Using a computerised decision support tool (software used by hospital prescribers) improved the adequacy of antibiotic coverage and adherence to guidelines, and may have reduced the risk of people dying. Only four studies reported on resistance to antibiotics, so no conclusions can be drawn about the impact of this tool on resistance.
Antibiotic stewardship programmes aim to get prescribers to think before they decide to prescribe antibiotics, then consider the type and dose of antibiotic. Computerised decision support aims to support this practice by embedding these principles into everyday practice.
From the NIHR Dissemination Centre
Thursday, 30 November 2017
NIHR Signal Blood test could shorten antibiotic treatment in newborns with suspected sepsis
Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase in the risk of re-infection or death.
Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but results of the blood culture takes time.
From the NIHR Dissemination Centre
Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but results of the blood culture takes time.
From the NIHR Dissemination Centre
NIHR Signal Men feel physically and psychologically ill-prepared for prostate cancer surgery.
Following prostate cancer surgery men often experience physical changes, such as urinary incontinence and erectile dysfunction, causing negative emotions and distress. This review found that men felt poorly prepared – psychologically and physically – for the changes they might experience after surgery. Surgery was often described as "life-changing", and men described worrying about their future.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
Ibrutinib for treating Waldenstrom’s macroglobulinaemia [TA491]
New technology appraisal guidance from NICE:
Evidence-based recommendations on ibrutinib (Imbruvica) for treating Waldenstrom’s macroglobulinaemia in adults after at least 1 previous therapy.
Ibrutinib is recommended for use in the Cancer Drugs Fund as an option for treating Waldenstrom's macroglobulinaemia in adults who have had at least 1 prior therapy, only if the conditions in the managed access agreement for ibrutinib are followed.
Evidence-based recommendations on ibrutinib (Imbruvica) for treating Waldenstrom’s macroglobulinaemia in adults after at least 1 previous therapy.
Ibrutinib is recommended for use in the Cancer Drugs Fund as an option for treating Waldenstrom's macroglobulinaemia in adults who have had at least 1 prior therapy, only if the conditions in the managed access agreement for ibrutinib are followed.
Nivolumab for treating squamous cell carcinoma of the head and neck after platinum-based chemotherapy [TA490]
New technology appraisal guidance from NICE:
Evidence-based recommendations on nivolumab (Opdivo) for treating squamous cell carcinoma of the head and neck in adults who have had platinum-based chemotherapy.
Nivolumab is recommended for use within the Cancer Drugs Fund as an option for treating squamous cell carcinoma of the head and neck in adults whose disease has progressed on platinum-based chemotherapy, only if:
Evidence-based recommendations on nivolumab (Opdivo) for treating squamous cell carcinoma of the head and neck in adults who have had platinum-based chemotherapy.
Nivolumab is recommended for use within the Cancer Drugs Fund as an option for treating squamous cell carcinoma of the head and neck in adults whose disease has progressed on platinum-based chemotherapy, only if:
- the disease has progressed within 6 months of having chemotherapy
- nivolumab is stopped at 2 years of uninterrupted treatment, or earlier in the event of disease progression and
- the conditions in the managed access agreement are followed.
Vismodegib for treating basal cell carcinoma [TA489]
New technology appraisal guidance from NICE:
Evidence-based recommendations on vismodegib (Erivedge) for treating basal cell carcinoma in adults.
Vismodegib is not recommended within its marketing authorisation for treating symptomatic metastatic basal cell carcinoma, or locally advanced basal cell carcinoma that is inappropriate for surgery or radiotherapy, in adults.
Evidence-based recommendations on vismodegib (Erivedge) for treating basal cell carcinoma in adults.
Vismodegib is not recommended within its marketing authorisation for treating symptomatic metastatic basal cell carcinoma, or locally advanced basal cell carcinoma that is inappropriate for surgery or radiotherapy, in adults.
1.2 This recommendation is not intended to affect treatment with vismodegib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Regorafenib for previously treated unresectable or metastatic gastrointestinal stromal tumours [TA488]
New technology appraisal guidance from NICE:
Evidence-based recommendations on on regorafenib (Stivarga) for previously treated gastrointestinal stromal tumours in adults.
Regorafenib is recommended as an option for treating unresectable or metastatic gastrointestinal stromal tumours in adults whose disease has progressed on, or who are intolerant to, prior treatment with imatinib and sunitinib, only if:
Evidence-based recommendations on on regorafenib (Stivarga) for previously treated gastrointestinal stromal tumours in adults.
Regorafenib is recommended as an option for treating unresectable or metastatic gastrointestinal stromal tumours in adults whose disease has progressed on, or who are intolerant to, prior treatment with imatinib and sunitinib, only if:
- their Eastern Cooperative Oncology Group (ECOG) performance status is 0 to 1 and
- the company provides regorafenib with the discount agreed in the patient access scheme.
Venetoclax for treating chronic lymphocytic leukaemia [TA487]
New technology appraisal guidance from NICE:
Evidence-based recommendations on venetoclax (Venclyxto) for treating chronic lymphocytic leukaemia in adults.
Venetoclax is recommended for use within the Cancer Drugs Fund, within its marketing authorisation, as an option for treating chronic lymphocytic leukaemia, that is, in adults:
Evidence-based recommendations on venetoclax (Venclyxto) for treating chronic lymphocytic leukaemia in adults.
Venetoclax is recommended for use within the Cancer Drugs Fund, within its marketing authorisation, as an option for treating chronic lymphocytic leukaemia, that is, in adults:
- with a 17p deletion or TP53 mutation and when a B‑cell receptor pathway inhibitor is unsuitable, or whose disease has progressed after a B‑cell receptor pathway inhibitor or
- without a 17p deletion or TP53 mutation, and whose disease has progressed after both chemo‑immunotherapy and a B‑cell receptor pathway inhibitor and
- only if the conditions in the managed access agreement are followed.
Hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea [IPG598]
New interventional procedures guidance from NICE:
Current evidence on the safety and efficacy of hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Current evidence on the safety and efficacy of hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Processed nerve allografts to repair peripheral nerve discontinuities [IPG597]
New interventional procedures guidance from NICE:
Current evidence on the safety and efficacy of processed nerve allografts to repair peripheral nerve discontinuities is adequate to support the use of this procedure for digital nerves provided that standard arrangements are in place for clinical governance, consent and audit.
The evidence on the safety of processed nerve allografts to repair peripheral nerve discontinuities in other sites raises no major safety concerns. However, current evidence on its efficacy in these sites is limited in quantity. Therefore, for indications other than digital nerve repair, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Current evidence on the safety and efficacy of processed nerve allografts to repair peripheral nerve discontinuities is adequate to support the use of this procedure for digital nerves provided that standard arrangements are in place for clinical governance, consent and audit.
The evidence on the safety of processed nerve allografts to repair peripheral nerve discontinuities in other sites raises no major safety concerns. However, current evidence on its efficacy in these sites is limited in quantity. Therefore, for indications other than digital nerve repair, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Brain Stimulation May Aid Cognition in Parkinson’s
New research suggests that low frequency stimulation of a deep brain region may be able to improve cognitive function in patients with Parkinson’s disease (PD). If true, the findings set the stage for the potential of brain stimulation for treating other cognitive diseases. Click here for article.
Wednesday, 29 November 2017
Self-help book works to combat burnout and stress -- without a therapist
Around a third of all employees find their work stressful. Interventions for stress and burnout are available, but often not accessible for many employees. A self-help book based on Acceptance and Commitment Therapy (ACT) has the potential to reduce burnout, stress and symptoms of depression - without any therapist contact. Click here for article.
UHCW audit on SGLT2 inhibitor (SGLT2-i) use
After almost 2 centuries, SGLT2-i have made their comeback in human pharmacology through successful re-introduction in diabetes type 2 (T2D). Via restriction of renal glucose reabsorption, SGLT2-i have shown promising results. The aim of this audit was to ensure that current practice at UHCW NHS Trust is in line with the agreed national standards, whilst collecting clinical data from the use of SGLT2-i.
The Effect of Alpha1-Proteinase Inhibitor Therapy on Changes in Regional Lung Density: Post-Hoc Analysis of the RAPID/RAPID Extension trial
Poster presented at ATS, May 19–24, 2017
- Alpha-1 antitrypsin deficiency (AATD) is associated with a risk of accelerated proteolytic destruction of lung tissue that may result in the development of severe, early-onset emphysema
- The classic description of AATD-associated emphysema is that of predominantly basal panlobular emphysema; however, the clinical phenotype is heterogeneous and it is increasingly understood that a significant proportion of PiZZ patients develop apical emphysema,1 which may be centrilobular
- Phenotypic heterogeneity may not only have implications for natural history but also for treatment response, as suggested by previous data
- We sought to explore whether there are regional differences in response to treatment with intravenous (IV) alpha1-proteinase inhibitor (A1-PI) therapy in a post hoc analysis of data from the 4 year RAPID program
UHCW Research: Darren Reed and David Parr
Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae
Hernia , Volume 21, Issue 6, pp 843–853
Purpose Incisional hernia (IH) is common complication following laparotomy. Research suggests that the use of a prophylactic mesh can reduce the rate of IH. We performed an updated meta-analysis to better understand the evidence regarding prevention of IH using prophylactic mesh.
UHCW Research: R. Payne and S. Ward
Purpose Incisional hernia (IH) is common complication following laparotomy. Research suggests that the use of a prophylactic mesh can reduce the rate of IH. We performed an updated meta-analysis to better understand the evidence regarding prevention of IH using prophylactic mesh.
UHCW Research: R. Payne and S. Ward
Most children and young people report good experiences of hospital care
The results of the 2016 children and young people’s survey show that the majority of children and young people who stayed in hospital overnight or were seen as a day case patient were happy with the care they received.
The survey results reveal what over 34,000 children and young people under the age of 16 and their parents and carers said about the hospital care they received during November and December 2016.
The survey results reveal what over 34,000 children and young people under the age of 16 and their parents and carers said about the hospital care they received during November and December 2016.
Electronic Prescription Service (EPS) to be piloted in urgent care settings
NHS Digital and partners will shortly begin trialling use of the Electronic Prescription Service (EPS) by prescribers in urgent care settings.
