Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh.
From the NIHR Dissemination Centre
Thursday, 31 August 2017
Treating subclinical thyroid dysfunction in pregnancy probably has no benefit
Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years.
A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism.
From the NIHR Dissemination Centre
A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism.
From the NIHR Dissemination Centre
Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck [TA473]
New Evidence-based recommendations on cetuximab (Erbitux) for treating recurrent or metastatic squamous cell cancer of the head and neck in adults.
Cetuximab in combination with platinum-based chemotherapy is recommended as an option for treating recurrent or metastatic squamous cell cancer of the head and neck in adults only:
Cetuximab in combination with platinum-based chemotherapy is recommended as an option for treating recurrent or metastatic squamous cell cancer of the head and neck in adults only:
- if the cancer started in the oral cavity and
- when the company provides the drug in line with the commercial access agreement with NHS England.
Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab [TA472[
New Evidence-based recommendations on obinutuzumab (Gazyvaro) with bendamustine for adults with follicular lymphoma that did not respond or progressed after treatment with rituximab.
Obinutuzumab in combination with bendamustine followed by obinutuzumab maintenance is recommended for use within the Cancer Drugs Fund as an option for treating adults with follicular lymphoma that did not respond or progressed during or up to 6 months after treatment with rituximab or a rituximab-containing regimen, only if the conditions in the managed access agreement for obinutuzumab are followed.
Obinutuzumab in combination with bendamustine followed by obinutuzumab maintenance is recommended for use within the Cancer Drugs Fund as an option for treating adults with follicular lymphoma that did not respond or progressed during or up to 6 months after treatment with rituximab or a rituximab-containing regimen, only if the conditions in the managed access agreement for obinutuzumab are followed.
Eluxadoline for treating irritable bowel syndrome with diarrhoea [TA471]
New Evidence-based recommendations on eluxadoline (Truberzi) for treating irritable bowel syndrome with diarrhoea in adults.
Eluxadoline is recommended as an option for treating irritable bowel syndrome with diarrhoea in adults, only if:
- the condition has not responded to other pharmacological treatments (for example, antimotility agents, antispasmodics, tricyclic antidepressants) or
- pharmacological treatments are contraindicated or not tolerated, and
- it is started in secondary care.
Fungitell for antifungal treatment stratification [MIB118]
New The technology described in this briefing is Fungitell, which measures serum levels of (1–3)‑beta‑D-Glucan (BDG), a marker of fungal infection.
The innovative aspects are that the Fungitell test is designed to determine the presence of several different fungal pathogens within 1 hour, which is much faster than current culture-based methods.
The innovative aspects are that the Fungitell test is designed to determine the presence of several different fungal pathogens within 1 hour, which is much faster than current culture-based methods.
Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer [IPG590]
New Evidence-based recommendations on biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer in adults. This involves using a liquid gel or a balloon to increase the distance between the prostate and the rectum to reduce the amount of radiation reaching the rectum.Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer
1 Recommendations
1.1 Current evidence on the safety and efficacy of insertion of a biodegradable spacer to reduce rectal toxicity during radiotherapy for prostate cancer is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
1.2 The procedure should only be done by clinicians with training in, and experience of, transperineal interventional procedures.
Staff friends and family test data
NHS England has published Q1 2017/18 data for the version of the friends and family test used to gauge the attitudes of staff to their place of work.
Anti-inflammatory drug may help prevent heart attacks
"Anti-inflammatory drug 'cuts heart attack risk'," BBC News reports. A major study found canakinumab – an anti-inflammatory drug originally designed to treat rheumatoid arthritis – could also reduce the risk of having another heart attack in people who have already had one.
The study included more than 10,000 people who'd already had a heart attack. They were assigned to receive either injections of the drug canakinumab or a placebo.
Canakinumab is an engineered antibody designed to modify the immune system. It turns off the process of inflammation, making it useful for serious inflammatory conditions like rheumatoid arthritis.
Not everyone who has a heart attack has raised cholesterol levels, so it's unclear whether giving statins to these groups of patients would reduce the risk of another heart attack. The researchers wanted to see if a drug that reduces inflammation would be of more use.
After four years, researchers found people who received the higher doses of canakinumab (150mg or 300mg) were significantly less likely to have had another heart attack or a stroke, or to have died from cardiovascular disease.
But people taking the drug had a higher risk of developing fatal infections. Though this outcome was rare, it's a serious risk that needs investigation.
The study included more than 10,000 people who'd already had a heart attack. They were assigned to receive either injections of the drug canakinumab or a placebo.
Canakinumab is an engineered antibody designed to modify the immune system. It turns off the process of inflammation, making it useful for serious inflammatory conditions like rheumatoid arthritis.
Not everyone who has a heart attack has raised cholesterol levels, so it's unclear whether giving statins to these groups of patients would reduce the risk of another heart attack. The researchers wanted to see if a drug that reduces inflammation would be of more use.
After four years, researchers found people who received the higher doses of canakinumab (150mg or 300mg) were significantly less likely to have had another heart attack or a stroke, or to have died from cardiovascular disease.
But people taking the drug had a higher risk of developing fatal infections. Though this outcome was rare, it's a serious risk that needs investigation.
Sexual health, reproductive health and HIV: a review of commissioning
This report from Public Health England outlines the findings of a 2016 survey, carried out jointly with the Association of Directors of Public Health, which aimed to gain a clear picture of the commissioning arrangements for sexual health, reproductive health and HIV services. The survey found that whilst there has been progress in improving services and the development of collaborative approaches there is also evidence of structural concerns which have the potential to impede effective commissioning. Key findings from the survey highlight the fragmentation of commissioning, barriers to access for those at greatest risk, increasing financial pressures and patient demand, and workforce concerns.
Endovascular management of iliac artery dissection during renal transplantation
CIRSE 2017 - P-670
We present a renal failure patient who received a donor kidney complicated with flow-limiting external iliac dissection.We demonstrate through our case that this rare complication can be
successfully managed with endovascular techniques that salvage a failing donor kidney.
UHCW Research: M.J. Maddock and J. Harding
We present a renal failure patient who received a donor kidney complicated with flow-limiting external iliac dissection.We demonstrate through our case that this rare complication can be
successfully managed with endovascular techniques that salvage a failing donor kidney.
UHCW Research: M.J. Maddock and J. Harding
Wednesday, 30 August 2017
Successful endovascular treatment of external iliac artery dissection causing renal allograft dysfunction
CIRSE 2017 P-639
We describe the diagnosis and endovascular treatment of external iliac artery dissection shortly following renal transplantation; this is a rare complication. This case emphasizes the high level of clinical suspicion needed to diagnose rare postoperative vascular complications and the importance of early interventional radiology involvement.
UHCW Research: R.S. Sagoo1, C. Imray, F. Lam and J. Harding
We describe the diagnosis and endovascular treatment of external iliac artery dissection shortly following renal transplantation; this is a rare complication. This case emphasizes the high level of clinical suspicion needed to diagnose rare postoperative vascular complications and the importance of early interventional radiology involvement.
UHCW Research: R.S. Sagoo1, C. Imray, F. Lam and J. Harding
Handbook of Anaesthesia & Peri-operative Medicine
9781910079195. TFM Publishing Ltd. 2017
Edited by Chandrashekhar Vaidyanath, University Hospitals Coventry and Warwickshire NHS Trust
Edited by Chandrashekhar Vaidyanath, University Hospitals Coventry and Warwickshire NHS Trust
Case Report: An Unusual Presentation of Metastatic Renal Cell Carcinoma with Per-Vaginal Bleeding
Urology & Nephrology Open Access Journal. Volume 4 Issue 2 - 2017
Renal cell carcinoma is an aggressive cancer, which could explain why as many as a third of cases are diagnosed as metastatic at presentation. With the incidence of renal cell carcinoma on the rise and a 5-year survival rate of just over 10% with metastatic disease, it is important to highlight the role of early detection of this cancer in order to optimize management and improve outcomes. Vulva and vagina represent rare sites for metastases from renal cell cancer, with clear cell renal cell cancer accounting for about a fifth of metastatic vulval cancer. We focus on this rare presentation of vulvo-vaginal metastases from renal clear cell carcinoma by presenting an unusual case of per-vaginal bleeding 3 months following detection of a renal lesion on CT imaging and highlight the importance of having a multidisciplinary approach to managing such complex cases to provide patients with the best possible outcomes.
UHCW Research: B Pisavadia, A Mevcha, D Patel, B Sinha, ARJ Blacker and AA Deshpande
Renal cell carcinoma is an aggressive cancer, which could explain why as many as a third of cases are diagnosed as metastatic at presentation. With the incidence of renal cell carcinoma on the rise and a 5-year survival rate of just over 10% with metastatic disease, it is important to highlight the role of early detection of this cancer in order to optimize management and improve outcomes. Vulva and vagina represent rare sites for metastases from renal cell cancer, with clear cell renal cell cancer accounting for about a fifth of metastatic vulval cancer. We focus on this rare presentation of vulvo-vaginal metastases from renal clear cell carcinoma by presenting an unusual case of per-vaginal bleeding 3 months following detection of a renal lesion on CT imaging and highlight the importance of having a multidisciplinary approach to managing such complex cases to provide patients with the best possible outcomes.
UHCW Research: B Pisavadia, A Mevcha, D Patel, B Sinha, ARJ Blacker and AA Deshpande
A qualitative examination of patients experiences of dietitians ' consultation engagement styles within nephrology
J Hum Nutr Diet. 00, 00–00 https://doi.org/10.1111/jhn.12504
Dietitians provide individuals with tailored, practical nutritional advice. For this reason, skills in effective interpersonal communication are essential. In the case of chronic kidney disease, the specifics of dietary advice may change according to renal function. The conveyance of accurate dietary advice and compliance is critical and requires full engagement with the service. The effect of communication styles on patients ' engagement experiences with renal dietetics is unknown. Accordingly, the present study aimed to explore patients ' engagement experiences with renal dietitians.
