Hearing aids for people with mild-to-moderate hearing loss make communication easier and improve listening ability. A range of similar ‘social’ benefits improved on scores designed to measure the quality of life alongside the improvements in hearing. There were no reports of adverse effects for hearing aids.
Hearing loss can have a far-reaching impact on people’s mental and physical health, taking a toll on their quality of life. It can be simply viewed as a natural part of ageing, but this review highlights the positive impact that hearing aids can have on conversation and socialisation before people’s hearing loss becomes severe. Despite hearing loss being common, it can take people ten years to get appropriate treatment.
From the NIHR Dissemination Centre
Friday, 29 December 2017
NIHR Signal Transfusing blood close to its use-by date does not increase deaths in critically ill adults
Transfusing more recently-collected red blood cells does not improve the chance of survival for critically-ill people who need blood transfusions, compared with blood that has been stored for longer.
This large international study included almost 5,000 critically ill people in intensive care units. Participants were transfused with either the freshest compatible blood available (mean storage 11.8 days) or the oldest compatible stored blood within its use-by date (mean storage time 22.4 days).
From the NIHR Dissemination Centre
This large international study included almost 5,000 critically ill people in intensive care units. Participants were transfused with either the freshest compatible blood available (mean storage 11.8 days) or the oldest compatible stored blood within its use-by date (mean storage time 22.4 days).
From the NIHR Dissemination Centre
NIHR Signal A strategy of 'delayed antibiotic prescribing' for respiratory infections may reduce antibiotic use
Delaying antibiotic prescribing made little difference to most symptoms of respiratory infection. It reduced antibiotic use and did not affect patient satisfaction compared with immediate prescribing of antibiotics.
Increasing antibiotic resistance is a global health concern. Many people don’t realise that viruses cause most respiratory infections and that antibiotics won’t help. The strategy allows some time for symptoms to improve naturally.
From the NIHR Dissemination Centre
Increasing antibiotic resistance is a global health concern. Many people don’t realise that viruses cause most respiratory infections and that antibiotics won’t help. The strategy allows some time for symptoms to improve naturally.
From the NIHR Dissemination Centre
Ribociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer [TA496]
New: Technology appraisal guidance
Evidence-based recommendations on ribociclib (Kisqali) as initial endocrine-based therapy for hormone-receptor positive, human epidermal growth factor receptor 2 (HER2)‑negative, locally advanced or metastatic (secondary) breast cancer in adults.
Evidence-based recommendations on ribociclib (Kisqali) as initial endocrine-based therapy for hormone-receptor positive, human epidermal growth factor receptor 2 (HER2)‑negative, locally advanced or metastatic (secondary) breast cancer in adults.
| Marketing authorisation | Ribociclib in combination with an aromatase inhibitor is indicated for the treatment of postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer as initial endocrine-based therapy. |
Wednesday, 27 December 2017
Palbociclib with an aromatase inhibitor for previously untreated, hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer [TA495]
New technology appraisal guidance from NICE. Palbociclib (Ibrance) as initial endocrine-based therapy for hormone-receptor positive, human epidermal growth factor receptor 2 (HER2)‑negative, locally advanced or metastatic (secondary) breast cancer in adults.
Recommendations:
Palbociclib, with an aromatase inhibitor, is recommended within its marketing authorisation, as an option for treating hormone receptor-positive, human epidermal growth factor receptor 2-negative, locally advanced or metastatic breast cancer as initial endocrine-based therapy in adults. Palbociclib is recommended only if the company provides it with the discount agreed in the patient access scheme.
Recommendations:
Palbociclib, with an aromatase inhibitor, is recommended within its marketing authorisation, as an option for treating hormone receptor-positive, human epidermal growth factor receptor 2-negative, locally advanced or metastatic breast cancer as initial endocrine-based therapy in adults. Palbociclib is recommended only if the company provides it with the discount agreed in the patient access scheme.
Subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death [IPG603]
New interventional procedures guidance from NICE. This involves placing a device under the skin of the chest, which detects and treats fast heartbeats called tachyarrhythmias.
Recommendations:
Current evidence on the safety and efficacy of subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Recommendations:
Current evidence on the safety and efficacy of subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure [IPG602]
New interventional procedures guidance from NICE. This involves replacing the 2 lower chambers of the heart with a mechanical device to improve circulation until heart transplantation.
Current evidence on the safety and efficacy of total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure is limited in quality and quantity. 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 total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure should:
- Inform the clinical governance leads in their NHS trusts.
- Ensure that patients understand the uncertainty about the procedure's safety and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
- Audit and review clinical outcomes of all patients having total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure (see section 6.3).
- Clinicians should enter details about all patients having total artificial heart implantation as a bridge to transplantation for end-stage refractory biventricular heart failure onto an appropriate registry and review local clinical outcomes.
- Patient selection should be done by a multidisciplinary team experienced in managing end-stage refractory biventricular heart failure in patients needing a heart transplant, for whom a donor organ is not expected to be available before their own heart fails completely.
- This technically challenging procedure should only be done in centres specialising in heart transplantation. Only cardiothoracic surgeons with specific expertise and training in inserting the device should carry it out.
Transcutaneous microwave ablation for severe primary axillary hyperhidrosis [IPG601]
New interventional procedures guidance from NICE: Evidence based recommendations on transcutaneous microwave ablation for severe primary axillary hyperhidrosis in adults. Current evidence on the safety and efficacy of transcutaneous microwave ablation for severe primary axillary hyperhidrosis is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do transcutaneous microwave ablation for severe primary axillary hyperhidrosis should:
Clinicians wishing to do transcutaneous microwave ablation for severe primary axillary hyperhidrosis should:
- Inform the clinical governance leads in their NHS trusts.
- Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In particular, during the consent process patients should be informed about the possibility of nerve damage. In addition, the use of NICE's information for the public is recommended.
- Audit and review clinical outcomes of all patients having transcutaneous microwave ablation for severe primary axillary hyperhidrosis (see section 7.3).
Endobronchial valve insertion to reduce lung volume in emphysema [IPG600]
New interventional procedures guidance from NICE. Endobronchial valve insertion to reduce lung volume in emphysema.
Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Patient selection should be done by a multidisciplinary team experienced in managing emphysema, which should typically include a chest physician, a radiologist, a thoracic surgeon and a respiratory nurse.
Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Patient selection should be done by a multidisciplinary team experienced in managing emphysema, which should typically include a chest physician, a radiologist, a thoracic surgeon and a respiratory nurse.
Patients selected for treatment should have had pulmonary rehabilitation. The procedure should only be done to occlude volumes of the lung where there is no collateral ventilation, by clinicians with specific training in doing the procedure.
Novel application of three-dimensional technologies in a case of dismemberment
Forensic Sci Int. 2016 Dec 2;270:139-145. doi: 10.1016/j.forsciint.2016.11.040. [Epub ahead of print]
This case study reports the novel application of three-dimensional technologies such as micro-CT and 3D printing to the forensic investigation of a complex case of dismemberment. Micro-CT was successfully employed to virtually align severed skeletal elements found in different locations, analyse tool marks created during the dismemberment process, and virtually dissect a charred piece of evidence. High resolution 3D prints of the burnt human bone contained within were created for physical visualisation to assist the investigation team. Micro-CT as a forensic radiological method provided vital information and the basis for visualisation both during the investigation and in the subsequent trial making it one of the first examples of such technology in a UK court.
UHCW Research: Brian A. Burnett
See also Corrigendum to "Novel application of three-dimensional technologies in a case of dismemberment" [Forensic Sci. Int. 270C (2017) 139-145].
This case study reports the novel application of three-dimensional technologies such as micro-CT and 3D printing to the forensic investigation of a complex case of dismemberment. Micro-CT was successfully employed to virtually align severed skeletal elements found in different locations, analyse tool marks created during the dismemberment process, and virtually dissect a charred piece of evidence. High resolution 3D prints of the burnt human bone contained within were created for physical visualisation to assist the investigation team. Micro-CT as a forensic radiological method provided vital information and the basis for visualisation both during the investigation and in the subsequent trial making it one of the first examples of such technology in a UK court.
UHCW Research: Brian A. Burnett
See also Corrigendum to "Novel application of three-dimensional technologies in a case of dismemberment" [Forensic Sci. Int. 270C (2017) 139-145].
Children best placed to explain facts of surgery to patients, say experts
Medical Devices & Surgical Technology Week; Atlanta [Atlanta]31 Dec 2017: 90.
Research shows that patients who are given clear information about their test, operation or care are less anxious and more satisfied with their care.
Patient information leaflets are a popular way to support verbal discussion with a health professional, particularly where consent is needed. However, the average reading age in the UK is 9 years, and some studies indicate that the average readability (a measure of how easy a piece of text is to read) needed for patient information leaflets is beyond 9 years.
So Dr Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues assessed the average readability of six NHS patient information leaflets for hip replacement surgery (total hip arthroplasty) and found an average readability score of 17 - well above a reading age of 9 years.
They then recruited 57 school children aged 8-10 at a local primary school to help revise the content.
Research shows that patients who are given clear information about their test, operation or care are less anxious and more satisfied with their care.
Patient information leaflets are a popular way to support verbal discussion with a health professional, particularly where consent is needed. However, the average reading age in the UK is 9 years, and some studies indicate that the average readability (a measure of how easy a piece of text is to read) needed for patient information leaflets is beyond 9 years.
So Dr Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues assessed the average readability of six NHS patient information leaflets for hip replacement surgery (total hip arthroplasty) and found an average readability score of 17 - well above a reading age of 9 years.
They then recruited 57 school children aged 8-10 at a local primary school to help revise the content.
A prospective, observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project
Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.