A pilot will take place for selected users of the Adastra system, the clinical software used in many urgent care settings. Care settings will include NHS 111, GP out of hours services, clinical
New rules on blood donation
Changes to the rules on blood donation in England came into force on 28 November. The new rules will allow more people to donate blood, without affecting the safety of the blood supply.
Before every donation, all donors must complete a Donor Health Check and have a private health screening where they may be asked confidential questions based on their completed form.
Subject to meeting the other donation rules, the following groups will now be able to donate after 3 months have passed since the last sexual activity:
Before every donation, all donors must complete a Donor Health Check and have a private health screening where they may be asked confidential questions based on their completed form.
Subject to meeting the other donation rules, the following groups will now be able to donate after 3 months have passed since the last sexual activity:
- men who have had sex with another man
- commercial sex workers
- people who have had sex with a partner at high risk of having a sexually transmitted infection
New maternity strategy to reduce the number of stillbirths
The government has announced a new maternity strategy to reduce the number of stillbirths as part of plans to make the NHS the safest place in the world to give birth.
Families who suffer stillbirth or life-changing injuries to their babies will be offered an independent investigation to find out what went wrong and why. Full-term stillbirths will be investigated by coroners.
Families who suffer stillbirth or life-changing injuries to their babies will be offered an independent investigation to find out what went wrong and why. Full-term stillbirths will be investigated by coroners.
Diabetes and learning disability, reasonable adjustments needed along a diabetes pathway
The prevalence rates of both Type 1 and Type 2 diabetes were identified to be higher in people with a learning disability compared to the general population.
To ensure the same care is available to people with a learning disability, NHS RightCare has published a pathway for diabetes including the reasonable adjustments expected to be made for people with a learning disability. This document will support commissioners applying the NHS RightCare Pathway for diabetes to people with learning disability, so that all receive the same level of care, understanding and outcomes.
To ensure the same care is available to people with a learning disability, NHS RightCare has published a pathway for diabetes including the reasonable adjustments expected to be made for people with a learning disability. This document will support commissioners applying the NHS RightCare Pathway for diabetes to people with learning disability, so that all receive the same level of care, understanding and outcomes.
National audit of intermediate care 2017
The national audit of intermediate care (NAIC) provides benchmarked information on service models, spend, activity, workforce and outcomes with data sharing arrangements in place so that commissioners’ positions will be shared between areas and with providers.
UK five year antimicrobial resistance strategy 2013-2018: annual progress report, 2016
DH's third annual progress report on the UK's antimicrobial resistance strategy describes the activities and achievements over 2016.
It notes that for the remaining two years of the strategy, the programme will focus on the delivery of the government's ambitions to halve certain types of infections and the inappropriate use of antibiotics.
See also Call to Action on Antimicrobial Resistance (AMR). a summary of roundtable on antimicrobial resistance. This report summarises the discussions that took place and the resulting underpinning principles for action as agreed by the co-hosts.
It notes that for the remaining two years of the strategy, the programme will focus on the delivery of the government's ambitions to halve certain types of infections and the inappropriate use of antibiotics.
See also Call to Action on Antimicrobial Resistance (AMR). a summary of roundtable on antimicrobial resistance. This report summarises the discussions that took place and the resulting underpinning principles for action as agreed by the co-hosts.
Training environments 2017: key findings from the national training surveys
This report from the GMC outlines the findings of an annual survey of doctors in training and trainers on the quality of UK medical training and training environments. The report warns that medical education and training is too reliant on the goodwill and sacrifices made by senior colleagues who act as trainers. The report also highlights the challenges faced by trainees who report that heavy workloads threaten the time that they have for training.
Tuesday, 28 November 2017
Avatar Therapy May Ease Schizophrenia Symptoms
New research suggests a new form of therapy which involves a face-to-face discussion between a person with schizophrenia and an avatar appears to help relieve hallucinations when provided along with usual treatment. Click here for article.
Optimism May Buffer Against Stress of Parenting Autistic Kids
Mothers of teenagers with autism spectrum disorder (ASD) or intellectual disability (ID) report higher levels of stress and other mental health problems, such as depression or anxiety, than mothers of typically developing teens, according to a new study published online in the Journal of Autism and Developmental Disorders. Click here for news item (not the study).
Negative Emotions Can Impact Opioid Use When Pain Is Low
An unexpected finding from a small study suggests a link between negative emotions, such as sadness and anxiety, and higher opioid use. Johns Hopkins researchers found that among people with sickle cell disease, opioid use hinged on negative emotions when pain levels were self-reported as relatively low. Click here for article.
Monday, 27 November 2017
Funding and staffing of mental health care: the mirage of parity - The King's Fund
In 2013 the government made a commitment to achieving parity of esteem between physical and mental health. That commitment was followed by a pledge of £1.25 billion for child and adolescent mental health, a national strategy for adult mental health and an investment of £1 billion to support its delivery. Click here to read full report.
Biomarkers May Aid in the Development of New Schizophrenia Drugs
A new study has identified biomarkers that may help in the development of better treatments for schizophrenia. The findings are published online in JAMA Psychiatry. Click here for article, (this link will not direct you to the research itself).
Cognitive Issues in Elderly May Hamper Face Recognition
Elderly people with mild cognitive impairment (MCI) have a much harder time remembering human faces in the short term compared to healthy elderly people, according to a new study by researchers at Kumamoto University in Japan. The findings also show that MCI patients appear to use a different type of gazing behavior while trying to memorize a face. Click here to read.
New initiative calls for collaboration and change in mental health science - QMUL article
The Synergi Collaborative Centre, a five year programme funded by Lankelly Chase, launched a briefing paper which provides the most up to date analyses on ethnic inequalities in UK mental health systems, looking at incidence, prevalence and pathways to care. Click here to read article.
Patient evaluation of trauma service
Emerg Med J. 2017 Dec;34(12):A890. doi: 10.1136/emermed-2017-207308.45.
Patient Experience of the Trauma System (PETS)Trauma care is highly organised, time critical medicine. Changes to patient management in trauma care are often the result of Random Control Trials, and expert opinion following rigorous evaluation of the evidence. Highly efficient, injury focused care is required to achieve the best outcomes for patients. One area that has not been researched so thoroughly however, is the patient experience of trauma care. As evidence already suggests that patients with high stress levels have poorer outcomes, we wanted to investigate the patient perception of the trauma system. We were particularly interested to find out if there were any areas where patient anxieties could be reduced or eliminated.
UHCW Research: C. Turner
Patient Experience of the Trauma System (PETS)Trauma care is highly organised, time critical medicine. Changes to patient management in trauma care are often the result of Random Control Trials, and expert opinion following rigorous evaluation of the evidence. Highly efficient, injury focused care is required to achieve the best outcomes for patients. One area that has not been researched so thoroughly however, is the patient experience of trauma care. As evidence already suggests that patients with high stress levels have poorer outcomes, we wanted to investigate the patient perception of the trauma system. We were particularly interested to find out if there were any areas where patient anxieties could be reduced or eliminated.
UHCW Research: C. Turner
Do nice guys finish last?
Emerg Med J. 2017 Dec;34(12):A879-A880. doi: 10.1136/emermed-2017-207308.30.
Emergency medicine is widely recognised as an intense specialty. Interruptions are known to derail thoughts, increasing cognitive load and result in longer periods before deep thought is re-established. Although approachability and warmth are regarded as important factors in clinicians we wondered what impact these characteristics had on the number of interruptions.
UHCW Research: Turner C and Turner J
Emergency medicine is widely recognised as an intense specialty. Interruptions are known to derail thoughts, increasing cognitive load and result in longer periods before deep thought is re-established. Although approachability and warmth are regarded as important factors in clinicians we wondered what impact these characteristics had on the number of interruptions.
UHCW Research: Turner C and Turner J
A regressing spindle cell tumour of Reed
BMJ Case Reports 2017; doi:10.1136/bcr-2017-222002
Spindle cell tumour of Reed is a benign melanocytic naevus which usually presents as a deeply pigmented mole. It is more commonly found on the lower extremities of young girls. It is an uncommon naevus but its incidence and prevalence are not known. A Reed naevus typically goes through a rapid initial growth phrase before stabilising in size and then regresses over time. Awareness of Reed naevus has been demonstrated to be low, even among dermatology doctors.
UHCW Research: Simon Tso, William Hunt and Joanna E Gach
Spindle cell tumour of Reed is a benign melanocytic naevus which usually presents as a deeply pigmented mole. It is more commonly found on the lower extremities of young girls. It is an uncommon naevus but its incidence and prevalence are not known. A Reed naevus typically goes through a rapid initial growth phrase before stabilising in size and then regresses over time. Awareness of Reed naevus has been demonstrated to be low, even among dermatology doctors.
UHCW Research: Simon Tso, William Hunt and Joanna E Gach
We need to be proactive, not reactive on mental health in schools - The National Student
Depression affects 350 million people worldwide, and one in four people in the UK. This and other mental health issues have been a major cause of concern recently, however, the government is not doing much in response to that. One of the most pressing matters that has come from this rise in poor mental health and mental illness is self- harm. Click here to read further.
Significant improvement in response to the GLP1-agonist 'Liraglutide' following change in injection site
Variability in treatment response with respect to GLP1 agents is well-accepted but incompletely understood. In a specialist GLP-1 clinic at UHCW, we describe a case of improved therapeutic response following change in injection site. Currently, advice is injection in the abdomen or thigh.
A 61 year old man was commenced on Liraglutide 1.2 mg subcutaneous OD injection, in 2013. Previously managed with glimepiride 4 mg and metformin 1 g BD, with suboptimal HbA1c of 93 mmol/mol, weight 111.4 kg.
This case highlights, therefore, anecdotal evidence suggesting site-specific efficacy with relation to liraglutide, and further work should focus on this and its potential mechanisms, including site-specific differences in absorption.
