Clinical Effectiveness Bulletin 50 March 2011

NHS Library and Information Service North Staffordshire
Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 50 – March 2011
About this Bulletin:
 It aims to draw attention to some of the key documents and reviews on clinical
effectiveness that have been published in the previous month.
 Where possible, links to the full text documents are included. If the article is in a
journal, you can contact the Health Library for a copy.
Link to request form: http://www.keele.ac.uk/depts/li/hl/illjournal.htm
[Please note - a charge of £2 per request is payable for most copies]
 If you need further assistance, please contact the Health Library or the NHS
Outreach Librarians, details below.
 The bulletin can be e-mailed to colleagues who may also find it useful.
 A list of websites that are checked in the production of this bulletin are listed on
the first page. Please suggest further useful sites.
 Feedback is always welcomed to inform future issues of the bulletin.
Contact information
Bulletin produced by NHS Outreach Librarians

Tel: FeatureNet 8429 (External calls 0300 123 1535 ext 8429)
E-mail: lindsay.snell@northstaffs.nhs.uk
clareh.powell@northstaffs.nhs.uk
North Staffs Health Library

Tel: 01782 556565
Fax: 01782 556582
E-mail: health.library@keele.ac.uk
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Contents in this issue

Alcohol Mental Health
Cancer Nutrition
Cardiovascular Diseases Obesity
Children and Young People Offender Health
Commissioning Older People
Dementia Palliative Care
Dental Health Patient Care and Safety
Deprivation of Liberty Physical Disabilities
Diabetes Prescribing
Eyes and Vision Public Health
Gastroenterology Research
General Practice Safeguarding Vulnerable
Adults
Guidance Screening
Hearing Disorders Service Management
Infections Sexual Health
Influenza Smoking
Kidney Diseases Substance Abuse
Learning Disabilities Vaccination and
Immunisation
Long Term Conditions Women's Health
Maternity Workforce
Sources for Clinical Effectiveness Bulletin

Please suggest further sites that should be monitored in the production of this bulletin
Websites
Bandolier http://www.medicine.ox.ac.uk/bandolier/
Clinical Knowledge Summaries [NLH] http://cks.library.nhs.uk/
Cochrane Library http://www.library.nhs.uk/
CRD Centre for Reviews and Dissemination http://www.crd.york.ac.uk/crdweb/
- DARE – (Database of Abstracts of Reviews of Effects)
- NHS Economic Evaluation Database
Department of Health http://www.dh.gov.uk/en/index.htm
Health Technology Assessment (HTA) Database http://www.ncchta.org/
NICE http://www.nice.org.uk/
NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/
SIGN http://www.sign.ac.uk/new.html
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Alcohol
Supporting partnerships to reduce alcohol harm: key findings, recommendations and
case studies from the Alcohol Harm Reduction National Support Team
Department of Health
This document records the methodology and findings of the Alocohol Harm Reduction National
Support Team. It provides collated and aggregated information about what the team have
recommended in visited areas, with the intention to provide readers with helpful information to
draw upon in their current work. It also contains signposting, case studies and examples of good
practice.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_125452
[back to topics]
Cancer
2011 Annual Evidence Update on Prostate Cancer
NHS Evidence: cancer
This is the sixth Annual Evidence Update (AEU) on Prostate Cancer prepared by NHS Evidence -
cancer. It includes the systematic reviews and guidance that have been published since March
2010.
http://www.library.nhs.uk/cancer/viewResource.aspx?
resid=405400&code=e245b9b9409b67f970c34f193d2d7f4a
Bowel (colorectal) cancer - UK incidence statistics

Cancer Research UK
This page presents bowel cancer incidence statistics by age and sex, socio-economic
deprivation, geographic variation, trends over time and by age, and prevalence.
http://info.cancerresearchuk.org/cancerstats/types/bowel/incidence/
How to reduce excess mortality from cancer: Guide for Health and Well-being Boards and
GP Commissioning Consortia
National Cancer Action Team
The purpose of this report is to advise those responsible for planning health and wellbeing
services for people in areas of poor health what they can do to reduce the rate at which people
die from cancer – helping those sections of population with most need improve fastest.
http://www.ncat.nhs.uk/our-work/improvement/equality
Primary cause? An audit of the experience in primary care of rarer cancer patients
Rarer Cancers Foundation
A survey by the RCF of patients diagnosed with rarer cancers has shown that, although many
receive an excellent service in primary care, leading to a prompt diagnosis, others are having the
signs and symptoms of their cancer missed.
http://www.rarercancers.org.uk/news/current/new_rcf_study_exposes_primary_care_challenges_i
n_diagnosing_rare_cancers
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Cardiovascular Diseases
Antihypertensive treatment and secondary prevention of cardiovascular disease events
among persons without hypertension: a meta-analysis
Thompson, A et al.
This meta-analysis and systematic review concluded that among patients with clinical history of
CVD but without hypertension, antihypertensive treatment was associated with decreased risk of
stroke, CHF, composite CVD events, and all-cause mortality. Additional randomized trial data are
necessary to assess these outcomes in patients without CVD clinical recommendations.
JAMA. 2011;305(9) p.913-922. doi: 10.1001/jama.2011.250
Cardiovascular Disease Profiles