UHCW Research: Charles E. Hutchinson
Friday, 22 December 2017
For Happiness, Body Acceptance May Beat Losing Weight
A new study at Florida State University (FSU) has strong advice if you want to enjoy greater mental and physical health this New Year: Lose the critical thoughts about your body. Click here to see PsychCentral article
Womb natural killer cell discovery could lead to screening for miscarriage risk
eLife (2017). DOI: 10.7554/eLife.31274
Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.
The new study Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium which is published in eLife shows two functions of the cells not previously known.
For the first time the functions of natural killer cells in the womb have been identified.
Researchers at the University of Warwick and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust have discovered the role that they play in preparing the womb for pregnancy.Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.
The new study Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium which is published in eLife shows two functions of the cells not previously known.
Chelsea and Westminster Hospital physios help develop hand therapy app
Physiotherapists at Chelsea and Westminster Hospital NHS Trust have been instrumental in developing an app to support people with hand injuries.
It provides patients with bespoke exercises prescribed by their therapist to aid recovery, according to a spokesperson for the trust, which treats more than 4,500 hand injury patients every year.
The app also contains a library of more than 80 instructional videos and audio tutorials, which patients can follow and replicate at home.
It provides patients with bespoke exercises prescribed by their therapist to aid recovery, according to a spokesperson for the trust, which treats more than 4,500 hand injury patients every year.
The app also contains a library of more than 80 instructional videos and audio tutorials, which patients can follow and replicate at home.
International recruitment quick guides updated
NHS Employers has updated its range of quick guides on international recruitment.
This resource is designed to help employers identify the right tier for different professions when recruiting individuals from outside of the UK that require a sponsor to work in the UK.
This resource is designed to help employers identify the right tier for different professions when recruiting individuals from outside of the UK that require a sponsor to work in the UK.
Immigration and the Tier 2 recruitment process
This guide sets out the recruitment process that an employer should follow to meet the Home Office UK Visas and Immigraion (UKVI) requirements to sponsor migrants under Tier 2 (General) of the points-based system.
Step-by-step guide to applying for certificates of sponsorship (CoS)
This step-by-step guide highlights the differences between the unrestricted and restricted certificates of sponsorship and the process that employers should use when applying for them.
This guide sets out the recruitment process that an employer should follow to meet the Home Office UK Visas and Immigraion (UKVI) requirements to sponsor migrants under Tier 2 (General) of the points-based system.
Step-by-step guide to applying for certificates of sponsorship (CoS)
This step-by-step guide highlights the differences between the unrestricted and restricted certificates of sponsorship and the process that employers should use when applying for them.
New RPS briefing on hospital pharmacy in England
There are approximately 7,000 pharmacists in hospitals and 16,000 pharmacy staff whose practice is being transformed by the outcomes of the Carter Review on hospital efficiencies and other NHS initiatives.
RPS England’s new Hospital Pharmacy Briefing provides a summary of the major activities affecting pharmacists with key points to help clarify what’s going on and what it means.
RPS England’s new Hospital Pharmacy Briefing provides a summary of the major activities affecting pharmacists with key points to help clarify what’s going on and what it means.
Daily Insight: Cancelling at Christmas
New year’s resolutions
NHS England has told under pressure hospitals they can cancel non-urgent elective procedures to free up beds for patients coming through accident and emergency.In a letter to trusts on Thursday afternoon, medical director Sir Bruce Keogh and national director for urgent and emergency care Dame Pauline Philip said the “expectation is that non-urgent inpatient elective care should be deferred until mid-January to ensure beds and staff are available for the sickest patients. By acting early, trusts can avoid last minute cancellations that can be costly and inconvenient for patients.”
To obtain this article copy and paste the post into an email and send to libraryw@uhcw.nhs.uk
Home Secretary's open letter to EU citizens
Home Secretary, Amber Rudd, has written directly to EU nationals offering reassurance about their rights to stay in the UK following the release of the joint report on 8 December.
The letter confirms that EU citizens living lawfully in the UK by 29 March 2019, will be able to stay and have broadly the same rights and benefits as they do now. It also highlights how EU staff's existing close family members living outside the UK retain the right to join them in the future.
The letter confirms that EU citizens living lawfully in the UK by 29 March 2019, will be able to stay and have broadly the same rights and benefits as they do now. It also highlights how EU staff's existing close family members living outside the UK retain the right to join them in the future.
RCoA survey shows resources needed for vulnerable patients
More than half of anaesthetic doctors would feel uncomfortable with a relative or close friend with dementia being admitted to an NHS hospital this winter, a survey from the Royal College of Anaesthetists (RCoA) has revealed.
The survey, undertaken by the RCoA in collaboration with Alzheimer’s Society, found that 57 per cent of respondents would be uncomfortable with the possibility of a relative or close friend with a diagnosis of dementia receiving treatment in an NHS hospital.
The survey, undertaken by the RCoA in collaboration with Alzheimer’s Society, found that 57 per cent of respondents would be uncomfortable with the possibility of a relative or close friend with a diagnosis of dementia receiving treatment in an NHS hospital.
Analysis of chromatin accessibility in decidualizing human endometrial stromal cells
FASEB J. 2017 Dec 19. pii: fj.201701098R. doi: 10.1096/fj.201701098R. [Epub ahead of print]
Spontaneous decidualization of the endometrium in response to progesterone signaling is confined to menstruating species, including humans and other higher primates. During this process, endometrial stromal cells (EnSCs) differentiate into specialized decidual cells that control embryo implantation. We subjected undifferentiated and decidualizing human EnSCs to an assay for transposase accessible chromatin with sequencing (ATAC-seq) to map the underlying chromatin changes. A total of 185,084 open DNA loci were mapped accurately in EnSCs. Altered chromatin accessibility upon decidualization was strongly associated with differential gene expression. Analysis of 1533 opening and closing chromatin regions revealed over-representation of DNA binding motifs for known decidual transcription factors (TFs) and identified putative new regulators. ATAC-seq footprint analysis provided evidence of TF binding at specific motifs. One of the largest footprints involved the most enriched motif-basic leucine zipper-as part of a triple motif that also comprised the estrogen receptor and Pax domain binding sites. Without exception, triple motifs were located within Alu elements, which suggests a role for this primate-specific transposable element (TE) in the evolution of decidual genes. Although other TEs were generally under-represented in open chromatin of undifferentiated EnSCs, several classes contributed to the regulatory DNA landscape that underpins decidual gene expression.
UHCW Research: Vrljicak P, Lucas, E S, and Brosens, J J
Spontaneous decidualization of the endometrium in response to progesterone signaling is confined to menstruating species, including humans and other higher primates. During this process, endometrial stromal cells (EnSCs) differentiate into specialized decidual cells that control embryo implantation. We subjected undifferentiated and decidualizing human EnSCs to an assay for transposase accessible chromatin with sequencing (ATAC-seq) to map the underlying chromatin changes. A total of 185,084 open DNA loci were mapped accurately in EnSCs. Altered chromatin accessibility upon decidualization was strongly associated with differential gene expression. Analysis of 1533 opening and closing chromatin regions revealed over-representation of DNA binding motifs for known decidual transcription factors (TFs) and identified putative new regulators. ATAC-seq footprint analysis provided evidence of TF binding at specific motifs. One of the largest footprints involved the most enriched motif-basic leucine zipper-as part of a triple motif that also comprised the estrogen receptor and Pax domain binding sites. Without exception, triple motifs were located within Alu elements, which suggests a role for this primate-specific transposable element (TE) in the evolution of decidual genes. Although other TEs were generally under-represented in open chromatin of undifferentiated EnSCs, several classes contributed to the regulatory DNA landscape that underpins decidual gene expression.
UHCW Research: Vrljicak P, Lucas, E S, and Brosens, J J
Implementing better births: continuity of carer
This guidance from NHS England sets out how local maternity systems can improve their services so that women experience continuity in the clinicians providing their maternity care.
Thursday, 21 December 2017
NHS England consults on freeing up 136 million to boost frontline NHS care by curbing prescription costs
NHS England has launched a public consultation on proposals to rein in prescriptions for some ‘over the counter’ products such as dandruff shampoo and drops for tired eyes, freeing-up up to £136 million to expand other treatments for major conditions such as cancer and mental health problems.
Learning from deaths: case studies from trusts
NHS Improvement has put together a collection of case studies that show the range of activity that trusts are taking to implement the implement the requirements of Learning from Deaths, as well as the challenges they have faced and how they are seeking to overcome these.
Draft AAGBI guideline Cell salvage for peri-operative blood conservation
A draft guideline on cell salvage for peri-operative blood conservation is in its final draft stage and comments are invited from members. Please read the draft and submit any comments to workingparties@aagbi.org. All comments submitted will be considered before a final version is brought before the AAGBI Board for approval. The closing date for comment submission is 5pm on Friday 12 January 2018.
Multiple sclerosis patients to have routine access to beta interferon drug, says NICE in new draft guidance
Multiple sclerosis drug, Extavia, has been approved for routine funding on the NHS, in NICE draft guidance.
Extavia is self-injected every 2 days and works by slowing down the damage to the nervous system caused by MS and by reducing the number of MS related relapses. The committee noted evidence that suggested drugs of this type become less effective over the first 2 years.
As part of this appraisal NICE did not recommend MS drugs glatiramer acetate and the other beta interferons (Avonex, Betaferon, Plegridy and Rebif), as they were found to be not cost effective.
Extavia is self-injected every 2 days and works by slowing down the damage to the nervous system caused by MS and by reducing the number of MS related relapses. The committee noted evidence that suggested drugs of this type become less effective over the first 2 years.
As part of this appraisal NICE did not recommend MS drugs glatiramer acetate and the other beta interferons (Avonex, Betaferon, Plegridy and Rebif), as they were found to be not cost effective.
Breast screening guidance
Public Health England has updated the following guidance:
Breast screening: guidance for breast screening mammographers
Breast screening: repeat mammograms
NHS breast screening programme procedures to collect, monitor and report repeat mammographic examinations.