A prospective study examining the role of myocardial Fibrosis in outcome following mitral valve repair IN DEgenerative mitral Regurgitation: rationale and design of the mitral FINDER study
BMC Cardiovascular Disorders 2017 17:282 https://doi.org/10.1186/s12872-017-0715-y
The optimal management of chronic severe primary degenerative mitral regurgitation (MR) is to repair the valve but identification of the optimal timing of surgery remains challenging. Current guidelines suggest ‘watchful waiting’ until the onset of symptoms or left ventricular (LV) dysfunction but these have been challenged as promoting ‘rescue surgery’. Better predictors are required to inform decision-making in relation to the necessity and timing of surgery. Chronic volume overload is a stimulus for adverse adaptive LV remodelling. Subclinical reduction in LV strain before mitral repair predicts a fall in LV ejection fraction following surgery and is thought to reflect the development of myocardial fibrosis in response to chronic volume overload. Myocardial fibrosis can be detected non-invasively using cardiac magnetic resonance (CMR) imaging techniques as an expansion of the extracellular volume (ECV).
UHCW Research: Thomas Barker and Ramesh Patel
The optimal management of chronic severe primary degenerative mitral regurgitation (MR) is to repair the valve but identification of the optimal timing of surgery remains challenging. Current guidelines suggest ‘watchful waiting’ until the onset of symptoms or left ventricular (LV) dysfunction but these have been challenged as promoting ‘rescue surgery’. Better predictors are required to inform decision-making in relation to the necessity and timing of surgery. Chronic volume overload is a stimulus for adverse adaptive LV remodelling. Subclinical reduction in LV strain before mitral repair predicts a fall in LV ejection fraction following surgery and is thought to reflect the development of myocardial fibrosis in response to chronic volume overload. Myocardial fibrosis can be detected non-invasively using cardiac magnetic resonance (CMR) imaging techniques as an expansion of the extracellular volume (ECV).
UHCW Research: Thomas Barker and Ramesh Patel
Letter from President Professor Wendy Burn to the Guardian Editor
Professor Wendy Burn, President of the Royal College Psychiatrists,
writes to the Guardian Editor about the imminent danger mental health
services are facing., 24 November, 2017. Click here to read.
Friday, 24 November 2017
Four ways carers told us they can be better supported
Carers play a vital role in supporting people who are frail, ill or disabled, but, in doing so, they often become vulnerable themselves. Find out four ways carers want to be better supported. Click here for Healthwatch article
Abandoning Mental Health Plan Would Represent 'Catastrophic Betrayal'
NHS boss Simon Stevens recently warned that without additional money, plans to improve cancer and mental health treatment were in danger. So it felt like there might be cause to celebrate when the Chancellor Philip Hammond announced £10bn capital spending for the NHS in addition to £2.8bn extra for NHS England. Click here for Huffpost blog
High-Intensity Exercise Can Boost Memory
Although the physical benefits of high-intensity exercise are widely known, new research suggests another major benefit: enhanced memory. Scientists believe the finding may have profound implications as our society copes with the growing problem of catastrophic diseases such as dementia and Alzheimer’s. Click here for PsychCentral article
Thursday, 23 November 2017
HSJ Awards winners announced
The winners of the Health Service Journal (HSJ) Awards 2017 were announced at a ceremony held at the InterContinental hotel in London. The awards highlight examples of outstanding practice and innovation that help to safeguard and improve patient care across the NHS.
National Prostate Cancer Audit (NPCA) Annual Report 2017
Only 8% of men with low-risk prostate cancer received potentially unnecessary radical treatment aimed at curing the disease[1] in 2015-16 according to the fourth Annual Report of the National Prostate Cancer Audit (NPCA) published by the Royal College of Surgeons. This is an improvement on 2014-15 figures, when 12% of men treated by the NHS in England may have received unnecessary treatment for low risk disease. This reflects the international trend in this area of prostate cancer therapy.
App that helps pregnant women monitor hypertension among new NHS innovations that will save lives and improve treatment
A wireless sensor that better detects breathing rate in hospital patients, an app to help pregnant women monitor hypertension and another that directs patients with minor injuries to treatment units with the shortest queues are among the latest innovations set to be spread across the NHS.
Falls risk screening tools ‘not accurate’ new report warns
The Royal College of Physicians’ National Audit for Inpatient Falls assessed 5,000 falls, and shows that although prevention across England and Wales has improved slightly, many patients are not receiving the right assessments that can help prevent harm.
The audit reveals that since 2015, many trusts and Local Health Boards (LHBs) have stopped using ‘falls risk screening or prediction tools’ (a drop from 74 per cent in 2015 to 34 per cent).
The audit reveals that since 2015, many trusts and Local Health Boards (LHBs) have stopped using ‘falls risk screening or prediction tools’ (a drop from 74 per cent in 2015 to 34 per cent).
NIHR Signal Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently
Older people who received comprehensive geriatric assessment when in hospital were slightly more likely to be living in their own homes one year later. Sixty percent were discharged to independent living compared with 56% receiving standard ward care. People who had received this proper assessment were also 20% less likely to be in a nursing home after three months or more.
Older people often have multiple complex conditions combined with frailty and are more likely to lose independence after illness. Comprehensive geriatric assessment is a careful review by a multidisciplinary specialist team of people’s medical, functional, mental and social capabilities. It aims to improve recovery and enable people to maintain function and independence.
This updated Cochrane review covered 29 trials comparing this assessment with routine care for people over 65, excluding those with stroke and orthopaedic conditions. It may save NHS resources, but the quality of evidence was too low to assess this reliably.
This assessment is not carried out in all hospitals, and the mode of delivery varies. Research has yet to answer how best to deliver this assessment to those most in need.
From the NIHR Dissemination Centre
Older people often have multiple complex conditions combined with frailty and are more likely to lose independence after illness. Comprehensive geriatric assessment is a careful review by a multidisciplinary specialist team of people’s medical, functional, mental and social capabilities. It aims to improve recovery and enable people to maintain function and independence.
This updated Cochrane review covered 29 trials comparing this assessment with routine care for people over 65, excluding those with stroke and orthopaedic conditions. It may save NHS resources, but the quality of evidence was too low to assess this reliably.
This assessment is not carried out in all hospitals, and the mode of delivery varies. Research has yet to answer how best to deliver this assessment to those most in need.
From the NIHR Dissemination Centre
NIHR Signal Exercise improves symptoms and function for people with ankylosing spondylitis
People with ankylosing spondylitis showed improvement in their symptoms and their ability to perform day-to-day tasks when they did more exercise. Symptom and function scores improved by almost one point on a 10-point scale after 3 to 12 weeks of exercise.
People with ankylosing spondylitis showed improvement in their symptoms and their ability to perform day-to-day tasks when they did more exercise. Symptom and function scores improved by almost one point on a 10-point scale after 3 to 12 weeks of exercise.
Ankylosing spondylitis is a type of arthritis which mainly affects the spine, causing pain, stiffness and progressive fusion of the spine. There have been recent advances in pharmacological treatment, and it was uncertain whether exercise along with modern drug treatment has useful benefits.
This review pooled the results of eight trials comparing different types of exercise with education or no exercise. People’s symptoms and ability to perform daily activities improved regardless of whether they were receiving new drug treatments.
The functional improvements shown in this research and the potential to prolong independence and working life for the most severely affected might also be another important reason to maintain activity.
From the NIHR Dissemination Centre
People with ankylosing spondylitis showed improvement in their symptoms and their ability to perform day-to-day tasks when they did more exercise. Symptom and function scores improved by almost one point on a 10-point scale after 3 to 12 weeks of exercise.
Ankylosing spondylitis is a type of arthritis which mainly affects the spine, causing pain, stiffness and progressive fusion of the spine. There have been recent advances in pharmacological treatment, and it was uncertain whether exercise along with modern drug treatment has useful benefits.
This review pooled the results of eight trials comparing different types of exercise with education or no exercise. People’s symptoms and ability to perform daily activities improved regardless of whether they were receiving new drug treatments.
The functional improvements shown in this research and the potential to prolong independence and working life for the most severely affected might also be another important reason to maintain activity.
From the NIHR Dissemination Centre
RCPsych response to the Budget 2017
In response to the Chancellor Philip Hammond's Budget 2017 announcement, Professor Wendy Burn, President of the Royal College of Psychiatrists said: “The Chancellor’s announcement of extra funding for the NHS is welcome but we now urgently need the Government and NHS England to confirm that they will keep existing plans for the delivery of mental health promises on track.
“It would be a catastrophic betrayal of people with mental illness if pledges already made to fund more services were to be abandoned now.” Click here for RCPsych blog
Autumn Budget 'another missed opportunity'
The Autumn Budget falls short of measures needed to relieve pressures facing the NHS, representing yet another missed opportunity to pull health and care services back from the brink, the head of the NHS Confederation said on Wednesday. Click here to see NHS Confederation blog
Grandad took own life just hours after mental health assessment team said he was 'not at risk'
Marlon Demaine, 50, 'was not correctly assessed by mental health services' two hours before he took his own life. Click here to see local news piece
Centre for Mental Health welcomes budget boost for NHS and calls for fair funding for mental health and social care
Centre for Mental Health today welcomed the Chancellor’s decision in the 2017 Budget statement to provide additional funding for the NHS between now and 2020 and called for assurances that funding to improve mental health services will be protected and that all local areas will see increases in mental health spending in line with promises made following the Five Year Forward View for Mental Health. Click here for press release
NIHR Signal Faecal transplant effectively treats recurrent or unresponsive Clostridium difficile
Using a faecal microbiota transplant cured 92% of people with Clostridium difficile that had recurred or had not responded to antibiotics. Faecal transplant also had a lower risk of treatment failure than the antibiotic vancomycin.
C. difficile is a potentially serious infection of the gut that can occur after a course of antibiotics unbalances the gut bacteria. Faecal transplant uses the diluted faeces of a healthy person delivered into the guts of the person with C. difficile to rebalance their gut bacteria.
Administering the transplant via colonoscopy or enema was more effective than via a stomach tube. This may help patients to overcome the aesthetic qualities of this treatment.
This review revealed many variations in how transplants were prepared and administered, so further work is needed to find the best preparation and volume.
From the NIHR Dissemination Centre
C. difficile is a potentially serious infection of the gut that can occur after a course of antibiotics unbalances the gut bacteria. Faecal transplant uses the diluted faeces of a healthy person delivered into the guts of the person with C. difficile to rebalance their gut bacteria.
