many health care professionals are unable to assist people effectively in optimising their technique, The UK Inhaler Group (UKIG) has developed standards and competencies for those prescribing inhaled medications. The standards set out how healthcare professionals can work with patients to optimise their technique and maximise the benefit of their medication.

Expressions of interest to support partnership working

NHS England is inviting expressions of interest from local health and care economies to receive in-depth, facilitated development work in order to foster local partnership working across CCGs, local authorities, and health and social care providers.

The offer will be provided by Capita with STO Healthcare who have been researching care sector forums across the country and identifying good practice. Using forum structures already in place, the support will aim to build enduring relationships between partners so that local systems are more sustainable, resilient and effective. The deadline for expressions of interest is 25 January 2017.

Sexually transmitted infections (STIs): managing outbreaks

Guidance on How to investigate and manage STI outbreaks, published by Public Health England,

FGM: mandatory reporting in healthcare

Resources published by the Department of Health explaining healthcare professionals' duty to report cases of female genital mutilation (FGM) in girls under 18.

From good to great: what the Five Year Forward View must do next

The mental health strategy in the Five Year Forward View is promising but needs to go further to be of most help to service users.

It is welcome news that the government has a mental health implementation plan for the Five Year Forward View.

Giving mental health its own stage with a specific five-year plan, set of targets and dashboard of metrics, is not only very promising but necessary. If achieved, increasing access to mental health interventions will be a major step forward in the way we care for the nation’s mental health and emotional wellbeing.

Novel underlying mechanism involved in PTSD and other anxiety disorders described

A novel mechanism has been identified for how stress-induced anxiety -- which can produce post-traumatic stress disorder, or PTSD -- affects circuit function in the hippocampus, the area of the brain where aversive memories are formed. These studies fill an important gap in knowledge between the molecular, circuit and behavioral effects of the brain-signaling molecule called neuropeptide Y, and could lead to new therapeutic targets for patients with anxiety disorders.

Read more HERE.

Social care sector is letting down older people with HIV, finds report

Research by the Terrence Higgins Trust into the care needs of older people with HIV has highlighted a “real need” for better training of social care staff, the chair of the National Care Association has said.

The charity’s Uncharted Territory report examined the experiences of more than 300 over 50s living with HIV and concluded that the social care sector is not currently meeting their needs.

It found that social care professionals are not routinely trained on HIV as part of basic inductions or required to remain up-to-date with HIV through their professional development.

Thousands of patients could be forced into care homes due to CCG cuts

Thousands of patients could be forced into residential care as a result of clinical commissioning groups restricting funding for care at home, data shared with HSJ reveals.

Thirty-seven CCGs have set cost restrictions on NHS Continuing Healthcare funding, which pays for ongoing care for adults who are assessed as having a primary medical care need. It is arranged and funded solely by the NHS.

New bedside vision check tool to help prevent hospital inpatient falls

A new tool from the Royal College of Physicians (RCP), that enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital, is being made available to Trusts and Local Health Boards in England and Wales from Monday 23 January 2017.

‘Look out! Bedside vision check for falls prevention’ is an innovatively designed guide which aims to support busy clinical staff assess visual impairment in older people. It uses a mixture of questions and visual aids to help doctors, nurses and therapists check eyesight at the patient’s bedside. Results give an indication of the extent of any visual problems, known or unknown, that the patient may have.

Health and Care of People with Learning Disabilities Experimental Statistics, 2014-15

The report Health and Care of People with Learning Disabilities Experimental Statistics, 2014-15, published NHS Digital finds that people with learning disabilities have poorer health and shorter life expectancy than those without.

Guidance on safeguarding children and information protection

NHS England has clarified the relevant guidance on sharing child protection information in the NHS standard contract 2017/19.

Child Protection Information Sharing (CP-IS) is included in the NHS Standard Contract 2017/19 and this guidance offers support to the Designated Professional Safeguarding Children system leadership (see below).

“The Provider must co-operate fully and liaise appropriately with third party providers of social care services in relation to, and must itself take all reasonable steps towards, the implementation of the Child Protection Information Sharing Project.”(NHS Standard Contract, 2017/19, SC32.8 page 35)

Palliative care clinical data set: evaluation report

This Evaluation report presents the story of pilot work to collect data about outcomes achieved for individuals by specialist palliative care services. It contains the lessons learned within the project and makes recommendations for the future.

The Evaluation report should be useful to policy makers, commissioners and providers in particular, to inform and guide future activity and should be read alongside the Palliative care clinical data set, Palliative care clinical data set Guidance and definitions report.

