Friday, 29 September 2017
TV/Video Games in Bedroom Can Lead to Child Issues
New research suggests that when a child has a TV or video games in their bedroom, negative consequences may happen.
Iowa State University investigators discovered bedroom access to TV or video games resulted in children spending less time reading, sleeping, or participating in other activities. In turn, these children did not do as well in school and were at greater risk for obesity and video game addiction.
Iowa State University investigators discovered bedroom access to TV or video games resulted in children spending less time reading, sleeping, or participating in other activities. In turn, these children did not do as well in school and were at greater risk for obesity and video game addiction.
Click here for news item
Postpartum depression risk, duration and recurrence
Postpartum affective disorder (AD), including postpartum depression (PPD), affects more than one in two hundred women with no history of prior psychiatric episodes, and raises the risk of later affective disorder for those women, according to a new study. Click here for news item
Community and inpatient mental health services in England and Wales up to 2016
The number of acute inpatient beds for adults with mental health problems in England and Wales fell by 15% between 2012/13 and 2015/16 while specialist community mental health services also reduced by about 6%, according to a new briefing published today by Centre for Mental Health with the NHS Benchmarking Network. Click here for news item by Centre for Mental Health
Look out for people at risk of having ADHD diagnosis missed, says NICE
NICE is urging doctors to think about a potential ADHD diagnosis in people who are at higher risk of having the condition, but who are usually overlooked. Click here for NICE news link
New CQC report on the state of care in mental health services
The Care Quality Commission (CQC) has launched the findings from its comprehensive review of mental health services.
The report, The state of care in mental health services 2014 to 2017, highlights several areas of concern over the last three years. Among them are the growing number of detentions under section 136 of the Mental Health Act; more people being forced to accept out-of-area care; longer waiting times for specialist treatments; variation and persistence in the use of restraints; and physical environments not designed to keep people safe. Click here for link to NHS Confederation
The report, The state of care in mental health services 2014 to 2017, highlights several areas of concern over the last three years. Among them are the growing number of detentions under section 136 of the Mental Health Act; more people being forced to accept out-of-area care; longer waiting times for specialist treatments; variation and persistence in the use of restraints; and physical environments not designed to keep people safe. Click here for link to NHS Confederation
Thursday, 28 September 2017
Costing newsletter: September 2017
Latest news from NHS Improvement's costing transformation programme. In this edition
- news about cost collections in 2018 - a big step towards a single national cost collection
- the national PLICS portal is ready to launch
- call for volunteers to review the 2018 acute standards and collection guidance
- your chance to have a say on mandating patient-level costing
- your opportunity to be a 2018 'early implementer'
Pathology networks
NHS Improvement has identified 29 potential pathology networks, allowing for the transformation of pathology services into a series of networks across the country.
They have been working with providers since the end of last year, to validate pathology data. These data collections have enabled the NHS to construct its most comprehensive picture of pathology services across the country, through which it is able to compare overall, regional and local performance year-on-year. By bringing together clinical expertise, pathology services will become more efficient, in order to deliver better value, high quality care for patients.
Sustainability and Transformation Fund (STF) and financial control totals: updated guidance
The 2017/18 and 2018/19 guidance has been revised to take account of the updated eligibility criteria for the 30% performance element of STF from quarter 2 onwards.
The payment of the whole 30% of these funds at Q2 and Q3 will be based on a combination of achieving the A&E 4 hour performance standard and also the required milestones on primary care front door streaming. The changes are detailed in section 3.5 of the revised guidance.
The payment of the whole 30% of these funds at Q2 and Q3 will be based on a combination of achieving the A&E 4 hour performance standard and also the required milestones on primary care front door streaming. The changes are detailed in section 3.5 of the revised guidance.
CSP launches video to demonstrate six simple exercises to stop falls
A new CSP animated video demonstrates how six simple exercises can keep people mobile and independent as they age.
The animation shows how the six exercises – widely used by physiotherapists – can reverse this trend, strengthen muscles and improve balance. While the animation is targeted at the general public, particularly those aged 55 and over, it is also designed to be used by physiotherapists and other health professionals working with older patients.
The animation shows how the six exercises – widely used by physiotherapists – can reverse this trend, strengthen muscles and improve balance. While the animation is targeted at the general public, particularly those aged 55 and over, it is also designed to be used by physiotherapists and other health professionals working with older patients.
Capital funds are coming for the NHS, but there's a catch
HSJ’s expert briefing on NHS finances, savings and efforts to get the health service back in the black.
Barring an unlikely U-turn from Philip Hammond, we know that more capital funding is coming in the autumn budget. What we don’t know is how much, or what the NHS will need to give up in return.
To obtain full article please contact libraryw@uhcw.nhs.uk
To obtain full article please contact libraryw@uhcw.nhs.uk
Healthcare on the brink: How parliamentarians can support their local NHS
The next five years will demand more from the NHS than at any point in its history.
Challenges in workforce, funding, transformation and mental health have been added to by uncertainty over Brexit negotiations, and in particular the UK’s status as a hub of medical research and the future of staff from the EU working in the UK.
Alongside this, in the last few years the UK has seen the largest growth in population since 1945 and significant growth in demand for health and care services from a rapidly ageing population. Yet funding growth during this period has been lower than at any time since the service was founded.
In spite of record demand, the National Health Service has coped and, throughout the UK, has continued to provide good care to millions. But the strains are also evident.
The NHS is gradually becoming unsustainable. Unless action is taken now, pressures will grow and patients will suffer.
This briefing from the NHS Confederation outlines the extent of the challenges facing the NHS and how MPs and Peers can support the health service at national and local level.
Challenges in workforce, funding, transformation and mental health have been added to by uncertainty over Brexit negotiations, and in particular the UK’s status as a hub of medical research and the future of staff from the EU working in the UK.
Alongside this, in the last few years the UK has seen the largest growth in population since 1945 and significant growth in demand for health and care services from a rapidly ageing population. Yet funding growth during this period has been lower than at any time since the service was founded.
In spite of record demand, the National Health Service has coped and, throughout the UK, has continued to provide good care to millions. But the strains are also evident.
The NHS is gradually becoming unsustainable. Unless action is taken now, pressures will grow and patients will suffer.
This briefing from the NHS Confederation outlines the extent of the challenges facing the NHS and how MPs and Peers can support the health service at national and local level.
Health & Care Women Leaders Network launches
NHS Employers is excited to launch its new-look women leaders network and announce its first full-day conference.
Formally known as the HSJ Women Leaders Network, the network now enters a new phase supported by NHS Employers and the NHS Confederation.
Book now for the Health & Care Women Leaders Conference
Formally known as the HSJ Women Leaders Network, the network now enters a new phase supported by NHS Employers and the NHS Confederation.
Book now for the Health & Care Women Leaders Conference
People with learning disabilities: making reasonable adjustments
These guides, recently updated by Public Health England, explain why reasonable adjustments must be made to health services and what adjustments help people with learning disabilities access services.
Risk of severe harm and death from infusing total parenteral nutrition too rapidly in babies
A warning alert has been issued by NHS Improvement on the risk of harm and death from infusing total parenteral nutrition too rapidly in babies.
High-precision radiotherapy for prostate cancer 'shows promise'
"Targeted radiotherapy 'cures' prostate cancer that kills thousands," reports The Times.
The news is based on a UK study of the use of high-precision radiotherapy to treat men with advanced localised prostate cancer.
Researchers wanted to see if they could safely target cancer cells that had spread outside the prostate to nearby lymph nodes without damaging nearby healthy cells, and reduce treatment side effects.
Prostate cancer is the most common cancer in men – more than 47,000 cases are diagnosed in the UK every year.
Some 447 men with locally advanced disease took part in the 10-year study, carried out by the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust.
The high-tech radiotherapy, called pelvic lymph node intensity modulated radiation therapy (PLN-IMRT), can modify the shape and strength of its beams to target cancerous cells more effectively.
The main aim of the study was to look at the side effects of the treatment, specifically on the bladder and bowels.
Five years after receiving treatment, up to 71% of patients were alive and disease-free. Only 8-16% of patients experienced bowel or bladder complications.
This is promising research that suggests PLN-IMRT should be studied further. Later-stage randomised controlled trials would be the best way of confirming the safety and potential benefit of this treatment for men with advanced localised prostate cancer and seeing how it compares with other treatment approaches.
The news is based on a UK study of the use of high-precision radiotherapy to treat men with advanced localised prostate cancer.
Researchers wanted to see if they could safely target cancer cells that had spread outside the prostate to nearby lymph nodes without damaging nearby healthy cells, and reduce treatment side effects.
Prostate cancer is the most common cancer in men – more than 47,000 cases are diagnosed in the UK every year.
Some 447 men with locally advanced disease took part in the 10-year study, carried out by the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust.
The high-tech radiotherapy, called pelvic lymph node intensity modulated radiation therapy (PLN-IMRT), can modify the shape and strength of its beams to target cancerous cells more effectively.
The main aim of the study was to look at the side effects of the treatment, specifically on the bladder and bowels.
Five years after receiving treatment, up to 71% of patients were alive and disease-free. Only 8-16% of patients experienced bowel or bladder complications.
This is promising research that suggests PLN-IMRT should be studied further. Later-stage randomised controlled trials would be the best way of confirming the safety and potential benefit of this treatment for men with advanced localised prostate cancer and seeing how it compares with other treatment approaches.
Treatment of Skin Disease E-Book: Comprehensive Therapeutic Strategies
Book. Various chapters. eISBN 978-0-7020-6913-0. Elsevier 2018
UHCW Research: Imtiaz Ahmed, Ajoy Bardhan, John Berth-Jones, Surod Qazaz, Rabia S. Rashid, Ure Eke, Joanna E. Gach, Andrew Ilchyshyn, Murtaza Khan and Tang Ngee Shim
UHCW Research: Imtiaz Ahmed, Ajoy Bardhan, John Berth-Jones, Surod Qazaz, Rabia S. Rashid, Ure Eke, Joanna E. Gach, Andrew Ilchyshyn, Murtaza Khan and Tang Ngee Shim
Wednesday, 27 September 2017
Improving staff retention: a guide for employers
This guide from NHS Employers reflects and builds upon the work that NHS Employers has been doing since late 2016 with 92 NHS trusts, to identify and implement actions that can reduce the rate of leavers in NHS organisations. It also includes a number of case studies that illustrate the breadth of work that is being done across the NHS to improve staff retention.
NICE sets out how to diagnose and treat Lyme disease
The draft NICE guidance outlines when doctors can diagnose Lyme disease without the need for tests.
If a person has had a tick bite and a circular red rash, known as erythema migrans, the draft guidance recommends doctors diagnose and treat Lyme disease with antibiotics.
If a person has had a tick bite and a circular red rash, known as erythema migrans, the draft guidance recommends doctors diagnose and treat Lyme disease with antibiotics.
NICE says not to give up on people trying to be independent after hospital discharge or in their own homes
In a new guideline on ‘intermediate care’ issued today NICE has set out how health and social care staff can support people to be independent following a hospital stay or when daily life at home becomes too difficult.