Administering the transplant via colonoscopy or enema was more effective than via a stomach tube. This may help patients to overcome the aesthetic qualities of this treatment.
This review revealed many variations in how transplants were prepared and administered, so further work is needed to find the best preparation and volume.
From the NIHR Dissemination Centre
Wednesday, 22 November 2017
Nutritional care tool report 2017
The BAPEN nutritional care tool report provides organisational-level data on how nutritional care is organised and patient-level data on the quality of nutrition in hospitals, care homes and community organisations.
A two-way street: what can CCGs teach us about accountability in STPs?
This report from the Nuffield Trust explores the accountability and performance management arrangements for CCGs and looks at the implications of these for STPs and accountable care systems. It is based on 13 interviews with senior CCG leaders and NHS England policy makers which took place in September 2016.
Does the NHS need more money?
Briefing from the King's Fund.
In recent years, spending on the NHS has been protected while other budgets, such as those for local government services and policing, have been subject to significant cuts. Despite this, health services are facing unprecedented financial and operational pressures, with many NHS organisations in deficit and key performance standards being missed.
In recent years, spending on the NHS has been protected while other budgets, such as those for local government services and policing, have been subject to significant cuts. Despite this, health services are facing unprecedented financial and operational pressures, with many NHS organisations in deficit and key performance standards being missed.
Latest NHS sickness absence statistics - July 2017
The latest figures released by NHS Digital show that for July 2017 NHS staff sickness absence was 4.01 per cent.
Transforming gastroenterology elective care services
This handbook from NHS England has been created to to support the improvement of local health and care systems for gastroenterology elective care services.
Transforming musculoskeletal and orthopaedic elective care services
This handbook from NHS England has been created to to support the improvement of local health and care systems for musculoskeletal and orthopaedic elective care services.
NHS England announces plans to break down barriers for research
NHS England has announced plans to accelerate the NHS’ national research strategy, cutting bureaucracy and speeding up access to new and innovative treatments.
NHS Chief Executive Simon Stevens will announce that proposals to streamline and standardise the process of setting up trials across multiple sites, needed to develop treatments for rare cancers and other complex conditions, and claiming back excess treatment costs that can be a barrier to innovation will be considered by the NHS England Board next week.
Stillbirth risk is doubled if pregnant women sleep on their backs in third trimester
New research published in BJOG: An International Journal of Obstetrics and Gynaecology suggests that the risk of stillbirth is doubled if pregnant women sleep on their backs during the third trimester.
The Midlands and North of England Stillbirth Study (MiNESS) is the largest study of maternal sleep position and risk of stillbirth. It looked at 291 pregnancies that ended in stillbirth and 735 women who had a live birth.
The findings suggest women who go to sleep on their back - known as the supine position - have a 2.3 fold increase in risk of late stillbirth (after 28 weeks of gestation) compared with women who sleep on their side.
The Midlands and North of England Stillbirth Study (MiNESS) is the largest study of maternal sleep position and risk of stillbirth. It looked at 291 pregnancies that ended in stillbirth and 735 women who had a live birth.
The findings suggest women who go to sleep on their back - known as the supine position - have a 2.3 fold increase in risk of late stillbirth (after 28 weeks of gestation) compared with women who sleep on their side.
Safeguarding Adults Collection (SAC), Annual Report, England 2016-17
Safeguarding Adults, Annual Report, England 2016/17 has been published by NHS Digital. It provides details of how many safeguarding concerns were raised during the year, how many safeguarding enquiries were started and how many were completed within that year under Section 42 of the Care Act 2014.
Patient and Public Voice (PPV) Partners and Chairs Survey November 2016
This NHS England report outlines the findings of a 2016 survey of PPV partners and chairs on their views and experiences. It finds that whilst most respondents feel that their input is valued, some are unsure of the impact of their role. The results also highlight areas in which improvements could be made in the role and activity of PPV partners.
Tumour diameter is not reliable for management of non-secreting pancreatic neuroendocrine tumours
doi: 10.1530/EC-17-0293 Endocr Connect 2017 vol. 6 no. 8 876-885
Small non-functioning pancreatic NETs (pNETs) ≤2 cm can pose a management dilemma in terms of surveillance or resection. There is evidence to suggest that a surveillance approach can be considered since there are no significant radiological changes observed in lesions during long-term follow-up. However, other studies have suggested loco-regional spread can be present in ≤2 cm pNETs. The aim of this study was to characterise the prevalence of malignant features and identify any useful predictive variables in a surgically resected cohort of pNETs. 418 patients with pNETs were identified from 5 NET centres. Of these 227 were included for main analysis of tumour characteristics. Mean age of patients was 57 years, 47% were female. The median follow-up was 48.2 months. Malignant features were identified in 38% of ≤2 cm pNETs. ROC analysis showed that the current cut-off of 20 mm had a sensitivity of 84% for malignancy. The rate of malignant features is in keeping with other surgical series and challenges the belief that small pNETs have a low malignant potential. This study does not support a 20 mm size cut-off as being a solitary safe parameter to exclude malignancy in pNETs.
UHCW Research: Saboor Khan, Martin O. Weickert
Small non-functioning pancreatic NETs (pNETs) ≤2 cm can pose a management dilemma in terms of surveillance or resection. There is evidence to suggest that a surveillance approach can be considered since there are no significant radiological changes observed in lesions during long-term follow-up. However, other studies have suggested loco-regional spread can be present in ≤2 cm pNETs. The aim of this study was to characterise the prevalence of malignant features and identify any useful predictive variables in a surgically resected cohort of pNETs. 418 patients with pNETs were identified from 5 NET centres. Of these 227 were included for main analysis of tumour characteristics. Mean age of patients was 57 years, 47% were female. The median follow-up was 48.2 months. Malignant features were identified in 38% of ≤2 cm pNETs. ROC analysis showed that the current cut-off of 20 mm had a sensitivity of 84% for malignancy. The rate of malignant features is in keeping with other surgical series and challenges the belief that small pNETs have a low malignant potential. This study does not support a 20 mm size cut-off as being a solitary safe parameter to exclude malignancy in pNETs.
UHCW Research: Saboor Khan, Martin O. Weickert
Hypertestosteronemia and primary infertility from a mediastinal extragonadal germ cell tumor
Case study poster on Hypertestosteronemia and primary infertility from a mediastinal extragonadal germ cell tumor from GK Dimitriadis, A Davasgaium, M Mytilinaiou, C Hewit, N Nalawade, D Sambrook and H S Randeva
Fat Hormones, Adipokines
Adipose tissue functions as a dynamic endocrine organ secreting multiple proteins, factors, and hormones into the systemic circulation that are collectively described as adipokines. Adipokines exert pleiotropic effects on target tissues/organs thereby regulating energy homeostasis, metabolism, and insulin sensitivity, as well as immune and cardiovascular functions. Expanding adipose tissue in obesity undergoes a change in the adipokine secretion profile characterized by an increase of proinflammatory adipokines and suppression of anti-inflammatory adipokines increasing proinflammatory pathways within adipose tissue depots and creating an adverse circulating adipokine profile, resulting in a chronic, low-grade, systemic inflammatory state. Compelling evidence directly links the adverse proinflammatory adipokine profile in obesity with a spectrum of detrimental cardio-metabolic effects including hepatic, skeletal muscle, and myocardial insulin resistance, hypertension, atherosclerosis, hypercoagulability, thrombosis, and endothelial and cardiac dysfunction. This chapter presents a brief overview of the nature of adipose tissue in obesity and focuses on selected adipokines that have direct and indirect effects on the heart and cardiovascular system.
UHCW Research: I Kyrou, H. S. Mattu and H. S. Randeva
Tuesday, 21 November 2017
Walk in Nature Beats Mall for Positive Mom-Daughter Bond
In a new study, researchers at the University of Illinois wanted to know how a mother-daughter walk through nature would compare to a walk in the mall when it comes to mental and relational benefits. Click here for PsychCentral article
Reducing the Pressure on Hospitals: 12 months on
With this winter fast approaching, has the Royal College of Occupational Therapists’s call to deploy occupational therapists to achieve optimum patient flow through hospital services made any difference? 12 months on from the launch, we contacted the services featured in our reports to find out. Click here to see report
Monday, 20 November 2017
Co-Parenting After A Violent Marriage: What to Expect
Sadly, intimate partner violence is not uncommon among divorcing couples. And, when kids are involved, the first year after the relationship break-up is critical as this is when custody and co-parenting arrangements are being decided. Click here to read PsychCentral article
Boosting Brain Activity May Buffer Against Anxiety
A new study at Duke University finds that boosting brain activity in regions related to thinking and problem-solving may help buffer against anxiety. Click here to read PsychCentral article
New training scheme for surgeons of the future opens for applications
The Royal College of Surgeons has announced that applications for the first Improving Surgical Training (IST) programme for trainee surgeons are open. The innovative pilot training programme will provide surgical trainees with a better balance between training and service provision and professionalise the role of the surgical trainer.
The programme will be piloted in general surgery, and from August 2019, will also be open to applicants to urology and vascular surgery. The programme will be open to all trainees applying for core-level surgical training posts through the 2017/2018 national selection process.
The programme will be piloted in general surgery, and from August 2019, will also be open to applicants to urology and vascular surgery. The programme will be open to all trainees applying for core-level surgical training posts through the 2017/2018 national selection process.
Surgeons asked to staff hospital front doors to head off emergency pressures this winter
The leaders of the Royal College of Surgeons (RCS) have written to surgeons in England, encouraging them to provide support at hospital front doors (e.g. rapid outpatient clinics and A&E) over the coming months as the NHS faces arguably its toughest winter in modern times. The surgeons have also called on government to make further funding available to the NHS in next week’s Budget.
The RCS says there is strong evidence that having more senior decision-makers at the front door of hospitals reduces unnecessary emergency admissions and delayed discharges, thereby freeing up beds for genuine emergencies and patients needing planned operations.