South East Public Health Observatory
These profiles provide a snapshot of key issues relating to heart disease and stroke, including
incidence, mortality, risk factors, treatments and costs. These profiles are intended to inform
commissioning and planning decisions to tackle CVD and improve the health of local
communities. They are available at local PCT level and at Cardiac Network level The profiles
have three elements:
• A summary spine chart showing a number of selected indicators in a simple format
• A more detailed profile, showing these and other indicators in graphical form, and with
longer time frames, or different comparators, as appropriate.
• An interactive atlas, allowing the indicators to be compared easily between PCT
anywhere in the country, or between different cardiac networks. Some indicators are only
to be found in the atlas.
http://www.sepho.org.uk/CVDprofiles.aspx
Chest Pain - 2011 Evidence Update

NHS Evidence: Cardiovascular
This Evidence Update has been carried out as a pilot of a new methodology, in which the scope
of the update directly reflects the scope of the most recent NICE Guideline on Chest Pain of
Recent Onset, and evidence was critically appraised before being sent to expert reviewers.
http://www.library.nhs.uk/cardiovascular/viewResource.aspx?resid=406483
Items in the Kidney Diseases and Dementia sections may also be of interest.
[back to topics]
Children and Young People

Better mental health outcomes for children and young people; a resource directory for
commissioners
National Mental Health Development Unit
This directory, published by the National CAMHS Programme, brings together a range of valuable
information, guidance and tools to help commissioners meet this aim. It is for everyone
commissioning children's mental health and emotional wellbeing services, in particular GP
consortia and local authorities. It will also be of interest to others commissioning specialist
services, as well as providers and the voluntary sector. It will help commissioners ensure that
services are sustainable, high quality, productive, efficient and grounded in the best available
evidence.
http://www.nmhdu.org.uk/news/better-mental-health-outcomes-for-children-and-young-people-a-
resource-directory-for-commissioners/
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Child Health Profiles for Local Authorities in England

Child and Maternal Health Observatory
Updated annually, each report includes:
• A snapshot of performance against 32 selected indicators compared with the rest of
England.
• Analysis and key findings about the situation in each top level local authority.
• A summary of performance for each local authority in the region.
http://www.chimat.org.uk/resource/view.aspx?QN=PROFILES_STATIC
Complex Needs, Complex Challenges: a report on research into the experiences of

families with deaf children with additional complex needs
National Deaf Children’s Society
There is a high incidence of additional complex needs amongst deaf children. This group raise
significant challenges for both families and services because of the complexity of needs. Fifty
families from across the UK, each of whom have a deaf child with additional complex needs, have
taken part in the largest ever study of parental experience of services. Parents faced a range of
barriers to accessing appropriate services for their children. A deaf child with additional complex
needs requires access to the full range of services available to children who have the disability of
deafness alone, and also full access to the full range of services appropriate to their additional
complex needs.
http://www.ndcs.org.uk/news/ndcs_news/health_and_support.html
Long-term antibiotics for preventing recurrent urinary tract infection in children

Williams, G et al.
The authors concluded that long-term antibiotics appear to reduce the risk of repeat symptomatic
UTI in susceptible children but the benefit is small and must be considered together with the
increased risk of microbial resistance.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001534/frame.html
NHS at home: children's community nursing services

This document shares the findings of a Department of Health review of the contribution
community children's nursing services, as a key component of community children's services, can
make to the future outcomes of integrated children's services. To ensure that the needs of ill and
disabled children are met, four groups of children and young people have been identified as
needing services: children with acute and short-term conditions; children with long-term
conditions; children with disabilities and complex conditions, including neonates; and children with
life-limiting and life-threatening illness.
H_124898
The personal response: developments in personalisation for children, young people and
families
Local Government Improvement and Development:
This report has been written in partnership with In Control, Action for Children and the Office of
Public Management. It gives an insight into the issues and challenges of the current strategy and
practice relating to personalisation across children’s services.
http://www.info4local.gov.uk/documents/publications/1856904
Items in the Mental Health sections may also be of interest.
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Commissioning
Delivering the Cancer Reform Strategy: twenty-fourth report of session 2010-11
House of Commons Public Accounts Committee
This report examined the Department of Health (DH) and the NHS’s performance in delivering
cancer services and on improving information on activity, cost and outcomes of cancer services. It
also looks at how the DH intends to deliver cost-effective cancer services in the new NHS.
http://www.publications.parliament.uk/pa/cm201011/cmselect/cmpubacc/667/66702.htm
The functions of GP commissioning consortia: a working document