Breast screening: women wanting to attend service out of area
Breast screening: guidance for breast screening mammographers
Guidance on the mammographic aspects (both clinical and technical) of breast screening QA and the quality control of radiographic procedures.
Breast screening: repeat mammograms
NHS breast screening programme procedures to collect, monitor and report repeat mammographic examinations.
Breast screening: women wanting to attend service out of area
Guidance for breast screening providers on dealing with requests from women who ask to be screened outside their area.
Support people to make decisions if they have capacity but find it difficult, NICE says
Health and social care professionals should support people to make decisions who find it difficult, NICE says in new draft guidance.
They should support people even if they make a decision that they may disagree with. Making an ‘unwise’ or ‘risky’ choice does not mean that a person lacks capacity and decisions need to be made on their behalf, the draft guidance on decision making and mental capacity says.
Using visual aids or involving friends and family can help a person communicate their wishes, NICE says.
They should support people even if they make a decision that they may disagree with. Making an ‘unwise’ or ‘risky’ choice does not mean that a person lacks capacity and decisions need to be made on their behalf, the draft guidance on decision making and mental capacity says.
Using visual aids or involving friends and family can help a person communicate their wishes, NICE says.
Wednesday, 20 December 2017
Mindfulness boosts student mental health during exams, study finds
Cambridge University research shows technique helps to build resilience among undergraduates even in periods of high stress. Click here to read newspaper
Making Safeguarding Personal What might ‘good’ look like for health and social care commissioners and providers?
Commissioners and providers across the health
and social care sectors play a critical part in
safeguarding adults, both on the front line and at
a strategic level, as partners on safeguarding
adults boards.
This resource is intended to support the joined up development of Making Safeguarding Personal across providers and commissioners in health and social care. The essential links between safeguarding and quality in delivering services must be emphasised.
This resource is intended to support the joined up development of Making Safeguarding Personal across providers and commissioners in health and social care. The essential links between safeguarding and quality in delivering services must be emphasised.
Brexit: the implications for health and social care
Briefing from the King's Fund
Although the EU has limited legal jurisdiction over how health and care services are organised and provided in member states, the UK’s vote to leave the EU will have major implications for health and social care in England.
First, because the government has been clear that Brexit will mean the UK leaving the European single market and the customs union – arrangements that currently play an important role in facilitating the delivery of health services, via access to workforce as well as goods and services. Second, because EU directives affect many areas of UK law that impact on the delivery of health and care services. Third, because the vote has ushered in a period of significant economic and political uncertainty at a time when the NHS and social care are already facing huge financial and operational pressures.
Although the EU has limited legal jurisdiction over how health and care services are organised and provided in member states, the UK’s vote to leave the EU will have major implications for health and social care in England.
First, because the government has been clear that Brexit will mean the UK leaving the European single market and the customs union – arrangements that currently play an important role in facilitating the delivery of health services, via access to workforce as well as goods and services. Second, because EU directives affect many areas of UK law that impact on the delivery of health and care services. Third, because the vote has ushered in a period of significant economic and political uncertainty at a time when the NHS and social care are already facing huge financial and operational pressures.
Falling short: Why the NHS is still struggling to make the most of new innovations
The idea that the NHS is slow to adopt seemingly well-evidenced innovations is not new and, for the most part, is accepted as fact. The reasons for this have been extensively studied. Last year, the Accelerated Access Review set out the barriers once again – proposing a number of useful solutions that, if implemented as envisaged, could go a long way to improving the situation. Report from the Nuffield Trust.
Admissions of inequality: emergency hospital use for children and young people
Does a child's socioeconomic background have an effect on rates of admissions to hospital for common conditions such as asthma, diabetes or epilepsy? Report from the Nuffield Trust.
Families should feel supported when their child is born preterm, says NICE
Children born preterm should be offered developmental check-ups to help identify any problems or disorders early on, NICE has said in its latest draft quality standard.
The draft standard aims to improve the follow-up care that is provided to families from when they start planning the discharge of their preterm child from hospital.
NHS England announces new specialised treatments for patients
NHS England has announced the results of the first of two prioritisation rounds to decide which new specialised commissioning treatments and services will be made available for patients for the 2018/19 financial year.
An initial three new treatments and services were approved for funding including a treatment for HIV, a new specialised service for adults with primary ciliary dyskinesia, a genetic disorder affecting the respiratory system, and a new specialised service for Stevens-Johnson syndrome, a serious disorder of the skin.
Funding for the new treatments and services will begin from April.
Funding for the new treatments and services will begin from April.
Group B Streptococcus (GBS) in pregnancy and newborn babies
This RCOG patient information leaflet provides advice for women who are pregnant or planning to become pregnant about Group B Streptococcus (GBS) infection in newborn babies.
GPhC Council gives green light to implementation of revalidation in a ‘step-change’ for pharmacy professionals
The General Pharmaceutical Council (GPhC) will introduce revalidation for pharmacy professionals from 30 March 2018, after its Council approved the framework for revalidation and agreed the timetable for its implementation.
Experiences of older people using services affected by fragmentation across local health and care systems, warns CQC
Those working within health and adult social care services are passionate about providing the best possible experience to the older people within their care.
However, their efforts can be compromised by the competing priorities, performance measures and accountabilities of their employing organisations. Collectively, this can limit choice and can make movement between services seem confusing and fragmented.
This is one the key themes the CQC has found, having completed a third of its Government-commissioned reviews that explore how well local systems work together to support and care for people aged over 65.
However, their efforts can be compromised by the competing priorities, performance measures and accountabilities of their employing organisations. Collectively, this can limit choice and can make movement between services seem confusing and fragmented.
This is one the key themes the CQC has found, having completed a third of its Government-commissioned reviews that explore how well local systems work together to support and care for people aged over 65.
Good work, wellbeing and changes in performance outcomes: illustrating the effects of good people management practices with an analysis of the National Health Service
This report from the What Works Centre for Wellbeing illustrates the effect of good people management with an analysis of the NHS. It found Trusts that made the most extensive use of good people management practices were over three times more likely to have the lowest levels of staff sickness absence and at least four times more likely to have the most satisfied patients. They were also more than twice as likely to have staff with the highest levels of job satisfaction compared to NHS Trusts that made least use of these practices, and over three times more likely to have staff with the highest levels of engagement.
Retaining your clinical staff
This improvement resource outlines key steps to improving retention of clinical staff. The advice is taken from interviews with trust HR directors, directors of nursing and medical directors.
The state of medical education and practice in the UK 2017
This report from the General Medical Council, which analyses data on the medical workforce across the UK, warns that the UK’s medical profession is at ‘a crunch point’ and will suffer increasing pressure over the next 20 years unless action is taken. It identifies a raft of challenges facing the medical profession today against a backdrop of an increasing and older population, and highlights four priorities for the UK’s governments and agencies responsible for medical training and workforce planning.
Seven day hospital services: challenges and solutions
Learning from other trusts who have identified key challenges in implementing seven-day hospital services.
New approach to NHS clinical assessment could save thousands of lives
NHS England is asking every hospital trust to adopt the Royal College of Physicians’ new clinical assessment system that could save nearly 2,000 lives and 627,000 bed days every year.
The National Early Warning Score (NEWS) has been produced by the Royal College of Physicians and is backed by the Royal College for Emergency Medicine, NHS Improvement, the Association of Ambulance Chairs and Sir Bruce Keogh, National Medical Director for NHS England.
The National Early Warning Score (NEWS) has been produced by the Royal College of Physicians and is backed by the Royal College for Emergency Medicine, NHS Improvement, the Association of Ambulance Chairs and Sir Bruce Keogh, National Medical Director for NHS England.
Burns challenges – A social media dictated phenomena in the younger generation
Burns Open , Volume 0 , Issue 0
‘Burns challenges’ leading to battle scars are a current youth culture phenomenon propagated by social media. Platforms such as YouTube, Twitter and Facebook have been noted to show adolescents perform these challenges resulting in an increasing incidence of flame, friction or chemical burns of varying severity.
Creative ways to demonstrate stealth by performing these burns injuries is a common occurrence and correlates to a rising incidence of these burns. Methods of social media clearly fuel this by publicising events. It is important to be vigilant in identifying this aetiology of burn injury, not to confuse it with non-accidental injury or psychotic deliberate self-harm, and to educate patients of the long-term consequences. Further studies should be done into understanding the significant influence social media has on risky behaviours in children and adolescents, and the general public, especially social media sites, should be educated on the extent of harm these challenges have so that hosting of these videos and contents can be better regulated.
UHCW Research: Lopa Patel
Tuesday, 19 December 2017
NIHR Signal Alternative drug may prevent atrial fibrillation following heart surgery
After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication by about a third.
About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.
From the NIHR Dissemination Centre
About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.
From the NIHR Dissemination Centre
NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births
Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
Transvaginal mesh repair of anterior or posterior vaginal wall prolapse [IPG599]
New interventional procedures guidance from NICE:
Evidence-based recommendations on transvaginal mesh repair of anterior or posterior vaginal wall prolapse. This involves inserting a mesh to replace tissue that has weakened and caused the pelvic organs to drop down (prolapse) into the vagina.
Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns. Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.nice
Evidence-based recommendations on transvaginal mesh repair of anterior or posterior vaginal wall prolapse. This involves inserting a mesh to replace tissue that has weakened and caused the pelvic organs to drop down (prolapse) into the vagina.
Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns. Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.nice
Department of Health gender pay gap revealed
Women working at the at the Department of Health earn up to 14 per cent less than men an hour – despite women making up two-thirds of its workforce.
The DH has published a report on its gender pay gap alongside other Whitehall departments, which reveals the scale of the challenge to achieve pay equality for women in the civil service.
