Keeping UHCW Current: February 2017

Tuesday, 28 February 2017

ARSAC Notes for Guidance: good clinical practice in nuclear medicine

Guidance from DH, PHE and ARSAC on certification and best use of radiopharmaceuticals and sealed radioactive sources in diagnosis, treatment or research.

Nearly one in four cardiac arrests in pregnancy are associated with complications of obstetric anaesthesia

Nearly one in four cardiac arrests in pregnancy are associated with complications of obstetric anaesthesia, according to a new study published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).

The aim of this study was to estimate the incidence of cardiac arrest in the UK obstetric population, describe how cardiac arrest in pregnancy is managed and report maternal and fetal outcomes.

Collaboration is key to the diabetes model of care

Dr Partha Kar, Associate National Clinical Director for Diabetes for NHS England, talks about the Portsmouth Super Six model of care, one of those which tried to answer the million dollar question: which bits of diabetes care need to be in hospitals?

Financial Sustainability Of The NHS

This report from the House of Commons Public Accounts Committee highlights concerns that the focus on action to restore financial stability is affecting patients’ access to services and their experience of care, and warns of the potentially damaging consequences of "repeated raids" on investment funds to meet day-to-day spending.

Molecular testing strategies for Lynch syndrome in people with colorectal cancer

Lynch Syndrome (LS) is the most common cause of hereditary bowel cancer and people with it also have an increased risk of developing other cancers including womb, ovarian and stomach.

This NICE guidance recommends that microsatellite instability (MSI) testing or immunohistochemistry (IHC) should be used to detect abnormalities that might mean the presence of Lynch Syndrome.

Monday, 27 February 2017

What Effect Does Prenatal and Postpartum Maternal Depression Have on Children?

The results of a large study do not support the notion that prenatal and postpartum maternal depression is particularly detrimental to children's psychological development. Instead, the most robust effects were found for maternal depression occurring during children's preschool years.

Extend GP mental health training to improve eating disorder care

The RCGP has refuted claims that GPs are not trained to treat patients with eating disorders, but called for extended training to allow a greater focus on mental healthcare.

Three out of 10 people with an eating disorder do not receive a referral from their GP to a mental health service for treatment, according to eating disorder charity Beat, which it said was despite NICE guidance advising immediate referral.

Drug misuse prevention: targeted interventions

National Institute for Health and Care Excellence (NICE)

This guideline highlights the role that local authorities can play in targeting people who use drugs or are at risk from doing so. It argues that local authorities can work together with gyms, nightclubs, festivals, sexual health services and supported accommodation for homeless people to make clear the support services and advice that are available.

Can community projects offer a way to affordable care?

With health and social care budgets feeling the squeeze, the need to find ways to care for people that are both affordable and effective is one of the country's biggest challenges.

Around the UK many attempts are being made to deliver care in different ways and here are three different approaches to community-based care.

How to achieve best practice in supported decision-making

There is a real connection between the Mental Capacity Act 2005 and the Care Act 2014 regarding supported decision-making. The shared duties and themes reinforce the absolute importance of working with all people from the presumption they have mental capacity to make their own decisions and are best placed to do so. Also of fundamental significance are the principles that all people must be provided with the information and support necessary to enable them to participate, and that any decisions affecting them must be built upon their wishes, feelings, beliefs and values to achieve the best outcome for them. Read more about supported decision-making HERE.

Development and implementation of non-medical practitioners in acute care

British journal of nursing. 25 (20) (pp 1129-1134), 2016. Date of Publication: 10 Nov 2016.

The purpose of this article is to discuss the evolving workforce required to deliver quality healthcare in NHS acute care settings within the UK. The development and implementation of non-medical practitioner (NMP) roles, such as advanced clinical practitioners, surgical care practitioners, surgical first assistants, physician associates and physician assistants in anaesthesia are discussed in relation to training, regulation, governance and evaluation in clinical practice.

UHCW Research: J Abraham

Case report of a successful pregnancy following spontaneous haemoperitoneum of pregnancy due to endometriosis

Poster presentation to Fertility 2017

To discuss the outcome of a subsequent pregnancy following the management of a rare life threatening obstetric emergency.

UHCW Research: Valarmathy Kandavel

P1 Risk-adjusted colorectal cancer screening using the FIT: development of a risk prediction model

Diagnostic and Prognostic Research February 2017, 1:7. Methods for Evaluating Medical Tests and Biomarkers, Birmingham, UK. 19–20 July 2016

The purpose of this study is to determine whether integrating routinely available predictors from the Bowel Cancer Screening System (BCSS) with the FIT result improves test performance.

UHCW Research: Steve Smith

Tears of colonoscopy

Gut. 2017 Feb 23. pii: gutjnl-2017-313846. doi: 10.1136/gutjnl-2017-313846. [Epub ahead of print]

UHCW Research: McFarlane M, Disney B and Eaden J.

Validation of an NGS mutation detection panel for melanoma

BMC Cancer. 2017 Feb 22;17(1):150. doi: 10.1186/s12885-017-3149-0.

Knowledge of the genotype of melanoma is important to guide patient management. Identification of mutations in BRAF and c-KIT lead directly to targeted treatment, but it is also helpful to know if there are driver oncogene mutations in NRAS, GNAQ or GNA11 as these patients may benefit from alternative strategies such as immunotherapy.

PCR methods are rapid, less time-consuming and less expensive than NGS, and could be used as triage for patients requiring more extensive diagnostic workup. The NGS panel described here is suitable for clinical use with formalin-fixed paraffin-embedded (FFPE) samples.

UHCW Research: A. Reiman, H Kikuchi, D Scocchia, P Smith, Y W Tsang, D Snead and I A Cree

This themed NIHR review brings together NIHR research on different aspects of health before, during and after pregnancy.

Health and social care integration

This report from the National Audit Office warns that progress with integration of health and social care has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities. It finds that the Better Care Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or hospital activity.

See also the integration resource library from the Local Government Association and also the Health and Social Care Integration (England) briefing paper from the House of Commons Library.

Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period. This report from the Nuffield Trust finds that the service seems to steer people away from emergency services, though there is great variability across England. In some areas, NHS 111 is likely too risk averse, as it is connecting more people to the ambulance service than sending people to A&E – which is the reverse of the usual pattern of NHS use.

Patients with rare conditions to benefit from new treatments

NHS England hasconfirmed that three new specialised treatments will be made available for patients in England.

Second allogeneic haematopoietic stem cell transplants – estimated to cover around 15 patients a year who suffer a relapse following a first transplant.
Eculizumab for the treatment of the kidney condition C3 glomerulopathy – which includes C3 glomerulonephritis and dense deposit disease – estimated to benefit up to 5 patients a year who suffer a relapse following a kidney transplant.
Riociguat for pulmonary arterial hypertension – estimated to benefit around 90-125 patients a year for whom other treatments have failed, subject to confirmation of a commercially in confidence discounted price offered by the manufacturer.

Working Longer Group launches new resources for managers and staff

NHS Employers' Working Longer Group (WLG) has launched two new resources to support managers, staff and their representatives with the challenges and opportunities associated with an ageing workforce.

Friday, 24 February 2017

Can methylphenidate be used for adults with attention deficit hyperactivity disorder (ADHD)?

This updated Medicines Q&A reviews the evidence evaluating the use of methylphenidate for the treatment of adults with ADHD.

Transforming community care

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service — a public sector organisation providing back-office services including IM&T to local government and health organisations across Northamptonshire, Cambridgeshire, Buckinghamshire and Norfolk — explains how mobile solutions are transforming the work of community-based health teams.

Zika virus: epidemiology and cases diagnosed in the UK

Guidance from Public Health England on the epidemiology and cases of the Zika Virus diagnosed in the UK.

Tackling cyberbullying in the NHS

A briefing from NHS Employers explores how the NHS currently tackles cyberbullying.

As the use of online communication tools continues to increase it is important that organisations across the NHS include cyberbullying in their most relevant HR policy. To help trusts with this, NHS Employers has also created an adaptable template cyberbullying policy for use on a local level.

Spreading new care models

Samantha Jones, director of the new care models programme recently shared her top tips for vanguards and others developing new models of care on how they might help do this.

Productivity, Technology And The NHS

This paper from Newchurch looks at the NHS in England approach to productivity improvement half-way through the implementation of NHS Engand's 'Five Year Forward View' (5YFV).