This document describes the proposed statutory functions of GP consortia. The document has
been developed in partnership with the RCGP, NHS Alliance, National Association of Primary
Care, Family Doctor Association and PCT network of the NHS Confederation. It has been
produced in response to requests from GPs and others involved in the development of consortia.
The document sets out:
• the proposed key statutory duties of consortia (the 'must dos')
• the proposed key statutory powers (the things consortia have the freedom to do, if they
wish, to help meet these duties)
• illustrative examples of what this could look like in the future
The document is not intended to be a substitute for the Health and Social Care Bill, but a helpful
summary to which GPs and emerging consortia can refer.
H_124979
Funding adult social care over the next decade: who cares?
BUPA
This report examines the potential effects on the care home sector in England if local councils
continue to pay fees at levels which are below the costs of looking after older people in care
homes. It predicts that if the current decline in fee rates continue, care homes will close and over
the next decade up to 100,000 frail older people could end up being admitted to hospital or left
without proper support in their own homes. In the report, Bupa calls for five steps to avoid this
happening, including council leaders ring-fencing the £2 billion the government allocated for
social care; and taking care home cost inflation into account when setting fees.
http://www.epolitix.com/fileadmin/epolitix/stakeholders/BUPA_Who_Cares.pdf
Including migrant populations in joint strategic needs assessment (JSNA)

Local Government Improvement and Development
This guide has been written to assist those writing a joint strategic needs assessment (JSNA) as
part of the process of commissioning. A JSNA pinpoints areas of concern that require changes to
provision in order to inform mid to long-term strategy; and areas needing further focused
assessment. Some understanding of migration and how it might be changing the local population
is essential, as migrants to any given area form part of the demography. Knowledge of local
migration and needs is also important in assessing equity of provision as migrants are in all
areas, even when not visible or seldom heard. This Guide will help planners and commissioners
to build an objective analysis of population needs, taking into account issues of perception and
prioritisation.
http://www.idea.gov.uk/idk/core/page.do?pageId=25719135
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NHS Outcomes Framework: Innovation in Outcomes competition

This document provides details of a Department of Health competition to invite people to suggest
new, innovative indicators for the NHS Outcomes Framework, both where gaps exist in the
current framework and in broader areas for future frameworks.
Closing date for entries: 1st June 2011
H_124920
Practice-based commissioning: budget guidance for 2011/12 - Methodological changes

and toolkit guide
PCTs are responsible for ensuring that practices receive an indicative budget that reflects the
needs of their population as accurately as possible. This allows practices, emerging pathfinders
and emerging consortia to access a 'fair share' of the resources available to the whole of the PCT
for its patients. The Department has updated the toolkit that can be used to determine weighted
capitation indicative budgets at sub-PCT level. The toolkit also provides information at practice
level that may be useful for emerging pathfinders and emerging consortia.
H_125562
Items in the Children and Young People, Learning Disabilities, Mental Health and Service
Management sections may also be of interest.
[back to topics]
Dementia
Atrial fibrillation and incidence of dementia: a systematic review and meta-analysis
Kwok, CS et al.
Meta-analysis of 14 studies showed that atrial fibrillation (AF) was associated with a significant
increase in dementia overall, with substantial heterogeneity. The authors also concluded that
there is consistent evidence supporting an association between AF and increased incidence of
dementia in patients with stroke whereas there remains considerable uncertainty about any link in
the broader population. The potential association between AF and incident dementia in mild
cognitive impairment merits further investigation.
Neurology March 8, 2011. 76(10) p.914-922. doi: 10.1212/WNL.0b013e31820f2e38
The European Dementia Research Agenda

International Longevity Centre - UK
This report finds there is widespread disparity in the diagnosis, treatment and care of people with
dementia across Europe. It argues that research needs to be afforded a greater role in tackling
Alzheimer’s disease and other dementias. The report suggests investment in clinical research
and translational research will reap its own rewards and holds the key to improved prevention,
diagnosis and treatment. The report found many EU countries are trailing behind with no
specifically targeted dementia research funding and/or national strategies.
http://www.ilcuk.org.uk/record.jsp?type=publication&ID=85
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Mapping the dementia gap