See also Palliative care clinical data set Guidance and definitions.

OP103. Using formulation in general psychiatric care: good practice

This paper is concerned with the use of formulation by psychiatrists in the context of general psychiatric care. Formulation is essential to a biopsychosocial approach. It is recognised within the psychiatry curriculum as a core competence for all psychiatrists (Royal College of Psychiatrists, 2013).

Government response to Five Year Forward View for Mental Health

The Government has published its response to the recommendations outlined in the Five Year Forward View for Mental Health and has announced that it will accept all of them in full.

The report focuses on the recommendations made to Government, which includes some for which responsibility is shared with NHS England and Arm’s Length Bodies. The recommendations and responses in brief are as follows:

Suicide prevention: interim report

This report presents interim findings from an inquiry that will go on to inform the updated suicide prevention strategy. It argues that the government should prioritise a clear implementation strategy and increase support for public mental health and early intervention services if it is to bring down the suicide rate. Ahead of the final report, the interim report highlights areas for action: a clear implementation strategy; improving services for those who are vulnerable to suicide; developing a consensus statement on sharing information with families; the need for more timely and consistent data to help prevent suicides; and greater adherence to media guidelines for reporting of suicides.

British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of actinic keratosis (AK). The document aims (i) to offer an appraisal of all relevant literature up to February 2016, focusing on any key developments; (ii) to address important, practical clinical questions relating to the primary guideline objective, including accurate diagnosis and suitable treatment; (iii) to provide guideline recommendations and, where appropriate, some health economic implications; and (iv) to discuss potential developments and future directions.

MRI scans could spare 25% of men from prostate biopsies

"Every man with suspected prostate cancer should have an MRI scan," The Guardian reports. That is the conclusion of a study looking at how well MRI scans compare with the current practice of biopsies; removing sections of prostate tissue for analysis.

Overall, this study provides good evidence that using an MP-MRI test before a biopsy can result in a much lower proportion of men undergoing unnecessary biopsy. The combination helps detect cancer and avoid unnecessary treatment.

However, the lower accuracy of predicting patients without the disease means that patients with a suspicious MP-MRI scan will still need a biopsy. That is because the current results suggest that in cases where the scan gives an "all-clear" there is around a 40% chance that this is actually an incorrect result.

See also Multi-parametric MRI scans prior to biopsyfor improving diagnosis of prostate cancer and the RCR's response to the study.

Inclusive Leadership in the NHS

In this podcast, the first episode in a series of two, NHS Employers explores the theoretical side of inclusive leadership with leading experts Dan Robertson, Joan Saddler and Michelle Tuckey.

Find out about the benefits of a diverse and inclusive workplace for both staff and patients, how values based leadership is key to developing a more diverse workforce, and the importance of inclusive leadership in creating inclusive workplaces.

Integration of next-generation sequencing in clinical diagnostic molecular pathology laboratories for analysis of solid tumours; an expert opinion on behalf of IQN Path ASBL

Virchows Archiv January 2017, Volume 470, Issue 1, pp 5–20

The clinical demand for mutation detection within multiple genes from a single tumour sample requires molecular diagnostic laboratories to develop rapid, high-throughput, highly sensitive, accurate and parallel testing within tight budget constraints. To meet this demand, many laboratories employ next-generation sequencing (NGS) based on small amplicons. Building on existing publications and general guidance for the clinical use of NGS and learnings from germline testing, the following guidelines establish consensus standards for somatic diagnostic testing, specifically for identifying and reporting mutations in solid tumours. These guidelines cover the testing strategy, implementation of testing within clinical service, sample requirements, data analysis and reporting of results. In conjunction with appropriate staff training and international standards for laboratory testing, these consensus standards for the use of NGS in molecular pathology of solid tumours will assist laboratories in implementing NGS in clinical services.
UHCW Research: Ian Cree

National Chronic Kidney Disease Audit

This report details the findings of the audit programme, which compared GP practice performance against NICE quality standards

It asked: 

1. Are people with risk factors being tested for CKD? 
2. Are people with CKD being correctly identified and given an appropriate CKD Read code? 
3. For people with CKD: 

• Are blood pressure targets being met?
• Is appropriate CVD risk management being initiated?
• Are annual CKD reviews being performed?
• Are appropriate immunisations being given?

Summary
National Report (Part 1)
Infographics

UK hospital patient discharge: the patient perspective

Eur J Hosp Pharm doi:10.1136/ejhpharm-2016-001134

Hospital discharge is a complex process that can result in errors and delays for patients, particularly around the supply of medicines and communication of information. To improve patient discharge, patient perspectives of the discharge service must be explored to determine where patients feel problems arise. This study aimed to explore inpatient perceptions and experiences of the current discharge process.