SAS Doctor Development: Summary of Resources and Further Work

The British Medical Association, Health Education England, the Academy of Medical Royal Colleges and NHS Employers have worked together to produce this guidance on the development of specialty and associate specialist (SAS) doctors in the NHS in England. It aims to help ensure that this group of doctors are helped to remain fit to practice and develop in their careers.

New outpatient tariffs and the impact on ophthalmology – managing change for commissioning services

The RCOphth has issued a further response to the December 2016 statement on how the new outpatient tariffs place unnecessary pressure on departments to discharge patients at a time when there is no suitable community care option available.

Supporting safer care for full-term babies

A resource alert has been issued by NHS Improvement to support NHS providers to reduce harm leading to avoidable admissions of full-term babies.

Thursday, 23 February 2017

Maternal mental health – women's voices

Royal College of Obstetricians and Gynaecologists
This report is based on the findings of a survey of over 2300 women on their experiences of care in relation to their mental health during pregnancy and in the postnatal period. It provides recommendations for healthcare professionals, managers, providers, commissioners and policy-makers.

Finding a hidden gem for mental health

NHS England’s National Transformation Adviser for Children and Young People’s mental health welcomes the evaluation of the CYP Schools Pilots:

Over the last eighteen months there has been a lot of interest in schools and their role in emotional and mental health and well-being.

Older people are losing out on Psychological Therapy

Depression in older people is common, underdiagnosed, undertreated and attracts therapeutic nihilism.

One in five older people have clinical depression and, contrary to some popular and professional opinion, it is eminently treatable.

Depression is associated with personal suffering, more physical health problems, social isolation, suicide and increased health and social care costs. It is a heterogeneous condition, can sometimes be the portent for dementia and treatment resistant depression can be associated with cerebrovascular disease.

Older people with depression can have similar and recurrent symptoms to younger people, less related to work stress but more commonly associated with a caring role or physical illness and frailty. It is often expressed through physical complaints (somatisation) causing fruitless physical investigations.

Cat ownership not linked to mental health problems

New UCL research has found no link between cat ownership and psychotic symptoms, casting doubt on previous suggestions that people who grew up with cats are at higher risk of mental illness.

Recent research has suggested that cat ownership might contribute to some mental disorders, because cats are the primary host of the common parasite Toxoplasma Gondii (T. Gondii), itself linked to mental health problems such as schizophrenia. However, the new study, published in Psychological Medicine, suggests that cat ownership in pregnancy and childhood does not play a role in developing psychotic symptoms during adolescence. The study looked at nearly 5000 people born in 1991 or 1992 who were followed-up until the age of 18. The researchers had data on whether the household had cats while the mother was pregnant and when the children were growing up.

Antenatal corticosteroids reduce breathing problems in late preterm babies

Giving corticosteroids to women at risk of preterm birth at 34 weeks of pregnancy or later reduced the risk of severe breathing problems in the baby after birth from 1.9% to 1.1%. Steroids also reduced the risk for babies born by planned caesarean section after 37 weeks (so not premature).

From the NIHR Dissemination Centre

Delivering Outcomes Based Care in Diabetes

Last November and December, commissioners were able to debate how current models of diabetes care could be adapted to tackle the crisis at two workshops. Write-ups of the presentations are now available.

Funding available for innovations to improve health care

The Health Foundation has £1.5 million available for up to 20 teams to test and develop innovative ideas to improve health care delivery in the UK.

The Health Foundation is particularly interested in applications from teams who will be applying an innovative use of data. The deadline for applications is 28 March 2017.

Latest Pharmacological Technology Briefings - February 2017

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

Very Senior Manager (VSM) update

NHS Improvement's 21 December 2016 bulletin advised that a national VSM framework is in development.

Pending publication of this framework, this interim guide provides advice to NHS trusts seeking executive VSM salary approval and to foundation trusts seeking VSM salary opinion.

Lateral interbody fusion in the lumbar spine for low back pain

New Interventional Procedures guidance on lateral interbody fusion in the lumbar spine for low back pain in adults. This involves removing the damaged disc and fixing parts of the spine together, to relieve pain.

Trabecular stent bypass microsurgery for open-angle glaucoma

New Interventional Procedures Guidance on trabecular stent bypass microsurgery for open-angle glaucoma. This involves inserting a hollow metal tube (stent) into the eye, to improve drainage of fluid from the eye.

Better Beginnings: Improving Health For Pregnancy

This themed review from the NIHR brings together NIHR research on different aspects of health before, during and after pregnancy. It features published studies, ongoing studies or interim results and questions for clinicians, commissioners, public health professionals and others.

Latest NHS sickness absence figures - October 2016

The latest figures released by NHS Digital show that NHS staff sickness absence has increased from 4.24% in October 2015 to 4.30% in October 2016.

Wednesday, 22 February 2017

Social Care funding

House of Commons Library

This paper examines the key funding pressures facing adult social care services in England and evidence of the impacts of these pressures on social care and health services. The paper explains the additional funding for adult social care that the government has made available through the social care precept, improved Better Care Fund and adult social care support grant. The paper also discusses stakeholder concerns about a growing social care ‘funding gap’, and calls for a comprehensive review of the long-term sustainability of social care.

New guidance on police support for incidents on mental health wards

The MoU on Police Use of Restraint in Mental Health & Learning Disability Settings aims to clarify when the police might take the lead and when they ought to hand management back over to care staff, writes Errol Archer

Staff who work on mental health wards, particularly psychiatric intensive care units, will be trained in de-escalation and control and restraint.

Exceptionally, health care professionals will require the assistance of the police to provide care safely to people experiencing acute mental illness.

These types of incidents most commonly occur either during the course of an assessment of the person for detention under the Mental Health Act or whilst the person is acutely unwell following detention and whilest being detained on a PICU.

Any mental health ward managers as well as other staff will be interested to read the Memorandum of Understanding on the Police Use of Restraint in Mental Health & Learning Disability Settings.

Treatment strategy for anorexia

New research conducted in adolescent rodents provides insights on the mechanisms behind anorexia nervosa and points to a potential treatment strategy.

In experiments involving food restriction and/or exercise, investigators found that the extent to which certain receptors are expressed in neurons in a particular region of the brain can influence whether an adolescent female rat develops anorexia nervosa-like behavior, such as to exercise, rather than eat, in spite of being hungry. The findings suggest that a risk factor for anorexia may be under-expression of these receptors, α4βδ-GABAA called receptors, following stress. Therefore, boosting the activity of these receptors may be a promising treatment strategy.

Collaborative care provides improvement for older adults with mild depression

Among older adults with subthreshold depression (insufficient levels of depressive symptoms to meet diagnostic criteria), collaborative care compared with usual care resulted in an improvement in depressive symptoms after four months, although it is of uncertain clinical importance, according to a study.

Mental health of young carers highlighted in study

Young carers in Scotland are more likely to suffer from mental health problems, stress and sleep disorders than their peers, a study has found.

The research also found that a quarter of the 238 young carers who took part are caring for someone on their own. A similar proportion are looking after more than one person.

But the report also suggested young carers often have greater feelings of self-worth than their counterparts who do not have caring responsibilities.

The study is said to be the first in Scotland to compare the health of young people who have responsibility for caring for someone in their household with those who do not.

Parkinson’s disease with motor fluctuations: safinamide - evidence summary (ES6)

New evidence summary from NICE on using safinamide in patients with parkinson’s disease with motor fluctuations.

Ultrasound could help diagnose giant cell arteritis

Ultrasound may aid diagnosis of giant cell arteritis in people referred from the community. It is less invasive than biopsy and might provide quicker results than a biopsy, but its role and place in the diagnostic pathway remain unclear.

From the NIHR Dissemination Centre

Use of physostigmine in patients presenting to the emergency department with anticholinergic poisoning

New from BestBETs:

In [patients presenting to the emergency department with anticholinergic toxidrome], does the administration of [physostigmine] compared to [any other treatment] reduces [length of stay or need for intubation]?

In patients presenting to the ED with anticholinergic poisoning, the use of physostigmine might reduce the intubation rate, but not the mean length of stay. Unfortunately, the current data is very weak and prone to bias. Further prospective randomized studies on the subject are needed to support its use in anticholinergic toxicity.