Alzheimers Society
Study mapping dementia prevalence and diagnosis rates. The report suggests that by 2021, over
half a million people will be living with dementia that has gone undiagnosed. The study includes
the number of people with dementia in each part of the UK and the percentage who receive a
diagnosis, plus plans to fight the disease. (Daily Health Bulletin, NHS Sheffield Library Service)
http://www.alzheimers.org.uk/site/scripts/download_info.php?downloadID=554
[back to topics]
Dental Health
Adult Dental Health Survey 2009 - Summary report and thematic series
NHS Information Centre
The 2009 Adult Dental Health Survey (ADHS) is the fifth in a series of national dental surveys that
have been carried out every ten years since 1968. The main purpose of these surveys has been
to get a picture of the dental health of the adult population and how this has changed over time.
The survey was carried out in England, Wales and Northern Ireland only: Scotland did not
participate in the 2009 survey. The aims of the survey were to establish the condition of the
natural teeth and supporting tissues; to investigate dental experiences, knowledge about and
attitudes towards dental care and oral hygiene; to examine changes over time in dental health,
attitudes and behaviour; and to monitor the extent to which dental health targets set by the
Government are being met.
http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/dentistry/adult-dental-health-
survey-2009--summary-report-and-thematic-series
[back to topics]
Deprivation of Liberty
The operation of the Deprivation of Liberty Safeguards in England, 2009/10
The Care Quality Commission
The Deprivation of Liberty Safeguards, which protect the rights of people in care homes and
hospitals who lack the mental capacity to consent to their care or treatment. They include people
with dementia or a learning disability. In its report on the first year of the safeguards, to the end of
March 2010, CQC says there were variations in their implementation across England. In some
care homes and hospitals a lack of awareness and training among managers and staff was
evident. Some councils and PCTs had not progressed as well as others in setting up the
mechanisms needed to deal properly with applications.
http://www.cqc.org.uk/publications.cfm?fde_id=17259
Patients' experiences of the First-tier Tribunal (Mental Health)

Care Quality Commission
This report details the experiences of patients who appealed to a tribunal against their detention
under the Mental Health Act. It makes recommendations for improvement aimed at those bodies
and individuals involved in the tribunal process, including hospital managers and staff, the
Tribunals Service, the tribunal judiciary, mental health clinicians and other health care
professionals, the Care Quality Commission, the Legal Services Commission and the Law
Society. (Local Government Improvement and Development)
http://www.cqc.org.uk/publications.cfm?fde_id=18105
[back to topics]
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Diabetes
Coding, Classification and Diagnosis of Diabetes: a review of the coding, classification
and diagnosis of diabetes in primary care in England with recommendations for
improvement
NHS Diabetes, Royal College of General Practitioners
This report brings together evidence of the impact an incorrect diagnosis can have on a person
with diabetes, describes the current research base for evidence of misdiagnosis and
misclassification, and shows the extent of that misclassification and misdiagnosis through an
analysis of GPs’ records. The report also provides front line staff with a simple and easy to use
classification algorithm to help make more accurate diagnoses.
http://www.diabetes.nhs.uk/our_work_areas/classification_of_diabetes/
Comparative cardiovascular effects of thiazolidinediones: systematic review and meta-

analysis of observational studies
Loke, YK et al.
The authors concluded that among patients with type 2 diabetes, use of rosiglitazone is
associated with significantly higher odds of congestive heart failure, myocardial infarction, and
death relative to pioglitazone in real world settings.
BMJ 2011; 342:d1309 doi: 10.1136/bmj.d1309 (Published 17 March 2011)
Diabetes with Kidney Disease: Key Facts

NHS Diabetes
The publication is based on literature searches undertaken during 2010/11 using reliable
information sources. It outlines some basic facts about diabetes with kidney disease; for example
how common it is, what puts people with diabetes at risk of developing kidney disease, and what
can be done about it. The target audience includes primary care professionals, commissioners
and also specialists in diabetes or kidney disease.
http://www.diabetes.nhs.uk/news.php?o=383
DiabetesE Sixth National Report

NHS Diabetes
DiabetesE, developed by Innove, is an online self assessment tool which measures and
benchmarks the quality of diabetes service provision. It was originally designed to support the
implementation of the Diabetes National Service Framework (NSF) and to drive continuous
quality improvement in diabetes care. Since the launch of the Diabetes NSF in 2003, DiabetesE
has been able to demonstrate that services have made improvements in line with the NSF
standards and delivery strategy. However, over the last two years, the questions and modules
have been revised and updated to reflect new evidence and best practice.
http://www.diabetes.nhs.uk/news.php?id=374
Erectile Dysfunction: Factsheet

