Outcomes for mental health services: what really matters?

This report examines the pursuit of outcomes by mental health services and highlights how frameworks for measuring outcomes are often too narrowly focused on clinical outcomes.  The report challenges mental health services to adopt a broader perspective on outcomes as a basis for collaborating with service users and a foundation for delivering more humane and effective care.  Click here to read further.

Outcomes for mental health services: what really matters?

There has been an increasing interest in the concept of value-based health care and how resources are allocated to improve outcomes. However, measuring outcomes in mental health services is often complex and fraught with difficulty, with professionals and service users often having very different perspectives on the nature of mental illness and the role of services in addressing it. Read Kings Fund publication here

New NICE Interventional procedures guidance [IPG613] Percutaneous balloon valvuloplasty for fetal critical aortic stenosis

New NICE Interventional procedures guidance [IPG613] Percutaneous balloon valvuloplasty for fetal critical aortic stenosis
Published date: May 2018 Next review: May 2021


Evidence-based recommendations on percutaneous balloon valvuloplasty for fetal critical aortic stenosis. This involves placing a catheter into the baby’s heart, while the baby is still in the womb. The aim is to help the heart develop properly.


For full guidance https://www.nice.org.uk/guidance/ipg613

Blue Book on the Management of Distal Radial Fractures

British Society for Surgery of the Hand publishes its Blue Book on the Management of Distal Radial Fractures


UHCW Consultant Orthopaedic Surgeon Helen Hedley and Electronic Systems & Resources Librarian Helga Perry contributed to this publication.


Obtain the full document at: http://www.bssh.ac.uk/_userfiles/pages/files/professionals/Radius/Blue%20Book%20DRF%20Final%20Document.pdf

Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children

NIHR Signal Lorazepam confirmed as first-line treatment for stopping prolonged seizures in children


Published on 17 April 2018


Intravenous lorazepam is as effective as intravenous diazepam for stopping children’s tonic-clonic seizures in hospital. https://discover.dc.nihr.ac.uk/content/signal-00586/lorazepam-confirmed-as-first-line-treatment-for-stopping-prolonged-seizures-in-children
From the NIHR Dissemination Centre

NIHR Signal Physiotherapy education before major abdominal surgery reduces lung complications

NIHR Signal Physiotherapy education before major abdominal surgery reduces lung complications


Published on 3 April 2018


A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves the risk of pneumonia.


https://discover.dc.nihr.ac.uk/content/signal-00579/physiotherapy-before-abdominal-surgery-helps-prevent-pneumonia


From the NIHR Dissemination Centre

NIHR Signal Short-duration dual antiplatelet treatment is possible for older people receiving drug-coated stents

NIHR Signal Short-duration dual antiplatelet treatment is possible for older people receiving drug-coated stents


Drug-eluting stents are more effective than bare-metal stents for preventing repeat procedures to open narrowed heart arteries in older adults with coronary heart disease. In this trial both types of stents were used alongside short courses of dual antiplatelet medication, outcomes for those receiving drug-eluting stents were improved with no difference in bleeding complications or rates of in-stent clots.
Published on 7 March 2018
Read full document at https://discover.dc.nihr.ac.uk/portal/article/4000966/short-duration-dual-antiplatelet-treatment-is-possible-for-older-people-receiving-drug-coated-stents

NIHR Signal Quality improvement collaboratives can improve clinical processes and patient outcomes

Quality improvement collaboratives (QICs) were largely effective across a wide range of healthcare problems and settings. Of the 64 studies included in this systematic review, 53 showed improvement in some of the healthcare processes and patient outcomes that they investigated. A small number of studies also showed that collaboratives were cost-effective, and the improvements were sustainable for at least six months.


Collaboratives originated in the US in the late 1980s. They provide opportunities for teams from different sites to learn from each other and jointly develop improvement initiatives around specific topics, often using a standard method and framework. They have become increasingly popular without strong evidence to support their use.


From the NIHR Dissemination Centre

NIHR Signal Delayed umbilical cord clamping reduces hospital mortality for preterm infants

Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%.


This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.


From the NIHR Dissemination Centre

NIHR Signal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation

In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.