Mycobacterium chimaera infections: guidance for secondary care

Guidance and advice from Public Health England for health professionals on Mycobacterium chimaera infections associated with cardiopulmonary bypass.

Tuesday, 21 February 2017

The impact of between analytical platform variability on the classification of pleural effusions into exudate or transudate using Light's criteria

BMJ Journal of Clinical Pathology. Published Online First: 16 February 2017. doi: 10.1136/jclinpath-2016-204142

Light's criteria are ratios of pleural fluid to serum total protein (TP), pleural fluid to serum lactate dehydrogenase (LDH) and pleural fluid LDH to the upper reference limit for serum LDH. They are used to classify pleural effusions into an exudate or transudate when pleural fluid protein is 25–35 g/L. We evaluated the impact of between analytical platforms on the classification of pleural effusions using Light's criteria.

Although Light's criteria are ratios, which should minimise interassay variability, we report 18% discordance between different analytical platforms. The discordance was largely due to the performance of LDH and to a lesser extent protein assays in pleural fluid. Laboratories should be aware that assays may perform differently in serum and pleural fluid.

UHCW Research: Claire Thomas and Catherine Darby

Delivering sustainability and transformation plans

STPs offer the best hope for the NHS and its partners to sustain services and transform the delivery of health and care, but how will STP footprints transform their plans into reality? This King's Fund report identifies the challenges that lie ahead.

Wheelchair data published for October-December 2016

NHS England has published wheelchair data for October to December 2016 (Q3).

The data shows that waiting times continue to increase: in Q2 25.4% of children were waiting more than 18 weeks for a wheelchair, increasing to 26.8% in Q3.

In Q2, 16% of adults were waiting more than 18 weeks for their wheelchair, increasing to 18.5% in Q3. CCGs are expected to use this data to target areas for improvement.

Quarterly Performance of the Provider Sector as at 31 December 2016

This NHS Improvement publication brings together data on the performance of NHS providers over quarter three of 2016/17. If finds that the demand for emergency treatment coupled with a significant reduction in bed available has led to providers collectively underperforming against several key health care standards.

Use of Agency Workers in the Public Sector

This report from the Office of Manpower Economics seeks to enhance understanding about use of agency staff in the UK public sector.

Re: Should we consider devolution of "head and neck" surgery from the specialties of oral and maxillofacial surgery; ear, nose and throat surgery; and plastic surgery?

Br J Oral Maxillofac Surg. 2017 Feb 14. pii: S0266-4356(17)30042-6. doi: 10.1016/j.bjoms.2016.12.019. [Epub ahead of print]

We were interested in Islam’s editorial regarding the devolution of head and neck surgery from the parent specialties that feed into it.1 We have had a devolved arrangement of practice at University Hospitals Coventry and Warwickshire Hospitals NHS Trust since 2003. To the best of our knowledge this is the only service in the country in which this is the case, and it is recognised as such within the clinical and management structure of the hospital. The service has a separate clinical lead, QIPS (Quality, Improvement, and Patient Safety), business, and departmental meetings

UHCW Research: Elledge R, Walton G, Sandhu R, Prasad S and Howe D.

State of the Health System: Beds in the NHS

This paper from the BMA presents NHS bed data from across the UK and it examines the causes and consequences of bed pressures within the health system.

What Caused The Spike In Mortality In England And Wales In January 2015?

This study from the London School of Hygiene and Tropical Medicine analyses the data surrounding a spike in mortality in England and Wales in January 2015. It found no evidence that the rise in mortality was attributable to data anomalies or cold weather and the data indicated that flu was unlikely to be the main cause. The researchers also examined NHS performance data during this period and found that the excess mortality in January 2015 coincided with evidence of health system failures.

2017-2020 Stroke Delivery Plan

This Stroke Delivery Plan from NHS Wales provides a framework for action by health boards and NHS trusts, working with their partners. It sets out the expectations of all stakeholders to tackle stroke in people of all ages, wherever they live in Wales and whatever their circumstances.

Cancer annual report 2016

Annual cancer report from NHS Wales covering incidence, diagnosis. service delivery, prevention and the care pathway.

Post-transplant food safety is imperative

Journal of Kidney Care, 2.1 (January 2017): 4.

The British Dietetic Association's (2016) renal transplant guidelines were a welcome addition to clinical practice. They amalgamate up-to-date food safety evidence to guide dietitians in post-transplant nutritional advice. Informed by stem cell transplant research (due to the lack of evidence in renal), the recommendations addressed potential conflicting theoretical dietary advice reflected in differing historical dietetic practice throughout the UK. For example, at one time there was differing advice on the number of months recommended to avoid eating outside the home after a transplant. Now definitive best practice guidelines exist. References

UHCW Research: Andrew Morris

Improving patient care by improving data visualistation and safety support mechanisms: interim assessment.

Published by West Midlands Health Informatics Network

Poor patient safety significantly affects the patient experience and can be life changing for those involved. Safety measurement has been slow to deliver demonstrable improvements in patient safety since the extent of fatal adverse events was established in the 1999 report ‘To err is human’.1 The QUESTT tool supports more effective safety performance measurement that rewards success and supports underperformance to deliver improvements.

UHCW Research: Judith Smith and Sarahjane Jones

Decision tree and random forest models for outcome prediction in antibody incompatible kidney transplantation

Biomedical Signal Processing and Control Available online 9 February 2017

Clinical datasets are commonly limited in size, thus restraining applications of Machine Learning (ML) techniques for predictive modelling in clinical research and organ transplantation. We explored the potential of Decision Tree (DT) and Random Forest (RF) classification models, in the context of small dataset of 80 samples, for outcome prediction in high-risk kidney transplantation. The DT and RF models identified the key risk factors associated with acute rejection: the levels of the donor specific IgG antibodies, the levels of IgG4 subclass and the number of human leucocyte antigen mismatches between the donor and recipient. Furthermore, the DT model determined dangerous levels of donor-specific IgG subclass antibodies, thus demonstrating the potential of discovering new properties in the data when traditional statistical tools are unable to capture them. The DT and RF classifiers developed in this work predicted early transplant rejection with accuracy of 85%, thus offering an accurate decision support tool for doctors tasked with predicting outcomes of kidney transplantation in advance of the clinical intervention.

UHCW Research: Robert Higgins and Sunil Daga

Adult social care: market shaping

The Department of Health have published New guidance aimed at people who buy social care services, including local authority and clinical commissioning group commissioners, as well as personal budget holders and people who fund their own care, care service providers and potential investors in the care sector.

The adult social care market refers to independent care sector providers and support organisations – those that provide Care Quality Commission regulated services, such as care and home care, as well as unregulated care, such as personal assistants, volunteers and communities and informal family carers, and wider support services.

Monday, 20 February 2017

Tadalafil Medical Expulsive Therapy in Ureteral Calculi: A New Kid on the Block?

New from BestBETs:

In [adult patients presenting to the Emergency Department with distal ureteral calculi] how does [tadalafil compared to alpha receptor blockers] increase the [time and success of spontaneous stone passage]?

The available literature suggests that tadalafil is neither more efficacious nor safer than tamsulosin. Combined therapy with tamsulosin and tadalafil may increase stone passage rate and decrease expulsion time relative to tamsulosin alone, however larger studies are needed to establish efficacy and safety of combination therapy.

Osteoarthritis pain management app launched

The ESCAPE Pain programme for osteoarthritis has launched an app with 16 exercise videos to improve joint pain and animations to help people learn about how to better manage their condition.

Improving A&E performance: innovative ideas from the north of England

NHS Improvment has worked with providers across the north of England to develop an alternative approach for delivering A&E services. Instead of more performance management, NHS providers applied an improvement methodology and mind-set.

The 90 day improvement and innovation cycle shows there's fantastic and innovative work being done by the NHS to manage A&E performance and to do the best for patients in very challenging circumstances.

Radical treatment for bladder cancer

The radical treatment for bladder cancer section of the Royal College of Radiologists' guidance on Radiotherapy Dose Fractionation (2nd ed.) has been corrected

National Audit of Cardiac Rhythm Management Devices

The 11th annual report for the National Cardiac Rhythm Management (CRM)Device Audit presents the official record of CRM device procedures and quality issues related to the provision of CRM devices between 1st April 2015 and 31st March 2016. Recommendations are made based on these findings. The report covers centres in England, Scotland, Northern Ireland and Wales.