The new guideline covers how to assess intermediate care needs, including setting goals with the person so that they can overcome the problems they are experiencing.
NICE says staff should talk openly about any risks but in a positive manner so as not to discourage people. The aim is to ensure that people can confidently get on with the things they would like to do themselves whilst any risks are discussed and managed safely.
The new guideline covers how to assess intermediate care needs, including setting goals with the person so that they can overcome the problems they are experiencing.
NICE says staff should talk openly about any risks but in a positive manner so as not to discourage people. The aim is to ensure that people can confidently get on with the things they would like to do themselves whilst any risks are discussed and managed safely.
Tuesday, 26 September 2017
Caris Molecular Intelligence for guiding cancer treatment [MIB120]
NEW advice. Caris Molecular Intelligence for guiding cancer treatment
The technology described in this briefing is Caris Molecular Intelligence (CMI). It is used to help guide future management of locally advanced or metastatic cancer.
The innovative aspects are that it uses multi-platform molecular profiling to provide a report describing which cancer treatments may have clinical benefit and any relevant, open clinical trials. The profile is based on the molecular characteristics of the patient's tumour, irrespective of its primary site.
The intended place in therapy would be as a tool to help guide treatment decisions for locally advanced or metastatic cancer in people who are fit for further treatment but have exhausted standard (evidence-based) treatment options and for whom no further guidance on therapy exists.
The main points from the evidence summarised in this briefing are from 5 observational studies in Australia and the US including a total of 1,572 adults in secondary and tertiary care centres. Most evidence shows that CMI‑guided treatment is associated with better progression-free survival than clinician decisions alone. There is also some evidence that CMI may lead to improved overall survival.
Technology
Caris Molecular Intelligence (CMI, Caris Life Sciences) is a solid tumour biomarker analysis service. It is intended as a tool to aid decision-making and help identify the best treatment plan for each patient. CMI was marketed as Target Now until 2013.
CMI uses a number of tumour profiling techniques to analyse protein, RNA and DNA in the tumour:
immunohistochemistry, to determine level of protein expression in situ hybridisation, to detect deletions and amplifications in a specific set of genes RNA sequencing, to identify fusions and rearrangements of 53 genes next-generation sequencing to detect DNA mutations in 592 genes, amplifications in 442 genes, total mutational load and microsatellite instability.
Innovations
CMI is done in a centralised laboratory, covering a wider range of molecular testing techniques than may be available in a local laboratory. The results are analysed and summarised in a single report, so the ordering clinician does not need to collate results from multiple tests. The report includes a list of ongoing clinical trials that match the patient's biomarker expression profile, which means that its usefulness will depend on the number of included trials which are open to NHS patients.
If standard treatments in line with existing guidance have failed but the patient is still fit for further therapy, CMI profiling can identify which of the existing chemotherapies may be of benefit for the patient, based on ongoing research. This information may not currently be available to the oncology treatment team and some of these drugs may not have been considered for use in the specific tumour site before. Treatment decisions based on CMI would represent a shift from therapy based on tumour site to a precision medicine approach based on the unique molecular characteristics of a patient's tumour.
The technology described in this briefing is Caris Molecular Intelligence (CMI). It is used to help guide future management of locally advanced or metastatic cancer.
The innovative aspects are that it uses multi-platform molecular profiling to provide a report describing which cancer treatments may have clinical benefit and any relevant, open clinical trials. The profile is based on the molecular characteristics of the patient's tumour, irrespective of its primary site.
The intended place in therapy would be as a tool to help guide treatment decisions for locally advanced or metastatic cancer in people who are fit for further treatment but have exhausted standard (evidence-based) treatment options and for whom no further guidance on therapy exists.
The main points from the evidence summarised in this briefing are from 5 observational studies in Australia and the US including a total of 1,572 adults in secondary and tertiary care centres. Most evidence shows that CMI‑guided treatment is associated with better progression-free survival than clinician decisions alone. There is also some evidence that CMI may lead to improved overall survival.
Technology
Caris Molecular Intelligence (CMI, Caris Life Sciences) is a solid tumour biomarker analysis service. It is intended as a tool to aid decision-making and help identify the best treatment plan for each patient. CMI was marketed as Target Now until 2013.
CMI uses a number of tumour profiling techniques to analyse protein, RNA and DNA in the tumour:
immunohistochemistry, to determine level of protein expression in situ hybridisation, to detect deletions and amplifications in a specific set of genes RNA sequencing, to identify fusions and rearrangements of 53 genes next-generation sequencing to detect DNA mutations in 592 genes, amplifications in 442 genes, total mutational load and microsatellite instability.
Innovations
CMI is done in a centralised laboratory, covering a wider range of molecular testing techniques than may be available in a local laboratory. The results are analysed and summarised in a single report, so the ordering clinician does not need to collate results from multiple tests. The report includes a list of ongoing clinical trials that match the patient's biomarker expression profile, which means that its usefulness will depend on the number of included trials which are open to NHS patients.
If standard treatments in line with existing guidance have failed but the patient is still fit for further therapy, CMI profiling can identify which of the existing chemotherapies may be of benefit for the patient, based on ongoing research. This information may not currently be available to the oncology treatment team and some of these drugs may not have been considered for use in the specific tumour site before. Treatment decisions based on CMI would represent a shift from therapy based on tumour site to a precision medicine approach based on the unique molecular characteristics of a patient's tumour.
Analysis: Highest number of patients waiting a year for treatment since 2008
A pool of NHS trusts prepared to offer trial employment to whistleblowers is being created by NHS Improvement.
It is part of a new support scheme to help whistleblowing staff to return to work in the health service.
The pilot is designed to offer help to existing and former staff who have made protected disclosures under the Public Interest Disclosure Act to maintain their careers and is part of the regulator’s response to Sir Robert Francis QC’s Freedom to Speak Up report, which exposed the victimisation of whistleblowers in the NHS and called for them to be given help to get back to work
To obtain this article please contactlibraryw@uhcw.nhs.uk
The pilot is designed to offer help to existing and former staff who have made protected disclosures under the Public Interest Disclosure Act to maintain their careers and is part of the regulator’s response to Sir Robert Francis QC’s Freedom to Speak Up report, which exposed the victimisation of whistleblowers in the NHS and called for them to be given help to get back to work
To obtain this article please contactlibraryw@uhcw.nhs.uk
Psychoactive substances in secure mental health settings
This review summarises the latest evidence and makes recommendations for secure mental health service commissioners and providers.
Making The Economic Case For Investing In Actions To Prevent And/Or Tackle Loneliness: A Systematic Review: A Briefing Paper
Campaign to End Loneliness -
This research, carried out by the London School of Economics, reviews the evidence on the economic impact of loneliness interventions. It finds that up to £3 of health care costs can be saved for every £1 spent on an effective intervention on loneliness. Click here for Kings Fund blog
This research, carried out by the London School of Economics, reviews the evidence on the economic impact of loneliness interventions. It finds that up to £3 of health care costs can be saved for every £1 spent on an effective intervention on loneliness. Click here for Kings Fund blog
New CQC report on the state of care in mental health services
The Care Quality Commission (CQC) has launched the findings from its comprehensive review of mental health services.
The report, The state of care in mental health services 2014 to 2017, highlights several areas of concern over the last three years. Among them are the growing number of detentions under section 136 of the Mental Health Act; more people being forced to accept out-of-area care; longer waiting times for specialist treatments; variation and persistence in the use of restraints; and physical environments not designed to keep people safe. Click here for details
Supporting the ageing agenda
Representatives from NHS trusts, local government, the academic sector, third sector and small and medium-sized businesses gathered yesterday (17 July) at a collaborative, regional event to discuss new ways of working to support happier, healthier ageing across the East of England. Click here for further details
New guidance on radiological investigations of suspected child abuse
The guidance, entitled “The Radiological Investigation of Physical Abuse in Children”, has been jointly produced by The Royal College of Radiologists (RCR) and the Society and College of Radiographers (SCoR), with input and endorsement from the Royal College of Paediatrics and Child Health (RCPCH).
It revamps initial guidance from 2008 and incorporates new evidence on child imaging techniques and follow-up protocols, as well as a series of new procedural templates to help radiologists, radiographers and referring paediatricians.
It revamps initial guidance from 2008 and incorporates new evidence on child imaging techniques and follow-up protocols, as well as a series of new procedural templates to help radiologists, radiographers and referring paediatricians.
Attract, retain and motivate your staff with Reward
NHS Employers has developed a quick guide to lead you through the three phases of the reward strategy toolkit to help you to develop an effective approach to reward for your organisation.
Heart of England launches back pain video to promote self-help
Heart of England NHS Trust has launched a video animation with the twin aims of helping people with back pain and reducing the need for hospital treatment.
The animation conveys the message ‘you are the best person to make your back better’. If the back pain is new, you do not need to seek advice from your GP or a therapist, and x-rays and scans are not normally needed because most people recover over time, it says.
It illustrates NHS-approved advice for easing back pain, including keep moving, find a comfortable position, take simple painkillers and anti-inflammatory tablets.
The animation conveys the message ‘you are the best person to make your back better’. If the back pain is new, you do not need to seek advice from your GP or a therapist, and x-rays and scans are not normally needed because most people recover over time, it says.
It illustrates NHS-approved advice for easing back pain, including keep moving, find a comfortable position, take simple painkillers and anti-inflammatory tablets.
Analysis: Highest number of patients waiting a year for treatment since 2008
The number of patients waiting more than a year to be treated on an elective pathway has more than doubled year on year, the latest NHS data shows.
For full text article libraryw@uhcw.nhs.uk
For full text article libraryw@uhcw.nhs.uk
'Major' safety fears over lack of regulation for advanced nurses
The lack of regulation of advanced nursing is a “major concern for public protection”, HSJ has been told.
The chair of the Association of Advanced Practice Educators, a network of 37 universities that train staff in advanced patient care, said some nurses who were dismissed from university courses for failing to meet standards continue to call themselves advanced nurses and remain in their jobs.
To request full article libraryw@uhcw.nhs.uk
To request full article libraryw@uhcw.nhs.uk
Evidence-based recommendations on cetuximab (Erbitux) and panitumumab (Vectibix) for previously untreated RAS wild-type metastatic colorectal cancer in adults.
This guidance replaces NICE technology appraisal guidance on cetuximab for the first-line treatment of metastatic colorectal cancer (TA176).
This guidance partially updates the terminated NICE technology appraisal on panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer (TA240).
In September 2017, this guidance was amended after a change to the commercial arrangements in August 2017. This change does not affect the cost effectiveness of cetuximab. Sections 1.3, 2 and 5.5 have been updated.
This guidance partially updates the terminated NICE technology appraisal on panitumumab in combination with chemotherapy for the treatment of metastatic colorectal cancer (TA240).
In September 2017, this guidance was amended after a change to the commercial arrangements in August 2017. This change does not affect the cost effectiveness of cetuximab. Sections 1.3, 2 and 5.5 have been updated.