This study showed that certain aspects of the discharge process need improving to provide safe, quality care for patients and improve patient experience of discharge. The findings from this study will inform the development of a new model of care for patient discharge from hospital.

Request this article from the library.

Physio makes respiratory MISSION possible

Called MISSION abc (which stands for modern innovative solutions improving outcomes in asthma, breathlessness and chronic obstructive pulmonary disease), the project has won two Healthcare News Journal awards, a patient safety award, and received local recognition.

Instead of waiting for at-risk patients to present at A&E or require unplanned care, the project identifies patients who are likely to benefit from a respiratory assessment via GP registers.

Stop smoking services may boost mental health of people with depression

Smokers with depression who successfully quit smoking using stop smoking services may see an improvement in their mental health, according to new research (link is external),* funded by Cancer Research UK and published in Annals of Behavioural Medicine.

Delegated commissioning case studies

Case studies on delegated commissioning published my NHS England.

Designing a High-Performing Health Care System for Patients with Complex Needs

Ten Recommendations for Policymakers from The Commonwealth Fund International Experts Working Group on Patients with Complex Needs

Teenagers who access mental health services see significant improvements

Young people with mental health problems who have contact with mental health services are significantly less likely to suffer from clinical depression later in their adolescence than those with equivalent difficulties who do not receive treatment, according to new research.

Redesigning a Memory Service the Devon way

NHS England’s National Clinical Director for Dementia and a Devon-based consultant psychiatrist review impressive changes to dementia diagnosis and care in the West Country:

The diagnosis of dementia can be complex and time consuming.

It involves detailed clinical assessment of cognitive, mental and physical health, blood and radiological investigations and carer interviews.

While memory clinics bring together this high level of expertise, they require sufficient capacity for timely access and integration with other services.

Transforming patient-level costing in the NHS

NHS Improvement is due to publish the next version of the Healthcare Costing Standards and Cost Collection Guidance at the end of January. To support the publication we are running two webinars.

• Improving costing: the new Healthcare Costing Standards for England, Thursday 2 February 2017, 12:30pm – acute standardsopens in a new window
• Improving costing: the new Healthcare Costing Standards for England, Thursday 2 February 2017, 2pm – ambulance and mental health standards

FOI National Reporting and Learning System (NRLS): Essure incidents

Incidents reported to NRLS and Strategic Executive Information System (StEIS) on use of Essure in hysteroscopic sterilisation 2009 – 2016.

Postoperative radiotherapy for breast cancer: UK consensus statements

Consensus statements form the Royal College of Radiologists covering:

• Cardiac sparing
• Breast boost radiotherapy after breast-conserving surgery
• Safe omission of radiotherapy after breast-conserving surgery
• Internal mammary chain radiotherapy
• Hypofraction
• Axillary management of sentinel lymph mode-positive disease
• Partial breast radiotherapy after breast-conserving surgery

Standards for providing a 24-hour interventional radiology service

Second edition of Standards for providing a 24-hour interventional radiology service, published by the Royal College of Radiologists.

Nine different drug classes reviewed for type 2 diabetes

Metformin worked best at keeping blood sugar levels under control and remains a good first choice as single therapy. Overall, the nine classes of blood sugar-lowering drugs had similar effect on risk of death from cardiovascular causes and overall mortality, though estimates are imprecise because so few people died in these studies. Risk of other side effects, such as weight gain or risk of low blood sugar did vary between treatments.

From the NIHR Dissemination Centre

Propranolol generally safe in treating childhood haemangioma birthmarks

Treating ‘infantile haemangioma’ strawberry birthmarks with oral propranolol is known to be effective and in this review was associated with low levels of adverse events. The most common adverse events included coldness in the hands and feet, diarrhoea, sleep disorders and upper respiratory infections.

From the NIHR Dissemination Centre

When the cows come home: occupational tinea barbae in a cattle farmer

British Journal of Oral and Maxillofacial Surgery. ePub ahead of Print 13/1/2017. http://dx.doi.org/10.1016/j.bjoms.2017.01.001

We recently treated a man with an unusual facial infection who had been admitted under the maxillofacial team. He was 29 years old, otherwise healthy, and presented with pyrexia and a severe, spreading, facial folliculitis, which had worsened over two weeks. He had initially been treated for suspected folliculitis with amoxicillin orally, but to no effect.