Use of Epinephrine in Out-of-Hospital Cardiac Arrest

New from BestBETs:

In [adults with out-of-hospital cardiac arrest] does [pre-hospital epinephrine] affect [long-term morbidity or mortality]?

Epinephrine used as an adjunctive treatment during OHCA improves ROSC and survival to hospital but not survival to discharge or neurological outcome.

Take part in national audit of intermediate care

The national audit of intermediate care (NAIC) currently provides the only comprehensive data on intermediate care services.

This year, NHS England is contributing to the funding of NAIC, allowing all commissioners and providers of intermediate care services to participate free of charge. The audit provides benchmarked information on service models, spend, activity, workforce and outcomes with data sharing arrangements in place. Matthew Swindells, NHS England’s national director for operations and information, has written to relevant organisations encouraging them to participate.

Creating a great place to work

Taking place on 23 March in London, and with a 20 per cent discount for Confed members, Great Place to Work is designed to help NHS leaders build a culture of trust and engagement that attracts and retains employees, drives creativity and maximises your organisation’s productivity.

The London Quality Standards: A Case Study In Changing Clinical Care

This review by the Nuffield Trust of the London Quality Standards (LQS), the London-wide precursor to the Seven Day Services Standards, argues that using seven-day standards as the basis for downgrading or closing hospital services is unjustified and counterproductive. The LQS aimed to reduce excess weekend deaths in hospitals and to improve access to services for patients.

Impact of gut hormone FGF-19 on type-2 diabetes and mitochondrial recovery in a prospective study of obese diabetic women undergoing bariatric surgery

BMC Medicine201715:34 DOI: 10.1186/s12916-017-0797-5

The ileal-derived hormone, fibroblast growth factor 19 (FGF-19), may promote weight loss and facilitate type-2 diabetes mellitus remission in bariatric surgical patients. We investigated the effect of different bariatric procedures on circulating FGF-19 levels and the resulting impact on mitochondrial health in white adipose tissue (AT).

UHCW Research: Ioannis Kyrou, Sudhesh Kumar and Philip G. McTernan

Physio urges prescribers of all disciplines to improve pain assessments

CSP member Paul Cameron, national lead clinician for chronic pain in Scotland, speaking at a national conference on non-medical prescribing for pain, held in London on 10 February, told delegates it was essential for non-medical prescribers to maintain their competence and skills so they could prescribe for pain in an effective way.

To help achieve this he outlined the pros and cons of a variety of pain assessment models, including the World Health Organization’s three-step ‘pain ladder’, which is commonly used as a framework for providing symptomatic pain relief.

Saving STPs: Achieving Meaningful Health And Social Care Reform

This report from Reform, identifies three key barriers to STPs being successfully implemented and outlines a series of changes to overcome these barriers.

The Health and Care of Older People in England 2017

This report from Age UK discusses the challenges facing older people who need care, and the impact of the failure to provide it on their health and wellbeing, as well as the NHS.

Corticosteroids given early reduce risk of heart problems in children with Kawasaki disease

Early treatment with corticosteroids on top of standard therapy reduces the risk of serious heart problems in children under five with the rare vascular disease, Kawasaki disease.

From the NIHR Dissemination Centre

Intervax BCG vaccine: training material for healthcare professionals

Training material from Public Health England for healthcare professionals on the use of the unlicensed Intervax BCG vaccine has been updated.

Information delivered by telemedicine can improve diabetes control

Telemedicine, such as text messaging or internet support systems used to communicate with patients, improves long-term blood sugar control in adults with type 1 or type 2 diabetes.

From the NIHR Dissemination Centre

Enhanced patient education improves bowel preparation before colonoscopy

People who are given extra information about preparing for their colonoscopy are likely to have clearer bowels before the procedure, meaning it is more likely to be successful. About a quarter of people currently having colonoscopy are poorly prepared and this prevents a good view of the whole bowel. Better preparation allows more accurate diagnoses, shorter procedures and fewer repeat procedures. This could lower costs.

From the NIHR Dissemination Centre

The shift to value-based healthcare

NHS England has published NHS Rightcare and the shift to value-based health.

This Board Paper summarises NHS RightCare's approach to delivering value-based population healthcare in England, by: explaining the principles behind NHS RightCare's aim of increasing value, reducing unwarranted variation and delivering better population healthcare; detailing how NHS RightCare is addressing the challenges related to better value; and updating on the accelerated roll out across the NHS in England

Long term conditions scenarios: osteoporosis and wound care

NHS RightCare has published two new scenarios in its long term conditions series. The scenarios, on osteoporosis and wound care, use fictional people to examine patient journeys, comparing sub-optimal but typical scenarios against ideal pathways. The scenarios contain modelled costs of care for commissioners.

Working with Care Providers to Understand Costs

The aim of this CIPFA guide is to enable and equip commissioners with the knowledge and skills to support informed dialogue with providers in the interest of working toward agreed fee rates that are affordable, good value for money and support market sustainability.

Managing conflicts of interest in the NHS

NHS England has issued new guidance on managing conflicts of interest in the NHS. It:

introduces common principles and rules for managing conflicts of interest
provides simple advice to staff and organisations about what to do in common situations
supports good judgement about how interests should be approached and manage

NHSI Midlands and East masterclass: Improving bank use and reducing agency spend

This masterclass is designed to support trusts in the Midlands and East region to increase the use of bank staff and reduce the use of high cost agency staff. Using the success of Northampton General Hospitals Trust (NGH) as a live case study, the session will provide you with practical support tools to help improve your trust’s bank utilisation.

Takes place 24th February 09.30-15.00 at Northampton General Hospital

Guide to managing ethical issues in quality improvement or clinical audit projects

This HQIP guide is intended to help those responsible to review and develop arrangements for the effective ethics oversight of QI and clinical audit activities, as required. The content in the guide is derived from an extensive search and review of published literature on ethics and QI on clinical audit carried out by Healthcare Quality Quest.

Financial Improvement Programme – Wave 2

Following the success of the first wave of the Financial Improvement Programme (FIP1), NHS Improvement is now launching FIP Wave 2 (FIP2).

If you would like to be involved, please respond by 12pm on Friday, 24 February.

Menopause Quality Standard

New Quality Standard from NICE on menopause.

Diagnosing acute myocardial infarction in the presence of ventricular pacing: can Sgarbossa criteria help?

New from BestBETs:

In [patients presenting to the ED with possible acute coronary syndrome and who have ventricular paced rhythm on the ECG], can [Sgarbossa criteria or Smith-modified Sgarbossa criteria] be used to [rule in AMI and/or acute coronary occlusion (ACO)]?

The clinical bottom line is that there is little current evidence to determine the value of the original and modified Sgarbossa criteria for diagnosing AMI or acute coronary occlusion. While further research is clearly needed, the existing evidence suggests that the original Sgarbossa criteria can ‘rule in’ acute coronary occlusion with high specificity.

Usefulness of IV Lidocaine in the Treatment of Renal Colic

New from BestBETs

In [adult patients presenting to the emergency department with renal colic], is [IV lidocaine as effective as IV opioids] for [pain control?]

In adult patients presenting to the ED for renal colic, intravenous lidocaine has been shown to be more affective for pain control than intravenous morphine. Furthermore, if intravenous lidocaine is used along with intravenous morphine, patients will be nausea free significantly sooner.

Acupuncture and Fibromyalgia

New from BestBETs:

In [adults with Fibromyalgia] does [acupuncture] have an effect on [reducing pain]?

Acupuncture may reduce pain in fibromyalgia syndrome. Most studies do not report on long-term pain outcomes and there are no large-scale studies.

Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide

New Evidence Summary from NICE on using oral glycopyrronium bromide for severe sialorrhoea (drooling) in children and young people with chronic neurological disorders.

Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Abscess

New from BestBETs:

In [patients with uncomplicated skin abscesses who have undergone abscess incision and drainage], does [treatment with oral trimethoprim-sulfamethoxazole compared to placebo] [reduce treatment failure at 7 days]?

Trimethoprim-sulfamethoxazole may help with abscess cure, and will decrease abscess formation at new sites.

Tranexamic acid in epistaxis - who bloody nose?

New from BestBETs

In [adults without a bleeding disorder who have uncomplicated epistaxis] is [tranexamic acid] effective at [stopping bleeding and/or preventing rebleeding]?