UHCW Research: Andrew Morris
Dietitians provide individuals with tailored, practical nutritional advice. For this reason, skills in effective interpersonal communication are essential. In the case of chronic kidney disease, the specifics of dietary advice may change according to renal function. The conveyance of accurate dietary advice and compliance is critical and requires full engagement with the service. The effect of communication styles on patients ' engagement experiences with renal dietetics is unknown. Accordingly, the present study aimed to explore patients ' engagement experiences with renal dietitians.
UHCW Research: Andrew Morris
Extracellular cardiac matrix biomarkers in patients with reduced ejection fraction heart failure as predictors of response to cardiac resynchronisation therapy: a systematic review
Conclusion Collagen synthesis biomarkers offer the most potential as ECM biomarkers for predicting CRT response. Heterogeneity between these studies was large and limited the ability to pool and compare results numerically. Use of different response definitions was one of the biggest challenges.
UHCW Research: Christopher J McAloon, Danish Ali, Prithwish Banerjee and Faizel Osman
UHCW Research: Christopher J McAloon, Danish Ali, Prithwish Banerjee and Faizel Osman
Factitious disorder: a rare cause of haematemesis
Clin J Gastroenterol (2017). https://doi.org/10.1007/s12328-017-0771-y
Acute upper gastrointestinal (GI) bleeding is a common condition in the UK with 50–70,000 admissions per year. In 20% of cases no cause can be found on endoscopy. Here, we present the case of a young female patient who was admitted on three occasions with large volume haematemesis and bleeding from other sites. She was extensively investigated and underwent multiple endoscopic procedures. She was eventually diagnosed with factitious disorder after concerns were raised about the inconsistent nature of her presentations. She was found to be venesecting herself from her intravenous cannula, and ingesting the blood to simulate upper GI bleeding. This is a rare cause of ‘haematemesis’ but perhaps not as rare as is thought.
UHCW Research: Jayne Eaden, Nicola Burch and Ben Disney
Acute upper gastrointestinal (GI) bleeding is a common condition in the UK with 50–70,000 admissions per year. In 20% of cases no cause can be found on endoscopy. Here, we present the case of a young female patient who was admitted on three occasions with large volume haematemesis and bleeding from other sites. She was extensively investigated and underwent multiple endoscopic procedures. She was eventually diagnosed with factitious disorder after concerns were raised about the inconsistent nature of her presentations. She was found to be venesecting herself from her intravenous cannula, and ingesting the blood to simulate upper GI bleeding. This is a rare cause of ‘haematemesis’ but perhaps not as rare as is thought.
UHCW Research: Jayne Eaden, Nicola Burch and Ben Disney
Whole body computed tomography for trauma: friend or foe?
Whole body CT (WBCT) is now an accepted practice in the primary management of the major trauma patient, but there remains a notable absence of a universal clinical decision tool for patient selection in any country. In the UK, The Royal College of Radiologists advises that a polytrauma protocol Multi-Detector Computed Tomography (MDCT) is indicated when there is haemodynamic instability, the mechanism of injury or presentation suggests that there may be occult severe injuries that cannot be excluded by clinical examination or plain films, plain films or Focussed Assessment with Songraphy for Trauma (FAST) suggest significant injury or there is obvious severe injury on clinical assessment.1 The 2016 National Institute for Health and Care Excellence Major Trauma Guidelines also broadly recommended to use WBCT in patients with ‘blunt major trauma and suspected multiple injuries’.2
Trauma team leaders must use their clinical judgement to weigh up the potential benefits of detecting significant injury with diagnostic certainty, against the risk of radiation exposure, the use of potentially nephrotoxic intravenous contrast and the cost of blocking a valuable imaging resource.
When assessing risks of imaging, the standard WBCT is equivalent to 2100 chest radiographs or 11 years of background radiation in the UK. The overall lifetime risk of developing an invasive cancer is 1 in 3 for women and 1 in 2 for men, and for a 20-year-old female, a WBCT will create an estimated additional lifetime risk of cancer of 1 in 184 or a 99.45% chance of having no effect.3 Younger age, female sex, higher body mass index and cumulative scans create a higher risk. However, the true risk of radiation exposure is impossible to quantify. Studies reporting cancer risk include …
UHCW Research: Caroline Leech
Major trauma in older people: implications for anaesthesia and intensive care medicine
Editorial in Anaesthesia. DOI: 10.1111/anae.14027
The Trauma Audit and Research Network (TARN ) is the independent monitor of trauma care in England and Wales. It produces reports for participating hospitals three times a year, and has also produced national reports on major trauma in children [1, 2]. It is the trauma equivalent of the Intensive Care National Audit and Research Centre (ICNARC) for Intensive Care Medicine. The latest themed report has just been published and is entitled ‘Major trauma in older people’ [3]. This first report on trauma in older people from TARN was written by a multidisciplinary group of healthcare professionals and we were privileged to be the representatives from anaesthesia.
UHCW Research: D. Surendra Kumar
The Trauma Audit and Research Network (TARN ) is the independent monitor of trauma care in England and Wales. It produces reports for participating hospitals three times a year, and has also produced national reports on major trauma in children [1, 2]. It is the trauma equivalent of the Intensive Care National Audit and Research Centre (ICNARC) for Intensive Care Medicine. The latest themed report has just been published and is entitled ‘Major trauma in older people’ [3]. This first report on trauma in older people from TARN was written by a multidisciplinary group of healthcare professionals and we were privileged to be the representatives from anaesthesia.
UHCW Research: D. Surendra Kumar
'It's like taking a bit of masculinity away from you': towards a theoretical understanding of men's experiences of infertility
Sociology of Health & Illness; Oxford
39.6 (Jul 2017): 878-892.
In the UK, nearly half of all cases of infertility involve a 'male-factor'. Yet, little empirical work has explored how men as men negotiate this terrain. Three interrelated concepts; 'hegemonic masculinity', 'embodied masculinity' and the linkages between 'masculinities' and male help-seeking, provide the theoretical framework that guided a qualitative study conducted with 22 men experiencing infertility. The paper explores men's propensity to delay their help-seeking in relation to infertility despite their desire for children. It also demonstrates how, in the context of infertility, the male body can be defined as both a failed entity in itself (unable to father a child) and a subordinated social entity (unable to measure up to hegemonic ideals) that characterises men's masculine identities. The paper also illustrates how men appear willing to accept responsibility for their infertility and adopt aspects of hitherto subordinate masculine practice. This does not, however, constitute the total unravelling of well understood and accepted expressions of masculinity. Finally, the paper demonstrates how infertility is perceived as having the potential to fracture current and even future relationships. Moreover, regardless of how well men measured up to other hegemonic ideals, ultimately they can do little to counteract the threat of other (fertile) men.
UHCW Research: Tarek Ghobara
39.6 (Jul 2017): 878-892.In the UK, nearly half of all cases of infertility involve a 'male-factor'. Yet, little empirical work has explored how men as men negotiate this terrain. Three interrelated concepts; 'hegemonic masculinity', 'embodied masculinity' and the linkages between 'masculinities' and male help-seeking, provide the theoretical framework that guided a qualitative study conducted with 22 men experiencing infertility. The paper explores men's propensity to delay their help-seeking in relation to infertility despite their desire for children. It also demonstrates how, in the context of infertility, the male body can be defined as both a failed entity in itself (unable to father a child) and a subordinated social entity (unable to measure up to hegemonic ideals) that characterises men's masculine identities. The paper also illustrates how men appear willing to accept responsibility for their infertility and adopt aspects of hitherto subordinate masculine practice. This does not, however, constitute the total unravelling of well understood and accepted expressions of masculinity. Finally, the paper demonstrates how infertility is perceived as having the potential to fracture current and even future relationships. Moreover, regardless of how well men measured up to other hegemonic ideals, ultimately they can do little to counteract the threat of other (fertile) men.
UHCW Research: Tarek Ghobara
Through each other's eyes
This document from the Mental Health Foundation evaluates a programme which sought to promote infants’ social and emotional development using video interaction guidance (VIG) where parents observe and reflect on video recordings of their positive interactions with their child. Results from the preliminary evaluations show that VIG has benefits for parents, practitioners and managers within early years services.
Health matters: making cervical screening more accessible
Attendance for cervical screening has been falling year on year. This professional resource aims to address this decline in attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.
Return to Practice Guidance: 2017 Revision
This AoMRC guidance is aimed at doctors who have been absent for three months or more and includes checklists for use pre (where possible) and post absence to conduct an individual evaluation of the doctor returning to practice. The guidance also gives recommendations for a return to practice action plan and suggests an organisational policy to ensure an effective return to practice in the interests of patient safety.
Consultation on standards of proficiency for registered nurses
The NMC's draft standards of proficiency reflect what we think the public will need in the future from the nurses who care for them. They are the minimum standards that a nurse will need to meet to be considered to be capable of safe and effective practice.
The consultation closes on the 12 September
NHS funds held on trust
NHS Funds Held on Trust
Guidance on the acceptance, management and
transfer of charitable funds for NHS bodies.
Culture of care barometer
The Culture of Care Barometer (CCB) is a survey tool designed to help organisations gauge the culture of care they provide. It supports organisations to understand the culture within organisations, multidisciplinary teams and groups by encouraging discussion and reflection.
NHS standard contract: guidance on the variations process (full-length and shorter-form contracts)
This document from NHS England contains guidance on the process to effect variations to a commissioning contract in the form of the NHS standard contract (full length or shorter-form) and is relevant to all commissioners and providers who are parties to an NHS standard contract.
Commissioning policy: Reimbursement of expenses for living donors
This is an NHS England policy designed to inform healthcare professionals and commissioning authorities about the principles and processes that underpin financial reimbursement for living organ donors.
Asthma action plans for HCPs working with non-English speakers
Asthma UK has responded to requests for non-English asthma action plans from healthcare professionals, pointing to the need for more health information in translation to help patients from ethnic minority populations to manage their asthma more effectively.