NHS Diabetes
This document highlights to healthcare professionals the importance of checking for erectile
dysfunction because it can be an indicator of underlying cardiovascular disease, as well as a
cause of poor quality of life.
http://www.diabetes.nhs.uk/document.php?o=2155
[back to topics]
9
Eyes and Vision

Non-surgical interventions for convergence insufficiency
Scheiman, M et al.
Current research suggests that outpatient vision therapy/orthoptics is more effective than home-
based convergence exercises or home-based computer vision therapy/orthoptics for children. In
adult population, evidence of the effectiveness of various non-surgical interventions is less
consistent.
[back to topics]
Gastroenterology
2011 Annual Evidence Update on Inflammatory Bowel Disease
NHS Evidence: gastroenterology and liver diseases
This update highlights the best peer reviewed guidelines and systematic reviews on the area and
includes additional comments/mini-reviews. It also scrutinises the areas of “uncertainties” in the
management of IBD still not answered by the current literature and this has become part of the
UK Database of Uncertainties about the Effects of Treatment (DUETs).
http://www.library.nhs.uk/Gastroliver/ViewResource.aspx?resID=407581
Efficacy of Biological Therapies in Inflammatory Bowel Disease: Systematic Review and

Meta-Analysis
Ford, AC et al.
Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory disorders of the gastrointestinal
tract of unknown etiology. Evidence for treatment of the condition with biological therapies exists,
but no systematic review and meta-analysis has examined this issue in its entirety.The authors
concluded that biological therapies were superior to placebo in inducing remission of active CD
and UC, and in preventing relapse of quiescent CD.
Am J Gastroenterol advance online publication 15 March 2011; doi: 10.1038/ajg.2011.73
Effect of laxatives and pharmacological therapies in chronic idiopathic constipation:

systematic review and meta-analysis
Ford, A et al.
The review concluded that laxatives, prucalopride, lubiprostone, and linaclotide were all superior
to placebo in terms of a reduction in risk of failure with therapy. Diarrhoea was significantly more
common with all therapies. The authors concluded that laxatives, prucalopride, lubiprostone and
linaclotide are all more effective than placebo for the treatment of CIC.
Gut 2011. 60 p.209-218 doi:10.1136/gut.2010.227132
[back to topics]
General Practice
The Good Practice Guidelines for GP electronic patient records - version 4 (2011)
The Good Practice Guidelines for GP electronic patient records v4 will act as a reference source
of information for all those involved in developing, deploying and using general practice IT
systems. These latest guidelines, issued in March 2011, supersede version 3.1(2005).
H_125310
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GP patient surveys
The GP Patient Survey has been developed with Ipsos MORI and academics from the University
of Cambridge and the Peninsula Medical School. Around 5 million registered patients in England
were invited to take part during January to March, April to June, July to September and October
to December 2010. Their responses provide timely and valuable information for Primary Care
Trusts (PCTs), GP practices and other patients about patients' experiences when they access
local services.
http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatientsurvey2007/index.h
tm
Improving the quality of care in general practice

King’s Fund
In terms of the current quality of care, the inquiry concluded that the majority of care provided by
general practice is good. However, there are wide variations in performance and gaps in the
quality of care that suggest there is significant opportunity for improvement. Practices need a lot
of support to encourage them to seek out and address variable performance, including:
appropriate data and information; skills development; protected time; and appropriate rewards for
excellence (as well as consequences for poor performance). Policy-makers, regulators,
commissioners and professional bodies could all do more to create a better environment that
supports general practice in its quest for quality.
Report and summary report for GPs available at:
http://www.kingsfund.org.uk/publications/gp_inquiry_report.html
Items in the Commissioning section may also be of interest.
[back to topics]
Guidance
NICE Clinical Guidelines
Clinical diagnosis and management of tuberculosis, and measures for its prevention and
control
Clinical guideline (CG117)
http://guidance.nice.org.uk/CG117
Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent
transmission among black African communities living in England
Public Health Guideline (PH33)
http://guidance.nice.org.uk/PH33
Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent
transmission among men who have sex with men
Public Health Guideline (PH34)
http://guidance.nice.org.uk/PH34
Psychosis with coexisting substance misuse

Clinical guideline (CG120)
http://guidance.nice.org.uk/CG120
[back to topics]
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NICE Technology Appraisals

Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's
disease
Technology Appraisal (TA217)
http://guidance.nice.org.uk/TA217
NICE Consultation Documents