The evidence is not sufficient to advise the routine use of tranexamic acid for patients attending ED with epistaxis. The evidence available is conflicting and there is a lack of sufficiently robust, well-designed trials on the topic to allow a recommendation to change current practice to include tranexamic acid. However, it is important to note that there is no evidence of tranexamic acid for epistaxis causing an increase in adverse events and the most robust study available currently shows a potential benefit. As such it is an area where more research would be beneficial. From the evidence available, it would seem that using the injectable form of tranexamic acid as a topical treatment would be the most likely to be beneficial and should be the starting point for future research. It may also be reasonable from the evidence currently available to offer topical tranexamic acid to patients such as the one in the clinical scenario above where the standard treatment of nasal packing is unacceptable to the patient.

Screening for delirium within the Emergency Department

New from BestBETs:

In [patients, greater than 75 years, presenting to the emergency department] is [an abbreviated mental test score assessment better than other cognitive screening tools] at [identifying delirium]?

The abbreviated mental test score has been largely adopted as a delirium screening tool within UK hospitals and there is little evidence in the literature evaluating its use within the ED setting.

Utility of ultrasound in the diagnosis of shoulder dislocation

New from BestBETs

In [adult patients with clinically presumed shoulder dislocations] is [ultrasound as reliable as radiography] in [identifying shoulder dislocation]?

The use of ultrasound shows promise as a method of confirming shoulder dislocation without requiring X-ray. Although both studies had sensitivity and specificity of 100% compared with plain X-rays, only two relatively small studies were found in the literature search; further validation of these findings would be required before recommending this as standard practice.

Low-dose Ketamine for Acute Pain in the Emergency Department

New from BestBETs:

[In ED patients with acute pain who do not respond to conventional therapies], is the [low-dose ketamine better than morphine] at [safely and effectively reducing pain scores]?

Ketamine can be an effective alternative or adjunct to intravenous opioid pain medications and in some instances may provide more effective pain relief when compared with opioids. However, further trials need to be performed to establish more robust data.

Preterm breech and caesarean delivery

Answer to the question, In women labouring at gestational ages of extreme prematurity, what is the evidence for delivering by Caesarean section if breech presentation?, posted to the RCOG Query Bank.

B vitamins reduce schizophrenia symptoms, study finds

A review of worldwide studies has found that add-on treatment with high-dose b-vitamins -- including B6, B8 and B12 -- can significantly reduce symptoms of schizophrenia more than standard treatments alone.

The research -- on the effect of vitamin and mineral supplements on symptoms of schizophrenia -- is funded by The Medical Research Council and University of Manchester, and is published in Psychological Medicine, one of the world's leading psychology journals.

Read more about it HERE.

Contraception, autism and breast cancer

Answer to the question, What would be the best contraception to advise a 15 year old autistic girl with a strong family history of breast cancer to use?, posted to the RCOG Query Bank.

Diabetes, caesarean section and steroids

Answer to the question, In a diabetic pregnant patient is there any evidence for the benefit or harm of steroids between 37 and 38+6 weeks gestation prior to elective caesarean section, posted to the RCOG Query Bank.

Should real resuscitationists use airway checklists?

New from BestBETs:

In [critically ill patients requiring endotracheal intubation] does [the use of a preprocedural checklist] reduce [the incidence of adverse events].

Current evidence suggests there may be a potential reduction in adverse events with the use of preprocedural checklists, during intubation of the critically ill patient outside a theatre environment. However, this evidence is level 3 at best and should be considered hypothesis generating. Further evidence is required before airway checklists can be considered a standard of care.

Do fluoroquinolones increase the incidence of adult tendinopathy?

New from BestBETs:

The use of fluoroquinolones was found to be associated with a broad range of tendon disorders, the risk being higher in the elderly and with concomitant use of corticosteroid.

Safety and Efficacy of Colchicine as Stand-alone Therapy for the Prevention of Recurrent Pericarditis

New from BestBETs:

There is no evidence supporting colchicine use as monotherapy, though inference suggests benefit and further studies are recommended.

Clinical guidance for the management of elderly major trauma patients

The Trauma Audit Research Network (TARN) reported that major trauma patients in England and Wales are becoming more elderly, and low level falls are now a leading cause of severe injury. However few clinical guidelines specifically focus on the needs of injured elderly patients admitted to major trauma networks.

In response, the London Major Trauma System has published new clinical guidance for use by major trauma centres and trauma units in conjunction with local guidance.

Bedside lung ultrasound for the diagnosis of pneumonia in children

New from BestBETs:

Recent evidence suggests that lung ultrasound can be considered as an accurate diagnostic modality and an adequate alternative to chest radiograph for pneumonia evaluation in children.

Healthcare social media toolkit

This toolkit from Skills for Health aims to support the health care sector in utilising social media effectively and efficiently. It includes guidance on strategy and content creation, downloadable templates and resources and advice on how to encourage team members in using social media.

Friday, 17 February 2017

Financial analysis of STPs

British Medical Association (BMA) -
This analysis of the 44 STPs in England estimates that £9.5bn of capital funding is required to create the infrastructure to deliver the plans. The BMA sent out a series of FOI requests and have compiled information for each STP area on the financial needs required to implement the plans in each area.

The sustainability and transformation plans: a critical assessment

Centre for Health and the Public Interest (CHPI) -
This report assesses the published drafts for STP plans and it raises concerns around the credibility of the implementation measures outlined in the plans. It argues that the scale of the planned reduction in hospital services implies rationing and risks the collapse of some services.

HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography

NICE: Evidence-based recommendations on HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography.

Health and social care integration

“Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort. It will be important to learn from the over-optimism of such plans when implementing the much larger NHS sustainability and transformation plans.The Departments do not yet have the evidence to show that they can deliver their commitment to integrated services by 2020, at the same time as meeting existing pressures on the health and social care systems.”

Amyas Morse, head of the National Audit Office, 8 February 2017

Warning signs: challenges to delivering the Cancer Strategy for England by 2020

Macmillan Cancer Support -
This report lays out the challenges an under-pressure health service in England faces in areas such as workforce as it seeks to transform cancer services so it can meet increased demand in the coming decades. It finds that 64 per cent of people recently diagnosed with cancer in England have experienced mental health problems such as anxiety and depression while waiting for their treatment to start. It also finds that confidence in delivering the cancer strategy is mixed amongst NHS leaders and GPs and that greater clarity is needed on who is responsible for redesigning cancer services at a local and regional level.

Department of Health named social worker: reflect and refine report

Social Care Institute for Excellence (SCIE) -
The Named Social Work pilot scheme aims to address the lack of continuity of care in social work by creating a role of a single named social worker. This report presents the interim findings on the scheme's progress and outlines the specifics of how this role is developing throughout the process of implementation.

Brain differences in ADHD

Largest imaging study of ADHD to date identifies differences in five regions of the brain, with greatest differences seen in children rather than adults.

Attention-deficit hyperactivity disorder (ADHD) is associated with the delayed development of five brain regions and should be considered a brain disorder, according to a study published in The Lancet Psychiatry.

Obesity in mental health secure units

This review summarises the latest evidence on obesity in secure mental health units. It has been produced by Public Health England and the University of Sheffield to support the NHS England Mental Health Programme of Care Board and the future commissioning of these services.

Wednesday, 15 February 2017

Meeting the health needs of people with learning disabilities

RCN staff guidance defining learning disabilities, outlining some specific health needs and explaining relevant legislation, which includes obtaining consent. It also details specialist services, how to support people accessing services and lists a number of helpful resources and organisations.

Meeting the health needs of people with learning disabilities: RCN guidance for nursing staff

Social workers issued guidance on coercive control

Social workers have been issued guidance on safeguarding people who are victims of controlling and coercive behaviour.

The Department of Health has funded a set of tools to help practitioners respond to the issue, which experts say underpins domestic abuse and can be a heightened risk among people with care and support needs.

Monday, 13 February 2017

Preventing suicides: staff perspectives

Prisons need a profound culture change to prevent people from losing their lives through suicide, according to a report published today by Centre for Mental Health and the Howard League for Penal Reform.