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
Medical profession at ‘crunch point’, GMC report finds
The UK’s medical profession is at ‘a crunch point’ and will suffer increasing pressure over the next 20 years unless action is taken, the General Medical Council’s (GMC’s) State of Medical Education and Practice report warns today. Click here to read GMC report
Workmates stay silent over mental health issues
Many people are happy to talk about their private lives at work with colleagues, including discussing the end of a relationship, money problems and even sex. However, it seems that chats or discussions about mental health are a different story. Click here for news paper article
Does Money Buy Happiness? Not Necessarily
How much people earn is associated with how they experience happiness, according to a new study. Click here for PsychCentral article
Could cognitive interventions be useful in treating depression?
A new study has examined whether cognitive bias modification (CBM) for facial interpretation, a digital health intervention that changes our perception for emotional expressions from negative to positive, might be useful in treating depression. Click here for ScienceDaily article
Culture and sensitivity reporting in odontogenic infections: do microbiology swabs change antibiotic prescribing practice?
British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e94 - e95
Odontogenic infections are commonly polymicrobial. Effective treatment depends on definitive drainage of abscesses and empirical antimicrobial therapy based on likely organisms.
UHCW Research: Jasdeep Singh Saggu, Jean Medard Croos, Ross Elledge and Gary Walton
Odontogenic infections are commonly polymicrobial. Effective treatment depends on definitive drainage of abscesses and empirical antimicrobial therapy based on likely organisms.
The impact of fixation method selection on neurosensory disturbance following bilateral sagittal split osteotomy
British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e174
The bilateral sagittal split osteotomy is a commonly performed procedure to correct dentofacial deformities such as retrognathia and prognathia. Fixation choices available to the surgeon include bicortical screws and monocortical fixation plates. Whilst there is evidence in the literature to support both methods in terms of stability, there is little about comparative rates of sensory deficit in the distribution of the inferior alveolar nerve.
UHCW Research: Naren Thanabalan, Ross Elledge, Hayley Kyte and Peter Stockton
The bilateral sagittal split osteotomy is a commonly performed procedure to correct dentofacial deformities such as retrognathia and prognathia. Fixation choices available to the surgeon include bicortical screws and monocortical fixation plates. Whilst there is evidence in the literature to support both methods in terms of stability, there is little about comparative rates of sensory deficit in the distribution of the inferior alveolar nerve.
UHCW Research: Naren Thanabalan, Ross Elledge, Hayley Kyte and Peter Stockton
The Assessment and Management of Simple Elbow Dislocations
The Open Orthopaedic Journal, Volume 11, 2017
The majority of simple elbow dislocations can be successfully managed non-operatively with good reliable outcomes. Careful follow up is essential, however, to identify patients that may occasionally develop persistent instability or stiffness and require intervention.
UHCW Research: Andrew J. Grazette and Alex Aquillina
The majority of simple elbow dislocations can be successfully managed non-operatively with good reliable outcomes. Careful follow up is essential, however, to identify patients that may occasionally develop persistent instability or stiffness and require intervention.
UHCW Research: Andrew J. Grazette and Alex Aquillina
Current Concepts in Elbow Trauma
Editorial in The Open Orthopaedics Journal vol 11, 2017
Elbow injuries are relatively common and have a significant socioeconomic impact, accounting for 10% of all injuries to the upper limb with almost one third of these being dislocations and approximately 10% being fractures. Furthermore, the elbow is the second most commonly dislocated joint in adults and the most commonly dislocated joint in the paediatric population with 40% of these injuries being associated with sport. Injuries patterns can range from simple low-energy dislocations up to high-energy complex fractures and fracture-dislocations.
Elbow injuries are relatively common and have a significant socioeconomic impact, accounting for 10% of all injuries to the upper limb with almost one third of these being dislocations and approximately 10% being fractures. Furthermore, the elbow is the second most commonly dislocated joint in adults and the most commonly dislocated joint in the paediatric population with 40% of these injuries being associated with sport. Injuries patterns can range from simple low-energy dislocations up to high-energy complex fractures and fracture-dislocations.
UHCW Research: Chetan S. Modi
A service evaluation of surgical tracheostomies in the emergency theatre at University Hospital, Coventry: time for a dedicated tracheostomy team?
British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e96
The routine practice of surgical tracheostomy has been challenged by bedside percutaneous dilatational tracheostomy (PDT). Whilst PDT is cost-effective and time-efficient, there is still a place for the open technique in patients with unfavourable anatomy, unstable cervical spine injuries and/or coagulopathies. Complication rates of the open technique are often lower, but booking such cases into busy emergency theatres may prove difficult.
NHS uses sickness data as early warning to cope with winter surges
A sickness surveillance system will help the NHS plan for surges in demand this winter by tracking outbreaks of norovirus, which causes vomiting and diarrhoea, and other illness around the country.
Data gathered by Public Health England will be used by NHS England operational monitoring teams to study winter trends and to help give early warning about rising outbreaks of flu, respiratory syncytial virus (RSV) and norovirus as well as other acute seasonal illnesses.
The findings will allow the NHS to anticipate rises in hospital admissions and produce a planned response by, for example, rescheduling planned surgery in advance to avoid inconveniencing patients as well as free up beds and converting ‘swing’ wards from elective to emergency care for patients with conditions such as respiratory problems.
Data gathered by Public Health England will be used by NHS England operational monitoring teams to study winter trends and to help give early warning about rising outbreaks of flu, respiratory syncytial virus (RSV) and norovirus as well as other acute seasonal illnesses.
The findings will allow the NHS to anticipate rises in hospital admissions and produce a planned response by, for example, rescheduling planned surgery in advance to avoid inconveniencing patients as well as free up beds and converting ‘swing’ wards from elective to emergency care for patients with conditions such as respiratory problems.
Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge
This best practice framework from NHS England aims to address two models and the implementation approach that needs to be taken by sustainability and transformation partnerships (STPs) and their provider organisations with ensuing threats to patient safety, during the winter months.
QuantiFERON®: test guidelines and order form
Guidelines from Public Health England on blood collection, storage and transportation. Includes order form for blood collection tubes.
National mycobacterium reference laboratory: user manual
Guidance from Public Health England on how to label, package and submit specimens to the laboratory for diagnostic testing.
Gadolinium contrast agents and risk of tissue accumulation—removal of Omniscan and intravenous Magnevist from February; restrictions to use of other linear agents
From 1 February 2018, intravenous forms of gadodiamide (Omniscan) and gadopentetic acid (also known as gadopentetate dimeglumine; intravenous Magnevist) linear contrast agents for MRI will no longer be licenced and any remaining stock will be recalled from the market. The authorised indication of the linear agents gadobenic acid (also known as gadobenate dimeglumine; MultiHance) and gadoxetic acid (Primovist) will be limited to delayed phase liver imaging only.
Summary of published key strategic guidance for health Emergency Preparedness, Resilience & Response (EPRR)
The charts shown in this NHS England document give an overview of the key strategic EPRR guidance documents currently published. For published documents, website links are embedded in the charts.
Good clinical practice for clinical trials
How to show MHRA you're meeting good clinical practice (GCP) standards and what to expect from an inspection. Good clinical practice (GCP) is a set of internationally-recognised ethical and scientific quality requirements that must be followed when designing, conducting, recording and reporting clinical trials that involve people.
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. They have recently been updated.
British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice
The aim of this guidance is to review the available literature on testosterone deficiency and provide evidence-based statements for UK clinical practice.
How the health and social care system is preparing for winter
This briefing from the NHS Confederation provides an overview of the key challenges facing health and social care over the winter period and the work being undertaken to prepare for the coming months.
Newborn hearing screening programme (NHSP) operational guidance
This PHE guidance supports healthcare professionals and stakeholders delivering and managing newborn hearing screening programmes in England has been updated.
Guidance on overseas visitors hospital charging regulations
Guidance, from the Department of Health, for NHS bodies who need to make and recover hospital charges from overseas visitors.
See also Overseas patient upfront tariff 2017/18.
See also Overseas patient upfront tariff 2017/18.
Monday, 18 December 2017
NHS Improvement publishes retention guide
To support employer organisations with retaining staff, NHS Improvement has published Retaining your staff: a practical guide.
Changes to data protection requirements under the General Data Protection Regulation (GDPR)
This factsheet from NHS Employers, developed in conjunction with Capsticks, outlines the key changes that will affect the way that employers in NHS organisations carry out tasks involving personal data, particularly around employment checks and recruitment processes.
Evaluating reward guide and template
NHS Employers' step by step guide to evaluating reward will help you understand and demonstrate the impact of your reward approach. It also helps you test your activities, improve communication and identify and replicate good practice.
The guide looks at the steps to consider when planning your evaluation and includes some examples of measurable outputs, ideas of activities and a template evaluation plan for you to use.
The guide looks at the steps to consider when planning your evaluation and includes some examples of measurable outputs, ideas of activities and a template evaluation plan for you to use.
Planning for seasonal demand in respiratory illness
Each winter, emergency departments experience a surge in respiratory attendances and emergency admissions for respiratory conditions double. It is therefore crucial to plan for this inevitable increase in demand so that patient flow is maintained.
A “quick guide” from NHS Improvement highlights ways to manage demand, including ambulatory emergency care, early supported discharge services, and urgent “hot” clinics. Use of these initiatives can reduce avoidable overnight admissions and improve patient flow and outcomes.
Local A&E delivery boards are advised to consider the recommendations as part of plans to manage the seasonal surge in respiratory admissions.
Local A&E delivery boards are advised to consider the recommendations as part of plans to manage the seasonal surge in respiratory admissions.
Making strategic commissioning work: lessons from home and away
With the move towards accountable care, clinical commissioners are starting to take on a more strategic role. This report from NHS Clinical Commissioners aims to support commissioners in these new functions by outlining best practice from health systems around the world which are developing policy around new care models and place-based systems of care.
Enabling BME nurse and midwife progression into senior leadership positions
This report from NHS England summarises the learning from engagement work, which identifed what the best performing trusts in the workforce race equality standard area were doing, and includes examples that outline best practice approaches and a number of suggested actions to support improvement.