UHCW Research: S. Al-Ali , R. Elledge, A. Ilchyshyn and P. Stockton

Stain Deconvolution Using Statistical Analysis of Multi-Resolution Stain Colour Representation

PLoS ONE 12(1): e0169875. doi:10.1371/journal.pone.0169875

Stain colour estimation is a prominent factor of the analysis pipeline in most of histology image processing algorithms. Providing a reliable and efficient stain colour deconvolution approach is fundamental for robust algorithm. In this paper, we propose a novel method for stain colour deconvolution of histology images. This approach statistically analyses the multi-resolutional representation of the image to separate the independent observations out of the correlated ones. We then estimate the stain mixing matrix using filtered uncorrelated data. We conducted an extensive set of experiments to compare the proposed method to the recent state of the art methods and demonstrate the robustness of this approach using three different datasets of scanned slides, prepared in different labs using different scanners.

UHCW Research: David Snead

Ruptured Abdominal Aortic Aneurysm: The Definitive Manual

Book Chapter: Operative Strategies in Ruptured Abdominal Aortic Aneurysm pp 161-258.  eISBN: 978-3-319-23844-9.  ISBN 978-3-319-23843-2. DOI: 10.1007/978-3-319-23844-9_13

UHCW Research: Ruth A. Benson

What do people think of dementia services?

With cases of dementia on the rise, it's more important than ever that services give people the support they need. Read our briefing to find out what people have told local Healthwatch about their experiences of care.

Supporting carers: mental health carers’ assessments in policy and practice

Centre for Mental Health -
This briefing outlines the challenges that mental health carers face in accessing carers’ assessments. It looks at the legal context and how the assessments work in practice.

• Briefing
• Centre for Mental Health - publications

Eating disorders in middle-aged women 'common'

"Eating disorders…affect a small but substantial number of women in their 40s and 50s," BBC News reports. While often regarded as a "disease of the young", a new survey suggests 3.6% of middle-aged women in the UK are affected by an eating disorder.

This article explores the Evidence behind the headline. 

CBT Shown to Ease Psychotic Symptoms Over Years

Cognitive-behavioral therapy (CBT) has been shown to strengthen specific brain connections in people with psychosis. Now, researchers at King’s College London have found that these stronger connections are associated with a long-term reduction in symptoms and recovery even eight years later.

Mens’ Chronic Work Stress May Increase Risk of Some Cancers

New Canadian research suggests that for men, prolonged exposure to work-related stress is linked to an increased likelihood of particular types of cancer.

Researchers discovered perceptions of work-related stress over the course of a man’s career was associated with increased risk of lung, colon, rectal, and stomach cancer and non-Hodgkins lymphoma.

New Standards for Microbiology

Public Health England has published the following UK Standards for Microbiology Investigations:

• SMI Q 5: Inoculation of culture media for bacteriology
• SMI B 40: Investigation of specimens for Mycobacterium species

Competency Framework for Supervisors

The College of Optometrists has launched its first competency framework for those supervising trainees in the college’s registration scheme. The framework is designed to help embed GOC’s standards of practice, which were launched last year. 

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

Appl Nurs Res. 2017 Feb;33:24-29. doi: 10.1016/j.apnr.2016.10.005. Epub 2016 Oct 7.

Aim was 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.

UHCW Research: M. Radford

ImprovementX #1 Event

Event supported by NHS Improvement on 'Making improvement part of everyday business'.  It will be held 30 Jan-3 Feb in Greenwich, London.

Ekso exoskeleton for rehabilitation in people with neurological weakness or paralysis

NICE has developed a medtech innovation briefing (MIB) on the Ekso exoskeleton for rehabilitation in people with neurological weakness or paralysis.

CentriMag for heart failure

NICE has developed a medtech innovation briefing (MIB) on CentriMag for heart failure.

Boston Keratoprosthesis Type I for corneal blindness

NICE has developed a medtech innovation briefing (MIB) on Boston Keratoprosthesis Type I for corneal blindness.

One dose per day compared to multiple doses per day of gentamicin for treatment of suspected or proven sepsis in neonates

The objective of this study was to compare the efficacy and safety of one dose per day compared to multiple doses per day of gentamicin in suspected or proven sepsis in neonates.  There is insufficient evidence from the currently available RCTs to conclude whether a 'once a day' or a 'multiple doses a day' regimen of gentamicin is superior in treating proven neonatal sepsis. However, data suggest that pharmacokinetic properties of a 'once a day' gentamicin regimen are superior to a 'multiple doses a day' regimen in that it achieves higher peak levels while avoiding toxic trough levels. There was no change in nephrotoxicity or auditory toxicity. Based on the assessment of pharmacokinetics, a 'once a day regimen' may be superior in treating sepsis in neonates of more than 32 weeks' gestation.