The RCS says there is strong evidence that having more senior decision-makers at the front door of hospitals reduces unnecessary emergency admissions and delayed discharges, thereby freeing up beds for genuine emergencies and patients needing planned operations.
Managers endorse CSP’s flexible working guide
The Building a better balance guide, already available to stewards, has been re-issued by the Chartered Society of Physiotherapists with specific guidance for managers dealing with requests for flexible working.
Healthy Child Record Standard
The Professional Records Standards Body (PRSB) has launched a new set of information standards, to ensure that children receive appropriate care by setting out what information on screening tests, immunisations and developmental milestones should be securely shared for their treatment, care and wellbeing.
Transportation and the role of hospitals
This report from the American Hospital Association explores the role of hospitals and health systems in addressing patient transport issues. It includes four case studies on hospitals and health systems in the US and their interventions to reduce transportation barriers in their communities.
Launch of advanced clinical practice framework
The new national multi-professional framework for advanced clinical practice in England has been launched by Health Education England.
Friday, 17 November 2017
Mental health trusts restrain patients 'every 10 minutes'
Mental health trusts in England are restraining patients on average every 10 minutes, figures have revealed. Click here to see news report
Randomized Trial: Computerized Brain Training Can Reduce Risk of Dementia
A newly published study is the first to show that computerized brain-training can reduce the risk of dementia among older adults. Click here to see PsychCentral article
Does Hospital Competition Improve Efficiency? The Effect Of The Patient Choice Reform In England
This paper investigates the effect of hospital competition on dimensions of efficiency including indicators of resource management and costs. Findings suggest that increased competition had mixed effects on efficiency. Click here to see Kings Fund blog
Does hospital competition improve efficiency? The effect of the patient choice reform in England
This paper from the Centre for Health Economics investigates the effect of hospital competition on dimensions of efficiency including indicators of resource management and costs. Findings suggest that increased competition had mixed effects on efficiency.
Breast cancer patients to have routine access to two life extending drugs after new deal, say NICE in draft guidance
NICE has recommended palbociclib and ribociclib for routine funding after the companies lowered the prices and gave more evidence for their effectiveness.
Palbociclib (Ibrance) from Pfizer and ribociclib (Kisqali) from Norvatis, are recommended for people with hormone receptor (HR) positive, HER2 negative locally advanced or secondary breast cancer.
Performance of the NHS provider sector for the month ended 30 September 2017
This report from NHS Improvement finds that despite the NHS treating more patients than even before, more people were seen within four hours in A&E and within 18 weeks for planned care. However, the combined end of year deficit for hospitals in England will be an estimated £127 million worse than planned.
Exclusive: One in four hospital trusts routinely pay suppliers late
More than a quarter of hospital trusts are now routinely delaying payments to their suppliers because of cash flow problems, analysis by HSJ reveals.
Data collected from annual reports since 2014-15 shows a threefold increase in acute providers paying more than half their invoices late, with dozens of trusts reporting a steep rise in late payments.
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
Thursday, 16 November 2017
New case study on how to run a successful recruitment fair
NHS Employers has published a new case study focusing on how Sandwell and West Birmingham Hospitals NHS Trust successfully ran a recruitment day to increase its nursing and health care assistant workforce.
The study looks at how the trust targeted nurses wanting to return to practice in the NHS, as well as more traditional groups such as nurses in training. The organisation reached out to experienced nurses working outside of the NHS through a variety of communications channels to secure over 160 attendees at their event. They interviewed 110 people leading to 95 job offers to both registered nurses and healthcare assistants.
The study looks at how the trust targeted nurses wanting to return to practice in the NHS, as well as more traditional groups such as nurses in training. The organisation reached out to experienced nurses working outside of the NHS through a variety of communications channels to secure over 160 attendees at their event. They interviewed 110 people leading to 95 job offers to both registered nurses and healthcare assistants.
Guy's and St Thomas' staff engagement case study
NHS Employers has published a new case study looking at how Guy's and St Thomas' NHS Foundation Trust has rolled out a series of listening exercises as part of its staff engagement work.
Use procurement data to help realise £300m of savings
NHS improvement's recent procurement league table presents an assessment of the relative performance of procurement departments using data on acute trusts’ procurement process efficiency and price performance.
To help identify your opportunities to save, you can use
To help identify your opportunities to save, you can use
- the Model Hospital to interrogate your own procurement data to help you identify areas to improve
- the Purchase Price Index and Benchmarking (PPIB) tool and the nationally contracted products programme to negotiate lower prices
Single Oversight Framework (SOF): 2017/18 version
NHS improvement has updated the Single Oversight Framework to reflect changes in national policy priorities and its approach to provider oversight.
Addressing ambulance handover delays: actions for local A&E delivery boards
Ambulance handover will be a key indicator for both winter monitoring and on an ongoing basis through publication of performance data.
This letter from NHS Improvement outlines its expectations and guidelines for management.
This letter from NHS Improvement outlines its expectations and guidelines for management.
RCOG position on PLOS Medicine study: Inducing first-time mothers aged 35 and over earlier could reduce stillbirths and neonatal deaths
A study published in PLOS Medicine has found that inducing first-time mothers aged 35 and over at 40 weeks could reduce the risk of stillbirth and neonatal death (the death of a baby 7 days after birth), when compared to current guidelines which recommend induction of labour between 41 and 42 weeks for all women regardless of age.
Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over...
Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over...
#Physio17: Researcher highlights difficulties accessing hard to reach groups
Speaking at the CSP’s annual conference in Birmingham, Gita Ramdharry, research lead and specialist neuromuscular physiotherapist at the Centre for Neuromuscular Diseases at University College London Hospitals, outlined some of the challenges of conducting research on rare populations or with small sample sizes.
Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial.
JAMA. 2017 Nov 14;318(18):1767-1776. doi: 10.1001/jama.2017.16429
Among patients 16 years or older with an acute, displaced, extra-articular fracture of the distal tibia, neither nail fixation nor locking plate fixation resulted in superior disability status at 6 months. Other factors may need to be considered in deciding the optimal approach.
UHCW Research: Costa, M. L.
Among patients 16 years or older with an acute, displaced, extra-articular fracture of the distal tibia, neither nail fixation nor locking plate fixation resulted in superior disability status at 6 months. Other factors may need to be considered in deciding the optimal approach.
UHCW Research: Costa, M. L.
At least £360m extra funding may be needed for NHS to meet four hour A&E target this winter
This winter, the extra capacity needed to help the NHS to meet its four hour A&E target could cost at least £360m, according to new analysis by the Health Foundation.
Recent measures taken to reduce pressures include an increase in people having the flu vaccine, more 111 calls being handled by clinicians and £100m of capital investment. This may reduce the number of people coming to A&E.
However, the impact of these measures is not yet known. New Health Foundation analysis shows that unless the trend of recent years is significantly improved, this winter could potentially see the worst performance against this target since records began in 2004/5.
Recent measures taken to reduce pressures include an increase in people having the flu vaccine, more 111 calls being handled by clinicians and £100m of capital investment. This may reduce the number of people coming to A&E.
However, the impact of these measures is not yet known. New Health Foundation analysis shows that unless the trend of recent years is significantly improved, this winter could potentially see the worst performance against this target since records began in 2004/5.
Autumn budget: £4 billion needed next year to stop NHS care deteriorating
The government must find at least £4 billion more for the NHS in the Budget to stop patient care deteriorating next year, three leading health charities warn today.
New analysis in a briefing from the Health Foundation, The King’s Fund and the Nuffield Trust shows that current spending plans fall well short of what the NHS needs based on an assessment of Office of Budget Responsibility (OBR) projections and historic rates of funding growth. Based on the government’s current spending plans, the analysis estimates there will be a funding gap of at least £20 billion by 2022/23.
See also Simon Stevens' speech about NHS funding.
New analysis in a briefing from the Health Foundation, The King’s Fund and the Nuffield Trust shows that current spending plans fall well short of what the NHS needs based on an assessment of Office of Budget Responsibility (OBR) projections and historic rates of funding growth. Based on the government’s current spending plans, the analysis estimates there will be a funding gap of at least £20 billion by 2022/23.
See also Simon Stevens' speech about NHS funding.
'I feel better for singing': the choir tackling mental health stigma
Choir members, including people with mental health problems, say their wellbeing and connectedness have improved since singing together. Read newspaper article here
Teenage depression linked to father's depression
Adolescents whose fathers have depressive symptoms are more likely to experience symptoms of depression themselves, finds a new study led by UCL researchers. Read article here
Wednesday, 15 November 2017
More Screen Time Tied to Depression, Suicidal Behavior in Teens
A new study suggests that greater screen time — whether in the form of computers, cell phones or tablets — may have contributed to a spike in depression and suicide-related behaviors and thoughts among American teens, particularly girls, between 2010 and 2015. Click here for PsychCentral article
Tests in secondary care to identify people at high risk of ovarian cancer [DG321
New: Diagnostic Guidance
Evidence-based recommendations on tests in secondary care to identify people at high risk of ovarian cancer. The tests are the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 250), ROMA and IOTA Simple Rules.
There is currently not enough evidence to recommend the routine adoption of the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 200 or 250), ROMA or IOTA Simple Rules in secondary care in the NHS to help decide whether to refer people with suspected ovarian cancer to a specialist multidisciplinary team (MDT).
Evidence-based recommendations on tests in secondary care to identify people at high risk of ovarian cancer. The tests are the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 250), ROMA and IOTA Simple Rules.
There is currently not enough evidence to recommend the routine adoption of the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 200 or 250), ROMA or IOTA Simple Rules in secondary care in the NHS to help decide whether to refer people with suspected ovarian cancer to a specialist multidisciplinary team (MDT).
Tuesday, 14 November 2017
Clinical Nurse Specialist in Early Pregnancy Care
The role of the clinical nurse specialist in early pregnancy care is intended to enhance the care for women who may be concerned about a complication in early pregnancy.
This RCN document outlines the key skills and knowledge required to develop the role of this specialist nurse/midwife and should provide clear direction for commissioners and managers when creating roles to support best practice in local service provision for women and their families.
This RCN document outlines the key skills and knowledge required to develop the role of this specialist nurse/midwife and should provide clear direction for commissioners and managers when creating roles to support best practice in local service provision for women and their families.