BOSU Surveillance Study Bursary
With the kind support from The Red Trust and the Ross Foundation, the BOSU is once again offering three research bursaries of £6000 to support ophthalmologists in training to undertake an epidemiological study of a rare eye condition through the British Ophthalmological Surveillance Unit or the Scottish Ophthalmological Surveillance Unit.
Estates professional services framework
This framework from the Crown Commercial Service enables organisations to buy advice, guidance and associated services to help them to manage their estates and assets, reduce property costs, release unwanted property assets, and identify savings and opportunities to generate income from land and buildings. It could save public sector bodies like local councils, NHS trusts, schools, the emergency services and housing associations £35 million over the next four years.
Managing patient flow and improving efficiencies: The role of technology
Having witnessed tracking technology first hand in two American health care organisations, Sophie Castle-Clarke sets out its strengths and how to implement it successfully.
Technology to track beds, equipment, staff and patients through a hospital has been used in the USA for years, with positive effect, and now there is growing interest in employing it in the NHS.
I joined a group of NHS leaders to look at how this technology has made a difference to flow and operational management in two different health care organisations in Florida. The results are impressive, although significant transformation is needed to realise the benefits.
Technology to track beds, equipment, staff and patients through a hospital has been used in the USA for years, with positive effect, and now there is growing interest in employing it in the NHS.
I joined a group of NHS leaders to look at how this technology has made a difference to flow and operational management in two different health care organisations in Florida. The results are impressive, although significant transformation is needed to realise the benefits.
‘Vaginal seeding’ birth trend could do more harm than good, say experts
The potential benefits of vaginal seeding do not outweigh the risks, according to a group of doctors who reviewed the available evidence published in BJOG: An International Journal of Obstetrics and Gynaecology.
Vaginal seeding is the practice of exposing babies born by caesarean section to their mother’s vaginal fluids in order to expose them to bacteria that may help to build their immunity against some chronic conditions, such as asthma and allergies. This involves taking a swab of vaginal fluid and applying it to the baby’s eyes, face and skin after birth.
Vaginal seeding is the practice of exposing babies born by caesarean section to their mother’s vaginal fluids in order to expose them to bacteria that may help to build their immunity against some chronic conditions, such as asthma and allergies. This involves taking a swab of vaginal fluid and applying it to the baby’s eyes, face and skin after birth.
Latest NHS sickness absence statistics - April 2017
The latest figures released by the NHS Digital show that NHS staff sickness absence has decreased from 4.01 per cent in April 2016 to 3.69 per cent April 2017. This is the lowest monthly rate since May 2011 when it was also 3.69 per cent.
Developing accountable care systems: lessons from Canterbury, New Zealand
New article published by the King's Fund
There are clear parallels between pressures the Canterbury health system was facing at the start of its programme of transformation and current pressures on the NHS – including financial deficits, rising demand and declining performance in emergency and elective care. Given the positive impact that the changes in Canterbury have had, it is worth considering the lessons that the NHS can learn as it embarks on its own journey of transformation.
The interventions and delivery models used in Canterbury offer practical lessons for other health systems, as does its approach to change, which includes a strong emphasis on system working, staff engagement, co-design and continuous quality improvement. Technology has been key to Canterbury’s success, and local investment and innovation have been central to this. Developing solutions in partnership with clinical users has been key to their successful design and uptake.
There are clear parallels between pressures the Canterbury health system was facing at the start of its programme of transformation and current pressures on the NHS – including financial deficits, rising demand and declining performance in emergency and elective care. Given the positive impact that the changes in Canterbury have had, it is worth considering the lessons that the NHS can learn as it embarks on its own journey of transformation.
The interventions and delivery models used in Canterbury offer practical lessons for other health systems, as does its approach to change, which includes a strong emphasis on system working, staff engagement, co-design and continuous quality improvement. Technology has been key to Canterbury’s success, and local investment and innovation have been central to this. Developing solutions in partnership with clinical users has been key to their successful design and uptake.
Is the NHS being privatised?
New article published by the King's Fund
Following the Health and Social Care Act 2012, the number of contracts awarded to private providers increased, though there is little evidence of a significant increase in spending on private providers or widespread privatisation of NHS services. In many cases the use of private providers to treat NHS patients reflects operational challenges within NHS providers and is a continuation of longstanding practices. Provided that patients receive care that it is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver. More positively, the NHS can benefit from partnerships and joint ventures with the private sector to deliver some clinical and non-clinical services.
Following the Health and Social Care Act 2012, the number of contracts awarded to private providers increased, though there is little evidence of a significant increase in spending on private providers or widespread privatisation of NHS services. In many cases the use of private providers to treat NHS patients reflects operational challenges within NHS providers and is a continuation of longstanding practices. Provided that patients receive care that it is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver. More positively, the NHS can benefit from partnerships and joint ventures with the private sector to deliver some clinical and non-clinical services.
Does the NHS need more money?
There is still scope to improve productivity in the NHS. Emerging evidence from the Getting It Right First Time programme – which aims to improve quality of care and increase productivity in more than 30 clinical specialties – underlines the opportunities to reduce waste, improve clinical practice and tackle unwarranted variations in care. However, the NHS can no longer maintain quality of care and meet performance standards within its current budget. In the short term, the government will need to find additional funding if the NHS is to be able to deliver the current range of services to existing standards of care. In the long term, as the OBR has made clear, NHS spending will need to increase as a proportion of GDP. As the Barker Commission argued, this is affordable if hard choices are made about taxation and public spending.
Cancer in the West Midlands
The aim of this report is to equip care providers and policy makers with an insight into the burden of cancer, as well as providing an overview of the extent of the identified risk factors, across the West Midlands population. It is intended to be used by commissioners of health services to enable more timely diagnosis and improve treatment pathways, and also by local authority commissioners in terms of the wider prevention agenda.
New charging regulations for overseas visitors
From Monday 23 October 2017 new charging regulations will apply for overseas visitors receiving healthcare in England.
The regulations place a new legal obligation on NHS providers to charge for non-urgent treatment in advance, once you have established whether a person is eligible. Commissioners will be implementing these arrangements with all providers of NHS-funded community and secondary care including independent providers.
When charges apply, the relevant body must make and recover charges in advance of providing NHS services, unless doing so would prevent or delay the provision of immediately necessary or urgent treatment.
The regulations place a new legal obligation on NHS providers to charge for non-urgent treatment in advance, once you have established whether a person is eligible. Commissioners will be implementing these arrangements with all providers of NHS-funded community and secondary care including independent providers.
When charges apply, the relevant body must make and recover charges in advance of providing NHS services, unless doing so would prevent or delay the provision of immediately necessary or urgent treatment.
Achieving excellence in pharmaceutical care: a strategy for Scotland
The strategy sets out a vision of how pharmaceutical care will evolve in Scotland and the contribution of pharmacists and pharmacy technicians, working together with other health and social care practitioners, to improve the health of the population and impact on health outcomes, especially for those with multiple long term and complex conditions.
Police calls for mental health issues up by a third
Calls to the Metropolitan Police about mental health have risen by almost a third in five years, figures show.
That compares to 86,520 in 2011-12 and equates to about 315 a day.
Call-outs included to people involved in or suspected of crime, those in crisis, support to other emergency services and local council health assessments.
Forty thousand of the calls had a police unit assigned - or sent out - to them, the detail showed.
The calls were a mixture of emergency 999 and 101 calls.
Read more HERE.
Better mental health: JSNA toolkit
The release of this toolkit signals the National Mental Health Intelligence Network’s (NMHIN) intent to support the development of mental health and wellbeing joint strategic needs assessments (JSNAs). It has been developed for those seeking to understand the breadth and complexity of mental health issues in their area, such as JSNA and mental health leads in local authorities and clinical commissioning groups (CCGs). It helps people to consider factors that affect mental health and wellbeing and to identify some of the key data, information and knowledge that local areas may use to build a picture of need.
Stocktake of local mental health prevention planning arrangements
This report provides a high-level summary of how local areas are currently incorporating mental health promotion and prevention of mental ill-health in their planning processes. The stocktake was undertaken by
the Kings Fund on commission from Public Health England.
The findings are based primarily on a content analysis of key planning documents in 35 local areas. This included a random sample of 16 areas across England and 19 areas selected as possible examples of transferable effective practice.
The findings from this review were used in the development of the ‘Prevention Concordat for Better Mental Health Prevention Planning Resource’.
The findings are based primarily on a content analysis of key planning documents in 35 local areas. This included a random sample of 16 areas across England and 19 areas selected as possible examples of transferable effective practice.
The findings from this review were used in the development of the ‘Prevention Concordat for Better Mental Health Prevention Planning Resource’.
Psychosocial pathways and health outcomes
This report highlights the current evidence that exists about the
relationships between social determinants, psychosocial factors and health outcomes.
It also provides a conceptual framework that focuses on the psychosocial pathways between factors associated with social, economic and environmental conditions, psychological and psychobiological processes, health behaviours and mental and physical health outcomes.
It also provides a conceptual framework that focuses on the psychosocial pathways between factors associated with social, economic and environmental conditions, psychological and psychobiological processes, health behaviours and mental and physical health outcomes.
Mental health services: cost-effective commissioning
Public Health have published return on investment resources to support local commissioners in designing and implementing mental health and wellbeing support services.
Tuesday, 29 August 2017
Overuse of Antipsychotic Medications for Developmental Disorders
A new study finds that antipsychotic medication is often prescribed to individuals with intellectual and developmental disabilities (IDD), often in the absence of an
accompanying psychiatric diagnosis. Common IDD include Down syndrome,
fetal alcohol syndrome, and autism.
Canadian researchers believe the findings suggest that antipsychotic medications are being used to manage behavioral issues, a practice that is only recommended if other options have failed.
The
study was conducted by the Centre for Addiction and Mental Health
(CAMH) and Institute for Clinical Evaluative Sciences (ICES) and appears
in The Canadian Journal of Psychiatry.
Canadian researchers believe the findings suggest that antipsychotic medications are being used to manage behavioral issues, a practice that is only recommended if other options have failed.