Heel casts do not improve heel ulcers in diabetes
Fibreglass casts moulded to the heel did not improve heel ulcers in people with diabetes when added to usual ulcer care. Ulcers healed within six months in 44% of people using casts compared with 37% without which was not a statistically significant difference.
Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effectiveness of using a similar approach for heel ulcers.
This NIHR-funded trial indicates that specially-moulded heel casts do not improve healing rates or pain, and were not a good use of NHS resources compared with usual care.
Uncertainty remains over the optimal approach for managing heel ulcers in people with diabetes.https://discover.dc.nihr.ac.uk/portal/article/4000781/heel-casts-do-not-improve-heel-ulcers-in-diabetes
Foot ulcers are a common complication of diabetes, and heel ulcers are particularly difficult to treat. Based on the success of casts for treating ulcers elsewhere on the foot this trial was designed to test the effect and cost-effectiveness of using a similar approach for heel ulcers.
This NIHR-funded trial indicates that specially-moulded heel casts do not improve healing rates or pain, and were not a good use of NHS resources compared with usual care.
Uncertainty remains over the optimal approach for managing heel ulcers in people with diabetes.https://discover.dc.nihr.ac.uk/portal/article/4000781/heel-casts-do-not-improve-heel-ulcers-in-diabetes
Developing support and services for children and young people with a learning disability, autism or both
This document from NHS England provides guidance for Transforming Care Partnerships (and their local CCG or local authority partners) in commissioning support and services for children and young people with learning disability, autism or both.
Action plan on hearing loss: what works guides
The Action plan on hearing loss, produced in 2015, identified ways that services for people with hearing loss could be improved.
This series of guides aims to support employers and service providers in delivering on the recommendations outlined in the plan.
This series of guides aims to support employers and service providers in delivering on the recommendations outlined in the plan.
Practical guidance on sharing of information and information governance for all NHS organisations specifically for Prevent and the Channel process
This guidance from NHS England is intended to assist those involved in information sharing and information governance for the purpose of Prevent, a counter-terrorism safeguarding programme. It is designed to assist in the decision making process about the appropriateness of sharing information (particularly sensitive health information) such as the decisions made by Caldicott Guardians.
How specialised services are transforming care
NHS England has launched a new animation about its specialised services.
The animation aims to build a greater understanding with patients and the public, clinicians and other stakeholders about the specialised services that NHS England commissions. The animation is supported by a brochure which explains in more detail about how specialised services are delivering cutting-edge car
Lightning Process 'could help children with chronic fatigue syndrome', study claims
"Controversial Lightning Process 'helps children with chronic fatigue syndrome'," reports The Guardian.
The story is based on a UK study investigating whether a treatment called the Lightning Process helped teenagers being treated for chronic fatigue syndrome (CFS), also known as ME (myalgic encephalomyelitis).
The study randomly split 100 young participants into two groups: those who received standard CFS/ME treatment and those who received the standard treatment plus the Lightning Process (LP).
LP treatment involved an intensive three-day group-therapy course aiming to teach participants how to use their brain to improve their body's health.
Researchers found those who received the LP were more active, less tired and less anxious after six months. At 12 months, they also had improved depression scores and school attendance.
However, this therapy is not recommended by the NHS, which currently suggests behavioural and exercise therapy for people with CFS/ME.
The story is based on a UK study investigating whether a treatment called the Lightning Process helped teenagers being treated for chronic fatigue syndrome (CFS), also known as ME (myalgic encephalomyelitis).
The study randomly split 100 young participants into two groups: those who received standard CFS/ME treatment and those who received the standard treatment plus the Lightning Process (LP).
LP treatment involved an intensive three-day group-therapy course aiming to teach participants how to use their brain to improve their body's health.
Researchers found those who received the LP were more active, less tired and less anxious after six months. At 12 months, they also had improved depression scores and school attendance.
However, this therapy is not recommended by the NHS, which currently suggests behavioural and exercise therapy for people with CFS/ME.
Most common ear infections should not be treated with antibiotics, says NICE
The draft guidance advises GPs and healthcare professionals how they should treat acute otitis media, a middle ear infection that is common in children and young people.
Estimates suggest one in four children experience a middle ear infection before they are 10 years old, and that 60% show signs of improvement (for example being in less pain) within 24 hours, even if they are not given antibiotics.
In light of this, NICE says children and young people should be cared for with pain relief rather than antibiotics.
Estimates suggest one in four children experience a middle ear infection before they are 10 years old, and that 60% show signs of improvement (for example being in less pain) within 24 hours, even if they are not given antibiotics.
In light of this, NICE says children and young people should be cared for with pain relief rather than antibiotics.
Role of tissue microenvironment resident adipocytes in colon cancer
World journal of gastroenterology 23.32: 5829-5835. (August 28, 2017)
Colorectal cancer (CRC) is a multifactorial disease characterized by several genetic and epigenetic alterations occurring in epithelial cells. It is increasingly recognized that tumour progression is also regulated by tumour microenvironment (TME). The bidirectional cross-talk between tumour resident adipocytes and cancer cells within TME has been proposed as active contributor to carcinogenesis. Tumour resident adipocytes exhibit an activated phenotype characterized by increased secretion of pro-tumorigenic factors (angiogenic/inflammatory/immune) which contribute to cancer cell proliferation, invasion, neoangiogenesis, evasion of immune surveillance and therapy resistance. Furthermore, adipocytes represent a fuel rich source for increasing energy demand of rapidly proliferating tumour cells. Interestingly, a relationship between obesity and molecular variants in CRC has recently been identified. Whether adipose tissue promotes cancer progression in subsets of molecular phenotypes or whether local tissue adipocytes are involved in inactivation of tumour suppressor genes and/or activation of oncogenes still needs to be explored. This editorial highlights the major findings related to cross-talk between adipocytes and colon cancer cells and how local paracrine interactions may promote cancer progression. Furthermore, we provide future strategies in studying colonic TME which could provide insights in bidirectional cross-talk mechanisms between adipocytes and colonic epithelial cells. This could enable to decipher critical signalling pathways of both early colonic carcinogenesis and cancer progression.
UHCW Research: Tabuso, Maria and Arasaradnam, Ramesh P.
UHCW Research: Tabuso, Maria and Arasaradnam, Ramesh P.
Persistent pain in neonates: challenges in assessment without the aid of a clinical tool
Acta Paediatr. Accepted Author Manuscript. doi:10.1111/apa.14081
Evaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used (iii) variation between clinicians’ assessments.
Pain assessment is challenging for staff. Most parents feel confident in assessing their babies’ comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers.
UHCW Research: Joanna Bradshaw and Kathryn I Blake
Evaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used (iii) variation between clinicians’ assessments.
Pain assessment is challenging for staff. Most parents feel confident in assessing their babies’ comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers.
UHCW Research: Joanna Bradshaw and Kathryn I Blake
1552P Evaluation of Antiemetic Practices for Prevention of Chemotherapy-induced Nausea and Vomiting (CINV): Results of a European Oncology Nurse Survey
Preventing CINV in most patients is possible when guideline-recommended prophylactic antiemetics are utilized. Because oncology nurses play a critical role in risk assessment and management of CINV, a survey of European nurses was conducted to evaluate antiemetic practices, determine awareness of and adherence to current guideline recommendations, and explore barriers to adherence.
UHCW Research: A. Young
Monday, 25 September 2017
Stress and social media fuel mental health crisis among girls
Girls and young women are experiencing a “gathering crisis” in their mental health linked to conflict with friends, fears about their body image and pressures created by social media, experts have warned. Click here for news article
Smartphone apps can reduce depression
New research has confirmed that smartphone apps are an effective treatment option for depression, paving the way for safe and accessible interventions for the millions of people around the world diagnosed with this condition. Click here for news piece
Friday, 22 September 2017
Many teenagers reporting symptoms of depression
NHS Choices - Behind the headlines - Many teenagers reporting symptoms of depression
"One in four British girls hit by depression at 14 as experts blame increase in cyber bullying and academic pressure," says the Sun after a large study found 24% of 14-year-old girls in the UK report symptoms of depression. See article
"One in four British girls hit by depression at 14 as experts blame increase in cyber bullying and academic pressure," says the Sun after a large study found 24% of 14-year-old girls in the UK report symptoms of depression. See article
Latest NHS sickness absence statistics - May 2017
The latest figures released by NHS Digital show that NHS staff sickness absence has remained the same in May 2017 as at May 2016 at 3.84 per cent, but lower than it was in May 2015 at 3.90 per cent.
STPs and accountable care
The programme from NHS Providers aims to ensure there is the right support and a strong advocate making the case for NHS trusts as they move to accountable care structures that deliver more integrated care for the public.
The state of pre and post-graduate medical recruitment in England, September 2017
This briefing from the BMA examines the current state of medical recruitment in England, with additional UK-wide data for the foundation programme. Looking at data from 2013 onward, it identifies some of the ongoing issues facing medical recruitment, and recommends how some of these key concerns can be addressed.
One year on: the Government response to the review of choice in end of life care
This DH report sets out how the National End of Life Care Programme Board is delivering personalisation and choice in care for people at or near the end of life.
Not enough specialist support for people with dementia
Most of the healthcare received by people in the later stages of dementia is provided by GPs or emergency services, with little support from specialist healthcare professionals.
The researchers, from the Marie Curie palliative care research department at University College London, found that GPs were the main providers of medical care, with 96% of people with advanced dementia seeing a GP in their last month of life. Paramedics also played a major role in assessment and healthcare towards the end of life, suggesting a reactive rather than planned response to patients’ needs – nearly one in five (19%) were seen by a paramedic in the month prior to their death.
The researchers, from the Marie Curie palliative care research department at University College London, found that GPs were the main providers of medical care, with 96% of people with advanced dementia seeing a GP in their last month of life. Paramedics also played a major role in assessment and healthcare towards the end of life, suggesting a reactive rather than planned response to patients’ needs – nearly one in five (19%) were seen by a paramedic in the month prior to their death.
Sleep and Cardio-Metabolic Disease
Curr Cardiol Rep. 2017 Sep 19;19(11):110. doi: 10.1007/s11886-017-0916-0.
This review summarises and discusses the epidemiological evidence suggesting a causal relationship between sleep duration and cardio-metabolic risk and outcomes in population.
UHCW Research: Cappuccio FP
This review summarises and discusses the epidemiological evidence suggesting a causal relationship between sleep duration and cardio-metabolic risk and outcomes in population.
UHCW Research: Cappuccio FP
Person-centred care in 2017: evidence from service users
This report from National Voices attempts to create a snapshot of the extent of person-centred care in the English health and care system, based on how people report their experience of treatment, care and support. This data was found through surveys of patients and service users. It concludes that NHS services do not give people adequate control of their own health and care, and there is no reporting of whether people’s care is coordinated across health and social care.