Hypertension (update)
Closing date for comments 22 March 2011.
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=53224
[back to topics]
Clinical Knowledge Summaries updated in March 2010
Important: communication from the National Institute for Health and Clinical Excellence
(NICE)
The Clinical Knowledge Summaries service has now reached the end of its contract term.
You will still able to access the Clinical Knowledge Summaries, however it should be noted that
the current website will no longer be updated with effect from the 1st of April 2011. Please refer to
the ‘How up to date is this topic’ section on the clinical topics pages to see details of publication
and revisions dates for that topic. NHS Evidence are currently tendering for a replacement
service, which will be named Evidence Summaries.
• Antenatal care - uncomplicated pregnancy (new)
• Boils, carbuncles, and staphylococcal carriage
• Bruising (new)
• Chest pain (new)
• Contraception - assessment
• Contraception - barrier methods and spermicides
• Contraception - combined hormonal methods
• Contraception - emergency
• Contraception - IUS/IUD
• Contraception - natural family planning
• Contraception - progestogen-only methods
• Contraception - sterilization
• Knee pain - assessment (new)
12
• Melanoma and pigmented lesions (new)
• Meningitis (bacterial)/meningococcal septicaemia (new)
• Osteoporosis - prevention of fragility fractures (new)
• Otitis media with effusion
• Paronychia - acute
• Whitlow (staphylococcal and herpetic
[back to topics]
Other Guidance
Guidance for public health management of meningococcal disease in the UK
Health Protection Agency
Guidance revised February 2011
http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1201094595231
Management of atopic eczema in primary care

SIGN
http://www.sign.ac.uk/guidelines/fulltext/125/index.html
Management of adult testicular germ cell tumours

SIGN
Management of patients with stroke: rehabilitation, prevention and management of

complications, and discharge planning
SIGN
Prescribing medicines for adults who are unable to swallow oral solid dosage forms
All Wales Medicines Strategy Group
http://www.wales.nhs.uk/sites3/page.cfm?orgid=371&pid=52702
[back to topics]
Other Health Technology Assessments

Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis: a systematic
review and economic evaluation
NIHR Health Technology Assessment programme
Review found that etanercept, infliximab and adalimumab are efficacious in the treatment of
psoriatic arthritis compared with placebo, with beneficial effects on joint symptoms, functional
status and skin. Length of follow-up in trials was limited but the evidence to support the use of
these biologic agents is convincing, given the size of treatment effect and quality of the data.
http://www.hta.ac.uk/project/2053.asp
A systematic review and economic evaluation of the use of tumour necrosis factor-alpha
(TNF-a) inhibitors, adalimumab and infliximab, for Crohn’s disease
13
NIHR Health Technology Assessment programme

The systematic review and economic evaluation found that both adalimumab and infliximab are
likely to be considered cost-effective (dominant relative to standard care) as induction therapy in
the treatment of severe Crohn’s disease (CD), and adalimumab (but not infliximab) is cost-
effective for moderate CD, according to limits generally accepted by the National Institute for
Health and Clinical Excellence. Neither drug is likely to be cost-effective as longer term
maintenance therapy for moderate or severe disease.
http://www.hta.ac.uk/project/1652.asp
Systematic review of the clinical effectiveness and cost-effectiveness of rapid point-of-

care tests for the detection of genital chlamydia infection in women and men
Hislop, J et al.
This review concluded that, despite the availability of rapid point-of-care tests, tests involving
nucleic acid amplification remained the most accurate method of diagnosing chlamydia infection.
This conclusion reflects the evidence presented, but limitations in the evidence base mean that it
should not be regarded as definitive. (Centre for Reviews and Dissemination).
Health Technol Assess 2010;14(29) p.1–126
[back to topics]
Hearing disorders
2011 Annual Evidence Update on Hearing Disorders
NHS Evidence: ENT and Audiology
This update aims to present expert commentary linked to a comprehensive collection of up-to-
date research evidence published in the 12 months since the 2010 Update.
http://www.library.nhs.uk/ENT/ViewResource.aspx?resID=406342&tabID=289
[back to topics]
Infections
Cost-utility analysis of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B
Dakin, H et al.
This study examined the cost-effectiveness of tenofovir disoproxil fumarate (TDF) in the treatment
of chronic hepatitis B compared with other nucleosides or nucleotides. It assessed the optimal
drug for patients who developed a resistance to first- or second-line treatment. The authors
concluded that, from the perspective of the NHS, first-line TDF was the most cost-effective
treatment, at a threshold of £20,000 per quality-adjusted life-year. The methods were robust and
very well described and the authors’ conclusions appear to be valid. (Centre for Reviews and
Dissemination)
Value in Health 13(8) p.922-33. DOI: 10.1111/j.1524-4733.2010.00782.x
[back to topics]
Influenza
The cost-effectiveness of vaccinating pregnant women against seasonal influenza in
England and Wales
Jit, M et al.
This study assessed the cost-effectiveness of seasonal influenza vaccination for pregnant
women, considering the timing of vaccination and the length of protection. The authors concluded
that vaccinating pregnant women against seasonal influenza might be cost-effective, when there
14
was protection for a single season and some benefits for infants. The study had a robust cost-
effectiveness framework and was well presented. The authors’ conclusions appear to be valid.
Vaccine 29(1), 10 December 2010, p.115-122
Pandemic Flu - National Planning Assumptions Assessments Tool