Santa's little helpers: a novel approach to developing patient information leaflets
BMJ (Clinical research ed.) Vol. 359, (December 13, 2017): j5565.
UHCW Research: Catrin Wigley
Obtaining valid consent before any intervention is a legal and ethical principle that underpins patient autonomy. For consent to be valid, the patient must have received sufficient information and understood the nature and purpose of the procedure. Emphasis is placed on providing information in a variety of formats that is comprehensible and free from technical jargon, which the average patient cannot reasonably be expected to understand.
One solution to increasing patient understanding and capacity for self determination is using patient information leaflets. Time constraints on clinicians and the growing importance of providing patient information have made patient leaflets a popular adjunct to verbal communication, particularly where consent is required. Studies have shown that patient satisfaction correlates strongly with the amount of information received
Characterization of Novel Missense Variants of SERPINA1 Gene Causing Alpha-1 Antitrypsin Deficiency
Am. J. Respir. Cell Mol. Biol. 2017 doi:10.1165/rcmb.2017-0179OC
SERPINA1 gene is highly polymorphic, with more than one hundred variants described in databases. The SERPINA1 encodes alpha-1 antitrypsin (AAT) protein, and the severe deficiency of AAT is a major contributor to pulmonary emphysema and liver diseases. We report seven new variants in Spanish patients with AAT deficiency. All variants involved amino acid substitutions in different exons: PiSDonosti (S+Ser14Phe), PiTijarafe (Ile50Asn), PiSevilla (Ala58Asp), PiCadiz (Glu151Lys), PiTarragona (Phe227Cys), PiPuerto Real (Thr249Ala) and PiValencia (Lys328Glu). The effect of these variants was analyzed to investigate their contribution to the disease. Mutant proteins were overexpressed in HEK293T cells and AAT expression, polymerization, degradation and secretion as well as anti-elastase activity were analyzed by PAS staining, western blot, pulse-chase and elastase inhibition assays. When overexpressed, S+S14F, I50N, A58D, F227C and T249A mutants formed intracellular polymers and did not secrete AAT protein. Two variants (E151K and K328E) did not form polymers and secreted AAT protein. However, K328E showed intracellular retention and reduced anti-elastase activity. In conclusion, we demonstrate that deficient variants may be more frequent than previously thought, and their discovery can only be possible by the complete sequencing of the gene and subsequent functional characterization. Better knowledge of SERPINA1 variants would improve diagnosis and care of AAT deficiency carriers.
UHCW Research: Lara Beatriz
SERPINA1 gene is highly polymorphic, with more than one hundred variants described in databases. The SERPINA1 encodes alpha-1 antitrypsin (AAT) protein, and the severe deficiency of AAT is a major contributor to pulmonary emphysema and liver diseases. We report seven new variants in Spanish patients with AAT deficiency. All variants involved amino acid substitutions in different exons: PiSDonosti (S+Ser14Phe), PiTijarafe (Ile50Asn), PiSevilla (Ala58Asp), PiCadiz (Glu151Lys), PiTarragona (Phe227Cys), PiPuerto Real (Thr249Ala) and PiValencia (Lys328Glu). The effect of these variants was analyzed to investigate their contribution to the disease. Mutant proteins were overexpressed in HEK293T cells and AAT expression, polymerization, degradation and secretion as well as anti-elastase activity were analyzed by PAS staining, western blot, pulse-chase and elastase inhibition assays. When overexpressed, S+S14F, I50N, A58D, F227C and T249A mutants formed intracellular polymers and did not secrete AAT protein. Two variants (E151K and K328E) did not form polymers and secreted AAT protein. However, K328E showed intracellular retention and reduced anti-elastase activity. In conclusion, we demonstrate that deficient variants may be more frequent than previously thought, and their discovery can only be possible by the complete sequencing of the gene and subsequent functional characterization. Better knowledge of SERPINA1 variants would improve diagnosis and care of AAT deficiency carriers.
UHCW Research: Lara Beatriz
Effects of a multi-strain probiotic supplement for 12 weeks in circulating endotoxin levels and cardiometabolic profiles of medication naïve T2DM patients: a randomized clinical trial
Journal of Translational Medicine 2017 15:249
The present randomized clinical trial characterized the beneficial effects of a multi-strain probiotics supplementation on improving circulating endotoxin levels (primary endpoint) and other cardiometabolic biomarkers (secondary endpoint) in patients with T2DM.
UHCW Research: Shaun Sabico
The present randomized clinical trial characterized the beneficial effects of a multi-strain probiotics supplementation on improving circulating endotoxin levels (primary endpoint) and other cardiometabolic biomarkers (secondary endpoint) in patients with T2DM.
UHCW Research: Shaun Sabico
A 3D deformable prostate model derived from orthogonal projections of radiotherapy CT data
Poster on a 3D deformable prostate model derived from orthogonal projections of radiotherapy CT data
Modern radiotherapy to the prostate uses daily imaging to track the prostate position and improve targeting accuracy. A 3D flexible model of prostate shape could be used to evaluate such techniques through simulation. Ideally such a model could shape variation during treatment and target definition errors from observer variability.
UHCW Research: J P Sage
Modern radiotherapy to the prostate uses daily imaging to track the prostate position and improve targeting accuracy. A 3D flexible model of prostate shape could be used to evaluate such techniques through simulation. Ideally such a model could shape variation during treatment and target definition errors from observer variability.
UHCW Research: J P Sage
Learning about mental health in school should be taught alongside literacy and numeracy, says new report
The joint report, ‘What really matters in children and young people’s mental health’ published today by the Values-Based Child and Adolescent Mental Health System Commission, puts the role of schools at the heart of improving mental health services for children and young people. Click here to see RCPsych press release
Royal College of Psychiatrists response to CQC report into how people are cared for when detained under the Mental Health Act
Registrar of the Royal College of Psychiatrists, Dr Adrian James said:
“The Royal College of Psychiatrists welcomes all attempts to safeguard the human rights of our patients. Better access to services across all levels of care will ensure that patients are cared for in the least restrictive environment and that effective care is given at the right time and in the right place. The report highlights many areas of good practice where mental health teams work positively with patients but support is needed to eradicate out of area placements - a key recommendation of Lord Crisp’s report on acute psychiatric care. However, in order to ensure full implementation across all areas it is essential that we train more mental health workers, including psychiatrists." Click here for RCPsych press release
An interesting case of tripronucleate cleavage observed during live cell time-lapse imaging
Poster supported by a University Hospitals Coventry and Warwickshire PhD Fellowship, and the Centre for Reproductive Medicine.
Here, we report an interesting observation made during the first cleavage division of a tripronucleate resulting from the oocyte of a 44 year-old female undergoing standard IVF treatment, into a two-cell embryo (fig 1). Whilst conducting time lapse experiments using the Chipman Cell IQ® live cell imaging system, we recorded the fusion of the three pronuclei, followed by the formation of a “Y-shaped” centrally-located blastomere arrangement. However, rather than development into a three-cell embryo, apparent fusion of two of the blastomeres resulted in the formation of a two-cell embryo. This embryo subsequently arrested.
Here, we report an interesting observation made during the first cleavage division of a tripronucleate resulting from the oocyte of a 44 year-old female undergoing standard IVF treatment, into a two-cell embryo (fig 1). Whilst conducting time lapse experiments using the Chipman Cell IQ® live cell imaging system, we recorded the fusion of the three pronuclei, followed by the formation of a “Y-shaped” centrally-located blastomere arrangement. However, rather than development into a three-cell embryo, apparent fusion of two of the blastomeres resulted in the formation of a two-cell embryo. This embryo subsequently arrested.
UHCW Research: Jaswinder Rai, Pavan Kachhwaha and Debbie Darrell
College response to the NHS Providers survey of CCG Mental Health spend
Sir Simon Wessely, President of the Royal College of Psychiatrists said:
“There is now overwhelming evidence that too many Clinical Commissioning groups are failing people with mental illness. This research shows that they aren’t passing on money meant for mental health services, but we also know that many are missing targets to ensure that people can access treatment and failing to implement essential changes to secure the mental health workforce for the future. This amounts to a betrayal of the promise that people with mental illness would get the same treatment as those with physical illnesses; we call on NHS England and NHS Improvement to take urgent action to hold CCG’s to account.” Click here for RCPsych blog
Coloring Books Relieve Some Stress, But Real Art Therapy Boosts Mood, Creativity
A new study shows that although the extremely popular adult coloring books can reduce stress, they are not nearly as effective for mental health as engaging in true art therapy. The findings show that participants who created their own art in a therapist-assisted open studio experienced heightened creativity, more positive mood and feelings of empowerment, whereas those who worked on coloring alone did not improve in these areas. Click here for PsychCentral article
LEFTY2 inhibits endometrial receptivity by downregulating Orai1 expression and store-operated Ca2+ entry
Mol Med (2017). https://doi.org/10.1007/s00109-017-1610-9
Early embryo development and endometrial differentiation are initially independent processes, and synchronization, imposed by a limited window of implantation, is critical for reproductive success. A putative negative regulator of endometrial receptivity is LEFTY2, a member of the transforming growth factor (TGF)-β family. LEFTY2 is highly expressed in decidualizing human endometrial stromal cells (HESCs) during the late luteal phase of the menstrual cycle, coinciding with the closure of the window of implantation. Here, we show that flushing of the uterine lumen in mice with recombinant LEFTY2 inhibits the expression of key receptivity genes, including Cox2, Bmp2, and Wnt4, and blocks embryo implantation. In Ishikawa cells, a human endometrial epithelial cell line, LEFTY2 downregulated the expression of calcium release-activated calcium channel protein 1, encoded by ORAI1, and inhibited store-operated Ca2+ entry (SOCE). Furthermore, LEFTY2 and the Orai1 blockers 2-APB, MRS-1845, as well as YM-58483, inhibited, whereas the Ca2+ ionophore, ionomycin, strongly upregulated COX2, BMP2 and WNT4 expression in decidualizing HESCs. These findings suggest that LEFTY2 closes the implantation window, at least in part, by downregulating Orai1, which in turn limits SOCE and antagonizes expression of Ca2+-sensitive receptivity genes.