Arthritis: the hidden impact on mental health
Journalist Juliette Wills has lived with inflammatory spinal arthritis
for 18 years. In part two of a six-part series, she meets 28-year-old
Anoushka, who has had to resign from two jobs and is awaiting her ninth
operation.
Arthritis is an unforgiving condition that doesn’t just cause physical pain; for many people it impacts so dramatically on their quality of life that it also causes emotional pain. A study conducted by Revealing Reality for the charity Arthritis Research UK found that a quarter of people with arthritis say they often or frequently feel “low or depressed” on account of their condition. This comes as no surprise to Dr Tom Margham, who works closely with the charity.
Arthritis is an unforgiving condition that doesn’t just cause physical pain; for many people it impacts so dramatically on their quality of life that it also causes emotional pain. A study conducted by Revealing Reality for the charity Arthritis Research UK found that a quarter of people with arthritis say they often or frequently feel “low or depressed” on account of their condition. This comes as no surprise to Dr Tom Margham, who works closely with the charity.
Cognitive-behavioral therapy particularly efficient in treating ADHS in adults
Cognitive-behavioral therapy (CBT) group training was shown to achieve
the same results as neurofeedback training in treating attention-deficit
hyperactivity disorder (ADHD). Both methods led to a comparable
decrease in symptoms. CBT, however, proved to be generally more
efficient, concluded new research.Read more HERE.
Psychotic disorders and obesity: New report shows big waistlines are to blame
A number of factors, including obesity, shorten the lifespan for those with schizophrenia by 20 years and by 10 years for those with bipolar disorder compared to the general population. In the first study to
compare long-term weight gain across psychotic disorders, researchers
show that expanding waistlines and the way body fat is distributed are
largely to blame.
One in five women with postpartum mood disorders keep quiet
A recent study from North Carolina State
University finds that 21 percent of recent mothers experiencing postpartum mood disorders (PPMDs), such as anxiety and depression, do not disclose their symptoms to healthcare providers.
Thursday, 24 August 2017
Radiofrequency treatment for haemorrhoids [IPG589]
Radiofrequency treatment for haemorrhoids Current evidence on the safety and efficacy of radiofrequency treatment for haemorrhoids is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do radiofrequency treatment for haemorrhoids should: Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having radiofrequency treatment for haemorrhoids (see section 7.1).
Clinicians wishing to do radiofrequency treatment for haemorrhoids should: Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having radiofrequency treatment for haemorrhoids (see section 7.1).
Liposuction for chronic lymphoedema [IPG588]
Liposuction for chronic lymphoedema Current evidence on the safety and efficacy of liposuction for chronic lymphoedema is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Patient selection should only be done by a multidisciplinary team as part of a lymphoedema service.
Wednesday, 23 August 2017
Holoclar for treating limbal stem cell deficiency after eye burns [TA467]
Holoclar (ex vivo expanded autologous human corneal epithelial cells containing stem cells) is recommended as an option in people with moderate to severe limbal stem cell deficiency after eye burns, only if:
- it is only used to treat 1 eye and
- people have already had a conjunctival limbal autograft or
- there is not enough tissue for a conjunctival limbal autograft or
- it is contraindicated andthe company provides it with the discount agreed in the patient access scheme.
Maternity care must not become further polarised
Bill Kirkup on the storm that has erupted following the royal college decision to withdraw its guidance on promoting normal birth Maternity care must not become further polarised
Last week, the Royal College of Midwives removed its guidance on promoting “normal” birth. That has been followed by an exchange of claims and counter claims in the press and in social media.
Last week, the Royal College of Midwives removed its guidance on promoting “normal” birth. That has been followed by an exchange of claims and counter claims in the press and in social media.
Baricitinib for moderate to severe rheumatoid arthritis [TA466]
Baricitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis Baricitinib for moderate to severe rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs), only if:
- disease is severe (a disease activity score [DAS28] of more than 5.1) and
- the company provides baricitinib with the discount agreed in the patient access scheme.
Baricitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to or who cannot have other DMARDs, including at least 1 biological DMARD, only if:
- disease is severe (a DAS28 of more than 5.1) and
- they cannot have rituximab and
- the company provides baricitinib with the discount agreed in the patient access scheme.
Baricitinib can be used as monotherapy for people who cannot take methotrexate because it is contraindicated or because of intolerance, when the criteria in sections 1.1 and 1.2 are met.
- Continue treatment only if there is a moderate response measured using European League Against Rheumatism (EULAR) criteria at 6 months after starting therapy. After an initial response within 6 months, withdraw treatment if at least a moderate EULAR response is not maintained.
- These recommendations are not intended to affect treatment with baricitinib that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma [TA465]
Olaratumab, in combination with doxorubicin, is recommended for use within the Cancer Drugs Fund as an option for advanced soft tissue sarcoma in adults, only if:
- they have not had any previous systemic chemotherapy for advanced soft tissue sarcoma
- they cannot have curative treatment with surgery or their disease does not respond to radiotherapy
- the conditions in the managed access agreement for olaratumab are followed. Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma
This recommendation is not intended to affect treatment with olaratumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
VEST external stent for coronary artery bypass grafts [MIB115]
The technology:
VEST (venous external support; Vascular Graft Solutions [VGS]) is an external stent for use in coronary artery bypass graft (CABG) surgery in which at least 1 saphenous vein is used as the bypass conduit. It is designed to improve conduit haemodynamics and reduce lumen irregularities, wall tension and intimal hyperplasia, with the ultimate aim of reducing the progression of vein graft disease and therefore the need for reintervention.
VEST is made of a cobalt chromium alloy mesh, which is designed to be kink and crush resistant. It is available in various lengths and diameters, and its implantation is done in a similar way to standard grafting techniques. Before being implanted, the correct size is chosen using the VGS selection tool (provided with the device). During CABG, VEST is threaded over the nonpressurised vein graft towards the distal anastomosis, then manipulated to cover the distal end of the graft (for sequential segments, an additional VEST device may be needed). VEST is then expanded by gently squeezing until it covers the entire vessel length. In doing so, VEST elongates and simultaneously reduces in diameter (for sequential grafts, this step is repeated for each VEST threaded onto each segment). Expansion can be done either before or after stitching the proximal anastomosis. VEST external stent for coronary artery bypass grafts
VEST cannot be used:
- for vein graft segments less than 4 cm
- for vein graft segments with an external pressurised diameter less than 3 mm
- in people with a known allergy to cobalt chrome alloy or its components. VEST was previously marketed as VGS Fluent.
Innovations: VEST is the only external stent designed to be used with vein grafts during CABG. It is designed to reduce the incidence of future cardiac events and the need for further interventions in people who have had CABG.
Bisphosphonates for treating osteoporosis [TA464]
Oral bisphosphonates (alendronic acid, ibandronic acid and risedronate sodium) are recommended as options for treating osteoporosis in adults only if:
- The person is eligible for risk assessment as defined in NICE's guideline on osteoporosis (recommendations 1.1 and 1.2) andthe 10‑year probability of osteoporotic fragility fracture is at least 1%.
- Intravenous bisphosphonates (ibandronic acid and zoledronic acid) are recommended as options for treating osteoporosis in adults only if:the person is eligible for risk assessment as defined in NICE's guideline on osteoporosis (recommendations 1.1 and 1.2) and the 10‑year probability of osteoporotic fragility fracture is at least 10% or the 10‑year probability of osteoporotic fragility fracture is at least 1% and the person has difficulty taking oral bisphosphonates (alendronic acid, ibandronic acid or risedronate sodium) or these drugs are contraindicated or not tolerated.
- Estimate the 10‑year probability of osteoporotic fragility fracture using the FRAX or QFracture risk tools, in line with NICE's guideline on osteoporosis.
- The choice of treatment should be made on an individual basis after discussion between the responsible clinician and the patient, or their carers, about the advantages and disadvantages of the treatments available. If generic products are available, start treatment with the least expensive formulation, taking into account administration costs, the dose needed and the cost per dose.
- These recommendations are not intended to affect treatment with alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid that was started in the NHS before this guidance was published. Adults having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Point of care ultrasound VS CT pulmonary angiogram in suspected pulmonary embolus
The ability of a multiorgan POCUS approach to help risk-stratify patients with clinical signs and symptoms of PE appears very promising, but more data are needed to make a definitive statement regarding validity in clinical practice.
Prehospital finger thoracostomy in patients with traumatic cardiac arrest
Tension pneumothorax is a cause of traumatic cardiac arrest that must be considered and rapidly treated if suspected. Finger thoracostomy can be performed quickly and with a low rate of complications. It appears acceptable for use as a method of chest decompression in the pre-hospital environment. Further research is required to evaluate its use by non-HEMS crews, with consideration to integrating ultrasound detection into the clinical decision making where feasible.
Syntocinon for postpartum haemorrhage (query bank)
Answer to the query, Is there any new evidence on the use of syntocinon infusion for the prevention and treatment of PPH? In particular, is there any evidence that a particular dose or regime is better? Is there any evidence that 20units in 2hours is as safe and as effective as a 40 unit syntocinon infusion over 4hours (10 units per hour)? posted to the RCOG Query Bank.
Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need to be treated to prevent one extra episode of vomiting.Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery.
From the NIHR Dissemination Centre
Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery.
From the NIHR Dissemination Centre
Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit
The benefits of giving anti-epileptic medication to children aged between six months and seven years who have had a convulsion while feverish, do not outweigh the harms. While diazepam given when a child becomes feverish reduced the chance of a convulsion from about 25% to 18% after a year, one in three children experienced adverse effects. Therefore, the authors suggest benefits do not seem to outweigh the harms.Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
New ‘Teach First’ to train teachers as mental health specialists
UK charity aims to recruit and develop teachers specially to help vulnerable pupils at risk of exclusion.
Alternative providers support children turned away by other schools. They can make the difference between hope and hopelessness, life and death,’ says Kiran Gill, founder of The Difference.
Alternative providers support children turned away by other schools. They can make the difference between hope and hopelessness, life and death,’ says Kiran Gill, founder of The Difference.