Preventing suicides: staff perspectives, is the last of four reports from a year-long investigation into suicide in prisons by the two charities, find that distress, self-harm and suicide attempts are too often seen as manipulative rather than signs of need and vulnerability among prisoners. And staff shortages, a ‘toxic’ working environment and a failure to recognise the traumatising impact of prison for both prisoners and staff all contribute to an unsafe environment.

Very premature babies at risk of mental health problems – research

Children who are born very prematurely are at greater risk of developing mental health and social problems that can persist well into adulthood, according to one of the largest reviews of evidence.

Those with an extremely low birth weight, at less than a kilogram, are more likely to have attention disorders and social difficulties as children, and feel more shyness, anxiety and depression as adults, than those born a healthy weight.

Government wants thousands of social workers accredited next year

Thousands of children’s social workers will face accreditation tests next year, under government plans.

A tender notice issued by the Department for Education shows the government wants 8,000 practitioners accredited by December 2018 as part of the first phase of a national rollout.
The social workers will come from a group of 31 councils, including the DfE’s favoured ‘partners in practice’ councils, that have signed up to pioneer the scheme. Social workers will go to regional assessment centres to sit the majority of the four-stage assessment, which includes an online test of knowledge and skills and a simulated practice observation using role play scenarios with actors.

The DfE said final decisions about accreditation rollout are subject to the results of a consultation currently underway. The consultation is also seeking feedback on a list of statutory social work duties ministers believe accreditation should be required for.

Friday, 10 February 2017

GP patients now being referred to more appropriate services thanks to new online tool

GPs have welcomed a new online feature which is expected to bring about a reduction in the number of patients being referred to inappropriate services.

Designed by NHS Digital, the new enhancement improves a GP's view of information - making it easier for them to view service referral criteria before referring a patient to secondary care.

The feature will also bring about a reduction in administration for staff, as well as lower costs.

The Verification of Referral Criteria was added to the NHS e-Referral Service on January 13 2017, and is just one of a number of key milestones on the development roadmap.

Operational productivity – expanding to community and mental health

NHS Improvement have now commenced a review into community and mental health trusts, building on the approach of the Carter report on operational productivity and performance in NHS acute hospitals.

Professor Kendall is taking up this post alongside his role under the same title at NHS England, where he has been in post since April 2016. He will join the nursing directorate as an expert advisor to the senior leadership team and help to continue supporting improvement in mental health services across England.

NICE seeks to support new mothers with mental health problems

NICE is calling on general practice staff to assess the mental health of all women who have recently given birth, as fears some may be left unsupported.

Some symptoms of mental health problems, such as changes to appetite or sleeping patterns, can be masked by what is considered normal for pregnant and postnatal women.
NICE – the National Institute for Health and Care Excellence – suggest that the routine six-week postnatal appointment could provide an opportunity for new mothers to be asked about their mental health.

Designing mental health care for young people

To mark Children’s Mental Health Week, one young man talks about how he is using his experiences to help others.

Read more from NHS Digital HERE.

Revolutionising children’s mental health care

To mark Children’s Mental Health Week, the Digital Lead at North East London Foundation Trust’s Emotional Wellbeing and Mental Health Service (EWMHS) looks at the importance of experience based co-design and service innovation:

Fathers have crucial role in a child's mental health

Fathers have a critical yet poorly recognised role in giving their children the best chance of good mental health throughout their lives, according to a briefing paper published today by Centre for Mental Health.

Making strides in schizophrenia diagnosis research

Researchers from the University of Maryland College Park (UMD) and Baltimore (UMB) campuses have developed a blood test that could help doctors more quickly diagnose schizophrenia and other disorders. Their study, "Redox Probing for Chemical Information of Oxidative Stress," was recently published in the journal Analytical Chemistry.

Early Depression May Indicate Genetic Risk for Additional Mental Illness

Emerging research suggests clinical features of major depressive disorder (MDD) may help identify patients with a genetic risk for major psychiatric disorders.

Researchers from the VU University Medical Center in Amsterdam, the Netherlands, discovered patients with depression at an early age, and a higher symptom severity, have an increased genetic risk for MDD, bipolar disorder, and schizophrenia.

The findings are reported in Biological Psychiatry.

Reward-Based Therapy Can Be Helpful for Alcohol Abuse

New research suggests that offering rewards can be an effective, low-cost treatment for alcohol abuse. The findings are important as alcohol abuse is the nation’s third leading preventable cause of death.

Researchers at Washington State University studied Seattle-area participants with serious mental illness — a population whose lifespan is estimated to be 20-25 years shorter than the average person’s.

The reward-based intervention provided simple prizes for addiction treatment attendance and negative urine test results for alcohol use.

A surprise benefit of the treatment was that it also decreased study participants’ tobacco and drug use.

Antrim hospital pilots emergency mental health scheme

An increasing number of people are turning up at emergency departments with mental health problems.

A new scheme in Northern Ireland is attempting to tackle the issue in order to save lives. Read more on the BBC website.

Figures from the Public Health Agency show that from March 2012 to April 2015, the number of people turning up at EDs with self-harm injuries increased by 11% from 5,977 to 6,630.

Five ways Britain wrecks young people’s mental health – and how to stop it

A study from the Varkey Foundation has revealed that young people in the UK suffer from some of the “lowest levels of mental wellbeing in the world” – second only to Japan.

This won’t be a shock to anyone familiar with statistics on child and adolescent mental health in Britain. Some 75% of mental illnesses begin before the age of 18, and the charity MQ estimates that on average, there are three children in every classroom with a diagnosable mental illness. This, combined with a continuing crisis in mental healthcare in Britain, means young people are not getting the help they need or deserve. But how exactly are young people being failed?

Rise in social workers quitting or switching jobs in adult services

NHS Digital report also finds shift of wider social care roles from councils to independent sector continues.

Turnover among social workers in adults’ services rose last year, official figures reveal.
One in six (16%) social workers in English council adults’ services departments quit or changed their jobs in 2016, up from 13% the previous year, according to the latest NHS Digital report on social care staffing. Almost one in five social workers (19%) started their jobs within the year, up from 15% in 2015.

Combined Performance Summary - December 2016

Monthly performance statistics for December 2016, covering:

NHS 111
ambulance quality indicators
A&E attendances and emergency admissions
waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
delayed transfers of care; and
early intervention in psychosis

Cost-effective commissioning of end of life care

These resources bring together existing evidence in palliative and end of life care, describe the wider policy context, and outline some of the key initiatives supporting the end of life care in England. The economic tool helps to inform commissioners in their decision-making for end of life care services. It explores the trade-offs between shifting end of life care out of secondary services and describes interventions that might be deployed to achieve such savings.

A New Relationship With People And Communities: Actions For Delivering Chapter 2 Of The NHS Five Year Forward View

As part of the NHS five year forward view, the People and Communities Board was invited to recommended a set of high-impact actions for adopting person- and community-centred approaches to health and social care. Chapter two of the forward view sets out a vision of health and care where people are fully engaged with their health. This report outlines actions and related recommendations for making this vision a reality. The actions address key areas in the NHS where substantial progress can be made over the next year.

U-Drain for people needing night drainage of urine or dialysis fluid

NICE has developed a medtech innovation briefing (MIB) on U-Drain for people needing night drainage of urine or dialysis fluid.

Smart One for measuring lung function

NICE has developed a medtech innovation briefing (MIB) on Smart One for measuring lung function

Engaging Health Care Volunteers to Pursue the Triple Aim

This report from the American Hospital; Association showcases how volunteer services support the Triple Aim, a framework developed by the Institute for Healthcare Improvement that outlines an approach for maximizing the performance of the health care system. This framework looks at improving the patient experience of care; improving the health of populations; and reducing the per-capita cost of health care.

Salisbury therapists launch integrative working initiative

Physiotherapists in Wiltshire are collaborating with occupational therapists on a quality improvement project aimed at better rehab and patient care.

DOP068 The virtual electronic chromoendoscopy score in ulcerative colitis exhibits very good inter-rater agreement in scoring mucosal and vascular changes after computerised module training: a study across academic and community practice

J Crohns Colitis. 2017 Feb 1;11(suppl_1):S65-S66. doi: 10.1093/ecco-jcc/jjx002.105.

UHCW Research: S. Ward

Consultation launched to ensure excellent care for patients with congenital heart disease

NHS England has today launched a public consultation on how it will put in place new standards for hospitals providing congenital heart disease services in England.