UHCW Research: Jan J. Brosens
Early embryo development and endometrial differentiation are initially independent processes, and synchronization, imposed by a limited window of implantation, is critical for reproductive success. A putative negative regulator of endometrial receptivity is LEFTY2, a member of the transforming growth factor (TGF)-β family. LEFTY2 is highly expressed in decidualizing human endometrial stromal cells (HESCs) during the late luteal phase of the menstrual cycle, coinciding with the closure of the window of implantation. Here, we show that flushing of the uterine lumen in mice with recombinant LEFTY2 inhibits the expression of key receptivity genes, including Cox2, Bmp2, and Wnt4, and blocks embryo implantation. In Ishikawa cells, a human endometrial epithelial cell line, LEFTY2 downregulated the expression of calcium release-activated calcium channel protein 1, encoded by ORAI1, and inhibited store-operated Ca2+ entry (SOCE). Furthermore, LEFTY2 and the Orai1 blockers 2-APB, MRS-1845, as well as YM-58483, inhibited, whereas the Ca2+ ionophore, ionomycin, strongly upregulated COX2, BMP2 and WNT4 expression in decidualizing HESCs. These findings suggest that LEFTY2 closes the implantation window, at least in part, by downregulating Orai1, which in turn limits SOCE and antagonizes expression of Ca2+-sensitive receptivity genes.
UHCW Research: Jan J. Brosens
Distal Biceps and Triceps Injuries
The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M4) 1364-1372
Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.
James C. Beazley, Thomas M. Lawrence, Steven J. Drew and Chetan S. Modi
Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.
James C. Beazley, Thomas M. Lawrence, Steven J. Drew and Chetan S. Modi
Clinical Anatomy and Assessment of the Elbow
The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M2) 1347-1352
The elbow is a complex synovial hinge joint comprising of three articulations. Satisfactory function and stability are provided by bony and soft tissue stabilising structures. Injuries around the elbow joint are common.
Knowledge of the intricate anatomy around the elbow joint is essential to successfully assessing and managing elbow injuries and restoring good function.
UHCW Research: Alexander L Aquilina and Andrew J Grazette
The elbow is a complex synovial hinge joint comprising of three articulations. Satisfactory function and stability are provided by bony and soft tissue stabilising structures. Injuries around the elbow joint are common.
Knowledge of the intricate anatomy around the elbow joint is essential to successfully assessing and managing elbow injuries and restoring good function.
UHCW Research: Alexander L Aquilina and Andrew J Grazette
Friday, 15 December 2017
Man sectioned under mental health act after police officer stabbed in Erdington
A 48-year-old man was arrested initially on suspicion of two counts of GBH. Click here for newspaper article
Father’s Rejection Can Lead to Teen Anxiety
In a new study, Pennsylvania State University investigators discovered rejection from fathers during adolescence may lead to increases in social anxiety and loneliness among teens. Click here for ScienceDaily article
Tonogenchoncel-L (Invossa) Gene Therapy for Regeneration of Cartilage in Patients with Degenerative Arthritis or Osteoarthritis of the Knee
Tonogenchoncel-L is a type of treatment which involves taking cells which make up the cartilage and altering them genetically to help stimulate the growth of the cartilage. These modified cells are injected directly into the knee joint with the intention of helping the lost cartilage regrow. If tonogenchoncel-L was licenced in the UK it could provide a unique treatment for people with knee osteoarthritis which has the potential to help cartilage regrow and improve symptoms.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Neridronic Acid (Nerixia) for Complex Regional Pain Syndrome
The cause of CRPS is unknown, but it is generally thought to be the result of the body reacting abnormally to an injury. It is difficult to estimate exactly how common CRPS is, as many cases may go undiagnosed or misdiagnosed. Currently there are no approved treatments for CRPS. Neridronic acid administered by injection is currently being developed to treat CRPS and early results indicate that it has the possibility to control the condition. If approved neridronic acid will be a potential new treatment for CRPS.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Upadacitinib for Adults with Moderate to Severe Active Rheumatoid Arthritis After Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) or Biologic DMARDs Failure
There is currently no cure for rheumatoid arthritis and treatment aims to improve quality of life and to prevent or reduce joint damage. The most common treatment options are steroids to reduce inflammation, medications to reduce pain and swelling, and medications that slow the progression of joint damage from RA. Upadacitinib is currently being developed to be taken orally as a treatment option for those who have active moderate to severe RA who do not respond to certain treatment options. This drug works by stopping the inflammation caused by a specific type of protein and if licensed, it may be an option that can be used earlier in the treatment pathway.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Tocilizumab (RoActemra) for Adults with Systemic Sclerosis – Second Line
There is currently no cure for systemic sclerosis and treatment options focus on the management of symptoms. Tocilizumab is intended for the treatment of systemic sclerosis in adults. It is currently in development and early research indicates that it is able to target the key mechanisms thought to be responsible for the disease. If licensed, it could provide a new treatment option for adults with systemic sclerosis.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Subcutaneous Tocilizumab (RoACTEMRA) With or Without Methotrexate for the Treatment of Inadequate Responders in Systemic Juvenile Idiopathic Arthritis
Tocilizumab is a drug that targets and blocks the IL-6 pathway and is currently used for the treatment of many diseases, including sJIA, rheumatoid arthritis and Giant Cell Arteritis (GCA). It is now being developed for patients with sJIA that may have been treated with, and have not responded to another drug called methotrexate. It is being developed to be administered as an injection under the skin (subcutaneous) as opposed to the usual intravenous infusion preparation and this has the potential to reduce patient inconvenience and clinical burden.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Upper GI Cancer Resection: How Much Blood Do We Need to Give and When?
International Journal of Surgery (INT J SURG), Nov2017 Supplement 1; 47: S93-S93.
Many upper GI centres routinely crossmatch blood for patients undergoing gastric or oesophageal resection. British Society of Haematology (BSH) guidelines state that at least half of the units of compatible blood provided should be used in surgery. We aimed to quantify the utilisation of cross matched blood within a tertiary Upper GI centre where we routinely crossmatch 4 units of blood prior to resection.
UHCW Research: Krishnamoorthy, A., Wall, R., Munasinghe, A., Khatri, C., Tan, L.C. and Menon, V.
Many upper GI centres routinely crossmatch blood for patients undergoing gastric or oesophageal resection. British Society of Haematology (BSH) guidelines state that at least half of the units of compatible blood provided should be used in surgery. We aimed to quantify the utilisation of cross matched blood within a tertiary Upper GI centre where we routinely crossmatch 4 units of blood prior to resection.
UHCW Research: Krishnamoorthy, A., Wall, R., Munasinghe, A., Khatri, C., Tan, L.C. and Menon, V.
New national data opt-out
A new national data opt-out will be introduced from March 2018 to give patients a clear choice on how their personally identifiable data is used for purposes beyond their individual care, as detailed in the government’s response to the national data guardian.
NHS Digital is developing the system now along with a suite of communications products for the workforce and patients to test.
AoMRC Medical Associate Professionals consultation
The AoMRC's response to the Department of Health’s consultation on the regulation of Medical Associate Professionals (MAPs).
Supporting staff retention with reward
In this NHS Employers' case study, Sandwell and West Birmingham Hospitals NHS Trust shares how they used their reward offer to improve staff retention, reduce agency and temporary staff spend and re-engaged the workforce.
NHS performance statistics - December 2017
Combined Performance Summary
- Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care
- Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures
- Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates
- Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies
Pulmonary rehabilitation associated with lower hospital admission rates
The Pulmonary rehabilitation: Beyond breathing better report from the Royal College of Physicians (RCP) National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme reveals that people who complete a full pulmonary rehabilitation programme are much less likely to be admitted to hospital than those who do not.
Lenalidomide (Revlimid) for Newly Diagnosed Multiple Myeloma – First Line
Lenalidomide in combination with bortezomib and dexamethasone is being developed for the treatment of adult patients with MM. While each of these drugs are already approved for treating a range of malignant blood diseases, the combination of the three drugs has shown significant potential particularly for the treatment of newly diagnosed MM. If approved, it will offer an additional treatment option for adult patients whether or not they are eligible or ineligible for bone marrow transplant.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
RCOphth Safety Announcement: BSS and Open Systems for Injectable Medicines
Following reported errors of drug misidentification in other specialties causing serious harm, when an injectable medication was decanted into an ‘open system’, e.g. a gallipot, before administration, NHS Improvement has expressed concerns to RCOphth about the widespread practice during cataract surgery of decanting BSS (balanced salt solution) from the infusion bag into a gallipot at the start of the procedure which may then be drawn up and used to re-inflate the eye later in the operation. In addition, concern was raised that BSS kept in a gallipot might pose a risk of potential bacterial contamination.
In response, the College has replied that given the short duration that BSS typically remains in a sterile gallipot during cataract surgery, it does not consider that this practice poses a sterility issue. However there is a potential risk for drug misidentification although no other drug would commonly be placed into a gallipot during cataract surgery. RCOphth has pointed out that BSS is not currently available as a pre-filled syringe and that preparing and labelling of several syringes of BSS at the beginning of each case would be both impractical and potentially wasteful.
In response, the College has replied that given the short duration that BSS typically remains in a sterile gallipot during cataract surgery, it does not consider that this practice poses a sterility issue. However there is a potential risk for drug misidentification although no other drug would commonly be placed into a gallipot during cataract surgery. RCOphth has pointed out that BSS is not currently available as a pre-filled syringe and that preparing and labelling of several syringes of BSS at the beginning of each case would be both impractical and potentially wasteful.