Young Cyberbullying Victims are at Double-Risk of Self-Harm
A new UK study finds that children and young people under-25 who become victims of cyberbullying are more than twice as likely to enact self-harm and attempt suicide than non-victims.
An interesting aspect of cyberbullying is that the perpetrator, or the person committing cyberbullying, is also more likely to experience suicidal thoughts and behaviors.
The
collaborative research, led by investigators at the University of
Birmingham, included the review of more than 150,000 children and young
people across 30 countries, over a 21-year period.
An interesting aspect of cyberbullying is that the perpetrator, or the person committing cyberbullying, is also more likely to experience suicidal thoughts and behaviors.
Tuesday, 22 August 2017
Biopatch for venous or arterial catheter sites [MIB117]
The technology described in this briefing is Biopatch. It is a hydrophilic foam dressing impregnated with chlorhexidine gluconate (CHG), and is used for covering central venous or arterial catheter sites.
The innovative aspects are that it releases CHG to reduce the risk of catheter-related bloodstream infections (CRBSIs), while the absorbent foam draws discharge away from the catheter site.
The intendedplace in therapy would be as an addition to standard sterile semipermeable transparent dressings to reduce the risk of a CRBSI in people with venous or arterial catheters.
The key points from the evidence summarised in this briefing are from 6 non-UK-based randomised controlled trials in a total of 3,674 adults and children in secondary care settings. Results are mixed with some evidence showing reductions in rates of bacterial colonisation and the number of CRBSIs compared with standard dressings in patients with venous or arterial catheters, and some showing no difference between Biopatch and standard care.
The innovative aspects are that it releases CHG to reduce the risk of catheter-related bloodstream infections (CRBSIs), while the absorbent foam draws discharge away from the catheter site.
The intendedplace in therapy would be as an addition to standard sterile semipermeable transparent dressings to reduce the risk of a CRBSI in people with venous or arterial catheters.
The key points from the evidence summarised in this briefing are from 6 non-UK-based randomised controlled trials in a total of 3,674 adults and children in secondary care settings. Results are mixed with some evidence showing reductions in rates of bacterial colonisation and the number of CRBSIs compared with standard dressings in patients with venous or arterial catheters, and some showing no difference between Biopatch and standard care.
Urethrotech UCD for difficult or failed catheterisation [MIB116]
The technology described in this briefing is the Urethrotech urethral catheterisation device (UCD). It is designed to be used for difficult or failed catheterisations in men.Urethrotech UCD for difficult or failed catheterisation
The innovative aspect is that it is the only currently available system which integrates a guidewire into a standard Foley catheter.
The intended place in therapy would be instead of cystoscopy and supra-pubic catheterisation methods after standard catheterisation has failed, or when it is difficult (such as in men with an enlarged prostate). The device could potentially be used in any healthcare setting by appropriately trained staff.
The main points from the evidence summarised in this briefing are from 2 conference abstracts reporting prospective non-comparative studies including a total of 157 patients in a UK setting. They show that the Urethrotech UCD can be a useful urethral catheterisation method in men, and reported no adverse events.
The innovative aspect is that it is the only currently available system which integrates a guidewire into a standard Foley catheter.
The intended place in therapy would be instead of cystoscopy and supra-pubic catheterisation methods after standard catheterisation has failed, or when it is difficult (such as in men with an enlarged prostate). The device could potentially be used in any healthcare setting by appropriately trained staff.
The main points from the evidence summarised in this briefing are from 2 conference abstracts reporting prospective non-comparative studies including a total of 157 patients in a UK setting. They show that the Urethrotech UCD can be a useful urethral catheterisation method in men, and reported no adverse events.
Cabozantinib for previously treated advanced renal cell carcinoma - guidance (TA463)
Cabozantinib is recommended, within its marketing authorisation, as an option for treating advanced renal cell carcinoma in adults after vascular endothelial growth factor (VEGF)-targeted therapy, only if the company provides cabozantinib with the discount agreed in the patient access scheme.
Evidence-based recommendations on cabozantinib (Cabometyx) for previously treated advance renal cell carcinoma in adults.
Evidence-based recommendations on cabozantinib (Cabometyx) for previously treated advance renal cell carcinoma in adults.
Mechanical clot removal for stroke reduces disability at two years
Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care.https://discover.dc.nihr.ac.uk/portal/article/4000740/mechanical-clot-removal-for-stroke-reduces-disability-at-two-years
Over a third of those in the thrombectomy group had good functional outcome compared with less than a quarter of the standard care group who received clot busting drugs. This was similar to the results at 90 days and was associated with improved quality of life in terms of self-care and mobility. Findings came from a trial of almost 400 people followed up over two years in the Netherlands.
From the NIHR Dissemination Centre
Over a third of those in the thrombectomy group had good functional outcome compared with less than a quarter of the standard care group who received clot busting drugs. This was similar to the results at 90 days and was associated with improved quality of life in terms of self-care and mobility. Findings came from a trial of almost 400 people followed up over two years in the Netherlands.
From the NIHR Dissemination Centre
A staged, endovascular approach to treat a ruptured external iliac artery mycotic pseudoaneurysm in an intravenous drug user: A case report
Int J Surg Case Rep. 2017 Aug 5;39:115-118. doi: 10.1016/j.ijscr.2017.07.054. [Epub ahead of print]
We have shown a successful outcome in managing a challenging patient using endovascular techniques as a bridge to definitive arterial reconstruction. This circumvents traditional approaches including primary arterial ligation, which carry a risk of limb-loss.
UHCW Research: Ahmad M, Poh YW and Imray CHE
We have shown a successful outcome in managing a challenging patient using endovascular techniques as a bridge to definitive arterial reconstruction. This circumvents traditional approaches including primary arterial ligation, which carry a risk of limb-loss.
UHCW Research: Ahmad M, Poh YW and Imray CHE
Elective care: model access policy
The purpose of this policy from NHS England is to ensure all patients requiring access to outpatient appointments, diagnostics and elective inpatient or day-case treatment are managed in line with national waiting time standards and the NHS Constitution.
Delivering high quality end of life care for people who have a learning disability
This guidance from NHS England provides resources and tips for commissioners, service providers and health and social care staff providing, or delivering care to people with a learning disability at the end of their lives.
Integrated support and assurance process
These documents describe the integrated NHS England and NHS Improvement process for supporting commissioners and providers looking to procure and bid for complex contracts.
Specialised services quality dashboards
These dashboards are designed to provide assurance on the quality of care by collecting information about outcomes from healthcare providers. The dashboards are a key tool in monitoring the quality of services, enabling comparison between service providers and supporting improvements over time in the outcomes of services commissioned by NHS England.
Plans to improve NHS Continuing Healthcare assessment processes
This letter, from NHS England, outlines revised guidance in relation to NHS Continuing Healthcare assessments in order to promote a reduction in delayed transfers of care.
The reduction in Delayed Transfers of Care (DTOCs) is a key priority for the NHS, with delays needing to reduce from approximately 6,428 per day to 4,080 per day in order to release the needed bed capacity within health systems. It is estimated that resolution of the factors causing delays due to NHS CHC assessment could help free up to a quarter of the total number of beds the NHS is required to release
New scheme launched to help NHS whistleblowers
A nationwide pilot to help NHS whistleblowers back into work has been launched by NHS England.
The Whistleblowers Support Scheme will offer a range of services including career coaching, financial advice and mediation for primary care staff who have suffered as a result of raising concerns about NHS practice. Working Transitions has been appointed to run the pilot until March 2018.
The scheme has been designed with the help of former staff who have also had experience of whistleblowing and the impact it can have on staff.
The Whistleblowers Support Scheme will offer a range of services including career coaching, financial advice and mediation for primary care staff who have suffered as a result of raising concerns about NHS practice. Working Transitions has been appointed to run the pilot until March 2018.
The scheme has been designed with the help of former staff who have also had experience of whistleblowing and the impact it can have on staff.
Details of clinical placements released
Details have been released by Health Education England (HEE) regarding the arrangements for funding additional clinical placements in nursing, midwifery and allied health pre-registration education.
NHS Digital launches e-nursing week campaign
NHS Digital has launched its first ever e-nursing week in support of the campaign for a digital-ready workforce.
Membrane sweeping (query bank)
Answer to the query How often can we do stretch and sweep / membrane sweep on term patients? Is there a limit on how many such procedures are recommended? Posted to the RCOG Query Bank
Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition
This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It aims to support healthcare professionals identify malnourished people and help them to choose the most appropriate form of support.
This guideline includes recommendations on:
Asfotase alfa for treating paediatric-onset hypophosphatasia [HST6]
Asfotase alfa (Strensiq) is available on the NHS as a possible treatment for paediatric-onset hypophosphatasia for people
- who meet particular criteria for treatment (outlined in the 5‑year managed access arrangement) and
- if they (or their parents or carers) agree to the conditions in this arrangement, such as attending clinics, data collection and assessment of how well the treatment is working.
- If you are not eligible for asfotase alfa but are already taking it, you should be able to continue until you and your doctor decide when best to stop.
Antidepressant Medications are not Placebos
A new Swedish study rebukes the assertion that the benefit of antidepressant drugs, especially selective serotonin reuptake inhibitors (SSRIs), are a result of the placebo effect.
The theory had gained considerable attention in international media, including Newsweek and the CBS broadcast 60 minutes.
According to the challenged hypothesis, the fact that many people medicating with antidepressants regard themselves as improved was because they expected to be improved by the medication — even if the medicine lacks actual effect.
The theory had gained considerable attention in international media, including Newsweek and the CBS broadcast 60 minutes.
Back-to-school worries for parents? One in three very concerned bullying, cyberbullying
Bullying and cyberbullying top parents' list of worries when it comes to their children's health, according to a new report from the C.S. Mott Children's Hospital National Poll on Children's Health at the University of Michigan. Close behind are internet safety and stress, motor vehicle accidents, and school violence.
But worries differed among racial groups, with African-American parents saying they were most concerned about racial inequities and school violence affecting their children.