Cabinet Office
To assist local planners in their preparations for an influenza pandemic central government has
developed a tool to facilitate the application of National Planning assumptions to the local setting.
http://www.cabinetoffice.gov.uk/resource-library/pandemic-flu-national-planning-assumptions-
assessments-tool
Review of the evidence base underpinning the UK influenza pandemic preparedness

strategy
Supporting documents underpinning the UK influenza pandemic preparedness strategy.
http://www.dh.gov.uk/en/Publicationsandstatistics/DH_125318
UK influenza pandemic preparedness strategy 2011: strategy for consultation

This document describes proposals for an updated, UK-wide strategic approach to planning for
and responding to the demands of an influenza pandemic. It builds on, but supersedes, the
approach set out in the 2007 National framework for responding to an influenza pandemic, taking
account of the experience and lessons learned in the H1N1 (2009) influenza pandemic and the
latest scientific evidence. A more detailed account of the science underpinning the proposals is
being published along with this strategy.
Closing date: 17 June 2011
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_125316
[back to topics]
Kidney Diseases
Antihypertensive and renoprotective effects of trandolapril/verapamil combination: a meta-
analysis of randomized controlled trials
Zou,Z et al.
The aim of this study was to estimate the efficacy and tolerability of trandolapril/verapamil (Tr/Ve)
combination for blood pressure control and renoprotection. The authors conclude that Tr/Ve
combination provides a superior blood pressure control and a favourable renoprotective effect
without an increase of overall AEs than verapamil monotherapy. The combination also shows a
slight advantage over trandolapril monotherapy by reducing DBP and albuminuria to a greater
extent.
Journal of Human Hypertension March 2011. 25 (3), p.203-210 doi:10.1038/jhh.2010.60
[back to topics]
Learning Disabilities
15
The misdiagnosis of epilepsy in people with intellectual disabilities: A systematic review

Chapman, M et al.
Where data was provided in the cohort studies between 32% and 38% of people with intellectual
disabilities were diagnosed as not having epilepsy or as having nonepileptic events. The main
reason for misdiagnosis was the misinterpretation of behavioural, physiological, syndrome
related, medication related or psychological events by parents, paid carers and health
professionals. The article concludes that those working in epilepsy and intellectual disability
services and families must be made more aware of the possibility of misdiagnosis. Future
research is needed about the misdiagnosis of epilepsy amongst people with intellectual
disabilities and carer knowledge.
Seizure, March 2011 20(2) p.101-6
The route to success in end of life care: achieving quality for people with learning
disabilities
National End of Life Care Programme
This publication aims to provide a practical guide which supports anyone caring for people with
learning disabilities to ensure that those who may be in the last months of their life receive high
quality end of life care. It may also be useful to health or social care professionals who come into
contact with people with learning disabilities in clarifying what measures need to be taken to
ensure that they can access appropriate care.
http://www.endoflifecareforadults.nhs.uk/publications/route-to-success-people-with-learning-
disabilities
[back to topics]
Long Term Conditions

2011 Annual Evidence Update on Multiple Sclerosis
NHS Evidence: neurological conditions
This Evidence Update highlights knowledge published in systematic reviews and guidelines in the
past 12 months on the diagnosis, treatment and management of MS. It includes additional expert
commentary.
http://www.library.nhs.uk/neurological/viewResource.aspx?resid=407609
Gabapentin for chronic neuropathic pain and fibromyalgia in adults

Moore, RA et al.
Gabapentin provides pain relief of a high level in about a third of people who take it for painful
neuropathic pain. Adverse events are frequent, but mostly tolerable. More conservative estimates
of efficacy resulted from using better definitions of efficacy outcome at higher, clinically important,
levels, combined with a considerable increase in the numbers of studies and participants
available for analysis.
Risk of adverse events including serious infections in rheumatoid arthritis patients treated
with tocilizumab: a systematic literature review and meta-analysis of randomized
controlled trials
Campbell, L et al.
This review aimed to assess the risk of adverse events (AEs) in patients with RA treated with
tocilizumab, an IL-6 receptor antibody, in published randomized controlled trials (RCTs).The
authors concluded that tocilizumab in combination with MTX as a treatment for RA is associated
with a small but significantly increased risk of AEs, which is comparable with that of other
biologics. Vigilance for untoward effects is, therefore, imperative in any patient treated with these
immuno-suppressive agents.
Rheumatology (2011) 50 (3) p.552-562.
Items in the Palliative Care and Learning Disabilities sections may also be of interest.
16
[back to topics]
Maternity
National Perinatal Mental Health Project Report
The remit of this report is to facilitate a better understanding of how and to what extent current
and planned perinatal provision is capable of meeting the needs of BME women.
H_124879
Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of
breastfeeding
Jaafar, SH et al.
Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is
established, did not significantly affect the prevalence or duration of exclusive and partial
breastfeeding up to four months of age. However, evidence to assess the short-term
breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is
lacking.
Responding to a proposal for merger or reconfiguration of Maternity Services Provision in