Wound complications remain a concern for CABG surgery using both mammary arteries

Rates of death, heart attack and stroke were similar at five years for people who underwent coronary artery bypass graft (CABG) using one or both mammary arteries.

From the NIHR Dissemination Centre

Transient ischaemic attacks may have greater long-term impact than previously thought

People are more likely to go to their GP about fatigue, psychological and cognitive impairment after a transient ischaemic attack (TIA) than similar people who have not had a TIA. Following a TIA people also go to their GP with these health problems sooner than those who haven’t had a TIA.

From the NIHR Dissemination Centre

Risks and benefits of ondansetron for children with acute gastroenteritis

Giving ondansetron to children with acute gastroenteritis can stop vomiting, reduce the risk of oral rehydration treatment failing, and reduce the chances of needing intravenous rehydration. But the drug can worsen diarrhoea symptoms.

From the NIHR Dissemination Centre

Group education linked to a lower chance of diabetes, for those who stick with the course

People at high risk of type 2 diabetes, who attend all three sessions of a diabetes prevention programme, are about 88% less likely to get diabetes than those who received leaflets only. But the people at highest risk may also be those least likely to start or complete the programme. If confirmed in practice, the programme could delay diabetes in about 4% of those who attend all sessions.

From the NIHR Dissemination Centre

National Careers Week 2017 #NCW2017

National Careers Week 2017 will be taking place between 6 - 10 March. The national campaign is an opportunity for employers to link up with local schools, colleges and job centres to promote the wide range of careers available within the NHS.

Patients coming to harm due to delays in treatment and follow-up appointments

The Royal College of Ophthalmologists has published a surveillance report of patients coming to harm due to delays in treatment and follow-up appointments. The research, conducted through the British Ophthalmological Surveillance Unit (BOSU), found patients suffering permanent and severe visual loss due to health service initiated delays.

HumiGard for preventing inadvertent perioperative hypothermia

New guidance form NICE on HumiGard for preventing inadvertent perioperative hypothermia.

Webinar on nasogastric (NG) tube safety issues – 2pm-3pm Monday 6 March

Incidents of misplaced NG tubes continue to be reported to the National Reporting and Learning System (NRLS). In partnership with Sign up to Safety, NHS Improvement's patient safety team is organising this webinar to address NG tubes safety issues and to hear about your experiences of implementing the NG tube guidance.

What's Behind Delayed Transfers Of Care?

This briefing from the Nuffield Trust explores what the data tells us about delayed transfers of care and dispels some myths about how to prevent them.

Breast screening: consultation on consolidated standards

The NHS Breast Screening Programme is consulting on draft consolidated programme standards.

Cortical Bony Thickening of the Lateral Intercondylar Wall

American Journal of Sports Medicine, Volume: 45 issue: 2, page(s): 394-402Article first published online: September 20, 2016;Issue published: February 1, 2017

The purpose of this study was to examine cortical thickening in the region of the ACL footprint (ie, the functional footprint of the ACL). It concludes that the findings of this study are consistent with those of recent studies describing fibers in the ACL of differing functional importance. The area in which the thickening was found has been defined and is likely to represent the functional footprint of the ACL.

UHCW Research: Andrew J. Metcalfe, Timothy Barlow, Peter J.M. Thompson andTimothy J.W. Spalding

What is social prescribing?

Social prescribing, sometimes referred to as community referral, is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.

Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

NICE recommends controlled use of targeted breast cancer radiotherapy treatment alongside further research

NICE has recommended the Intrabeam Radiotherapy System for people with early breast cancer in limited circumstances with additional data collection.

The recommendation for further data to be collected is because it is not yet certain whether Intrabeam, marketed by Carl Zeiss UK, is as effective as conventional radiotherapy in stopping the cancer coming back. However, the independent appraisal committee heard the risk of this happening is low in the patients who would receive Intrabeam and that people may be prepared to accept some uncertainty if it means they don’t need radiotherapy after their surgery.

For this reason, the committee has also recommended that patients are provided with information on the treatment options available, including their risks and benefits, so that they can make an informed choice about their treatment.

Wednesday, 8 February 2017

Career and Education Framework for Cancer Nursing

Guidance from the Royal College of Nursing and the Oncology Nursing Society for pre-registration nursing students support workers in health and social care registered nurses providing general or specialist cancer care.

Eazyplex SuperBug kits for detecting carbapenemase-producing organisms

A new medtech innovation briefing (MIB) on eazyplex SuperBug kits for detecting carbapenemase-producing organisms.

Perivillous fibrin deposition recurrence

Answer to the question Is there any treatment recommended to reduce the risk of recurrent perivillous fibrin deposition/maternal floor infarction in women with no evidence of thrombophilia/ antiphospholipid syndrome?, posted to the RCOG query bank.

Urodynamic testing prior to surgery

Answer to the question, What is the value of urodynamic testing prior to surgery? posted to the RCOG query bank.

Thromboprophylaxis after miscarriage

Answer to the question What thromboprophylaxis is recommended after first trimester miscarriage? posted to the RCOG query bank.

Mortality benefits from minimally invasive aneurysm repair aren’t sustained in the long term

Minimally invasive surgery to repair abdominal aortic aneurysm (AAA) was associated with fewer aneurysm-related deaths in the short-term, up to six months. From eight years onwards the open surgical procedures were associated with fewer aneurysm-related deaths, suggesting on-going monitoring is required.

From the NIHR Dissemination Centre

Excision is probably better than stapling in the long-term for haemorrhoids

Recurrences of haemorrhoids (piles) are three times less likely if they are surgically removed rather than treated with a relatively new stapling procedure.

From the NIHR Dissemination Centre

Specialist hip fracture services linked to fewer deaths in South Central region

Following a hip fracture, nurse-led fracture liaison services or specialist consultant (orthogeriatrician) input both reduce deaths. They did not reduce the small number of people having a second hip fracture within two years of the first. Both models of care were cost effective, although the orthogeriatric model was favoured.

From the NIHR Dissemination Centre

Health and Social Care Funding Explained

The UK currently spends over £140bn a year on public provision of health and over £20bn on social care. But how does that break down and how has spending changed over time? The charts below cover some of the key past, present and future trends in funding and activity across the UK and in England.

Three new Ophthalmic Services Guidance Chapters

Three new guidance chapters have recently been updated and added to the RCOpth Ophthalmic Services Guidance:

Building a culture of learning and development at Sheffield Teaching Hospitals

Find out how staff at STHFT have used strong partnership working to embed learning and development in their organisational culture, in this latest case study published by NHS Employers..

Towards Inclusion Programme

University Hospitals of Morecambe Bay tell NHS Employers about their Towards Inclusion Programme and the benefits of engaging directly with different groups of staff.

Overseas Visitor and Migrant NHS Cost Recovery Programme: Formative Evaluation - Final Report

Ipsos MORI was commissioned to undertake a formative evaluation of the Overseas Visitor and Migrant NHS Cost Recovery Programme. This DH report finds that progress has been made in improving the awareness of the programme and the majority of key planned activities have been delivered within the first two years of the programme. The evaluation highlights challenges such as the need for greater support for staff, the level of resourcing required for cost recovery and the level of buy-in from senior trust staff.

State of Maternity Services Report 2016

This annual report from the Royal College of Midwives examines the statistics and figures around maternity services in order to identify emerging issues and trends. This year's report identifies a demographic change in both patients and workforce. The number of midwives under 50 has fallen and the report highlights concerns around a future shortfall of midwives in the UK's workforce.

Tuesday, 7 February 2017

Prescription Drug Misuse Among Youth a Global Concern

Prescribing drugs to those in need while simultaneously curbing nonmedical use of these same drugs may be one of the world’s most difficult challenges, according to a perspective article published in the journal World Psychiatry.

Nonmedical prescription drug use is defined as using without a prescription or for reasons other than what the medication is intended for. It is a global problem primarily driven by the increasing nonmedical use of prescription opioids among young people.

Time to Talk Day: the mental health statistics you need to know

Time to Talk Day, an annual drive by Time to Change, is a campaign led by charities Mind and Rethink Mental Illness, intended to encourage people to speak out about their mental health and end widespread stigma.

Launched in 2014 and held on the first Thursday in February, the day has reached millions of people, enabling vital conversations about mental illness at work, in schools, and between friends and families. It's also a chance for bosses to think about stigma at the workplace, and includes an Employer Pledge.