Thursday, 21 September 2017
Fidgeting Helps Kids with ADHD Concentrate
Many a parent has expressed frustration when they watch their child with attention-deficit hyperactivity disorder squirm and fidget in school and while doing their homework, yet appear laser-focused and motionless sitting in front of the TV.
New research should appease concerns as investigators discover lack of motivation or boredom with school isn’t to blame for the differing behavior. Click to see article
Occupational Therspy Week 2017
OTWeek2017, 6 - 12 November 2017, is fast approaching and our resources pack will help you to promote occupational therapy as a career and talk about your work as an occupational therapist. Last year the packs we sent to members really helped to show the #ValueofOT.
World Occupational Therapy Day 2017 will take place on Friday 27 October and this year's theme is “Inform, Inspire, Influence”.
NJR 14th Annual Report: significant increase in joint replacement procedures with “very impressive” outcomes
The orthopaedic joint replacement register for England, Wales, Northern Ireland and the Isle of Man has published a new report which highlights a record number of procedures being performed.
More joint replacements than ever before were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the National Joint Registry (NJR). This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period.
More joint replacements than ever before were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the National Joint Registry (NJR). This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period.
Are services well-led? Continuous improvement
Sets out how providers should carry out developmental reviews of their leadership and governance using the well-led framework.
Culture and leadership programme: phase 2 'design
This is the second in a series of three resources designed to help NHS providers develop cultures that enable and sustain continuously improving safe, high quality and compassionate care.
See also phase 1, 'Discover.'
Monitoring e.coli
NHS Improvement has published two resources to help meet the ambition to reduce healthcare associated Gram-negative bloodstream infection by 50% by 2021.
The first is a tool to enable providers and CCGs to understand the number of deaths associated with E. coli bloodstream infections and the savings that can be made if infection rates are reduced.
Using published data from Public Health England on healthcare acquired E.coli infection rates, we've also produced a map to display NHS providers and clinical commissioning groups (CCGs) with the highest and lowest infection rates in 2016/17.
This letter sets out the additional data collection required to help reduce healthcare associated Gram-negative infections. You will now need to submit data on Klebsiella species and Pseudomonas aeruginosa in addition to the E.Coli data..
The first is a tool to enable providers and CCGs to understand the number of deaths associated with E. coli bloodstream infections and the savings that can be made if infection rates are reduced.
Using published data from Public Health England on healthcare acquired E.coli infection rates, we've also produced a map to display NHS providers and clinical commissioning groups (CCGs) with the highest and lowest infection rates in 2016/17.
This letter sets out the additional data collection required to help reduce healthcare associated Gram-negative infections. You will now need to submit data on Klebsiella species and Pseudomonas aeruginosa in addition to the E.Coli data..
Nivolumab now available for lung cancer after company offers NICE new CDF deal
Lung cancer patients in England can now be prescribed nivolumab, also known as Opdivo, after NICE says it should be available through the Cancer Drugs Fund (CDF).
Wednesday, 20 September 2017
College of Optometrists launches videos for National Eye Health Week
As part of National Eye Health Week (18-24 September), the College of Optometrists has launched a series of educational videos that explain some of the most common eye conditions experienced by patients.
The videos detail the signs to look out for and treatments for a range of conditions including glaucoma, cataract, amblyopia and dry eye.
National Guardian's Office publishes findings from Freedom to Speak Up guardian survey
The National Guardian's Office has published a report outlining the findings of their first Freedom to Speak Up (FTSU) guardian survey.
The survey finds that a significant amount of progress has already been made, with:
The survey finds that a significant amount of progress has already been made, with:
- nearly 9 out of 10 guardians reporting that they are communicating their role internally
- over 8 out of 10 guardians saying they feel supported by their senior management teams and chief executives (with only 3 in 100 reported feeling that they don’t get this support)
- 7 out of 10 guardians saying that their organisations are actively tackling barriers to speaking up.
First two trusts meet milestone of all electronic NHS referrals
Two hospital trusts and their referring GP practices have become the first in the country to adopt a digital process for booking patient hospital appointments. Sherwood Forest Hospitals NHS Foundation Trust and County Durham & Darlington NHS Foundation Trust are now processing all of their hospital referral appointments electronically via the NHS e-Referral Service. Patients are also able to change or cancel their appointments through the system with analysis showing that use of electronic referrals has halved the rate of patients missing appointments from 10% to 5%.
Noncommunicable Diseases Progress Monitor 2017
This WHO report outlines progress made by WHO member states against globally agreed targets to control long-term conditions and chronic diseases. It finds that whilst the United Kingdom has fully achieved on many targets in relation to smoking and unhealthy diets, there is still progress to be made on reduction measures on harmful use of alcohol.
Have your say on which products should be available on prescription
The NHS wants to know which drugs and treatments patients think should be made available on prescription.
The consultation is focusing on medicines deemed to be a low priority for NHS funding, and could see items currently available on prescription no longer offered in this way.
3,200 items are being reviewed, including products such as sunscreen, laxatives, eye drops and eczema cream. In the future, people may have to buy such things over the counter.
3,200 items are being reviewed, including products such as sunscreen, laxatives, eye drops and eczema cream. In the future, people may have to buy such things over the counter.
Career Development Framework: Guiding Principles for Occupational Therapy published
The new Career development framework: guiding principles for occupational therapy, published by the RCOT, is an overarching set of guiding principles for occupational therapy, offering a structured process to guide careers, learning and development within the profession.
The Framework contains four interacting Pillars of Practice (Professional Practice; Facilitation of Learning; Leadership; and Evidence, Research and Development), each with nine Levels. It can help you to identify the things you have already learnt and areas for continuing professional development.
The Framework contains four interacting Pillars of Practice (Professional Practice; Facilitation of Learning; Leadership; and Evidence, Research and Development), each with nine Levels. It can help you to identify the things you have already learnt and areas for continuing professional development.
What is commissioning and how is it changing?
The current system is based on arrangements set out in the Health and Social Care Act 2012, which aimed to put GPs at the forefront of the commissioning process. Although the structures established by the Act have remained in place since it came into force in 2013, the way that commissioning is delivered in practice has evolved since then – and is continuing to do so.
Key changes include the delegation of some commissioning responsibilities from national to local organisations, greater joint working at a local level, and an increasingly population or ‘place-based’ approach to commissioning. All these changes are intended to support the development of more integrated systems of care, including between health and social care.
Key changes include the delegation of some commissioning responsibilities from national to local organisations, greater joint working at a local level, and an increasingly population or ‘place-based’ approach to commissioning. All these changes are intended to support the development of more integrated systems of care, including between health and social care.
OP27.07: Does imaging correlate with clinical findings for morbidly adherent placenta? An audit from University Hospitals Coventry and Warwickshire
Ultrasound Obstet Gynecol, 50: 137. doi:10.1002/uog.17953
The incidence of morbidly adherent placenta is rising secondary to the increasing Caesarean rate and advancing maternal age. The Royal College of Obstetricians and Gynecologists (RCOG) recommends that women with an anterior low placenta and a Caesarean section scar at 32 completed weeks gestation undergo further imaging with either ultrasonography and/or magnetic resonance imaging (MRI) to distinguish if there is likely placenta accreta. The aim of this audit was to determine if imaging correlated with clinical findings in our unit.
UHCW Research: L.J. Ewington, E.A. Swift and P. Parthasarathy
The incidence of morbidly adherent placenta is rising secondary to the increasing Caesarean rate and advancing maternal age. The Royal College of Obstetricians and Gynecologists (RCOG) recommends that women with an anterior low placenta and a Caesarean section scar at 32 completed weeks gestation undergo further imaging with either ultrasonography and/or magnetic resonance imaging (MRI) to distinguish if there is likely placenta accreta. The aim of this audit was to determine if imaging correlated with clinical findings in our unit.
UHCW Research: L.J. Ewington, E.A. Swift and P. Parthasarathy
EP04.37: Fetal persistent left superior vena cava: a case report and review of the literature
Ultrasound in Obstetrics & Gynecology; London
50.S1 (Sep 2017): 279-279.
We present a case of a fetal persistent left superior vena cava (PLSVC). A 34-year-old primigravida underwent a successful round of in vitro fertilisation. She was normally fit and well, the only medical history to note was loop excision of transformation zone six years prior to pregnancy. She had normal booking bloods and low risk Trisomy screening. However, her PAPP-A MoM came back at 0.21. At the twenty week anomaly scan she was found to have an abnormal four chamber heart view, and so was referred to the fetal medicine department where a discordance in atrial size was found and also an abnormal three vessel view. Therefore, she was referred to a tertiary centre. Here at 22+4 the fetus was found to have PLSVC draining into the coronary sinus. There were no obvious valvar or ventricular septal defects. As no other anatomical abnormalities were detected the couple deferred the decision for invasive testing. The pregnancy is still ongoing and further fetal medicine scans have been arranged. PLSVC has a prevalence of 0.3-0.5% of the general population and is thought to arise due to an in utero failure of development of the left cardinal vein. 60% of cases are associated with intra-cardiac anomalies and 37% of cases are associated with extra-cardiac anomalies. 12.5% of cases had a chromosomal abnormality. 21% of cases with isolated PLSVC can develop coarctation, therefore, follow-up scans are necessary in utero. Survival rates for isolated PLSVC are high as often the venous blood returns to the right atrium.
UHCW Research: L.J. Ewington and P. Parthasarathy
50.S1 (Sep 2017): 279-279.We present a case of a fetal persistent left superior vena cava (PLSVC). A 34-year-old primigravida underwent a successful round of in vitro fertilisation. She was normally fit and well, the only medical history to note was loop excision of transformation zone six years prior to pregnancy. She had normal booking bloods and low risk Trisomy screening. However, her PAPP-A MoM came back at 0.21. At the twenty week anomaly scan she was found to have an abnormal four chamber heart view, and so was referred to the fetal medicine department where a discordance in atrial size was found and also an abnormal three vessel view. Therefore, she was referred to a tertiary centre. Here at 22+4 the fetus was found to have PLSVC draining into the coronary sinus. There were no obvious valvar or ventricular septal defects. As no other anatomical abnormalities were detected the couple deferred the decision for invasive testing. The pregnancy is still ongoing and further fetal medicine scans have been arranged. PLSVC has a prevalence of 0.3-0.5% of the general population and is thought to arise due to an in utero failure of development of the left cardinal vein. 60% of cases are associated with intra-cardiac anomalies and 37% of cases are associated with extra-cardiac anomalies. 12.5% of cases had a chromosomal abnormality. 21% of cases with isolated PLSVC can develop coarctation, therefore, follow-up scans are necessary in utero. Survival rates for isolated PLSVC are high as often the venous blood returns to the right atrium.
UHCW Research: L.J. Ewington and P. Parthasarathy
Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients
PLoS One; San Francisco12.9 (Sep 2017): e0183926.
Patients with advanced chronic kidney disease (CKD) experience complex functional and structural changes of the cardiopulmonary and musculoskeletal system. This results in reduced exercise tolerance, quality of life and ultimately premature death. We investigated the relationship between subjective measures of health related quality of life and objective, standardised functional measures for cardiovascular and pulmonary health.