Faulty by design: the state of public-service commissioning

The purpose of this paper from Reform is to evaluate the success of current approaches to commissioning. To do so, interviews with experts, from government, providers and third-parties, were conducted, alongside a literature review and evaluation of the publicly available data. The aim is to outline a case for change, for commissioners to learn from past actions when approaching commissioning in the future.

SMI V 37: Chlamydia trachomatis infection: testing by nucleic acid amplification tests (NAATs)

UK Standards for Microbiology Investigations V 37: Chlamydia trachomatis infection: testing by nucleic acid amplification tests (NAATs)

Support Overdue: Women’s experiences of maternity services

This report is based on the NCT's second survey of women’s experiences of their maternity care carried out with the WI. Women are generally positive about the maternity care they receive and many praised the kindness and professionalism of the staff who cared for them. However, some findings gave cause for concern.

Antimicrobial stewardship: prescribing antibiotics

New Key Therapeutic Topic from NICE:

This document summarises the evidence-base on antimicrobial stewardship: prescribing antibiotics (previously titled: antibiotic prescribing – especially broad spectrum antibiotics). The 2017 update includes key points from the previous key therapeutic topic 3-day courses of antibiotics for uncomplicated urinary tract infection. It is a key therapeutic topic which has been identified to support medicines optimisation. It is not formal NICE guidance.

Thromboprophylaxis at gynaecological surgery

Answer to the question What is the evidence for thromboprophylaxis in gynaecological surgeries and early pregnancy? posted to the RCOG query bank.

Ulipristal acetate, fibroids and pregnancy

Answer to the question Is there any evidence to support the use of ulipristal acetate in women with large fibroids with the aim of reducing the size of the fibroid prior to pregnancy? posted to the RCOG query bank.

Nuchal cord

Answer to the question Is there any relevance to detection of cord around neck on antenatal ultrasound? posted to the RCOG query bank.

Maternal position for vaginal breech delivery

Answer to the question With regard to vaginal delivery of breech baby, has the evidence changed with regard to positioning of the woman? Lithotomy was previously what was taught and is in RCOG guideline, however juniors seem to favour all fours position. posted to the RCOG query bank.

Fertility after ectopic pregnancy

Answer to the question Does salpingectomy for ectopic pregnancy reduce future fertility rate in a 30yr old woman with normal ovaries and normal contralateral tube? If so by how much? posted to the RCOG query bank.

Birth interval after caesarean

Answer to the question If a patient fell pregnant within 4 months of having a cesarean, does the short duration between pregnancies have a bearing on our counseling for VBAC versus Elective repeat CS in the second pregnancy? posted to the RCOG query bank.

Testosterone supplementation

Answer to Is low testosterone levels an indication for using testosterone supplementation in a premenopausal woman, who has both ovaries and uterus? posted to the RCOG query bank.

Standards for integrated reporting in cellular pathology

Standards for integrated reporting in cellular pathology from the Royal College of Pathologists.

Refractory extrapulmonary sarcoidosis: infliximab

New Evidence Summary from NICE

According to specialists involved in this evidence summary, infliximab may be an option for some patients with severe, refractory extrapulmonary sarcoidosis (particularly cutaneous or neurological sarcoidosis); for example, those affected by disabling or disfiguring disease, or whose life expectancy is likely to be reduced.

Whole brain radiotherapy provides little benefit for lung cancer that has spread

Radiotherapy to the whole brain makes little difference to people with the commonest type of lung cancer that has spread to the brain and cannot be operated on.
From the NIHR Dissemination Centre

General surgery is mostly safe during pregnancy

Routine data from English hospitals show that general surgery during pregnancy, such as removing the appendix or gallbladder, does not commonly harm mother or baby. This suggests that surgery in pregnant women is generally safe, but that mothers could be provided with more specific estimates of the risks.

From the NIHR Dissemination Centre

The nitric oxide breath test offers little benefit when monitoring asthma

Using exhaled nitric oxide levels to guide the dose of asthma medication at regular clinic visits may reduce flare-ups but does not improve overall symptoms or quality of life. In this review hospitalisations and the total inhaled steroid doses were unaffected by the intervention.

From the NIHR Dissemination Centre

Patient Safety Update - July - September 2016

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

Treatment strategy provides mental health benefits to war trauma survivors

A study shows that a certain intervention called testimony therapy plus ceremony reduced symptoms of posttraumatic stress disorder, anxiety, and depression among Khmer Rouge torture survivors from across Cambodia.