Could adding friction to spending improve people's mental health?

A recent report from the Money and Mental Health Policy Institute has revealed what many people with mental health problems already knew – mental illness can have a significant, and often terrifying, impact on your finances.

Banks, the report argued, are simply not doing enough to protect people in this position. Many of the options available to other vulnerable people are simply not offered to those with mental health issues. People with visual or hearing impairments, for example, have a wider range of communication options – these could also benefit those with anxiety. Adults with conditions like Down’s syndrome are sometimes offered “third party mandate” accounts, and even corporate or high net worth accounts have options to set spending limits or delegate permissions to named individuals – functionalities that could be advantageous to many others.

First-person shooter, first-person surgeon

RCS Bulletin Volume: 99 Issue: 2, February 2017, pp. 72-74. DOI: http://dx.doi.org/10.1308/rcsbull.2017.72

Performing surgery is an extremely complex, highly visual activity. Case notes or operative notes have their limitations in documenting the complexity of surgery. Video recording allows for detailed capturing of all intraoperative events within their rich context, and intraoperative recording is becoming increasingly important for training, assessment and medicolegal purposes.

In this report, we investigated the feasibility of using of a head-mounted digital camera with a head strap to record surgery from the surgeon’s point of view. We determined whether a relatively cheap and readily available device can be used intraoperatively to serve the same function as purpose-designed cameras, with comparable quality.

UHCW Research: M Venus

A million decisions campaign

Health Education England and the Chartered Institute of Library and Information Professionals have launched a joint campaign for decisions in the healthcare sector to be fully evidence-based. Every day more than a million decisions are made that have a profound and lasting impact on people's lives and which influence the quality of healthcare and the cost of services. The #milliondecisions campaign calls for everyone involved in policy making and care delivery to use the skills of librarians and knowledge specialists in meeting their obligations under the Health and Social Care Act 2012

Cumbria’s new persistent physical symptom management service – improving value for patients, the population and the NHS

The new persistent physical symptom management service (PPSS) introduced by Cumbria CCG in April 2016, offers GPs a single point of access to a biopsychosocial symptoms management service, whatever the patients’ diagnosis. Early evaluation shows it is improving access; has high patient and GP satisfaction; and there is positive improvement on core measures for Improving Access to Psychological Therapies (IAPT) depression and quality of life outcomes. Early financial indicators, whilst not the key driver, look to show measurable cost savings.

Recovering the cost of NHS treatments given to overseas visitors

New regulations requiring all hospitals to check upfront whether patients are eligible for free NHS treatment will be in place under plans to recover the cost of health treatments provided to patients not ordinarily resident in the UK.

Legal changes will require all hospitals to establish whether patients are eligible for free treatment, and to charge upfront those who are not eligible, for any non-urgent, planned care. The law will change from April 2017.

Work In Progress: Towards A Leaner, Smarter Public Sector Workforce

This report from Reform evaluates recent governments’ approaches to workforce design across the NHS, education, central and local government and the police. It argues that the current workforce is a legacy of past approaches and is built around siloed attitudes of past governments. The report makes the case for greater automation and user-centered service design in order to meet user expectations and improve outcomes.

New physiotherapy and occupational therapy degree apprenticeship launched

A hospital trust from Lincolnshire has been given ministerial approval to lead on the development of the first ever apprenticeship degree for the roles of physiotherapist and occupational therapist (OT).

The degree apprenticeship hopes to boost numbers of allied health professionals (which include physiotherapist and occupational therapist roles) in a bid to tackle both local and national staffing shortages. It will provide an alternative route for those wishing to become a registered healthcare professional but who want to combine their studies with on the job training.

The Trailblazer group, led by United Lincolnshire Hospitals NHS Trust (ULHT) and the Lincolnshire Talent Academy, will develop a nationally recognised standard for these roles. The group will include representatives from NHS Employers, multiple NHS trusts from across the country and employer representatives from small and medium sized private organisations, in addition to the College of Occupational Therapists and the Chartered Society of Physiotherapy.

The Economics of Health Inequality in the English NHS: the Long View

This paper from the Centre for Health Economics provides a historical overview of health inequality policy in England and how government policy and academic research has evolved over time in response to shifts in socioeconomic inequalities.

Tuesday, 28 February 2017

ARSAC Notes for Guidance: good clinical practice in nuclear medicine

Nearly one in four cardiac arrests in pregnancy are associated with complications of obstetric anaesthesia

Collaboration is key to the diabetes model of care

Financial Sustainability Of The NHS

Molecular testing strategies for Lynch syndrome in people with colorectal cancer

Monday, 27 February 2017

What Effect Does Prenatal and Postpartum Maternal Depression Have on Children?

Extend GP mental health training to improve eating disorder care

Drug misuse prevention: targeted interventions

Can community projects offer a way to affordable care?

How to achieve best practice in supported decision-making

Development and implementation of non-medical practitioners in acute care

Case report of a successful pregnancy following spontaneous haemoperitoneum of pregnancy due to endometriosis

P1 Risk-adjusted colorectal cancer screening using the FIT: development of a risk prediction model

Tears of colonoscopy

Validation of an NGS mutation detection panel for melanoma

Health and social care integration

Winter Insight: NHS 111

Patients with rare conditions to benefit from new treatments

Working Longer Group launches new resources for managers and staff

Friday, 24 February 2017

Can methylphenidate be used for adults with attention deficit hyperactivity disorder (ADHD)?

Transforming community care

Zika virus: epidemiology and cases diagnosed in the UK

Tackling cyberbullying in the NHS

Spreading new care models

Productivity, Technology And The NHS

SAS Doctor Development: Summary of Resources and Further Work

New outpatient tariffs and the impact on ophthalmology – managing change for commissioning services

Supporting safer care for full-term babies

Thursday, 23 February 2017

Maternal mental health – women's voices

Finding a hidden gem for mental health

Older people are losing out on Psychological Therapy

Cat ownership not linked to mental health problems

Antenatal corticosteroids reduce breathing problems in late preterm babies

Delivering Outcomes Based Care in Diabetes

Funding available for innovations to improve health care

Latest Pharmacological Technology Briefings - February 2017

Very Senior Manager (VSM) update

Lateral interbody fusion in the lumbar spine for low back pain

Trabecular stent bypass microsurgery for open-angle glaucoma

Everolimus for advanced renal cell carcinoma after previous treatment

Apremilast for treating active psoriatic arthritis

Migalastat for treating Fabry disease

Better Beginnings: Improving Health For Pregnancy

Latest NHS sickness absence figures - October 2016

Wednesday, 22 February 2017

Social Care funding

New guidance on police support for incidents on mental health wards

Treatment strategy for anorexia

Collaborative care provides improvement for older adults with mild depression

Mental health of young carers highlighted in study

Parkinson’s disease with motor fluctuations: safinamide - evidence summary (ES6)

Ultrasound could help diagnose giant cell arteritis

Use of physostigmine in patients presenting to the emergency department with anticholinergic poisoning

Mycobacterium chimaera infections: guidance for secondary care

Tuesday, 21 February 2017

The impact of between analytical platform variability on the classification of pleural effusions into exudate or transudate using Light's criteria

Delivering sustainability and transformation plans

Wheelchair data published for October-December 2016

Quarterly Performance of the Provider Sector as at 31 December 2016

Use of Agency Workers in the Public Sector

Re: Should we consider devolution of "head and neck" surgery from the specialties of oral and maxillofacial surgery; ear, nose and throat surgery; and plastic surgery?

State of the Health System: Beds in the NHS

What Caused The Spike In Mortality In England And Wales In January 2015?

2017-2020 Stroke Delivery Plan

Cancer annual report 2016

Post-transplant food safety is imperative

Improving patient care by improving data visualistation and safety support mechanisms: interim assessment.

Decision tree and random forest models for outcome prediction in antibody incompatible kidney transplantation

Adult social care: market shaping

Monday, 20 February 2017

Tadalafil Medical Expulsive Therapy in Ureteral Calculi: A New Kid on the Block?

Osteoarthritis pain management app launched

Improving A&E performance: innovative ideas from the north of England

Radical treatment for bladder cancer

National Audit of Cardiac Rhythm Management Devices

Use of Epinephrine in Out-of-Hospital Cardiac Arrest