Red2Green: making a difference to our patients
A helfpul video from NHS Improvement for other trusts looking for ways to reduce delayed discharges. It explains the processes put in place across Hampshire Hospitals NHS Foundation Trust to speed up discharges and how they have been successfully implemented.
The main focus is Red2Green, but it also talks about the reasons why these measures have been brought in, with particular reference to the fact that 10 days in bed equates to 10 years worth of muscle wastage in patients over the age of 80.
The main focus is Red2Green, but it also talks about the reasons why these measures have been brought in, with particular reference to the fact that 10 days in bed equates to 10 years worth of muscle wastage in patients over the age of 80.
Should we consider devolution of “head and neck” surgery from the specialties of oral and maxillofacial surgery; ear, nose, and throat surgery; and plastic surgery?
Br J Oral Maxillofac Surg. 2017 Jun;55(5):566. doi: 10.1016/j.bjoms.2016.12.019. Epub 2017 Feb 14.
Editorial published in the British Journal of Oral and Maxillofacial Surgery
In the United Kingdom the practice of vascular surgery has now become recognised as the tenth independent surgical specialty by the Royal College of Surgeons of England and the General Medical Council (GMC). Traditionally, surgical trainees developed their subspecialty vascular interest within the parameters of obtaining a certificate of completion of training (CCT) in General Surgery. The process of devolution of areas of subspecialty may also apply to other surgical specialties.
Editorial published in the British Journal of Oral and Maxillofacial Surgery
In the United Kingdom the practice of vascular surgery has now become recognised as the tenth independent surgical specialty by the Royal College of Surgeons of England and the General Medical Council (GMC). Traditionally, surgical trainees developed their subspecialty vascular interest within the parameters of obtaining a certificate of completion of training (CCT) in General Surgery. The process of devolution of areas of subspecialty may also apply to other surgical specialties.
UHCW Research: Elledge R, Walton G, Sandhu R, Prasad S, Howe D
Fab Change week – A bag to remember
My words – Only just a few months ago as a hospital Chaplain I was called out to Carlton Coleby ward at Lincoln County hospital to the death of a young Mum.
This lady had a young son who was 13 years of age and as you can imagine he was devastated. Later that week when I went to the ward for a debrief I quickly picked up from the staff that it was so difficult to have a young boy there whose Mum had died suddenly and find, that words seemed few and “What do you say or do” at a time like this was prevalent. Click here to see the blog and idea
£600,000 funding of 12 projects by PHE to help prevent HIV
Through the HIV Prevention Innovation Fund, PHE is funding 12 projects to help develop new and innovative ways of preventing HIV. Click here to see government report
NHS cracks down on mental health patients being sent out of area
Mental health trusts are being forced as part of an NHS England crackdown to reveal how many patients they are sending elsewhere for treatment because they have too few beds. Click here to read newspaper article
How well do we perceive other people's stress levels in the workplace
A new study finds that people often project their own experiences with stress onto their colleagues and employees, causing miscommunication and, often, missed opportunities. Click here to view article
Health At A Glance 2017
OECD - This report outlines the latest comparable data and trends on different aspects of the performance of health systems in OECD countries. The analysis of the UK health system finds that the overall health of Britons is similar to the OECD average and that access to care is generally strong but that the indicators for quality of care are below the OECD average. Click here for Kings Fund Blog
New podcast on reducing agency spend
New case study from NHS Employers:
- reduced agency spend by £5 million
- moved from a master vendor agreement to an in-house agency solution
- avoid time-sheet fraud
- improved the quality of services.
Regulation of MAP roles - have your say
The Department of Health is seeking views on the regulation of four medical associate profession (MAP) roles in the UK.
- Physician Associate (PA)
- Physicians’ Assistant (Anaesthesia) (PA(A))
- Surgical Care Practitioner (SCP)
- Advanced Critical Care Practitioner (ACCP).
Complete its short survey by 13 December 2017 to ensure that your views are represented.
A realist informed mixed methods evaluation of Schwartz Center Rounds in England
This summary from the National Institute of Health Research outlines initial findings from an in-depth study of Schwartz Center Rounds and the impact that they have on clinical and non-clinical staff.
Researchers from The King's Fund, the University of Surrey, Kings College London and the University of Sheffield found that health care staff who regularly share the emotional, social or ethical challenges they face in the workplace experience less psychological distress, improved teamwork and increased empathy and compassion for patients and colleagues.
Researchers from The King's Fund, the University of Surrey, Kings College London and the University of Sheffield found that health care staff who regularly share the emotional, social or ethical challenges they face in the workplace experience less psychological distress, improved teamwork and increased empathy and compassion for patients and colleagues.
Commissioning children's palliative care in England: 2017 edition
This report from Together for Short Lives highlights that only a third of CCGs in England are implementing a government commitment to the prioritisation of palliative care for babies, children and young people.
Health matters: preventing infections and reducing AMR
Guidance from Public Health England outlining the importance of infection prevention and control and how it can contribute to reducing antimicrobial resistance (AMR).
Behavioural design teams: the next frontier in clinical delivery innovation?
This briefing from the Commonwealth Fund examines how embedded behavioural design teams could help providers rethinking the delivery of care in their organisations. Using interviews with experts in clinical delivery innovation and members of behavioural design teams, it highlights best practice in embedded behavioural design teams within health care organisations.
Health at a glance 2017
This report from the OECD outlines the latest comparable data and trends on different aspects of the performance of health systems in OECD countries. The analysis of the UK health system finds that the overall health of Britons is similar to the OECD average and that access to care is generally strong but that the indicators for quality of care are below the OECD average.
Antimicrobial prescribing: Ceftazidime/avibactam [ES16]
New: Evidence Summary from NICE:
This evidence summary outlines the best available evidence for a new intravenous antimicrobial, ceftazidime/avibactam (Zavicefta). It is indicated for treating:
Ceftazidime/avibactam is indicated for treating complicated intra-abdominal infections, complicated urinary tract infections, including pyelonephritis, hospital‑acquired pneumonia, including ventilator‑associated pneumonia, and infections due to aerobic gram‑negative organisms in adults with limited treatment options.
For full information see the summary of product characteristic (SPC): ceftazidime/avibactam.
This evidence summary outlines the best available evidence for a new intravenous antimicrobial, ceftazidime/avibactam (Zavicefta). It is indicated for treating:
Ceftazidime/avibactam is indicated for treating complicated intra-abdominal infections, complicated urinary tract infections, including pyelonephritis, hospital‑acquired pneumonia, including ventilator‑associated pneumonia, and infections due to aerobic gram‑negative organisms in adults with limited treatment options.
For full information see the summary of product characteristic (SPC): ceftazidime/avibactam.
Physios win praise for cutting hospital admissions
Physiotherapists in Cumbria have been praised for an initiative with social care, which has reduced the number of people who need to be admitted to hospital.
The team worked with social care staff from the local Eden Community Response Team to strengthen assessment and care in the community, so reducing the number of people who need to be admitted to hospital.
The team worked with social care staff from the local Eden Community Response Team to strengthen assessment and care in the community, so reducing the number of people who need to be admitted to hospital.
UCLH robots help stroke patients regain upper limb movement
Staff at UCLH’s stroke rehabilitation unit have become the first in the NHS to use robotic devices in conjunction with more traditional therapies to help patients regain arm and hand movement.
The robots, which help patients practise exercises to build up strength and dexterity, can be supervised by a physiotherapy assistant and were introduced as part of UCLH’s intensive three-week upper limb neuro rehabilitation programme.
The robots, which help patients practise exercises to build up strength and dexterity, can be supervised by a physiotherapy assistant and were introduced as part of UCLH’s intensive three-week upper limb neuro rehabilitation programme.
Use antibiotics effectively to reduce drug-resistance
Research, published in the Lancet, has found antibiotic stewardship programmes can reduce the number of hospital infections caused by multidrug-resistant bacteria by 51%. It also shows the number of people experiencing drug-resistant infections decreases further when infection control measures, such as good hand hygiene, are followed.
Quarter of hospital patients denied rapid review – even on weekdays
More than one in four patients do not see a medical consultant within 14 hours of being admitted to hospital – even on weekdays, new data from NHS England reveals.
The information shows that on weekdays across all trusts, 73 per cent of patients see a consultant within the period, which is a key requirement under national “seven day service” standards.
The information shows that on weekdays across all trusts, 73 per cent of patients see a consultant within the period, which is a key requirement under national “seven day service” standards.
The figure is even lower – 70.3 per cent – at weekends.
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
Daily Insight: The price of avoiding a 5 million waiting list
Last week, Simon Stevens warned the NHS Providers conference: “On the current funding outlook, the NHS waiting list will rise to 5 million people by 2021… the government would have to publicly, legally abolish patients’ national waiting times guarantees.”
Waiting times expert Rob Findlay has calculated how much it would cost the government to get 18 week waits back on track. He says: “In short, the government has a choice: constrain the money and abandon the right to treatment within 18 weeks, or cough up and honour it.”
The abridged version is: “With some guesses about the costs per case, I calculate recovering 18 weeks sustainably might cost £2.1bn next year and £350m the year after, if other pressures and enough mainstream capacity are funded. Or £4.2bn next year and £1bn the year after, if austerity continues.”
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
Waiting times expert Rob Findlay has calculated how much it would cost the government to get 18 week waits back on track. He says: “In short, the government has a choice: constrain the money and abandon the right to treatment within 18 weeks, or cough up and honour it.”
The abridged version is: “With some guesses about the costs per case, I calculate recovering 18 weeks sustainably might cost £2.1bn next year and £350m the year after, if other pressures and enough mainstream capacity are funded. Or £4.2bn next year and £1bn the year after, if austerity continues.”
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
Monday, 13 November 2017
World Mental Health Day
Speaking about World Mental Health Day, Genevieve Smyth, RCOT professional advisor for mental health and learning disabilities, emphasises: “World Mental Health Day is an important time to remember that we all have mental health, we can all get sick through no fault of our own and we all need a bit more compassion. Life can be really tough. The important thing is to get help; from your cat, from your friend, from online support groups, from wherever is right for you.