In CKD and HTN, objective physical performance has a significant effect on quality of life; particularly self-reported physical health and functioning. Therefore, these quality of life measures are indeed a good reflection of physical health correlating highly with objective physical performance measures.
UHCW Research: A. Rogan, K. McCarthy, C. McGregor, G. Evans, S. Hewins, N. Aldridge, S. Fletcher, N. Krishnan and R. Higgins
12.9 (Sep 2017): e0183926.Patients with advanced chronic kidney disease (CKD) experience complex functional and structural changes of the cardiopulmonary and musculoskeletal system. This results in reduced exercise tolerance, quality of life and ultimately premature death. We investigated the relationship between subjective measures of health related quality of life and objective, standardised functional measures for cardiovascular and pulmonary health.
In CKD and HTN, objective physical performance has a significant effect on quality of life; particularly self-reported physical health and functioning. Therefore, these quality of life measures are indeed a good reflection of physical health correlating highly with objective physical performance measures.
UHCW Research: A. Rogan, K. McCarthy, C. McGregor, G. Evans, S. Hewins, N. Aldridge, S. Fletcher, N. Krishnan and R. Higgins
Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid
Knee Surgery, Sports Traumatology, Arthroscopy , Volume 25, Issue 10, pp 3229–3236
The aim of this study was to evaluate whether glenohumeral arthroscopy is an appropriate gold standard for the diagnosis of long head of biceps (LHB) tendon pathology. The objectives were to evaluate whether the length of tendon that can be seen at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses at arthroscopy when compared to an open approach.
UHCW Research: Robert W. Jordan
The aim of this study was to evaluate whether glenohumeral arthroscopy is an appropriate gold standard for the diagnosis of long head of biceps (LHB) tendon pathology. The objectives were to evaluate whether the length of tendon that can be seen at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses at arthroscopy when compared to an open approach.
UHCW Research: Robert W. Jordan
Sacubitril/valsartan in chronic symptomatic heart failure with reduced ejection fraction: first clinical experience from a large UK tertiary centre
Appendix: poster 1. Br J Cardiol 2017;24:(3)
Dr Danish Ali presented a poster based on the work of his team at University Hospital Coventry, a large tertiary cardiac centre in the Midlands, and their assessment of the success of sacubitril/valsartan.
UHCW Research: Danish Ali et al.
Immediate nipple reconstruction in combination with implant reconstruction using dermal sling
Breast J. 2017;00:1–3. https://doi.org/10.1111/tbj.12904
The inferior de-epithelialized dermal flap with implant is increasingly used for immediate breast reconstruction. We have adapted the technique to provide concurrent immediate nipple reconstruction by recruiting the triangle of skin above the excised nipple as a modified C-V flap. The safety and efficacy of this technique has been assessed in 15 patients, of which eight were bilateral and seven were unilateral cases. We suggest that this is a safe, reliable, and original technique for immediate nipple reconstruction in patients undergoing immediate breast reconstruction with an inferior dermal sling and implant.
UHCW Research: George Filobbos, Nathan Hamnett, Joseph Hardwicke and Joanna Skillman
The inferior de-epithelialized dermal flap with implant is increasingly used for immediate breast reconstruction. We have adapted the technique to provide concurrent immediate nipple reconstruction by recruiting the triangle of skin above the excised nipple as a modified C-V flap. The safety and efficacy of this technique has been assessed in 15 patients, of which eight were bilateral and seven were unilateral cases. We suggest that this is a safe, reliable, and original technique for immediate nipple reconstruction in patients undergoing immediate breast reconstruction with an inferior dermal sling and implant.
UHCW Research: George Filobbos, Nathan Hamnett, Joseph Hardwicke and Joanna Skillman
Moving to the enlightened side: a personal journey to a career in medical leadership and management
I have been Chief Medical Officer (CMO) and an Executive Director at University Hospitals Coventry and Warwickshire since May 2012 and Deputy Chief Executive Officer since December 2014. I have a Chair at Institute of Digital Health, Warwick University and I am a Senior Founding Fellow of the Faculty of Medical Leadership and Management. I thoroughly enjoy my role and have immense pride in the achievements of the team that I lead.
Medical Director roles are complex and require an ability to influence and negotiate with a diverse group of professionals. As CMO, I am often required to investigate and find solutions for ‘wicked problems’. These problems are not only clinical; they could be financial, workforce related or operational. I fully understand the fact that solutions to such problems cannot be achieved unilaterally or in isolation. I recognise that solutions reached by teams who do the work themselves are more likely to achieve transformational change and my role is to facilitate such change.
I decided to become a medical leader in 2008 when I witnessed the adverse effects on a service that lacked credible leadership. I started the transition through initial training in medical leadership at the King’s Fund …
UHCW Research: Professor M. Pandit
Tuesday, 19 September 2017
A Novel Measure for Nuclear Pleomorphism in Lung Adenocarcinoma
Bioinformatics meets digital patholgy
Nuclear morphology is used as a significant cue in different histology grading systems such as grading of breast cancer [1]. At the early stages of cancer, tumour nuclei have similar shape, size and texture. At the advanced stages, tumour nuclei deform into non-uniform shapes and unequal sizes. In lung cancer, several studies have shown that nuclear pleomorphism is a potential prognostic indicator and could be correlated with patient survival [2, 3]. Pathologists normally score nuclear pleomorphism by comparing them with the normal cells. They typically observe nuclei size, shape and the visibility of nucleoli [1]. This scoring mechanism is hugely affected by the subjectivity of human perception, as enormous variations in nuclear morphology make it very difficult for human observer to describe it in a precise way. Therefore, the reproducibility and reliability of these scoring systems are uncertain [4, 5].
In this study, we provide an automatic and objective method to measure the variability of nuclei shapes in tumour regions to overcome the limitations of the current clinical routine in nuclei scoring.
UHCW Research: D. Snead
Nuclear morphology is used as a significant cue in different histology grading systems such as grading of breast cancer [1]. At the early stages of cancer, tumour nuclei have similar shape, size and texture. At the advanced stages, tumour nuclei deform into non-uniform shapes and unequal sizes. In lung cancer, several studies have shown that nuclear pleomorphism is a potential prognostic indicator and could be correlated with patient survival [2, 3]. Pathologists normally score nuclear pleomorphism by comparing them with the normal cells. They typically observe nuclei size, shape and the visibility of nucleoli [1]. This scoring mechanism is hugely affected by the subjectivity of human perception, as enormous variations in nuclear morphology make it very difficult for human observer to describe it in a precise way. Therefore, the reproducibility and reliability of these scoring systems are uncertain [4, 5].
In this study, we provide an automatic and objective method to measure the variability of nuclei shapes in tumour regions to overcome the limitations of the current clinical routine in nuclei scoring.
UHCW Research: D. Snead
Taking the Anxiety out of the Eportfolio - the Benefits of Peer-Led Induction Teaching for New Foundation Doctors / How Confident Are Your New Doctors? Benefits of a Foundation Doctor-Led Teaching Programme
DEMEC 2017 – abstract poster submissions : Category 3: Postgraduate training
Taking the Anxiety out of the Eportfolio - the Benefits of Peer-Led Induction Teaching for New Foundation Doctors
Tomorrow’s Doctors’(1) states the expert use of ePortfolio is vital in progressing through
foundation training, yet studies show Foundation Year 1 doctors (FY1’s) are not confident in its use(2). The national induction programme was established by NHS England in 2012, but gives no specific guidance(3), which has led to variety in course content(4).
FY1 Survival Guide (FY1SG) based in University Hospital Coventry & Warwickshire (UHCW) and George Eliot Hospital (GEH) offered peer-led teaching by Foundation Doctors to hospital inductees. We led a series of interactive workshops over three days with a focus on personal experience, one of which covered ePortfolio.
How Confident Are Your New Doctors? Benefits of a Foundation Doctor-Led Teaching Programme
The start of new foundation year doctors is commonly titled ‘Black Wednesday’ in the UK or the
‘July Phenomenon’ in US. This is an anxious time for patients and doctors alike with 4-12% rise in morality rates (1,2). Studies (3) have shown induction programmes do improve confidence and competence. A specific example from University Hospital Bristol (4) showed a 45% reduction in critical incidents in the first 4 months due to induction training.
We identified a key opportunity to increase the confidence of newly qualified doctors through a peer-led induction region-wide teaching programme by current foundation doctors. The Foundation Year 1 Survival Guide (FY1SG) was delivered over two years, with a series of interactive workshops over three days.
UHCW Research: Muthalagappan S.
Taking the Anxiety out of the Eportfolio - the Benefits of Peer-Led Induction Teaching for New Foundation Doctors
Tomorrow’s Doctors’(1) states the expert use of ePortfolio is vital in progressing through
foundation training, yet studies show Foundation Year 1 doctors (FY1’s) are not confident in its use(2). The national induction programme was established by NHS England in 2012, but gives no specific guidance(3), which has led to variety in course content(4).
FY1 Survival Guide (FY1SG) based in University Hospital Coventry & Warwickshire (UHCW) and George Eliot Hospital (GEH) offered peer-led teaching by Foundation Doctors to hospital inductees. We led a series of interactive workshops over three days with a focus on personal experience, one of which covered ePortfolio.
How Confident Are Your New Doctors? Benefits of a Foundation Doctor-Led Teaching Programme
The start of new foundation year doctors is commonly titled ‘Black Wednesday’ in the UK or the
‘July Phenomenon’ in US. This is an anxious time for patients and doctors alike with 4-12% rise in morality rates (1,2). Studies (3) have shown induction programmes do improve confidence and competence. A specific example from University Hospital Bristol (4) showed a 45% reduction in critical incidents in the first 4 months due to induction training.
We identified a key opportunity to increase the confidence of newly qualified doctors through a peer-led induction region-wide teaching programme by current foundation doctors. The Foundation Year 1 Survival Guide (FY1SG) was delivered over two years, with a series of interactive workshops over three days.
UHCW Research: Muthalagappan S.
The Future Of The Mental Health Workforce
Centre for Mental Health -
This report calls for reform of mental health services in order to develop a workforce that is able to meet people's needs in the future. The report describes commissioning of mental health services as in crisis with a diminishing workforce, growing expectations and increasing demand putting pressure on staff across the country. Kings Fund blog
This report calls for reform of mental health services in order to develop a workforce that is able to meet people's needs in the future. The report describes commissioning of mental health services as in crisis with a diminishing workforce, growing expectations and increasing demand putting pressure on staff across the country. Kings Fund blog
Merger trust seeks to fix 'cultural' differences between managers and clinicians
Trust leaders have outlined plans to address “cultural” differences between clinicians and managers at Royal Manchester Children’s Hospital.
For full text please request from libraryw@uhcw.nhs.uk
For full text please request from libraryw@uhcw.nhs.uk
Landmark hospital merger to lead to major service reshuffle
A merger to create one of the country’s largest acute trusts will lead to some specialist services being shifted between hospitals, an NHS Improvement report reveals.