Workforce Race Equality Standard data reporting – December 2017
The 2017 report is the third publication since the NHS Workforce Race Equality Standard (WRES) was mandated and covers all nine indicators.
Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer
JAMA. 2017 Dec 12;318(22):2199-2210. doi: 10.1001/jama.2017.14585.
In the setting of a challenge competition, some deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. Whether this approach has clinical utility will require evaluation in a clinical setting.
UHCW Research: Rajpoot N
In the setting of a challenge competition, some deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. Whether this approach has clinical utility will require evaluation in a clinical setting.
UHCW Research: Rajpoot N
Ultrasonography of occipital arteries to diagnose giant cell arteritis: a case series and literature review
Clin Rheumatol. 2017 Dec 12. doi: 10.1007/s10067-017-3946-5. [Epub ahead of print]
We describe four cases of giant cell arteritis (GCA) that presented with occipital headache in the last 6 months. Typical ultrasound features of GCA were found in the occipital arteries which helped to confirm the diagnosis. One patient had already suffered significant visual loss by the time the diagnosis was made, reflecting the similarity in prognosis to the more typical GCA patients. These cases prompted a review of the literature to evaluate the evidence regarding the use of occipital artery ultrasonography in the investigation of GCA. We searched PubMed, Google Scholar and Web of Science and identified 17 papers but only four of these were relevant studies. The studies available show that typical features of GCA can be detected in the occipital arteries using ultrasonography. They also suggest that ultrasonography can detect changes in the occipital arteries when temporal arteries are not involved. However, occipital artery abnormalities were less common than temporal artery abnormalities in GCA. We advocate maintaining a high index of suspicion for GCA in patients presenting with atypical features, such as occipital headache. Ultrasonography has a vital role to play in the diagnosis of these patients. We recommend priority imaging of the affected area to facilitate prompt and accurate diagnosis of GCA, especially when atypical vessels are involved.
UHCW Research: Pinnell J, Tiivas C, Perkins P, Blake T, Saravana S and Dubey S.
We describe four cases of giant cell arteritis (GCA) that presented with occipital headache in the last 6 months. Typical ultrasound features of GCA were found in the occipital arteries which helped to confirm the diagnosis. One patient had already suffered significant visual loss by the time the diagnosis was made, reflecting the similarity in prognosis to the more typical GCA patients. These cases prompted a review of the literature to evaluate the evidence regarding the use of occipital artery ultrasonography in the investigation of GCA. We searched PubMed, Google Scholar and Web of Science and identified 17 papers but only four of these were relevant studies. The studies available show that typical features of GCA can be detected in the occipital arteries using ultrasonography. They also suggest that ultrasonography can detect changes in the occipital arteries when temporal arteries are not involved. However, occipital artery abnormalities were less common than temporal artery abnormalities in GCA. We advocate maintaining a high index of suspicion for GCA in patients presenting with atypical features, such as occipital headache. Ultrasonography has a vital role to play in the diagnosis of these patients. We recommend priority imaging of the affected area to facilitate prompt and accurate diagnosis of GCA, especially when atypical vessels are involved.
UHCW Research: Pinnell J, Tiivas C, Perkins P, Blake T, Saravana S and Dubey S.
NHS becomes first healthcare system in the world to publish numbers of avoidable deaths
The NHS will become the first healthcare organisation in the world to publish estimates of how many patients may have died because of problems in their care.
The data will be published each quarter by individual trusts. 171 of the 223 trusts in England have already released or are releasing their first estimates by the end of December.
Each trust will make its own assessment of the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems.
The data will be published each quarter by individual trusts. 171 of the 223 trusts in England have already released or are releasing their first estimates by the end of December.
Each trust will make its own assessment of the number of deaths due to problems in care. The data will not be comparable and will not be collated centrally. This will allow trusts to focus on learning from mistakes and sharing lessons across their organisations and their local healthcare systems.
National health and care workforce strategy unveiled
A system-wide workforce strategy for the NHS and social care launches today for consultation: Facing the Facts, Shaping the Future, A Health and Care Workforce Strategy for England to 2027.
The content has been led and coordinated by Health Education England, but is published as a product of the whole national system including NHS England, NHS Improvement and Public Health England.
The draft strategy looks at the major workforce plans for the Five Year Forward View priorities: cancer; mental health; maternity; primary and community care; and urgent and emergency care.
The content has been led and coordinated by Health Education England, but is published as a product of the whole national system including NHS England, NHS Improvement and Public Health England.
The draft strategy looks at the major workforce plans for the Five Year Forward View priorities: cancer; mental health; maternity; primary and community care; and urgent and emergency care.
New ways to avoid wrong IOLs
The Royal College of Ophthalmologists is aware that never events relating to the insertion of wrong intraocular lenses (IOLs) is an ongoing problem and that members continue to have concerns about how best to avoid such incidents, and about how to ensure there is no unhelpful blame or punitive measures which lead to financial penalties or inhibit reporting and learning.
New analysis shows impact of redesigning urgent and emergency care in Northumberland
The Health Foundation has published analysis examining the early impact of changes to A&E and urgent care services in Northumberland following the opening of the country’s first bespoke emergency hospital in Cramlington in 2015.
GMC begins work to deliver Medical Licensing Assessment
The General Medical Council (GMC) has approved the initial model for a two-part Medical Licensing Assessment (MLA) that will provide more consistency in the ways doctors enter UK practice.
GMC consults on plans for medical licensing assessment
The GMC is making plans for a medical licensing assessment (MLA) that will provide a single route to the medical register for all doctors who wish to practise in the UK.
The proposals aim to address the current variation in arrangements for medical students across the country and those wishing to join the register from outside the UK.
GMC consults on plans for medical licensing assessment
The GMC is making plans for a medical licensing assessment (MLA) that will provide a single route to the medical register for all doctors who wish to practise in the UK.
The proposals aim to address the current variation in arrangements for medical students across the country and those wishing to join the register from outside the UK.
Distal Humeral Fractures-Current Concepts
The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M3) 1353-1363
Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.
This review discusses the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we discuss controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.
UHCW Research: James C. Beazley, Njalalle Baraza, Robert Jordan and Chetan S. Modi
Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.
This review discusses the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we discuss controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.
UHCW Research: James C. Beazley, Njalalle Baraza, Robert Jordan and Chetan S. Modi
Thursday, 14 December 2017
Your mood depends on the food you eat, and what you should eat changes as you get older
Young adults and mature adults require different food to improve their mental health Click here for ScienceDaily article
How visible are you as an occupational therapist?
You are on Facebook, you Tweet, you Snapchat, you Instagram, but how well established is your online professional profile?
How does anyone outside your immediate locality know about the great work you do? Click here for RCOT article
Mental Health In Prisons
House of Commons Committee of Public Accounts - This report says record levels of self-inflicted deaths and self-harm in prisons are a damning indictment. It concludes that the system for improving the mental health of prisoners isn’t working as it should. Click here for Kings Fund blog
Taselisib in Combination with Fulvestrant for Advanced ER Positive, HER2-negative Breast Cancer – Second Line After Aromatase Inhibitor Therapy
Taselisib is investigated as a new oral treatment for ER+, HER2- type of breast cancer. It is being investigated as a medicine to work on a pathway regulating cell growth and cell survival. If taken in combination with an intramuscular injection of fulvestrant, which stops the effect of hormones altering the breast cells, taselisib has the potential to prolong survival. If licenced, this combination of treatments will offer an additional therapy option for those who have already had hormonal therapy but their cancer has relapsed.
From the NIHR Innovation Observatory.
From the NIHR Innovation Observatory.
Venetoclax in Combination with Obinutuzumab for the Treatment of Previously Untreated Chronic Lymphocytic Leukaemia – First Line
Venetoclax is a drug that attaches to a protein in the body called Bcl-2. This protein presents in high amounts in CLL cancer cells, where it helps the cancer cells survive for longer in the body and makes them resistant to cancer medicines. Venetoclax causes the death of cancer cells and thereby slows the progression of the disease. In combination with obinutuzumab the body’s immune system gets strengthened. If licenced, venetoclax with obinutuzumab will offer an additional treatment option for patients with previously untreated CLL.
From the NIHR Innovation Observatory.
From the NIHR Innovation Observatory.
Subcutaneous Tocilizumab (RoACTEMRA) With or Without Methotrexate for the Treatment of Inadequate Responders in Systemic Juvenile Idiopathic Arthritis
Tocilizumab is a drug that targets and blocks the IL-6 pathway and is currently used for the treatment of many diseases, including sJIA, rheumatoid arthritis and Giant Cell Arteritis (GCA). It is now being developed for patients with sJIA that may have been treated with, and have not responded to another drug called methotrexate. It is being developed to be administered as an injection under the skin (subcutaneous) as opposed to the usual intravenous infusion preparation and this has the potential to reduce patient inconvenience and clinical burden.
From the NIHR Innovation Observatory.
From the NIHR Innovation Observatory.
IMCgp100 for the Treatment of Advanced or Metastatic Uveal Melanoma
There are currently few effective treatments available for advanced or metastatic uveal melanoma, including surgery to remove the cancer, radiotherapy or chemotherapy. IMCgp100 is a drug under development that would enable the body’s own immune system to recognise and specifically target and kill cancer cells. IMCgp100 is given by intravenous infusion and is currently being studied in patients with advanced/ metastatic uveal melanoma. It will offer a new treatment option if licenced.
From the NIHR Innovation Observatory.
From the NIHR Innovation Observatory.