The report is based on responses from 2,051 adults -- including 1,505 parents of children ages 0-18- from a nationally representative household survey. Read more HERE
But worries differed among racial groups, with African-American parents saying they were most concerned about racial inequities and school violence affecting their children.
The report is based on responses from 2,051 adults -- including 1,505 parents of children ages 0-18- from a nationally representative household survey. Read more HERE
Position statement on children and young peoples' mental health
This intercollegiate statement, produced in conjunction with the Royal College of Paediatrics and Child Health and the Royal College of Psychiatrists, outlines five principles to improve the care and support of children and young people (CYP) with mental health problems. The guidance highlights the need for a shared vision for CYP mental health across all professions and agencies.
Monday, 21 August 2017
Eye Scans Detect Signs of Alzheimer’s Years Before Patients Show Symptoms
A new study shows that a noninvasive eye scan could detect the key signs of Alzheimer’s disease years before patients experience symptoms.
According to neuroscience investigators at Cedars-Sinai, Alzheimer’s disease affects the retina — the back of the eye — similarly to the way it affects the brain.
Using
a high-definition eye scan developed especially for the study,
researchers detected the warning signs of Alzheimer’s disease:
Amyloid-beta deposits, a buildup of toxic proteins.
According to neuroscience investigators at Cedars-Sinai, Alzheimer’s disease affects the retina — the back of the eye — similarly to the way it affects the brain.
Call for mental health 'champions' to help 999 workers
Calls have been made for more emergency service workers to take on a role offering mental health support to colleagues.
More than 50 people have signed up to the role since the launch of the initiative in April.
Emergency services said they are increasing the different types of mental health support available. The most recent figures from Mind Cymru showed about 90% of emergency workers have experienced stress while 25% have contemplated suicide.
Wheelchair services data collection: Q1 2017/18 data
NHS England has published wheelchair data for April to June 2017, which shows that waiting times continue to reduce slightly
Degree level apprenticeship standard in occupational therapy released for consultation
The degree level apprenticeship standard in occupational therapy has been released for consultation.
Use of buccal cortex as interpositional graft in mandibular setbacks
Br J Oral Maxillofac Surg.2017 Aug 14. pii: S0266-4356(17)30240-1. doi: 10.1016/j.bjoms.2017.07.009. [Epub ahead of print]
The most commonly used options for mandibular fixation after sagittal split ramus osteotomy (SSRO) are monocortical plates and bicortical screws, which have comparable stability.1 We have recently changed our practice to the routine use of bicortical screws where possible, particularly for mandibular setbacks. They are faster to place and need to be removed less often than miniplates.2
UHCW Research: Rohit Chandegra and Peter Stockton
The most commonly used options for mandibular fixation after sagittal split ramus osteotomy (SSRO) are monocortical plates and bicortical screws, which have comparable stability.1 We have recently changed our practice to the routine use of bicortical screws where possible, particularly for mandibular setbacks. They are faster to place and need to be removed less often than miniplates.2
UHCW Research: Rohit Chandegra and Peter Stockton
Thoracic incisions for open surgery
Shanghai Chest 2017;1:20
A large number of thoracic surgical procedures are still being performed via open incisions. The indications, approaches and potential benefits vary depending of the procedure to be performed, experience of the surgeons and patients’ choice. Even for surgeons with advanced minimally invasive skills open surgery remains the choice for certain procedures. We aim to describe in detail different incisions for open thoracic surgery, alongside their indications, possible pitfalls and advantages. Intraoperative pictures have been taken in order to clearly describe different steps of these different approaches.
UHCW Research: Antonio E. Martin-Ucar
A large number of thoracic surgical procedures are still being performed via open incisions. The indications, approaches and potential benefits vary depending of the procedure to be performed, experience of the surgeons and patients’ choice. Even for surgeons with advanced minimally invasive skills open surgery remains the choice for certain procedures. We aim to describe in detail different incisions for open thoracic surgery, alongside their indications, possible pitfalls and advantages. Intraoperative pictures have been taken in order to clearly describe different steps of these different approaches.
UHCW Research: Antonio E. Martin-Ucar
Friday, 18 August 2017
CVI has been updated – important changes for all ophthalmologists to be aware of
The Department of Health (England) has updated the Certificate of Vision Impairment and revised the Explanatory Notes for consultant ophthalmologists and hospital eye clinic staff in England.
Young people with chronic illness more likely to attempt suicide
Young people between the ages of 15 and 30
living with a chronic illness are three times more likely to attempt
suicide than their healthy peers, according to a new study from the
University of Waterloo.
The study found that chronic conditions -- such as asthma, diabetes and Crohn's disease -- increase a young person's odds of suicidal thoughts by 28 per cent and plans to die by suicide by 134 per cent. Having a chronic condition increases the odds of a suicide attempt by 363 per cent.
The study found that chronic conditions -- such as asthma, diabetes and Crohn's disease -- increase a young person's odds of suicidal thoughts by 28 per cent and plans to die by suicide by 134 per cent. Having a chronic condition increases the odds of a suicide attempt by 363 per cent.
Thursday, 17 August 2017
Depression overshadows the past as well as the present
Depressed people have a peculiar view of the past -- rather than glorifying the 'good old days', they project their generally bleak outlook on to past events, according to new research.
Psychologists at Germany's Heinrich Heine Universität Düsseldorf and at the UK's University of Portsmouth published their research in Clinical Psychological Science.
Now and Zen: Lower prenatal stress reduces risk of behavioral issues in kids
Expectant mothers may want to consider adopting today's trend towards
stress management, in light of new research pointing to its ability to
lower the risk of problematic behavior in their offspring. Researchers
found that mothers who are exposed to high levels of stress during pregnancy have kids who are more than twice as likely to have chronic symptoms of hyperactivity and conduct disorder.
Personalized Blood Tests Provide Better Way to Predict Suicide Risk
A newly developed universal blood test can help to predict if a person is at high suicide risk. Indiana University researchers say the
test is unique as it can be given to everyone. The scientists also
report the development of personalized blood tests for different
subtypes of suicidality, and for different psychiatric high-risk groups.
Researchers explain that two apps — one based on a suicide risk checklist and the other on a scale for measuring feelings of anxiety and depression – have been designed to be used in conjunction with the blood tests to enhance the precision of tests and to suggest lifestyle, psychotherapeutic, and other interventions.
Researchers explain that two apps — one based on a suicide risk checklist and the other on a scale for measuring feelings of anxiety and depression – have been designed to be used in conjunction with the blood tests to enhance the precision of tests and to suggest lifestyle, psychotherapeutic, and other interventions.
NHS Health Check 40-64 dementia pilot research findings
This report summarises the findings from a pilot project into the
effectiveness of dementia risk reduction messaging in NHS Health Checks.
It found that the pilot project showed promise in shifting public
awareness and understanding of dementia risk with 75 per cent of the 164
participants recalling the advice on dementia risk and 80 per cent
reporting that the advice would impact on their behaviour.
Rethink Mental Illness examine co-production in CCG mental health service design and delivery
A new report by Rethink Mental Illness explores the important role of co-production in mental health commissioning.
‘Progress through Partnership: involvement of people with lived experience of mental illness in CCG commissioning’ argues that co-production should be the norm, not the exception.
Rethink’s report suggests that, while there is national commitment to co-production, the majority of Clinical Commissioning Groups (CCGs) do not have clear plans in place for involving people with experience of mental illness in the design and commissioning of mental health services, also known as co-production. CCGs told Rethink that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts by experience.
Rethink submitted Freedom of Information requests to 209 CCGs, with 196 responding. They also undertook a literature review, carried out interviews and drew on qualitative data from their own co-produced services.
The FOI responses showed that:
‘Progress through Partnership: involvement of people with lived experience of mental illness in CCG commissioning’ argues that co-production should be the norm, not the exception.
Rethink’s report suggests that, while there is national commitment to co-production, the majority of Clinical Commissioning Groups (CCGs) do not have clear plans in place for involving people with experience of mental illness in the design and commissioning of mental health services, also known as co-production. CCGs told Rethink that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts by experience.
Rethink submitted Freedom of Information requests to 209 CCGs, with 196 responding. They also undertook a literature review, carried out interviews and drew on qualitative data from their own co-produced services.
The FOI responses showed that:
- Only 15 percent of CCGs has used a co-production approach at least once in mental health commissioning
- Only 8 percent had ambition to increase co-production
- Only 1 percent explicitly stated that co-production was a standard approach to commissioning
Connecting allied health professionals (AHPs)
NHS Improvement recently hosted four regional events for provider AHP leads on evidencing the quality and productivity of AHPs’ care.
The events provided an introductionopens in a new window to the Model Hospital, AHP job planning, and the early findings of a deployment tracker metric that some AHP leads are currently implementing.
The events provided an introductionopens in a new window to the Model Hospital, AHP job planning, and the early findings of a deployment tracker metric that some AHP leads are currently implementing.
Alternative cancer therapies' may increase your risk of death
"Cancer patients who use alternative medicine more than twice as likely to die," is the stark message from The Independent. Researchers found that people who chose alternative medicine instead of conventional cancer treatments were much less likely to survive for at least five years.
Conventional treatments included surgery, radiotherapy, chemotherapy or hormone treatments. The research only applies to people who choose not to have conventional treatments.
Overall, 78% of people having conventional treatment for cancer survived at least five years, compared to only 55% of people having alternative treatment alone. The difference was biggest for breast cancer, where people who chose alternative therapies were more than five times as likely to die within five years as those who chose conventional treatments.
Conventional treatments included surgery, radiotherapy, chemotherapy or hormone treatments. The research only applies to people who choose not to have conventional treatments.
Overall, 78% of people having conventional treatment for cancer survived at least five years, compared to only 55% of people having alternative treatment alone. The difference was biggest for breast cancer, where people who chose alternative therapies were more than five times as likely to die within five years as those who chose conventional treatments.