The Competition and Markets Authority cleared the merger of University Hospitals Birmingham and Heart of England foundation trusts last month.
For full text please request from libraryw@uhcw.nhs,uk
For full text please request from libraryw@uhcw.nhs,uk
Commissioning framework for biological medicines
The purpose of this document from NHS England is to support commissioners to act promptly to make the most of the opportunity presented by increased competition amongst biological medicines, including biosimilar medicines. In particular, this framework seeks to set out the importance of taking a collaborative approach to the commissioning of biological medicines, including biosimilar medicines, from the outset, as well as setting out how this can be achieved.
Death, Dying and Devolution
This report, from the The University of Bath Institute for Policy Research, reviews policy areas associated with death, dying and bereavement within the context of devolution. It focuses on the national and regional delegation of power, resources and authority across the UK and the implications of this for those who are dying, dead, or bereaved as well as those tasked with organising and running the services that support these groups of people.
Scrutiny: the new assurance? A good governance discussion document
As collaboration and partnership working need to become more streamlined, more strategic and more effective, organisations spending public monies should be constantly redefining their roles and responsibilities, searching for constant improvement.
This paper from the Good Governance Institute looks at scrutiny across a number of organisations, as all four home nations are seeking better outcomes by the alignment of health, social care and other funders and providers.
This paper from the Good Governance Institute looks at scrutiny across a number of organisations, as all four home nations are seeking better outcomes by the alignment of health, social care and other funders and providers.
Uniportal VATS lymphadenectomy
criticism of limitations in minimally invasive techniques regarding lymphadenectomy has been shown not to be evidenced. We describe the techniques of mediastinal lymphadenectomies during the uniportal VATS (uniVATS) approach with video attachments.
UHCW Research: Antonio E. Martin-Ucar
Surveillance Audiometry
This document replaces all previous versions. Its purpose is to describe a standard
procedure, and to provide recommendations, for effective pure-tone surveillance audiometry primarily on those exposed to noise at work. It also includes the
recommended format for audiogram forms. This document is not intended to provide
guidance on specific circumstances or on interpretation of results
Updated guideline on the management of common bile duct stones (CBDS)
Common bile duct stones (CBDS) are estimated to be
present in 10–20% of individuals with symptomatic
gallstones. They can result in a number of health
problems, including pain, jaundice, infection and acute
pancreatitis. A variety of imaging modalities can be
employed to identify the condition, while management
of confirmed cases of CBDS may involve endoscopic
retrograde cholangiopancreatography, surgery and
radiological methods of stone extraction. Clinicians are
therefore confronted with a number of potentially valid
options to diagnose and treat individuals with suspected
CBDS.
The British Society of Gastroenterology first published a guideline on the management of CBDS in 2008. Since then a number of developments in management have occurred along with further systematic reviews of the available evidence. The following recommendations reflect these changes and provide updated guidance to healthcare professionals who are involved in the care of adult patients with suspected or proven CBDS. It is not a protocol and the recommendations contained within should not replace individual clinical judgement.
The British Society of Gastroenterology first published a guideline on the management of CBDS in 2008. Since then a number of developments in management have occurred along with further systematic reviews of the available evidence. The following recommendations reflect these changes and provide updated guidance to healthcare professionals who are involved in the care of adult patients with suspected or proven CBDS. It is not a protocol and the recommendations contained within should not replace individual clinical judgement.
Revised British Society of Gastroenterology recommendation on the diagnosis and management of Barrett’s oesophagus with low-grade dysplasia
The most recent guidelines for the managementof Barrett’s oesophagus published
in 2014 recommended endoscopic
surveillance for patient with histological
evidence of low-grade dysplasia (LGD) on
random biopsies.1 In the last 2 years, new
evidence on the natural history of LGD in
Barrett’s oesophagus and on the safety
and efficacy of endoscopic treatment in
this subgroup of patients has been
published.
Deprivation of Liberty in the Rehabilitation Setting
Position statement from the British Society of Rehabilitation Medicine on the Deprivation of Liberty in the Rehabilitation Setting.
Quality Standards for Paediatric Gastroenterology, Hepatology & Nutrition
The Royal College of Paediatrics and Child Health and the British Society of Paediatric
Gastroenterology, Hepatology and Nutrition have worked together to develop these new
standards.
The standards apply to children receiving gastroenterology, hepatology and nutrition care in the secondary and tertiary care settings across the UK.
The standards apply to children receiving gastroenterology, hepatology and nutrition care in the secondary and tertiary care settings across the UK.
Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant – A Framework for Practice
Guidance from the British Association of Perinatal Medicine on the Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant.
Consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems,
owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the
fetus/infant from in utero exposure or via breast milk.
These consensus guidelines from the British Association of Psychopharmacology aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
These consensus guidelines from the British Association of Psychopharmacology aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
CEU Statement: Weight and contraception
Statement from the Faculty of Sexual and Reproductive Health's Clinical Effectiveness Unit on weight and contraception.
Quick Starting Contraception
This update of the 2010 Quick Starting Contraception guideline has been developed by the FSRH and brings together evidence and expert opinion on the provision of contraception to women at any time in their cycle.
SIGN 149 • Risk estimation and the prevention of cardiovascular disease
This guideline deals with the management of cardiovascular risk, both primary prevention, defined as the
potential for intervention prior to the disease presenting through a specified event (any incident linked
to critical disruption of blood flow that may cause damage to the heart, brain or peripheral tissues), and
secondary prevention, defined as the potential for intervention after an event has occurred.
Gender services consultation launched
NHS England has launched a consultation on gender identity services. The consultation is seeking discussion and feedback around two proposed service specifications for adult gender identity services (people aged 17 and above). The service specifications are based on engagement with the trans community and clinical experts and describe new proposals for patients who are looking for support and/or treatment.
NHS England has extended a consultation on gender identity services until 16 October 2017.
NHS England has extended a consultation on gender identity services until 16 October 2017.
People with schizophrenia are dying younger
People with schizophrenia have a mortality rate that is three times greater each year than those without schizophrenia, and die on average, eight years earlier than people without schizophrenia according to a new study.
Heath and Justice mental health services: Safer use of mental health medicines
This document provides a background to prescribing and mental health medicines in secure environments with some common principles that apply throughout the medicines optimisation pathway, and more detailed information within the pathway to support safer practice.
British Society of Gastroenterology position statement on serrated polyps in the colon and rectum
Serrated polyps have been recognised in the last decade
as important premalignant lesions accounting for
between 15% and 30% of colorectal cancers. There is
therefore a clinical need for guidance on how to manage
these lesions; however, the evidence base is limited.
The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions.
Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement)
The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations—serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions.
Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement)
Ultrasound training recommendations for medical and surgical specialties - 3rd ed.
This document from the Royal College of Radiologists makes recommendations for ultrasound training in a broad range of areas to help ensure that ultrasound training is of the same high standard for both medical non-radiologists and radiologists.
Use of Imaging in the management of patients with myeloma
The role of imaging in myeloma has gained increasing importance over the past few years. The recently revised definition of myeloma from the International Myeloma Working Group (IMWG) includes cross sectional imaging as a method to define bone disease and also incorporates its use in the disease definition for patients with suspected smouldering myeloma.
The National Institute for Health and Care Excellence myeloma guidelines also recommend cross sectional imaging for patients with suspected myeloma. There is also increasing use of imaging in disease assessments and the International Myeloma Working Group has recently incorporated imaging in defining new response categories of minimal residual disease negativity, with or without imaging-based evidence of disease. Plain X-rays have previously been the standard imaging modality included in a myeloma work up at presentation but evidence is mounting for use of cross-sectional modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and 18fluoro-deoxyglucose (18F-FDG) positron emission tomography (PET)/CT. Funding and therefore availability of newer imaging techniques remains a barrier.
Here, we propose an evidence-based approach to the use and technical application of the latest imaging modalities at diagnosis and in the follow-up of patients with myeloma and plasmacytoma.
Eating disorders: recognition and treatment [NG69]
This NICE guideline covers assessment, treatment, monitoring and inpatient care for children, young people and adults with eating disorders. It aims to improve the care people receive by detailing the most effective treatments for anorexia nervosa, binge eating disorder and bulimia nervosa.
Diagnostic Laparoscopy
Consent advice No. 2 from the Royal College of Obstetricians and Gynaecologists. This paper provides advice for clinicians in obtaining the consent of women undergoing diagnostic laparoscopy.
Management of Inherited Bleeding Disorders in Pregnancy
This guideline is intended for both specialist haematologists and obstetricians who have experience in managing pregnant patients with bleeding disorders. In addition, it may be a useful reference text for obstetric anaesthetists and neonatologists.
Women who have inherited bleeding disorders may be at significant risk of bleeding following miscarriage, abortion, antenatal procedures and delivery. They require multidisciplinary specialised care tailored to the individual, with cross-specialty communication, including anaesthetists and neonatologists as necessary.
The conditions covered in this guideline are haemophilia A and B, von Willebrand disease (VWD), factor XI deficiency, rare factor deficiencies, fibrinogen disorders, Bernard Soulier Syndrome (BSS), Glanzmann’s thrombasthenia (GT) and other platelet function disorders.
The conditions covered in this guideline are haemophilia A and B, von Willebrand disease (VWD), factor XI deficiency, rare factor deficiencies, fibrinogen disorders, Bernard Soulier Syndrome (BSS), Glanzmann’s thrombasthenia (GT) and other platelet function disorders.
Guideline for the prescription and monitoring of non-biologic Disease-Modifying Anti-Rheumatic Drugs
The mainstay of treatment for inflammatory rheumatic disease involves DMARDs. The last 30 years have seen enormous shifts in the use of DMARDs, with earlier initiation in disease course as well as combination strategies. Many of the drugs used have potential for harm as well as benefit. Appropriate screening prior to DMARD initiation, as well as vigilant monitoring during therapy, are required to minimize the risk of harm. This current guideline supersedes the previous 2008 BSR/BHPR guideline.
Guideline for the management of adults with primary Sjögren’s Syndrome
Primary Sjogren's Syndrome (pSS) is a classic, immune-mediated, condition of unknown aetiology characterized by focal lymphocytic infiltration of exocrine glands
This guideline reviews the treatment of the glandular and systemic features of pSS The management of the glandular features includes conserving, replacing and stimulating secretions. Systemic features may require system-specific therapy and immunomodulatory treatment. Holistic management is important and many patients benefit from non-pharmacological therapies and general support.
This guideline reviews the treatment of the glandular and systemic features of pSS The management of the glandular features includes conserving, replacing and stimulating secretions. Systemic features may require system-specific therapy and immunomodulatory treatment. Holistic management is important and many patients benefit from non-pharmacological therapies and general support.