“Sometimes we need help from health and social care professionals like occupational therapists. It’s ok to get help! Click here for page from RCOT
New Getting It Right First Time leads announced
Clinical leads for three areas of the Getting It Right First Time programme have been announced.
The £60m clinical efficiency and safety programme is run by NHS Improvement and sees clinician led teams look at service lines in every trust in England to determine whether they are operating at sufficient scale, among other factors.
Some trusts change their practices or stop providing some services as a result of the subject area GIRFT reports published so far on orthopaedics and general surgery.
The programme announced clinical leads for endocrinology, rheumatology and stroke medicine last week.
To obtain this article copy and past it into an email and send to: librasryw@uhcw.nhs.uk
Some trusts change their practices or stop providing some services as a result of the subject area GIRFT reports published so far on orthopaedics and general surgery.
The programme announced clinical leads for endocrinology, rheumatology and stroke medicine last week.
To obtain this article copy and past it into an email and send to: librasryw@uhcw.nhs.uk
Revealed: The cost of restoring 18 week waits
With some guesses about the costs per case, I calculate recovering 18 weeks sustainably might cost £2.1bn next year and £350m the year after, if other pressures and enough mainstream capacity are funded. Or £4.2bn next year and £1bn the year after, if austerity continues.
“Our duty of candour requires us to explain the consequences of [the current funding settlement] to help inform the difficult choices which will be made in the years ahead. On the current funding outlook, the NHS waiting list will rise to 5 million people by 2021… the government would have to publicly, legally abolish patients’ national waiting times guarantees.”
To obtain this article copy and paste the post into an email and send it to: libraryw@uhcw.nhs.uk
To obtain this article copy and paste the post into an email and send it to: libraryw@uhcw.nhs.uk
GDm-Health for people with gestational diabetes [MIB131]
New: Medtech innovation briefing from NICE:
GDm‑Health (Oxford University NHS Foundation Trust and The University of Oxford) comprises 2 parts: a patient-facing mobile app, which is downloaded to the patient's mobile device, and a secure clinician-facing website designed to allow remote blood glucose monitoring.
The mobile app is available for iOS and Android operating systems. The app downloads data from the user's blood glucose meter (through Bluetooth or near-field communication [NFC]). It then automatically sends these blood glucose measurements to the secure website through wifi or a mobile internet connection. The user may also enter notes alongside the measurements, such as explanations of unusually high readings, and these are also sent to the website.
GDm‑Health (Oxford University NHS Foundation Trust and The University of Oxford) comprises 2 parts: a patient-facing mobile app, which is downloaded to the patient's mobile device, and a secure clinician-facing website designed to allow remote blood glucose monitoring.
The mobile app is available for iOS and Android operating systems. The app downloads data from the user's blood glucose meter (through Bluetooth or near-field communication [NFC]). It then automatically sends these blood glucose measurements to the secure website through wifi or a mobile internet connection. The user may also enter notes alongside the measurements, such as explanations of unusually high readings, and these are also sent to the website.
WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage
Postpartum haemorrhage (PPH) is a major cause of mortality, morbidity and long term disability related to pregnancy and childbirth. Effective interventions to prevent and treat PPH exist and can largely reduce the burden of this life-threatening condition.
Given the availability of new scientific evidence related to the use of tranexamic acid in the prevention and treatment of PPH, this document updates previous WHO recommendations.
Given the availability of new scientific evidence related to the use of tranexamic acid in the prevention and treatment of PPH, this document updates previous WHO recommendations.
COPD Best Practice Guide
This best practice guideline and series of case
studies from NHS Scotland bring a strong focus to streamlining COPD management, using the Six Essential Actions of
Unscheduled Care, and in particular essential
actions 5 and 6
Eyes Right!
New RCN guidance, Eyes Right!, helping non-ophthalmic health care professionals deliver quality care safely.
Safe, sustainable and productive staffing in urgent and emergency care
Draft resource from NHS Improvement to help standardise safe, sustainable and productive staffing decisions in urgent and emergency care.
Safe, sustainable and productive staffing for neonatal care and children and young people's services
Draft resources from NHS Improvement to help standardise safe, sustainable and productive staffing decisions in neonatal care and children and young people's services.
Safe transfusion practice: use a bedside checklist
Serious Hazards of Transfusion (SHOT), has repeatedly identified that patients are harmed, and some die, as a result of being given the incorrect type of blood.
SHOT therefore recommends a structured process with a bedside checklist; this alert provides information against which organisations should assess their bedside systems.
SHOT therefore recommends a structured process with a bedside checklist; this alert provides information against which organisations should assess their bedside systems.
Sickle cell and thalassaemia screening: handbook for laboratories
These documents from Public Health England set out policy and standards for laboratories working with the sickle cell and thalassaemia (SCT) screening programme.
Understanding benchmarking
RCN guidance for nursing staff working with children
and young people. This publication is an updated version of the
original guidance published in 2007 and updated
in 2014. The model identified in the original
version is as relevant today as it was then.
The aim of this guidance is to increase understanding of benchmarking and to encourage each of us to get involved. The process of benchmarking relies on you to share evidence of best practice with your peers.
The aim of this guidance is to increase understanding of benchmarking and to encourage each of us to get involved. The process of benchmarking relies on you to share evidence of best practice with your peers.
Managing Unacceptable Behaviour
Guidelines for Accredited Representatives
and Relevant RCN Staff. These guidelines introduce its Respect Charter, which governs how all our stakeholders
should approach working with each other at
all times.
They also: highlight what steps will be taken when the standards in its Respect Charter are not met; provide guidance for our accredited representatives who are subjected to unacceptable behaviour; and outline what support is available to them
They also: highlight what steps will be taken when the standards in its Respect Charter are not met; provide guidance for our accredited representatives who are subjected to unacceptable behaviour; and outline what support is available to them
Plasma irisin is elevated in type 2 diabetes and is associated with increased E-selectin levels
Cardiovasc Diabetol. 2017 Nov 9;16(1):147. doi: 10.1186/s12933-017-0627-2.
BACKGROUND: Irisin is a hormone released mainly from skeletal muscle after exercise which increases adipose tissue energy expenditure. Adipocytes can also release irisin after exercise, acting as a local adipokine to induce white adipose tissue to take on a brown adipose tissue-like phenotype, suggesting that irisin and its receptor may represent a novel molecular target for the treatment of obesity and obesity-related diabetes. Previous reports provide conflicting evidence regarding circulating irisin levels in patients with type 2 diabetes (T2DM).
CONCLUSION:These data suggest that elevated plasma irisin in T2DM is associated with indices of adiposity, and that irisin may be involved in pro-atherogenic endothelial disturbances that accompany obesity and T2DM. Accordingly, irisin may constitute a potentially novel therapeutic opportunity in the field of obesity and cardiovascular diabetology.
UHCW Research: Kyrou I and Randeva HS
BACKGROUND: Irisin is a hormone released mainly from skeletal muscle after exercise which increases adipose tissue energy expenditure. Adipocytes can also release irisin after exercise, acting as a local adipokine to induce white adipose tissue to take on a brown adipose tissue-like phenotype, suggesting that irisin and its receptor may represent a novel molecular target for the treatment of obesity and obesity-related diabetes. Previous reports provide conflicting evidence regarding circulating irisin levels in patients with type 2 diabetes (T2DM).
CONCLUSION:These data suggest that elevated plasma irisin in T2DM is associated with indices of adiposity, and that irisin may be involved in pro-atherogenic endothelial disturbances that accompany obesity and T2DM. Accordingly, irisin may constitute a potentially novel therapeutic opportunity in the field of obesity and cardiovascular diabetology.
UHCW Research: Kyrou I and Randeva HS
The Yellow Card Scheme: guidance for healthcare professionals
Details of the Yellow Card Scheme, which is the system for recording adverse incidents with medicines and medical devices in the UK.
This was updated in November 2017.
This was updated in November 2017.
Use of resources assessment: a brief guide for acute non-specialist trusts
The Use of resources assessment framework aims to improve understanding of how effectively and efficiently NHS providers are using their resources. By the end of 2019, all acute non-specialist trusts will have undergone an assessment. This briefing from NHS Improvement provides an overview for non-specialist acute trusts on the agenda for the onsite visit and other useful information.
See also this consultation from the CQC on reporting and rating NHS trusts’ use of resources.
See also this consultation from the CQC on reporting and rating NHS trusts’ use of resources.
Top miscarriage research priorities identified by women and health professionals
First study of its kind reveals what the public and health professionals want future miscarriage research to focus on.
More research is needed to improve psychological and emotional support for women and their partners affected by miscarriage, reveals a survey published in BMJ Open.
Other top priorities include research into preventative treatment, relevance of pre-existing medical conditions, importance of lifestyle factors and genetic and chromosomal causes, investigation after different numbers of miscarriage and male causal factors.
More research is needed to improve psychological and emotional support for women and their partners affected by miscarriage, reveals a survey published in BMJ Open.
Other top priorities include research into preventative treatment, relevance of pre-existing medical conditions, importance of lifestyle factors and genetic and chromosomal causes, investigation after different numbers of miscarriage and male causal factors.
NHS England strikes new deals to make two new innovative treatments available routinely on the NHS
From 10 November hundreds of patients with Multiple Sclerosis are set to benefit from a new treatment option, Mavenclad, following a deal with drug company Merck.
NHS England and Roche have also reached a commercial agreement on the use of Pertuzumab, which unlocks the final stage of NICE’s appraisal and opens the way for continued access to this important treatment for breast cancer.
NHS England and Roche have also reached a commercial agreement on the use of Pertuzumab, which unlocks the final stage of NICE’s appraisal and opens the way for continued access to this important treatment for breast cancer.
Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room
Mycobacterium chimaera (M. chimaera) is a recently characterised bacterium that can cause life-threatening infections in small numbers of patients who undergo cardiopulmonary bypass during cardiac surgery. The likely mode of transmission is thought to occur through aerosolisation from contaminated water reservoirs. The airborne bacteria then contaminate the surgical field, leading to an infection months or even years later. The preferred practical solution to disrupt the transmission of these airborne bacteria to the patient is to remove the heater-cooler units (HCUs) from the operating room (OR). We describe a process of achieving this in order to provide information to guide other institutions who wish to do a similar thing.