Veliparib in Combination with Carboplatin and Paclitaxel for Breast Cancer – First to Third Line
Veliparib is a new oral drug that is being developed for patients with HER2- breast cancer that is advanced and cannot be removed completely through surgery. The drug acts by targeting specific enzymes involved in the repair of damaged DNA that helps the body to kill cancer cells while allowing ordinary cells to survive. Veliparib is being developed to be used in combination with the chemotherapy drugs paclitaxel and carboplatin. If licenced, this combination will offer an additional treatment option for patients with HER2- metastatic or locally advanced unresectable BRCA-associated breast cancer.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Risankizumab (by Subcutaneous Injection) for Moderate to Severe Chronic Plaque Psoriasis
Risankizumab is a drug which is injected into the skin. It works in a unique way by blocking a specific process which allows the body’s immune cells (specifically T-cells) from attacking and damaging the skin. Risankizumab is currently being trialled in a range of diseases involving the immune system including Crohn’s disease, and psoriatic arthritis.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
ALXN 1210 for Paroxysmal Nocturnal Haemoglobinuria
ALXN1210 is an antibody under development that prevents the destruction of red blood cells (RBCs). The drug is administered by intravenous injection that requires fewer dosing regimen compared to current treatment option. If ALXN1210 is licensed for use in the UK, it could represent an additional treatment option for patients with paroxysmal nocturnal haemoglobinuria.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Wednesday, 13 December 2017
Voxelotor for Sickle Cell Disease
Voxelotor is as an oral, once-daily therapy that is being developed for treatment of SCD. It is designed to work by helping haemoglobin hold onto more oxygen as the red blood cells travel through the body. This keeps red blood cells in their normal shape and helps stop sickling. As there is a desperate need for new treatments for SCD, voxelotor, if licensed, will offer a new treatment option for patients with SCD.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Rivaroxaban (Xarelto) in Combination with Aspirin for Prevention of Major Cardiovascular Events in Coronary or Peripheral Artery Disease
Rivaroxaban and aspirin are drugs that reduce blood clots in blood vessels and are currently being given to some patients with CAD and PAD. The combination of rivaroxaban with aspirin is being developed as a more effective treatment. If licensed, this combination will offer a new option for the prevention of major cardiovascular events.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Alpelisib in Combination with Fulvestrant for Advanced HR Positive, HER2-negative Breast Cancer in Men and Postmenopausal Women
Alpelisib is a new drug that is being developed for patients with the HR+/HER2- type of advanced breast cancer. The drug is being developed to be given in combination with fulvestrant, a drug that is already in use for the treatment of advanced breast cancer. Alpelisib targets a very specific enzyme that transmits signals to cells, stopping the growth and survival of cancer cells. Alpelisib is taken orally while fulvestrant is given by injection. If approved, the combination of both drugs will offer additional treatment options for patients with advanced HR+/HER2- breast cancer that have not responded well to other drugs.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Lenadogene Nolparvovec (GS-010) for Vision Loss from Leber’s Hereditary Optic Neuropathy Due to Mutation of the ND4 Gene
There are currently very few treatment options for LHON. Most treatment methods are used to support the patient rather than cure them. Lenadogene nolparvovec is a new gene-targeted treatment intended for vision loss caused by LHON due to an alteration in a specific gene. As a genetic medicine, lenadogene nolparvovec could be a promising option to treat LHON and if licensed, could provide a new treatment option for those with LHON.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Ribociclib and Fulvestrant and PI3K Inhibitor (Buparlisib or Alpelisib) for HR Positive, HER2 Negative Postmenopausal Breast Cancer – Second or Third Line
The combination of ribociclib, fulvestrant, and buparlisib or alpelisib is being developed for the treatment of HR+ and HER2- locally recurrent or advanced metastatic breast cancer. Ribociclib is given by mouth (capsules). It acts by helping to slow the progression of cancer by inhibiting two certain types of proteins that play a role in ensuring that cancer cells do not grow uncontrollably. Buparlisib and alpelisib are other types of drugs that act by reducing tumour cell growth and survival. Both are also given by mouth. Fulvestrant is a drug that is given by injection and is already in use for the treatment of advanced breast cancer. If licensed, the combination of ribociclib, fulvestrant, and buparlisib or alpelisib will offer an additional treatment option for postmenopausal women with HR+, HER2-negative locally recurrent or advanced metastatic breast cancer.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Ponesimod for Relapsing-remitting Multiple Sclerosis
Ponesimod is a drug which works by blocking the signals which allow the body’s immune cells to travel to and damage the nerve cells. By preventing the immune cells from damaging the nerves, it is thought this drug will stop the damage which causes MS ‘relapses’. In clinical trials it has been shown that ponesimod reduces the number of ‘relapses’ in people with MS and reduced the amount of damage to the nerves (measured by brain scans) compared to a placebo.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Guadecitabine for Treatment of Naïve Acute Myeloid Leukaemia
The most common treatment option for AML is chemotherapy to kill the cancerous cells. Guadecitabine is a new treatment being developed for patients who have not received prior treatment (treatment naïve) and are ineligible to undergo intensive chemotherapy. If licenced, guadecitabine would offer a new treatment option for patients that cannot tolerate the standard of care chemotherapy treatments.
From the NIHR Innovation Observatory
From the NIHR Innovation Observatory
Benralizumab for Chronic Obstructive Pulmonary Disease (COPD)
Benralizumab is a new drug being developed for the treatment of chronic obstructive pulmonary disease. It is administered by injection under the skin and acts by targeting specific proteins that
causes the airway to narrow. If benralizumab is licensed for use in the UK, it could be a new treatment option for patients with chronic obstructive pulmonary disease that may improve quality of life and reduce the number of exacerbations.
From the NIHR Innovation Observatory
causes the airway to narrow. If benralizumab is licensed for use in the UK, it could be a new treatment option for patients with chronic obstructive pulmonary disease that may improve quality of life and reduce the number of exacerbations.
From the NIHR Innovation Observatory
Medical Innovation and Brexit; Beyond Geographic Location
The past month saw Holland edge a head to head battle with Italy to host the European Medicines Agency. The move from London to Amsterdam exposes the depth of impact of Brexit. Although some Brits may struggle with being European, in the medical world we are tied together with an umbilicus – from research to regulation.
There is a clear loss of knowledge, insight and experience, with not all of the staff wanting to relocate to Amsterdam. But, the real impact of this relocation extends far beyond just changing the host city.
From the NIHR Innovation Observatory
There is a clear loss of knowledge, insight and experience, with not all of the staff wanting to relocate to Amsterdam. But, the real impact of this relocation extends far beyond just changing the host city.
From the NIHR Innovation Observatory
NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births
Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.
This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.
From the NIHR Dissemination Centre
This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.
From the NIHR Dissemination Centre
NIHR Signal Alternative drug may prevent atrial fibrillation following heart surgery
After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication by about a third.
About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.
From the NIHR Dissemination Centre
About 11 people would need this treatment to prevent one of them developing atrial fibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation.
From the NIHR Dissemination Centre
NIHR Signal Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously
Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group.
Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.
From the NIHR Dissemination Centre
Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.
From the NIHR Dissemination Centre
NIHR Signal Low FODMAP diet may improve irritable bowel symptoms more than other diets
Adults with irritable bowel syndrome (IBS) who followed a low FODMAP diet had fewer symptoms than those who followed standard dietary advice. They scored their symptoms about 50 points better on a 500 point scale.
The low FODMAP diet is an emerging approach for IBS. It is based on the theory that certain carbohydrates can expand or ferment in the gut and cause symptoms for some people.
From the NIHR Dissemination Centre
The low FODMAP diet is an emerging approach for IBS. It is based on the theory that certain carbohydrates can expand or ferment in the gut and cause symptoms for some people.
From the NIHR Dissemination Centre
National Data Guardian for Health and Care 2017 report: impact and influence for patients and service users
This report from the National Data Guardian looks back over the past three years since the creation of the National Data Guardian role and it describes future priorities. It sets out a case for the independent advice and challenges that the role provides to ensure that confidential data collected by the NHS and social care services is safeguarded and used appropriately to improve care.
Introducing 'opt-out' consent for organ and tissue donation in England
This DH consultation seeks views on proposed plans to make it easier for people to give consent to be an organ donor.
The consultation is specifically seeking input on how much input families have in deceased relative's donation decisions, whether exemptions to opting out is needed and how these proposals may affect certain groups depending on age, disability, race or faith. The consultation closes on 6 March 2018.
The consultation is specifically seeking input on how much input families have in deceased relative's donation decisions, whether exemptions to opting out is needed and how these proposals may affect certain groups depending on age, disability, race or faith. The consultation closes on 6 March 2018.
Horizon scanning future health and care demand for workforce skills in England
This WHO briefing outlines the findings of a horizon scanning exercise, carried out by the Department of Health, which has informed workforce planning for the future health and care workforce and the skills needed to keep pace with changing health needs.
Measles outbreaks in five areas across UK
Public Health England (PHE) has issued advice for the public to ensure they have had the MMR vaccine after outbreaks of measles are confirmed in five areas of England.
As of 8 December 2017, there have been 28 confirmed cases in Leeds, 18 confirmed cases in Liverpool, 13 confirmed cases in Birmingham, 7 confirmed cases in Surrey, and 4 confirmed cases in Manchester. All of the cases have been reported in children and adults who have not received 2 doses of the MMR vaccine.
As of 8 December 2017, there have been 28 confirmed cases in Leeds, 18 confirmed cases in Liverpool, 13 confirmed cases in Birmingham, 7 confirmed cases in Surrey, and 4 confirmed cases in Manchester. All of the cases have been reported in children and adults who have not received 2 doses of the MMR vaccine.
Study shows home-based service for acute lung patients frees NHS beds
An acute ‘hospital-at-home’ scheme for patients with lung disease could save the NHS millions if replicated nationally. A study of the multidisciplinary service, which includes physiotherapists, found that it had reduced hospital stays from an average of 9.1 days to 2.5 days, saving £1,400 per case and has proven to be as effective as purely hospital-based treatment when measured by the number of re-admissions.
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