Guideline for the Management of Gout
The British Society for Rheumatology/British Health Professionals in Rheumatology (BSR/BHPR) guideline for the management of gout was published in 2007 [2]. There are four broad reasons why a revised and updated guideline is now required. First, new pharmaceutical treatment options have become available and the evidence base for the efficacy and safety of available drugs has expanded. Second, the incidence, prevalence and severity of gout have increased [1] despite the availability of safe, effective and potentially curative therapy. Third, research studies and audits have consistently shown that fewer than 50% of patients with gout seen in general practice receive urate-lowering therapy (ULT) [22–25] and that many patients with gout being treated with ULT in both primary [1, 26] and secondary care [27, 28] do not achieve reductions of serum uric acid (sUA) levels to the target level recommended in the BSR/BHPR (300 µmol/l) or EULAR (360 µmol/l) guidelines.
Finally, as evidence has accumulated that the provision of information to patients with gout is suboptimal [29] and qualitative studies have begun to define a range of patient and provider barriers to effective care [30–32], preliminary data are emerging that demonstrate that these barriers can be overcome, and outcomes improved, with better provision of information and a package of care based on guideline recommendations [33].
Finally, as evidence has accumulated that the provision of information to patients with gout is suboptimal [29] and qualitative studies have begun to define a range of patient and provider barriers to effective care [30–32], preliminary data are emerging that demonstrate that these barriers can be overcome, and outcomes improved, with better provision of information and a package of care based on guideline recommendations [33].
Monday, 18 September 2017
NIHR Signal Blood test and ECG may safely rule out heart attack
A high sensitivity troponin test accurately ruled out a heart attack amongst a third of patients presenting to the emergency department with chest pain. A patient with no detectable troponin and normal electrocardiogram was almost certain not to have had a heart attack.
Depression In Children And Young People: Identification And Management
This guideline covers identifying and managing depression in children and young people aged between 5 and 18 years. Based on the stepped care model, it aims to improve recognition and assessment and promote effective treatments for mild, moderate and severe depression. The guidance has been updated to clarify the training needed for therapists.
Mental health and behavioural conditions account for nearly one-in-three known fit notes
Mental health and behavioural conditions have accounted for 31% of all fit notes, where the diagnosis was known, written in England between December 2014 and March 2017.
This was the most common known reason for issuing a fit note, new experimental figures from NHS Digital have revealed.
This was the most common known reason for issuing a fit note, new experimental figures from NHS Digital have revealed.
Friday, 15 September 2017
Resignations send stark warning to chief execs on A&E performance
To obtain full article please contact library@uhcw.nhs.uk
Study Probes Differences in Aggression Among Dementias
New research provides insight into how the course of illness in those with Alzheimer’s or frontotemporal dementia impacts physical aggression.
The study from Lund University in Sweden suggests that one-third of patients with the diagnosis Alzheimer’s disease or frontotemporal dementia were physically aggressive towards health care staff, other patients, relatives, animals, and complete strangers. Click here for news piece
P – 37 Non-adherence to Antihypertensive Medications is related to Total Pill Burden
Journal of Human Hypertension; London31.10 (Oct 2017): 657-686. Abstracts from the 2017 Annual Scientific Meeting of the British and Irish Hypertension Society (BIHS)
Non-adherence to medication is present in greater than or equal to 50% of patients with apparent treatment resistant hypertension. We examined the factors associated with non-adherence detected by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) based urine antihypertensive drug assay.
UHCW Research: Francesco P Cappuccio
31.10 (Oct 2017): 657-686. Abstracts from the 2017 Annual Scientific Meeting of the British and Irish Hypertension Society (BIHS)Non-adherence to medication is present in greater than or equal to 50% of patients with apparent treatment resistant hypertension. We examined the factors associated with non-adherence detected by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) based urine antihypertensive drug assay.
UHCW Research: Francesco P Cappuccio
Practical guide for large scale change launched
NHS England has launched a refreshed guide to support health and care leaders to deliver large scale change.
The guide will help them meet the challenges set out in the Next Steps on the NHS Five Year Forward View published earlier this year. Click here for further details
NHS efficiency map
Healthcare Financial Management Association -
This map promotes best practice in identifying, delivering and monitoring cost improvement programmes in the NHS. It contains links to a range of tools and guidance to help NHS bodies improve their efficiency. The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. It highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency.
This map promotes best practice in identifying, delivering and monitoring cost improvement programmes in the NHS. It contains links to a range of tools and guidance to help NHS bodies improve their efficiency. The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. It highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency.
Equally Outstanding: Equality And Human Rights – Good Practice Resource
Care Quality Commission -
This guidance aims to help providers put equality and human rights at the heart of their improvement work so that the quality of care gets better for everyone. It contains case studies and identifies nine common success factors. Click here for blog
This guidance aims to help providers put equality and human rights at the heart of their improvement work so that the quality of care gets better for everyone. It contains case studies and identifies nine common success factors. Click here for blog
Beatrice Fraenkel elected NHS Chair Representative
The Mental Health Network has appointed Beatrice Fraenkel, Chair of Mersey Care Foundation Trust, to the Board.
Beatrice was elected by network members from a strong field of candidates and will take up her seat at the next Mental Health Network Board meeting in October. For further details click here
Adult native knee extensor mechanism ruptures
Injury. 2016 Oct;47(10):2065-2070. doi: 10.1016/j.injury.2016.06.032. Epub 2016 Jun 27.
Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.
UHCW Research: Pengas I. P. and Spalding, T.
Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.
UHCW Research: Pengas I. P. and Spalding, T.
Equally outstanding: equality and human rights – good practice resource
This CQC guidance aims to help providers put equality and human rights at the heart of their improvement work so that the quality of care gets better for everyone. It contains case studies and identifies nine common success factors.
Getting into shape: delivering a workforce for integrated care
This paper from Reform focuses on the structural barriers to delivering integrated care. It studies issues such as the medical labour market, devolved workforce planning and pay, and professional boundaries.
New bill to improve patient safety
The draft Health Service Safety Investigations Bill will establish and enshrine in law the powers of the Health Service Safety Investigations Body (HSSIB).
The HSSIB will take forward the work of the current Healthcare Safety Investigation Branch (HSIB), which came into operation in April 2017 as a division of NHS Improvement.
Under the proposals, the HSSIB will be independent of the NHS and at arm’s length from government. It will have far-reaching access to investigate serious safety incidents or risks to patient safety.
The HSSIB will take forward the work of the current Healthcare Safety Investigation Branch (HSIB), which came into operation in April 2017 as a division of NHS Improvement.
Under the proposals, the HSSIB will be independent of the NHS and at arm’s length from government. It will have far-reaching access to investigate serious safety incidents or risks to patient safety.
Hip fracture care still improving, but two in five patients still not receiving best practice care
The National Hip Fracture Database's (NHFD's) ninth annual report shows that while more patients are receiving early surgery and surviving a hip fracture, two in five are not receiving all of the recommended elements of a hip fracture programme that represent ‘best practice’.
The NHFD report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. It reports much good practice within inpatient care, with the majority of patients getting prompt surgery, specialist geriatric assessment and consideration of their nutritional status.
The NHFD report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. It reports much good practice within inpatient care, with the majority of patients getting prompt surgery, specialist geriatric assessment and consideration of their nutritional status.
New liver disease atlas shows major variation across England
New data published by Public Health England (PHE) shows a wide variation of premature mortality rates from liver disease across England.
The atlas shows premature mortality rates – dying before the age of 75 – ranged from 3.9 per 100,000 in South Norfolk clinical commissioning group (CCG) to 30.1 per 100,000 in Blackpool CCG, a 7.7 fold difference.
The atlas paints a mixed picture, with 10 indicators showing improvements including a reduction of premature deaths and fewer alcohol-specific hospital admissions for under 18s. Nine of the indicators have become worse over time, including a doubling of hospital admission rates for cirrhosis from 54.8 per 100,000 to 108.4 per 100,000 people over the past decade.
The atlas shows premature mortality rates – dying before the age of 75 – ranged from 3.9 per 100,000 in South Norfolk clinical commissioning group (CCG) to 30.1 per 100,000 in Blackpool CCG, a 7.7 fold difference.
The atlas paints a mixed picture, with 10 indicators showing improvements including a reduction of premature deaths and fewer alcohol-specific hospital admissions for under 18s. Nine of the indicators have become worse over time, including a doubling of hospital admission rates for cirrhosis from 54.8 per 100,000 to 108.4 per 100,000 people over the past decade.
Number of written complaints about NHS increases 4.9 per cent
There were 208,400 written complaints received by the NHS during 2016/172 - up 4.9 per cent on the previous year, NHS Digital figures show.
The report, entitled Data on Written Complaints in the NHS, 2016/17, shows numbers of complaints about both primary and secondary care.
There was a 1.4 per cent year-on-year increase in secondary care complaints with 117,800 complaints received in 2016/17, up from 116,200 in 2015/1611, but a smaller proportion of resolved secondary care complaints were fully upheld than the previous year.
There was a 1.4 per cent year-on-year increase in secondary care complaints with 117,800 complaints received in 2016/17, up from 116,200 in 2015/1611, but a smaller proportion of resolved secondary care complaints were fully upheld than the previous year.
Thursday, 14 September 2017
NHS England funding restrictions under fire after patient's death
A 74-year-old man died of a bleed on his brain after he was refused treatment aimed at preventing strokes. NHS England is assessing the treatment as part of Commissioning Through Evaluation
Charity claims it warned NHS England of potential deaths for more than a year.
To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.
Charity claims it warned NHS England of potential deaths for more than a year.
To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.
Group B Streptococcal Disease, Early-onset (Green-top Guideline No. 36)
Women who go into labour before 37 weeks of pregnancy should be offered antibiotics to prevent a possible transmission of Group B Streptococcal (GBS), according to updated guidance published today (13 September) by the Royal College of Obstetricians and Gynaecologists
RCOG statement on hormone therapy use for menopause
Hormone therapy use up to 7 years among postmenopausal women was not associated with an increased risk of death from cardiovascular, cancer, or all causes for nearly 2 decades of follow up, a new analysis shows.The results from the Women's Health Initiative trial are published in JAMA.
Emergency flow improvement tool
Trialled with 150 staff including 30 acute hospitals, NHS Improvement has developed this emergency flow improvement tool. It provides extensive information and allows:
- you to appreciate and understand where the bottlenecks and strains are within the system and implement plans to tackle them
- you to use this information to implement plans that can help see and treat patients more quickly
- leaders and board members to have an overview of their organisation's performance
Why should STPs worry about primary care?
Sustainability and transformation partnerships (STPs) have a tough job to do – focused on making the books balance, hamstrung by provider deficits, trying to make an unsustainable system sustainable.
Yet the majority of patient contacts and opportunity for upstream intervention is in primary care, most obviously general practice but also community pharmacies, dentists and optometrists. In this article, PCC chief executive Helen Northall makes the case for better understanding of and engagement with primary care by STPs.
Yet the majority of patient contacts and opportunity for upstream intervention is in primary care, most obviously general practice but also community pharmacies, dentists and optometrists. In this article, PCC chief executive Helen Northall makes the case for better understanding of and engagement with primary care by STPs.