Depression as hard on the heart as obesity and cholesterol

Depression poses a risk for cardiovascular diseases in men that is just as great as that posed by high cholesterol levels and obesity. This is according to a report recently published in the Atherosclerosis journal by researchers from the Helmholtz Zentrum München, together with colleagues from the Technical University of Munich (TUM) and the German Center for Cardiovascular Disease (DZHK).

Most autism practice not supported by good evidence

Opportunities to improve the lives of autistic people are being lost because practice is insufficiently evidence-based, writes Yo Dunn.

Monthly performance statistics, November 2016

Performance statistics for November 2016 have been released by NHS England, covering the following:

• the NHS 111 service; 
• ambulance quality indicators; 
• A&E attendances and emergency admissions; 
• waiting times for diagnostic tests, referral to treatment for consultant-led elective care, cancer services; 
• delayed transfers of care; and 
• Early Intervention in Psychosis.  

See also the NHS Confderation's analysis.

POEMS Syndrome: a case report and review

Case Reports in Internal Medicine 2017, Vol. 4, No. 1

POEMS syndrome is a rare multi-system condition that arises from an underlying plasma cell disorder. We report a case of a 69-year-old lady who presented with symptoms of exertional breathlessness and leg swelling, and a recent history of peripheral neuropathy, borderline diabetes mellitus and monoclonal gammopathy of undetermined significance (MGUS). The development of worsening right heart failure, which remained refractory despite diuretic therapy, pulmonary hypertension, organomegaly, hypothyroidism, chronic kidney disease, right pleural effusion and ascites, did not lead to a definitive diagnosis until cutaneous abnormalities were recognised. A resumptive diagnosis of POEMS was subsequently confirmed with the finding of raised serum levels of VEGF and bone marrow histopathology. Our case highlights the complex nature of this multi-system syndrome, the potential for delayed diagnosis and the importance of an integrated sub-specialty approach to management.

UHCW Research: Toisa Nisar and David G. Parr

Female athlete experiences of seeking and receiving treatment for an eating disorder

Eating Disorders. (pp 1-5), 2017. Date of Publication: 06 Jan 2017.

Clinical eating disorders are common among athletes; however research has yet to explore the process of seeking and receiving treatment for an eating disorder in this population. Semi-structured interviews were conducted with 13 female athletes currently receiving treatment for an eating disorder. A total of three themes emerged: challenges to treatment seeking, feeling out of place, and coping with exercise transitions. Athletes reported low levels of eating disorder literacy and lacked

motivation to engage with therapy due to a lack of perceived relevance. Athletes found it challenging to relinquish exercise behaviours in treatment and expressed concerns around managing a return to sport. It may be necessary to provide additional support to athletes when embarking on and leaving treatment programs, particularly with regards to managing expectations about exercise. Copyright &#xa9; 2017 Taylor & Francis ISSN 1064-0266

UHCW Research: C. Meyer

Emergency Care is in crisis

The Royal College of Emergency Medicine has for a number of years urged the NHS to tackle the ever increasing problems facing emergency and urgent care.

Despite frequent and repeated warnings, the situation has steadily deteriorated and we now face the worst four hour performance in almost 15 years. Emergency care is in a state of crisis.

The figures bear this out. In the week leading up to Christmas there were 332,118 attendances in England alone, but an average of 87.6% of all beds were occupied – above the recommended safety limit. The number of patients experiencing delayed transfers of care has risen by 28% in the space of a year.

Our own Winter Flow data suggests that average four hour performance was around 77% with some Trusts struggling in the 50-60% range. Our expert view is that this type of performance leads to serious safety issues. Data so far also suggests a year on year drop in performance in the range of 4 to 11%.

Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER)

Requirements of IRMER 2000 with regard to exposures much greater than intended and diagnostic reference levels.

NHS terms and conditions for procuring goods and services

Terms and conditions for the NHS when procuring goods and services from commercial organisations.

Using Allied Health Professionals to transform health, care and wellbeing. 2016/17 - 2020/21

The AHPs into Action is a product for leaders and decision makers, to inform and inspire the system about how AHPs can be best utilised to support future health, care and wellbeing service delivery. It offers examples of innovative AHP practice and a framework to develop a plan of delivery

Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT

Pediatrics (PEDIATRICS), Sep2016; 138(3): 1-11. (11p)

Premature infants have a higher risk of invasive pneumococcal disease and are more likely to have lower vaccine responses compared with term infants. Increasingly, immunization schedules are including a reduced, 2-dose, pneumococcal conjugate vaccine priming schedule. Our goal was to assess the immunogenicity of 3 commonly used 13-valent pneumococcal conjugate vaccine (PCV13) priming schedules in premature infants and their response to a 12-month booster dose.