From the NIHR Dissemination Centre

Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma [TA504]

New: Technology appraisal guidance




Ixazomib, with lenalidomide and dexamethasone, is recommended for use within the Cancer Drugs Fund as an option for treating multiple myeloma in adults only if:

• they have already had 2 or 3 lines of therapy and
• the conditions in the managed access agreement for ixazomib are followed.

This recommendation is not intended to affect treatment with ixazomib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

NIHR Signal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis

The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less than 60 minutes.


This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins.


From the Dissemination Centre

Memokath-051 stent for ureteric obstruction [MTG 35]

New: Medical technologies guidance


The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.


The case for adopting Memokath‑051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath‑051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians (see section 4.8) and in appropriate patients (see section 1.2), Memokath‑051 is associated with equivalent success rates and a better patient experience compared with double‑J stents. Using Memokath‑051 may also reduce the number of stent replacements needed compared with using double‑J stents.

NIHR Signal Study raises questions about NHS “weekend effect”

The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness.

Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data.

Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate within 30 days was slightly higher for these admissions, it is likely that this was due to more severe illness. There was no difference in mortality for people who attended A&E but were not admitted.
NHS Trusts have been told by NHS England to reorganise services in line with “seven day working” to eliminate the weekend effect. These studies raise doubts as to whether such a reorganisation will achieve a reduction in mortality overall.

From the NIHR Dissemination Centre

NIHR Signal Early use of tranexamic acid reduces bleeding more effectively

In people bleeding after trauma or giving birth, tranexamic acid within an hour of the start of bleeding increases the chances of survival by 72% compared with a placebo. Overall the trial data showed that at least six deaths from bleeding complications were prevented for every 1,000 people treated and potentially more if treatment is started early.




Tranexamic acid is an antifibrinolytic drug which reduces the breakdown of blood clots and is known to reduce serious bleeding. The researchers wanted to see if the benefits of tranexamic acid were greater if given as early as possible.




The current guidance recommends giving tranexamic acid for bleeding after trauma and in women with bleeding after giving birth. It is now clearer that every 15-minute delay after the first hour can reduce survival by about 10%.


From the NIHR Dissemination Centre

Ibrutinib for treating relapsed or refractory mantle cell lymphoma [TA 502]

New:  Technology appraisal guidance


Ibrutinib (Imbruvica, Janssen) inhibits a protein called Bruton's tyrosine kinase, stopping B-cell (lymphocyte) proliferation and promoting cell death.


Ibrutinib has a marketing authorisation in the UK for the treatment of adults 'with relapsed or refractory mantle cell lymphoma'.


The most common adverse reactions associated with ibrutinib include diarrhoea, musculoskeletal pain, upper respiratory tract infection, haemorrhage, bruising, rash, and nausea. For full details of adverse reactions and contraindications, see the summary of product characteristics.

NIHR Signal Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate

It seems safer to reduce the dose of biological drugs, rather than to stop them if people with rheumatoid arthritis and their doctors want to avoid relapse. Stopping these powerful drugs caused the disease to recur in 58% of people compared with 29% who continued them. Reducing the dose also led to more relapses for people in remission, but did not cause those with low-grade disease activity to worsen.




Rheumatoid arthritis is a chronic disease which causes pain, swelling and stiffness in the small joints of the hands and feet. It can cause more widespread inflammation. The disease has episodes of improvement and deterioration so judging the effects of treatment can be difficult. Drug treatments suppress the immune system, putting people at higher risk of infection.




From the NIHR Dissemination Centre

NIHR Signal Blood test reduces mortality and shortens antibiotic use among adults with chest infection

It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier.


This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test.


From the NIHR Dissemination Centre

NIHR Signal Blood test reduces mortality and shortens antibiotic use among adults with chest infection

It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier.


This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test.


From the NIHR Dissemination Centre

NIHR Signal Two common operations to fix a broken tibia have similar outcomes

In people who had broken the lower part of their tibia (shin bone), fixation using a metal rod nailed to the inside the bone was compared with a locking plate screwed onto the surface of the bone. There was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique.






NICE guidance recommends that surgery takes place within 24 hours of injury but does not mandate which type of surgery to perform. This NIHR UK-based trial was funded to find which treatment was better for lower tibial fractures.




From the NIHR Dissemination Centre