New improvements to help fight sepsis
Thousands of nurses, care home staff and pharmacists will be told how to check for signs and symptoms of sepsis, as part of a new NHS plan to improve treatment of the condition.
Health Secretary challenges NHS to deliver digital services nationwide
By the end of 2018 – the 70th birthday year of the NHS – the Health Secretary said he expects every patient in England to be able to do the following online through an app:
- access NHS 111
- access their healthcare record
- book a GP appointment
- order repeat prescriptions
- express their organ donation preferences
- express their data sharing preferences
- access support for managing a long term condition
Workplace health needs assessment
A health needs assessment can be a useful and simple way to gather anonymous information about the health of a company’s workforce, and also provide a baseline of data against which to track progress. This document provides practical advice for employers on workplace health and a tool for carrying out workplace health needs assessments.
Leading large scale change: a practical guide
This guide from NHS England aims to support all those seeking to achieve transformational change in complex health and care environments. The guide has been informed by the learning and lived experience of system leaders who have strived for sustainable transformational change.
Test Beds: the story so far
This report describes the progress on the Test Beds Programme so far and how they are tackling clinical challenges such as dementia, diabetes and mental health through technology including algorithms, sensors and the Internet of Things.
These real-word trials
are testing ‘combinatorial’ innovation (new combinations
of products and processes) aiming to improve patient
outcomes at the same or less cost than current practice;
whilst supporting economic growth.
NHS England specialised commissioning service development policy
The service development policy sets out NHS England’s approach for making decisions about which new treatments and interventions to routinely commission, and the approach used for updating existing service specifications, or creating new ones.
Spotlight on specialised services
This report provides an insight into some of the specialised services that are already being delivered and will continue to be rolled out over the coming years in the NHS.
Spotlight on specialised services
This report provides an insight into some of the specialised services that are already being delivered and will continue to be rolled out over the coming years in the NHS.
New quality of life measure for recovering cancer patients
In a world leading move, quality of life for cancer patients will be tracked as part of ambitious plans by NHS England to radically improve care and support for people once treatment ends.
The new ‘quality of life metric’, which is the first of its kind, will use questionnaires to measure how effective this support is and the data will be made available on My NHS – helping patients, the public, clinicians and health service providers see how well their local after cancer care support is doing.
The new ‘quality of life metric’, which is the first of its kind, will use questionnaires to measure how effective this support is and the data will be made available on My NHS – helping patients, the public, clinicians and health service providers see how well their local after cancer care support is doing.
Partnerships for improvement: ingredients for success
The idea of partnerships and collaboration across organisational boundaries is at the heart of NHS reforms in England. Although we have helped to develop the evidence base for how networks of people can improve quality of care, less is known about what makes for successful partnerships between providers at an organisational level.
For this reason, the Nuffield Trust commissioned the Health Services Management Centre at the University of Birmingham to look at a range of current organisational partnerships. This report focuses on five different partnering arrangements, as well as interviews with national leaders, and draws learning to help inform and guide policymakers and providers.
For this reason, the Nuffield Trust commissioned the Health Services Management Centre at the University of Birmingham to look at a range of current organisational partnerships. This report focuses on five different partnering arrangements, as well as interviews with national leaders, and draws learning to help inform and guide policymakers and providers.
Wednesday, 13 September 2017
NIHR Signal 52-week programme leads to more weight loss than 12-week
Obese people referred to a 52-week group weight management programme lost about 2kg more weight on average by one and two years compared to those referred for the standard 12 weeks. These modest health gains were also more likely to be sustained over time in the long programme. A brief intervention led to 3kg weight loss at 12 months, but the 12- and 52-week more intensive programmes led to 23% and 46% more weight loss respectively.
NIHR Signal Group rehabilitation activities improve walking after stroke
Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other.
NIHR Signal A range of anti-epilepsy drugs are effective as first-line
Lamotrigine and levetiracetam are emerging as first-line treatments for epilepsy, which people may be more likely to keep taking than carbamazepine. Reducing the risk of adverse events and treatment withdrawal is important when selecting an anti-epilepsy drug as it usually will need to be taken long-term.
Ab externo canaloplasty for primary open-angle glaucoma [IPG591]
New Evidence-based recommendations on ab externo canaloplasty for primary open-angle glaucoma in adults. This involves widening the eye’s main draining canal by inserting a tiny tube, then removing the tube and stitching the canal to keep it open.
This guidance replaces NICE interventional procedures guidance on canaloplasty for primary open-angle glaucoma (IPG260).
This guidance replaces NICE interventional procedures guidance on canaloplasty for primary open-angle glaucoma (IPG260).
High-intensity focused ultrasound for symptomatic breast fibroadenoma [IPG592]
New Evidence-based recommendations on high-intensity focused ultrasound for symptomatic breast fibroadenoma in adults. This involves using high-frequency sound waves to heat up the tissues in the lump.
Aptiva for painful diabetic neuropathy [MIB119]
NICE has developed a medtech innovation briefing (MIB) on Aptiva for painful diabetic neuropathy.
The technology described in this briefing is Aptiva. It uses a frequency rhythmic electrical modulation system (FREMS) to treat painful diabetic neuropathy.
The innovative aspect of the technology is that it is designed to be a non-drug option for treating painful diabetic neuropathy, with a novel mechanism of action.
Rehabilitation after critical illness in adults [QS158]
New NICE quality standard covers adults with rehabilitation needs as a result of critical illness that required level 2 or level 3 critical care. It describes high-quality care in priority areas for improvement.
End of life care for infants, children and young people [QS160]
New quality standard covers end of life care for infants, children and young people (from birth to 18 years) who have a life-limiting condition. Life-limiting conditions are those that are expected to result in an early death for the person. It also covers support for family members and carers. It describes high-quality care in priority areas for improvement.
NHS England will invest in artificial intelligence, says Stevens
NHS England is to invest more in artificial intelligence over the next 12 months and will roll out new regional patient data schemes, chief executive Simon Stevens has said.
To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.
To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.
Simon Stevens: Cut DTOCs to prepare for possible flu outbreak
Freeing up delayed transfer of care beds will be vital to ensuring the NHS has enough capacity to manage winter pressures and a possible flu outbreak, Simon Stevens has warned.
To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.
To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.
Tuesday, 12 September 2017
Signal: Use of public defibrillators linked to out-of-hospital cardiac arrest survival
Providing a shock using a defibrillator to people with out-of-hospital cardiac arrest before the arrival of emergency medical services increases their chance of survival.
The UK survival rate is around 8%, which is lower than in other developed countries. This review found that bystander assistance through cardiopulmonary resuscitation and attaching a defibrillator increased it to 32%, compared to 12% for police or firefighters. Survival rates were even higher for people who had a rhythm that could be treated by a shock from the defibrillator, at 53% following intervention by bystanders. The higher survival rate seen following bystander assistance was probably due to the shorter time response time, although time to intervention was not reported by the researchers.
Whether it was the speed of first response or cause of cardiac arrest that accounted for these differences, it is clear that members of the public have an important role to play. Although this review did not examine training, pilot studies are investigating the potential of medical dispatch alerts for public first aiders.
Overall, the review findings support the current installation of publicly available defibrillators so members of the public can assist those with cardiac arrest until emergency medical services arrive.
From NIHR Dissemination Centre
The UK survival rate is around 8%, which is lower than in other developed countries. This review found that bystander assistance through cardiopulmonary resuscitation and attaching a defibrillator increased it to 32%, compared to 12% for police or firefighters. Survival rates were even higher for people who had a rhythm that could be treated by a shock from the defibrillator, at 53% following intervention by bystanders. The higher survival rate seen following bystander assistance was probably due to the shorter time response time, although time to intervention was not reported by the researchers.
Whether it was the speed of first response or cause of cardiac arrest that accounted for these differences, it is clear that members of the public have an important role to play. Although this review did not examine training, pilot studies are investigating the potential of medical dispatch alerts for public first aiders.
Overall, the review findings support the current installation of publicly available defibrillators so members of the public can assist those with cardiac arrest until emergency medical services arrive.
From NIHR Dissemination Centre
As NHS approaches 70 it is time to unleash the potential of innovation to transform patient care
The head of NHS England, Simon Stevens has set out an ambitious vision for the National Health Service as it approaches its landmark 70th anniversary.
Mr Stevens will unveil new plans to free up funds for the latest world class treatments by slashing hundreds of millions from the nation’s drugs bill and announce that new and cutting edge treatments will be routinely available for the first time. Innovations include:
Mr Stevens will unveil new plans to free up funds for the latest world class treatments by slashing hundreds of millions from the nation’s drugs bill and announce that new and cutting edge treatments will be routinely available for the first time. Innovations include:
- Revolutionary new treatment for Hepatitis C is set to save NHS England more than £50 million as well as saving thousands more lives
- New measures to slash up to another £300 million from the nation’s medicines bill
- Trailblazing new treatment to restore sight using patients’ own teeth
- Routine commissioning of the latest technology to help deaf children hear
- An expansion of the test-bed programme testing the treatments and care models of tomorrow
Funding available for research applying behavioural insights to health care
The Health Foundation has £1.8m available in its behavioural insights research programme.
This researcher-led open call aims to support up to eight multidisciplinary research teams to generate new knowledge of what can motivate people to act in more efficient and less wasteful ways in UK health care services.
The deadline for applications is noon on Friday 20 October 2017.
The deadline for applications is noon on Friday 20 October 2017.
Seven day stroke service wins Welsh national award
Twenty physiotherapists were part of an award-winning therapy team whose seven-day pilot service improved the care of stroke patients at the University Hospital of Wales.
The project involved 54 volunteer therapists and aimed to provide earlier therapy assessments in the hospital’s acute stroke unit.
The project involved 54 volunteer therapists and aimed to provide earlier therapy assessments in the hospital’s acute stroke unit.
Accountable care models contract: proposed changes to regulations
The Department of Health is seeking views on changes to the regulations on the running of an NHS standard contract (accountable care models).
The development of the Accountable Care Organisations contract has identified some necessary changes to regulation. This is largely to ensure that current rules continue to apply to the new contract, and the organisations using it.
The development of the Accountable Care Organisations contract has identified some necessary changes to regulation. This is largely to ensure that current rules continue to apply to the new contract, and the organisations using it.
Under pressure? NHS maternity services in England
This briefing finds that NHS maternity units are more likely to close towards the end of the week and during holiday periods due to low staffing levels. It reviews the evidence on the long-run pressures faced by maternity units from changes in the number of maternity admissions and the case mix.
While the number of maternity cases has remained largely constant since 2010, the case mix continues to change, with women giving birth later in life and with more complex health conditions. There are implications for maternity units if this evolving case mix of mothers requires more care in terms of staffing or other resources.
While the number of maternity cases has remained largely constant since 2010, the case mix continues to change, with women giving birth later in life and with more complex health conditions. There are implications for maternity units if this evolving case mix of mothers requires more care in terms of staffing or other resources.
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