UHCW Research: P. Satodia

Quantification of Lung PET Images: Challenges and Opportunities

J Nucl Med. 2017 Jan 12. pii: jnumed.116.184796. doi: 10.2967/jnumed.116.184796. [Epub ahead of print]

This article reviews the data evaluating18F-FDG PET quantification approaches in lung diseases, focusing on methods to account for variations in lung components and the interpretation of the derived parameters.

UHCW Research: D. Parr

New Bite-Size Guides to Patient Insight

The following bite-size guides have been published by NHS England on patient insight:

• Bite-size guide to ‘how and when to commission new insight and feedback’
• Bite-size guide to ‘what’s already available’

Why Always Events matter

Always Events® are defined as ‘those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the health care delivery system’. 

A toolkit based on the learning from pilot sites has now been published. NHS England is now looking to spread Always Events® framework to additional sites and a series of calls and webinars will be available for interested organisations commencing in January.

Medicines optimisation in long-term pain

New key therapeutic topic from NICE on medicines optimisation in long-term pain.

Multimorbidity and polypharmacy

New NICE key therapeutic topic on mulitmorbidity and polypharmacy.

Safer insulin prescribing

New key therapeutic topic from NICE on safer insulin prescribing.

The 2nd Atlas of Variation in NHS Diagnostic Services in England

The 2017 diagnostics themed atlas has been published by Public Health England.  It covers imaging, screening, physiological diagnostics, and endocopy

Follow-up report to the March 2015 Patients Association publication on the Parliamentary and Health Service Ombudsman.

It is now two years since the Patients Association issued its initial report setting out the failings of the Parliamentary and Health Services Ombudsman (PHSO) in dealing with complaints raised bypatients and their relatives about their experience of NHS services (Patients Association: 2014).  Two years on from the first report we find ourselves in a similar position. Instead of a decrease in complaints, an increase is being observed, for example in June 2016 there were 68 separate cases of individuals raising concerns.

Taking revalidation forward: Improving the process of relicensing for doctors

Sir Keith Pearson’s review of medical revalidation.

National guardian publishes her ‘first 100 days’ report

Dr Henrietta Hughes, national guardian for speaking up freely and safely in the NHS has published a new report, which outlines the progress made since her appointment in October 2016.

Over the last 100 days, Dr Hughes has set up the national office and established a national network of Freedom to Speak Up guardians. Key points include:

• 201 NHS trusts now have an FTSU guardian in place
• twelve trusts are in the process of making an appointment of an FTSU guardian
• 21 trusts have yet to appoint to the role
• online resources and training available for guardians (including eight training sessions being led by the National Guardian's Office (NGO)
• guardians are encouraged to join regional networks to share progress and provide neighbouring support
• the NGO plans to issue good practice guidance.

NICE Technology Appraisals in the NHS in England, Innovation Scorecard - to June 2016

The Innovation Scorecard reports on the use of medicines and medical technologies in the NHS in England, which have been positively appraised by the National Institute for Health and Care Excellence (NICE).

NHS Digital has produced and published the Innovation Scorecard quarterly as an Official Statistic since January 2013 on behalf of the Office of Life Sciences. It can be used by local NHS organisations to monitor progress in implementing NICE Technology Appraisal (TA) recommendations.

Tuberculosis Quality standard [QS141]

This quality standard from NICE covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults.

Becoming an apprentice assessor organisation

The Skills Funding Agency has issued guidance for organisations who are interested in applying to the register of apprentice assessment organisations (RAAO).

The RAAO will list organisations who have shown that they are capable of delivering an independent end-point assessment against a particular apprenticeship standard. Only registered organisations will be eligible to carry out these assessments.

STPs: Community and primary care grow fastest as acute spend held down

Community and primary care would see the fastest increases in funding, at the expense of slow growth in mental health and general acute spending falling in real terms, under detailed STP forecasts analysed by HSJ.

Study Aims for Sweet Spot of Teens’ Screen Time

A new UK study may help to relieve digital anxiety among parents and pediatricians as researchers discovered the relationship between screen time and well-being is weak at best, even at high levels of digital engagement.

"Digital screens are now an inextricable part of modern childhood. Depending on who you ask they’re either part of creating a generation of so called ‘digital natives’ or a bogeyman who may dispose young people to all kinds of delinquencies,” said psychological scientist Dr. Andrew Przybylski of the University of Oxford, lead researcher on the study.