Latest patient-led assessments reveal quality of healthcare premises
NHS Digital has published annual patient-led assessments of non-clinical elements of care such as food and waiting areas.
This assessment focuses particularly on issues of access such as wheelchairs, mobility and signage, as well as provision of visual/audible appointment alert systems and hearing loops.
Information for nurses and midwives on responding to unexpected incidents or emergencies
Following recent terrorist incidents, the Nursing and Midwifery Council (NMC) has provided information for nurses and midwives on responding to unexpected incidents or emergencies.
Wednesday, 16 August 2017
Randomised feasibility trial into the effects of low-frequency electrical muscle stimulation in advanced heart failure patients
Low-frequency electrical muscle stimulation (LF-EMS) may have the potential to reduce breathlessness and increase exercise capacity in the chronic heart failure population who struggle to adhere to conventional exercise. The study’s aim was to establish if a randomised controlled trial of LF-EMS was feasible.
UHCW Research: Ennis, Stuart, McGregor, Gordon and Banerjee, Prithwish
Inpatient Monitoring of Decompensated Heart Failure: What Is Needed?
Current Heart Failure Reports pp 1–5 DOI 10.1007/s11897-017-0352-x
Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients.
UHCW Research: Ali, Danish
Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients.
UHCW Research: Ali, Danish
Evidence Based Data in Hand Surgery and Therapy
XXII. FESSH Congress & XII. EFSHT Congress 21-24 June 2017 | Budapest, Hungary
See 3.5 Systematic Review of the Management of Distal Radial Fractures
UHCW Research: Helen Hedley
See 3.5 Systematic Review of the Management of Distal Radial Fractures
UHCW Research: Helen Hedley
Shortlist of nine inspirational nominations for Kate Granger Awards
Nine nominees make up the final shortlist for this year’s Kate Granger Compassionate Care Awards.
The finalists were selected from 117 entrants in the three award categories. The shortlist is made up of three nominees in each of the three award categories. The first award is for an individual working in the NHS or delivering NHS funded services. The others are for teams or organisations who are part of the NHS, or who deliver NHS funded services. These services can be delivered in hospitals, or in a primary care, community or residential setting.
The finalists were selected from 117 entrants in the three award categories. The shortlist is made up of three nominees in each of the three award categories. The first award is for an individual working in the NHS or delivering NHS funded services. The others are for teams or organisations who are part of the NHS, or who deliver NHS funded services. These services can be delivered in hospitals, or in a primary care, community or residential setting.
The north-south NHS divide: how where you are not what you need dictates your care
This report, from the Medical Technology Group, outlines the findings of an examination of data from 209 CCGs to assess patient access to medical technology. It finds wide variation in access between the north and south of England and argues that CCG performance against access indicators should be made clearer to patients.
Awards recognise best use of patient feedback
NHS England is backing awards to recognise the best initiatives to improve NHS services through the use of insight and feedback from patients and staff.
The “using insight for improvement” category of the Patient Experience Network National Awards 2017 opened for entries on 31 July and will close on 24 November.
Revised ACO contract to replace MCP and PACS versions
In July 2016, NHS Improvement published the multispecialty community provider (MCP) emerging care model and contract framework. As well as describing the MCP care model in more detail, it introduced the MCP Contract and business model that underpins it. An initial draft version of the MCP Contract was published in December 2016 for a period of public engagement and informal feedback.
Following this feedback, the Accountable Care Organisation (ACO) Contract and supporting documents have now been revised for use by local commissioners to inform the early stages of their procurement processes. Importantly, the Contract can now be used for accountable care models generally, including MCP and integrated primary and acute care system (PACS) models.
The ACO Contract has been produced following intensive joint work with a number of vanguards with whom we are co-developing the approach to ensure that the Contract is able to help facilitate local plans.
We will be working with commissioners in the most advanced areas to test the revised Contract and to improve it further and plan to release an updated version for formal consultation in 2018.
Following this feedback, the Accountable Care Organisation (ACO) Contract and supporting documents have now been revised for use by local commissioners to inform the early stages of their procurement processes. Importantly, the Contract can now be used for accountable care models generally, including MCP and integrated primary and acute care system (PACS) models.
The ACO Contract has been produced following intensive joint work with a number of vanguards with whom we are co-developing the approach to ensure that the Contract is able to help facilitate local plans.
We will be working with commissioners in the most advanced areas to test the revised Contract and to improve it further and plan to release an updated version for formal consultation in 2018.
Report from the UK Shape of Training Steering Group
The UK Shape of Training Steering Group (UKSTSG), chaired by Professor Ian G Finlay, has today published its report providing policy advice and structure to guide implementation of the recommendations from Professor David Greenaway’s independent Shape of Training review.
- Report from the UK Shape of Training Steering Group (UKSTSG) (pdf)
- Annexes to the UK Shape of Training Steering Group Report (UKSTSG) (pdf)
- Four-nation ministerial statement (pdf)
See also the GMC's response.
Resources to support safe transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks
A resource alert has been issued by NHS Improvement to support providers to safely manage the transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks.
Patient safety incidents are occurring due to the accidental administration of medication intended for intravenous use via a neuraxial device, and vice versa, resulting in the patient receiving drugs through the wrong delivery route, which in some cases has been fatal.
To prevent these errors a new dedicated connector for neuraxial and regional block devices – NRFitTM (ISO 80369-6:2016) has been developed and is now being introduced to the NHS. Devices with this connector are not compatible with Luer connectors, preventing the risk of drugs being delivered through the wrong route. Industry has now adopted this new ISO standard for use throughout the UK and NRFitTM is now the dedicated connector for neuraxial devices. The Surety® devices introduced as an interim safety measure while the new ISO standard was being developed will now be discontinued.
To prevent these errors a new dedicated connector for neuraxial and regional block devices – NRFitTM (ISO 80369-6:2016) has been developed and is now being introduced to the NHS. Devices with this connector are not compatible with Luer connectors, preventing the risk of drugs being delivered through the wrong route. Industry has now adopted this new ISO standard for use throughout the UK and NRFitTM is now the dedicated connector for neuraxial devices. The Surety® devices introduced as an interim safety measure while the new ISO standard was being developed will now be discontinued.
Using mesh does not improve results in vaginal prolapse surgery
Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh. This large pragmatic study looked at over 3000 women with vaginal prolapse. Half of these were randomised; the rest contributed data but were not part of the main evaluation. The study separately compared mesh and biological grafts to a repair without these additions.
Monday, 14 August 2017
Older Adults Need More Follow-Up after ER Screenings for Suicide
Nearly half of adults over the age of 70 who committed suicide visited an emergency room in the year before their death.
However, when healthcare providers see older adults in the emergency room, some may be too quick to assume that the warning signs for suicide are just a natural part of aging. As a result, many older adults may not get the help they need to address suicidal thoughts, according to a new study.
According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides is higher among older adults than younger people. When older adults try to commit suicide, they are more likely to be successful compared to younger adults. This is why suicide prevention strategies are especially important for older men and women, researchers noted.
However, when healthcare providers see older adults in the emergency room, some may be too quick to assume that the warning signs for suicide are just a natural part of aging. As a result, many older adults may not get the help they need to address suicidal thoughts, according to a new study.
According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides is higher among older adults than younger people. When older adults try to commit suicide, they are more likely to be successful compared to younger adults. This is why suicide prevention strategies are especially important for older men and women, researchers noted.
Ambulance call-outs for mental health patients in England soar by 23%
The number of ambulance call-outs for people experiencing mental health problems in England has soared by nearly a quarter in two years.
Data obtained under the Freedom of Information Act shows paramedics helped over 30,000 more patients (172,799) in crisis in 2016-17 compared with 140,137 in 2014-15, a rise of 23%.
An additional 55,000 hours were spent supporting people with their mental health last year, compared with 2014-15 – up by 32%. In London the time spent rose by 45%, according to the request for information made by the Labour MP Luciana Berger.
Data obtained under the Freedom of Information Act shows paramedics helped over 30,000 more patients (172,799) in crisis in 2016-17 compared with 140,137 in 2014-15, a rise of 23%.
An additional 55,000 hours were spent supporting people with their mental health last year, compared with 2014-15 – up by 32%. In London the time spent rose by 45%, according to the request for information made by the Labour MP Luciana Berger.
Friday, 11 August 2017
Mesh Oversight Group Report on vaginal mesh implant
This Mesh Oversight Group Report follows on from the Mesh Working Group Interim Report of December 2015. Both reports are about vaginal mesh implants used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women.
See RCOG's and BSUG's joint response to the report.
See RCOG's and BSUG's joint response to the report.
STP progress dashboard
This report outlines baseline data for each STP area in England relating to progress so far on STP plans against nine domains. The nine domains focus on hospital performance, patient-focused change and transformation
See this briefing from The King's Fund. Yet more performance ratings for the NHS: new STP ratings are narrowly focused and centrally driven, which relates to the dashboard.
See this briefing from The King's Fund. Yet more performance ratings for the NHS: new STP ratings are narrowly focused and centrally driven, which relates to the dashboard.
21 teams selected to put innovative ideas into practice
The Health Foundation has selected 21 new projects to be part of the sixth round of its £1.5 million innovation programme, Innovating for Improvement.
Innovating for Improvement aims to improve health care delivery and/or the way people manage their own health care through the redesign of processes, practices and services.
The selected projects will be led by clinical teams and will develop their innovative ideas and approaches, put them into practice and gather evidence about how their innovation improves quality.
Innovating for Improvement aims to improve health care delivery and/or the way people manage their own health care through the redesign of processes, practices and services.
The selected projects will be led by clinical teams and will develop their innovative ideas and approaches, put them into practice and gather evidence about how their innovation improves quality.
Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial
Int J Chron Obstruct Pulmon Dis. 2016 Jun 2;11:1161-9. doi: 10.2147/COPD.S91253. eCollection 2016.
Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.
SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.
UHCW Research: C. Gelder, V. Johnson-Warrington
Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.
SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.
UHCW Research: C. Gelder, V. Johnson-Warrington
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services
What is this framework? It’s the first version of a national framework to guide local, regional and national action on developing NHS-funded staff.