UHCW Research: Thomas A. Barker, Uday Dandekar, Nina Fraser, Lincoln Dawkin, Paul Sweeney, Fraser Heron, Jacqui Simmons and Jitendra Parmar
UHCW Research: Thomas A. Barker, Uday Dandekar, Nina Fraser, Lincoln Dawkin, Paul Sweeney, Fraser Heron, Jacqui Simmons and Jitendra Parmar
Friday, 10 November 2017
Health app: Sleepio for adults with poor sleep [MIB129]
New: Medtech Innovation Briefings
Sleepio (Big Health) is a self-help sleep improvement programme based on cognitive behavioural therapy for insomnia (CBT‑I). It is accessed through a website or an app for iOS mobile devices, and can link to a compatible wearable fitness tracker to monitor sleep (currently Fitbit and any other device that uses Apple's Healthkit).
The programme is structured around a series of 6 weekly interactive sessions, lasting about 20 minutes each. Users can access the programme for 12 months after their first login. They can also access electronic library articles, online tools and the online Sleepio user community.
Sleepio (Big Health) is a self-help sleep improvement programme based on cognitive behavioural therapy for insomnia (CBT‑I). It is accessed through a website or an app for iOS mobile devices, and can link to a compatible wearable fitness tracker to monitor sleep (currently Fitbit and any other device that uses Apple's Healthkit).
The programme is structured around a series of 6 weekly interactive sessions, lasting about 20 minutes each. Users can access the programme for 12 months after their first login. They can also access electronic library articles, online tools and the online Sleepio user community.
Concerns as mixed sex ward breaches more than double
NHS England’s latest mixed sex breaches data showed there were 969 breaches in September – a breach rate of 0.6 per 1,000 finished consultant episodes.
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
Revealed: 'Broad principles' agreed for major pay reform
- Informal talks between Agenda for Change unions and NHS Employers agree on principles for reform
- Lack of money for pay rise meant talks stalled but budget could bring new impetus
- Increment reforms wanted by both sides but government ‘sleight of hand’ could be ‘toxic’ to a deal
The amendments to the Agenda for Change pay contract are on hold, pending the budget later this month. Senior sources have told HSJ if the Treasury releases funds for a “significant” pay rise for NHS staff, negotiations over reforming terms and conditions could start within months.
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
To obtain this article copy and paste the post into an email and send to: libraryw@uhcw.nhs.uk
High dose, fast delivery magnesium sulphate in a 3-year-old acute severe asthmatic
Australasian Medical Journal (Online); Floreat Vol. 10, Iss. 9, (2017): 826-828
Case details A three and a half year-old 14.3kg female atopic asthmatic with seven previous hospital admissions since the age of 2% yrs. for acute asthma provoked by upper respiratory tract infection was admitted to the paediatric ward with another infection. Norflurane is the propellant HFA134a in pressurised metered dose inhalers.2 The usually suggested adult IV MgSO4 doses in asthma of 1.2 to 2g over 20 minutes3 (children 25-75mg.kg-1 over 20 min) will not reach serum levels high enough to relax smooth muscle; an indication of relaxation of skin vessels is "flushing" and a feeling of warmth. Conclusion Alternatives to reverse bronchospasm are intramuscular adrenaline (epinephrine) which is first line therapy of ambulance para-medical staff for respiratory compromise in acute asthma.14 Suggested in the National Review of Asthma Deaths (NRAD) after a first episode of lifethreatening asthma is the prescription of auto adrenaline injectors (AAI) to those at risk of further attacks.15,16 There is case report evidence from the Netherlands of the successful use of IV enoximone 1 to 2mg.kg-1 bolus as a fast acting and safe bronchodilator in moribund and ventilated asthma patients.17 Enoximone is a selective phosphodiesterase inhibitor used in cardiology for vascular smooth muscle dilatation.
UHCW Research: Elton, John R and Mclachlan, Karen
Follicular porokeratosis: four new cases
Clinical and Experimental Dermatology, 42(8) 2017
Porokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.
UHCW Research: Odeke, M.
Porokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.
UHCW Research: Odeke, M.
Combined Performance Summary - October 2017
This publication from NHS England summarises the data around NHS performance for October 2017. It contains a summary of the monthly performance statistics on:
- NHS 111
- ambulance quality indicators
- A&E attendances and emergency admissions
- waiting times for diagnostic tests, referral to treatment for consultant-led elective care and cancer services;
- delayed transfers of care; and
- early intervention in psychosis
STPs: destined to fail or the road to better care? - the hospital doctors’ view
This report from the Hospital Consultants and Specialists Association aims to contribute to existing debates, setting out HCSA members’ experience and views of STPs. The key themes covered in this research were: hospital clinicians’ knowledge of the STP process; clinicians’ engagement in the STP process; and clinicians’ views on the impact of STPs.
Complications in Distal Radius Fracture Fixation: A Comparative Case Series
Medical Case Reports, 3(3:21) 2017 DOI: 10.21767/2471-8041.100056
Aim was to compare the complication rate for 471 distal radius fracture treated with either the synthes two column plate or the DePuy distal volar radius plate (DVR) for fixation of distal radius fractures.
UHCW Research: Rory Norris and Andrew Mahon
Aim was to compare the complication rate for 471 distal radius fracture treated with either the synthes two column plate or the DePuy distal volar radius plate (DVR) for fixation of distal radius fractures.
UHCW Research: Rory Norris and Andrew Mahon
Thursday, 9 November 2017
National Maternity and Perinatal Audit Clinical report 2017
The National Maternity and Perinatal Audit (NMPA) has published a major clinical report that identifies areas of good practice and opportunities for improvement in the care of women and babies in maternity services across Britain.
While the vast majority of women have a safe birth, and despite on-going improvements in the safety of maternity services, findings show that variation exists in a number of clinical processes and outcomes in maternity care. Some of the variation found will be due to differences in data quality, completeness and the risk profile of women being seen in different units.
Cataract rationing survey reveals 66% of responding eye units have some restrictions to access surgery
The Royal College of Ophthalmologists (RCOphth) has undertaken a survey of ophthalmic clinical leads to understand how the current situation of visual acuity thresholds and other imposed restrictions are affecting access to cataract surgery. Of 140 leads contacted in England and Northern Ireland, 87 replied, a response rate of 62%.
Download a summary of the key findings: Cataract surgery: current limitations to patients accessing treatment
Download a summary of the key findings: Cataract surgery: current limitations to patients accessing treatment
Embedding a culture of quality improvement
This report from the King's Fund explores thefactors that have helped organisations to launch a quality improvement strategy,and the key enablers for sustaining a focus on continuous quality improvement.
The report draws on a roundtable event, semi-structured interviews with senior
NHS leaders and stakeholders involved in quality improvement initiatives, and a
literature review. It identifies relevant learning from organisations that have already
adopted quality improvement approaches, and focuses on how senior leaders can
create the right conditions for quality improvement to emerge and flourish.
Confirming removal or flushing of lines and cannulae after procedures
A patient safety alert from NHS Improvement on the need to confirm intravenous (IV) lines and cannulae have been effectively flushed or removed at the end of the procedure.
What is happening to waiting times in the NHS?
In a speech ahead of the Autumn Budget on 22 November, the Chief Executive of NHS England, Simon Stevens, warned that without extra funding the improvements made in reducing waiting times for patients over the past decade will be reversed and the waiting list for elective treatment could increase to 5 million people by 2021. The King's Fund examines the big issues and recent NHS performance on waiting times.
Jacqui Dyer: Talking about race and mental health is everyone’s business
As a government adviser on its new review of the Mental Health Act, Jacqui Dyer aims to address the ‘dirty secret’ that black people are too often detained in inpatient facilities. Click here for newspaper article
Bipolar Patients with Schizophrenia Genes May Not Respond to Lithium
Patients with bipolar disorder who do not respond to lithium treatment all share something in common: a high number of genes previously identified for schizophrenia, according to a new international study led by the University of Adelaide in Australia. Click here for PsychCentral article
NHS Pension Scheme: Proposed Changes To Regulations 2018
The Department of Health is consulting on proposals to change NHS pension scheme regulations. Proposed changes include: the removal of the need for a nomination form for unmarried or cohabiting partners to claim survivor pensions; ensuring access to the pension scheme for staff delivering services under new integrated care models; and making technical changes to improve the operation of scheme regulations. The consultation document describes these changes and gives details on how to submit a response. The closing date for comments is 29 December 2017. Click here for Kings Fund blog
Learning from improvement: special measures for quality
Four years after the introduction of special measures, NHS Improvement reviewed the experience of trusts that exited the process so we can better understand why they entered special measures, what actions they took and how they implemented change to improve.
Join enhanced care improvement collaborative for inpatient acute/community trusts
NHS Improvement is launching an enhanced care improvement collaborative in March 2018 to deliver an improved experience for critically ill or vulnerable patients in hospital. The programme will build on the learning from the pilot programme in 2015/16 and roll out best practice.
Tocilizumab (RoACTEMRA) [subcutaneous injection with an auto injector device] for adult patients with moderate to severe active rheumatoid arthritis - after DMARD failure
There is currently no cure for rheumatoid arthritis. The most common treatment options are steroids to reduce inflammation, medications to reduce pain and inflammation and medications that slow the progression of joint damage from RA. Tocilizumab is already licensed for the treatment of RA as both intravenous and subcutaneous (pre-filled syringe) formulations, however its use, via an auto-injector device is being developed. This is expected to improve the ease of patients treating themselves, in those who have active moderate to severe RA who do not respond to some conventional treatments
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Galcanezumab for the prophylaxis of episodic and chronic migraine
Galcanezumab is being developed as one of a class of specific anti-migraine preventative drugs. By stopping a very specific protein in the brain and nervous system, galcanezumab reduces migraine attacks. Additionally as it is given once-a-month as treatment, it avoids the need to take numerous pills per day. If marketed, galcanezumab may be more preferable to current treatment options for episodic migraine and chronic migraine prevention.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
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