Psychotropic medicines in people with learning disabilities whose behaviour challenges

This document summarises the evidence-base on psychotropic medicines in people with learning disabilities whose behaviour challenges. It is a key therapeutic topic which has been identified to support medicines optimisation. It is not formal NICE guidance.

Managing risk in social care

Managing risk is one of the most important and complex areas of social work practice. When risk isn’t correctly handled and responded to, the consequences can be catastrophic. For team managers, being responsible for the risks your social workers are holding, and knowing how to support and challenge their practice, can be daunting.

NICE: Everyone with learning disabilities should have their mental health checked annually

Experts acknowledge that mental health problems may be more difficult to diagnose for people with learning disabilities. This is because it can be harder for the person to explain how they are feeling and what help they would like.

NICE is recommending that everyone with learning disabilities receive an annual health check, which includes a review of their mental health.

Specialist substance misuse services for young people

Public Health England (PHE) -
PHE commissioned The Children’s Society to undertake scoping research, to understand some of the opportunities and challenges currently facing those now responsible for commissioning and delivering young people’s specialist substance misuse services and to outline some critical good practice principles. Four main commissioning principles have been developed for the commissioning and provision of specialist substance misuse provision for young people, based on the findings, research and evidence based guidelines.

• PHE - publications

Stress may increase risk of heart disease and stroke

Heightened activity in the amygdala -- a region of the brain involved in stress -- is associated with a greater risk of heart disease and stroke, according to a study published in The Lancet that provides new insights into the possible mechanism by which stress can lead to cardiovascular disease in humans.

Class review of the GLP-1 receptor agonists for the treatment of type 2 diabetes

Class review of the GLP-1 receptor agonists for the treatment of type 2 diabetes from the Midlands Therapeutics Review and Advisory Committee.

Asthma: vitamin D has a beneficial effect on the risk of exacerbations

New Medicines Evidence Commentary from NICE:

A Cochrane review found that vitamin D supplementation had a beneficial effect on the risk of asthma exacerbations requiring treatment with systemic corticosteroids or those resulting in hospital admission or an emergency department visit. However, caution is needed when interpreting these findings and, in particular, when generalising them to people with recurrent severe asthma exacerbations or children. It is also unclear from the review how any potential beneficial effects relate to either baseline vitamin D levels or the dose of vitamin D given. Public Health England made general recommendations about vitamin D intake to protect bone and muscle health in July 2016. However, further research is required before any recommendations relating specifically to vitamin D intake for asthma can be made.

NICE approves kidney cancer drug for NHS use

Patients with advanced kidney cancer will have routine NHS access to the drug everolimus following recommendations by NICE, rather than apply to the Cancer Drugs Fund (CDF).

Sustainable Development Management Plan Guidance For Health And Social Care Organisations

This guidance from the Sustainable Development Unit has been brought up to date with the current NHS standard contract and aims to provide more detailed guidance as to which areas are more or less appropriate for large providers, small providers and CCGs. It is intended to support organisations to understand the key elements that make up a Sustainable Development Management Plan (SDMP). It also provides some advice on how you can develop your organisation’s SDMP.

Stain Deconvolution Using Statistical Analysis of Multi-Resolution Stain Colour Representation

PLoS One. 2017 Jan 11;12(1):e0169875. doi: 10.1371/journal.pone.0169875. eCollection 2017

Stain colour estimation is a prominent factor of the analysis pipeline in most of histology image processing algorithms. Providing a reliable and efficient stain colour deconvolution approach is fundamental for robust algorithm. In this paper, we propose a novel method for stain colour deconvolution of histology images. This approach statistically analyses the multi-resolutional representation of the image to separate the independent observations out of the correlated ones. We then estimate the stain mixing matrix using filtered uncorrelated data. We conducted an extensive set of experiments to compare the proposed method to the recent state of the art methods and demonstrate the robustness of this approach using three different datasets of scanned slides, prepared in different labs using different scanners.

UHCW Research: D. Snead

Latest review of new and emerging technologies in development for epilepsy

The NIHR Horizon Scanning Research and Intelligence Centre has published a new online report that describes over 100 exciting new technologies that being developed to improve the diagnosis, treatment and management of epilepsy in the future.

Patients benefit from space age rehab machines

Physiotherapy patients in Northern Ireland have benefited from two new anti-gravity treadmills after fundraisers raised almost £80,000 to pay for them.

Using technology designed by NASA to help astronauts exercise in space, the anti-gravity treadmills can be used by patients with weight-bearing difficulty, neurological, cardiovascular or other long-term conditions.