Its sponsors are the main national organisations with NHS responsibilities. The framework applies to everyone in NHS-funded roles in all professions
and skill areas, clinical and otherwise. Future updates are expected to cover
people in social care as well.
What is the framework’s purpose? To equip and encourage people in NHS-funded roles to deliver continuous improvement in local health and care systems and gain pride and joy from their work. To that end, the framework aims to guide team leaders at every level of the NHS to develop a critical set of improvement and leadership capabilities among their staff and themselves.
What is the framework’s purpose? To equip and encourage people in NHS-funded roles to deliver continuous improvement in local health and care systems and gain pride and joy from their work. To that end, the framework aims to guide team leaders at every level of the NHS to develop a critical set of improvement and leadership capabilities among their staff and themselves.
National maternity and perinatal audit: organisational report 2017
This report finds large increase in midwife-led units co-located with obstetric units, increasing birthplace choice for pregnant women but also describes variation in availability of staff, facilities and services. The National Maternity and Perinatal Audit (NMPA) is the largest evaluation of NHS maternity and neonatal services undertaken in Britain. It aims to help maternity and neonatal services to identify good practice and areas for improvement in the care of women and babies.
National Heart Failure Audit 2015-16 published
Improvements in patient care mean hundreds more people are surviving heart failure, a new independent study has found.
The National Heart Failure Audit 2015-16, published by the British Society of Heart Failure has found that the mortality rate for people admitted to hospital with heart failure has dropped from 9.6 per cent to 8.9 per cent. The reduction in the mortality rate means that in the region of 500 lives have been saved in the past year compared to 2014/15.
The National Heart Failure Audit 2015-16, published by the British Society of Heart Failure has found that the mortality rate for people admitted to hospital with heart failure has dropped from 9.6 per cent to 8.9 per cent. The reduction in the mortality rate means that in the region of 500 lives have been saved in the past year compared to 2014/15.
Thursday, 10 August 2017
Loneliness Epidemic Growing into Biggest Threat to Public Health
Loneliness and social isolation could be a greater public health hazard than obesity, and their impact will continue to grow, according
to research presented at the 125th annual convention of the American
Psychological Association.
“Being connected to others socially is widely considered a fundamental human need — crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment,” said Julianne Holt-Lunstad, Ph.D., a professor of psychology at Brigham Young University.
“Being connected to others socially is widely considered a fundamental human need — crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment,” said Julianne Holt-Lunstad, Ph.D., a professor of psychology at Brigham Young University.
Cost-Benefit Analysis Favors Intensive Early Intervention for Autism
Early therapeutic intervention is considered best practice for children with an autism spectrum disorder. But many insurance carriers and agencies are reluctant to pay for the care.
New research suggests the costs associated with the intensive treatment are quickly recovered as the children will need less services over time.
Autism
spectrum disorder (ASD) affects one in every 68 children in the United
States. The neuro-developmental disorder presents as difficulty
socializing and communicating needs and desires, and often is
accompanied by restricted interests or activities.
New research suggests the costs associated with the intensive treatment are quickly recovered as the children will need less services over time.
Stress at work is 'causing' poor mental health in men
Men are more likely to blame work for mental health problems than women, according to a new report.
32% of men with poor mental health said work was responsible for their illness, compared to just 14% of women.
Charity Mind surveyed 15,000 people across the UK about the impact of their workplace.
30 organisations across the UK took part including Jaguar Land Rover, PepsiCo, Deloitte and Barnardo's.
Only 29% of men surveyed said they'd taken time off work due to mental health issues, compared to 43% of women.
32% of men with poor mental health said work was responsible for their illness, compared to just 14% of women.
Charity Mind surveyed 15,000 people across the UK about the impact of their workplace.
30 organisations across the UK took part including Jaguar Land Rover, PepsiCo, Deloitte and Barnardo's.
Only 29% of men surveyed said they'd taken time off work due to mental health issues, compared to 43% of women.
Lidocaine with propofol to reduce pain on injection
New from BestBETs:
Lidnocaine pre-treatment or mixed with propofol reduced pain at the injection site. Further research is however required to see how much of this effect is that of lidocaine alone or the change in propofol formulation.
Lidnocaine pre-treatment or mixed with propofol reduced pain at the injection site. Further research is however required to see how much of this effect is that of lidocaine alone or the change in propofol formulation.
Larotrectinib (LOXO-101) for advanced solid cancers [with an NTRK1, NTRK2, or NTRK3 gene fusion]
Due to new technologies, rearrangement of genes in cells can be discovered which result in two normally separate genes being brought together (a fusion), which can cause abnormalities in control of cell growth leading to development of solid tumor cancers. Fusions of a family of normal genes called NTRK have been found to cause normal cells to become cancerous and can happen in cells of both adults and children. Many different solid tumor cancers have NTRK fusions. Blocking the activity of these fusions with an oral drug called larotrectinib can be a new method of cancer treatment.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Atezolizumab (Tecentriq) and Cobimetinib (Cotellic) for advanced/metastatic colorectal cancer - third line
The combination of atezolizumab (Tecentriq), given by injection, and cobimetinib (Cotellic), given orally, is being developed to increase the options available for the treatment of mCRC. This treatment combination will target people that have received at least two previous treatments and did not show any improvements or who initially benefitted but whose disease has since progressed. It is thought that this treatment combination will increase the survival rates for people with mCRC.
From the NIHR Innovation Observatory
Pemetrexed for the maintenance treatment of non-small-cell lung cancer [TA190]
New NICE technology appraisal guidance on pemetrexed disodium (Alimta) for the maintenance treatment of non-small-cell lung cancer.
Pemetrexed is recommended as an option for the maintenance treatment of people with locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous cell histology if disease has not progressed immediately following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.
Pemetrexed is recommended as an option for the maintenance treatment of people with locally advanced or metastatic non-small-cell lung cancer other than predominantly squamous cell histology if disease has not progressed immediately following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.
Biopatch for venous or arterial catheter sites
Medt ech innovation briefing on Biopatch for venous or arterial catheter sites.
The technology described in this briefing is Biopatch. It is a hydrophilic foam dressing impregnated with chlorhexidine gluconate (CHG), and is used for covering central venous or arterial catheter sites.
The innovative aspects are that it releases CHG to reduce the risk of catheter-related bloodstream infections (CRBSIs), while the absorbent foam draws discharge away from the catheter site.
The innovative aspects are that it releases CHG to reduce the risk of catheter-related bloodstream infections (CRBSIs), while the absorbent foam draws discharge away from the catheter site.
Baricitinib for moderate to severe rheumatoid arthritis - guidance (TA466)
New technology appraisal guidance from NICE on baricitinib (Olumiant) for moderate to severe rheumatoid arthritis in adults.
Baricitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs), only if:
Baricitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs (DMARDs), only if:
- disease is severe (a disease activity score [DAS28] of more than 5.1) and
- the company provides baricitinib with the discount agreed in the patient access scheme.
Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma - guidance (TA465)
New technology appraisal guidance from NICE on olaratumab (Lartruvo) plus doxorubicin for treating advanced soft tissue sarcoma in adults.
Olaratumab, in combination with doxorubicin, is recommended for use within the Cancer Drugs Fund as an option for advanced soft tissue sarcoma in adults, only if:
Olaratumab, in combination with doxorubicin, is recommended for use within the Cancer Drugs Fund as an option for advanced soft tissue sarcoma in adults, only if:
- they have not had any previous systemic chemotherapy for advanced soft tissue sarcoma
- they cannot have curative treatment with surgery or their disease does not respond to radiotherapy
- the conditions in the managed access agreement for olaratumab are followed.
Cabozantinib for previously treated advanced renal cell carcinoma - guidance (TA463)
New technology appraisal guidance on cabozantinib (Cabometyx) for previously treated advance renal cell carcinoma (kidney cancer) in adults.
Cabozantinib is recommended, within its marketing authorisation, as an option for treating advanced renal cell carcinoma in adults after vascular endothelial growth factor (VEGF)-targeted therapy, only if the company provides cabozantinib with the discount agreed in the patient access scheme.
Cabozantinib is recommended, within its marketing authorisation, as an option for treating advanced renal cell carcinoma in adults after vascular endothelial growth factor (VEGF)-targeted therapy, only if the company provides cabozantinib with the discount agreed in the patient access scheme.
Asfotase alfa for treating paediatric-onset hypophosphatasia - guidance (HST6)
New Highle Specialised Technologies Guidance from NICE on asfotase alfa (Strensiq) for treating paediatric-onset hypophosphatasia in adults and children.
Asfotase alfa is recommended as an option for treating paediatric-onset hypophosphatasia only:
Asfotase alfa is recommended as an option for treating paediatric-onset hypophosphatasia only:
- for people who meet the criteria for treatment within the managed access arrangement (see section 4.18), and
- for the duration of this arrangement and in line with the other conditions it specifies, and
- when the company provides asfotase alfa with the confidential commercial terms agreed with NHS England.
Hysteroscopic sterilisation by insertion of intrafallopian implants - guidance (IPG587)
New interventional procedures guidance on hysteroscopic sterilisation by insertion of intrafallopian implants in adults.
Current evidence on the safety and efficacy of hysteroscopic sterilisation by insertion of intrafallopian implants is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance and audit.
Current evidence on the safety and efficacy of hysteroscopic sterilisation by insertion of intrafallopian implants is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance and audit.
Transcatheter aortic valve implantation for aortic stenosis - guidance (IPG586)
New NICE interventional procedures guidance on using transcatheter aortic valve implantation (TAVI) for aortic stenosis. This involves inserting a new valve through a catheter, usually by way of a large blood vessel at the top of the leg, into the heart and inside the existing faulty valve.
Current evidence on the safety and efficacy of transcatheter aortic valve implantation (TAVI) for aortic stenosis is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Current evidence on the safety and efficacy of transcatheter aortic valve implantation (TAVI) for aortic stenosis is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
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