England: a good practice guide
RCM
These guides aim to help Royal College of Midwives (RCM) regional/national officers and RCM
activists respond professionally and constructively to proposals for mergers or reconfigurations of
maternity services. The intended outcome is to ensure services of the highest quality are provided
for women and their babies.
http://www.rcm.org.uk/reconfigurations/
Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-2008
CEMACH
This report finds that the overall number of maternal deaths in the UK has fallen over the last
three years despite a rise in the number of women dying from infection. For the first time there
has been a reduction in the inequalities gap, with a significant decrease in maternal mortality
rates among those living in the most deprived areas and those in the lowest socio-economic
group. In addition an aide-memoire for healthcare professionals has been produced. The new
chapter ‘Back to basics’, provides a list for the identification and management of the most
commonly occurring conditions in pregnancy.
http://www.cemach.org.uk/Publications-Press-Releases/Report-Publications/Maternal-
Mortality.aspx
Staffing in maternity units: getting the right people in the right place at the right time
King’s Fund
This report concludes that using midwives and other maternity staff more effectively is the key to
improving maternity care. The report considers the available evidence about the relationship
between staffing levels and deployment practices and safety of care for mothers and babies,
focusing specifically on labour and birth. It sets out the policy background and the workforce
issues currently faced by maternity services. The report includes a small number of case studies
to illustrate innovative approaches to staffing in maternity services in England. Some of these
have the potential to improve safety and women’s experience of labour while also saving costs.
http://www.kingsfund.org.uk/publications/maternity_unit_staff.html
An item in the Influenza section may also be of interest.
17
[back to topics]
Mental Health
Facing up to the challenge of personal health budgets: the view of frontline professionals
NHS Confederation
This report examines attitudes and motivations to personal health budgets amongst frontline
professionals working with mental health service users. These are based on research findings
from 60 in-depth, qualitative interviews and a national quantitative survey amongst 645
respondents. It outlines the key challenges involved if frontline professionals are to effectively put
into practice the theoretical principles behind personal health budgets. It draws attention to the
complex nature of the main barriers involved, as well outlining how professionals might best be
supported if these barriers are to be overcome.
http://www.nhsconfed.org/Publications/reports/Pages/Facing-up-to-the-challenge-of-personal-
health-budgets.aspx
Guidance for Commissioning IAPT Training 2011/12 –2014/15

IAPT: Improving Access to Psychological Therapies
This document is a guide for education and training commissioners of the Improving Access to
Psychological Therapies (IAPT) workforce via the Multi Professional Education and Training
(MPET) allocation.
http://www.iapt.nhs.uk/news/guidance-for-commissioning-iapt-training-201112-201415/
Improving Wellbeing through Healthy Life Choices

Improving Well-being through Healthy Life Choices provides some key learning to help Increasing
Access to Psychological Therapy (IAPT) services collaborate with, in this case Health Trainer
(HT) services, to improve access for clients to make physical and mental healthy life choices.
Well-being as a positive outcome in improved physical and/ or mental health is of prime concern
to both HT and IAPT programmes.
http://www.nmhdu.org.uk/news/improving-wellbeing-through-healthy-life-choices/
Mental Health Factfiles

These 7 short factfiles outlining key facts and figures on Mental Health:
• Factfile 1: Mental Health and Employment
• Factfile 2: Mental Health and Housing
• Factfile 3: The costs of mental ill health
• Factfile 4: Public mental health and well-being
• Factfile 5: Equalities in mental health
• Factfile 6: Stigma and discrimination in mental health
• Factfile 7: Ensuring greater access to talking therapies
http://www.nmhdu.org.uk/news/nmhdu-factfiles-/
Mental Well-being Checklist

This checklist helps the reader become more familiar with the major influences on mental well-
being and provides a quick reference source to help with local improvements and actions as part
of local commissioning, development, review, delivery or evaluation. The checklist is designed
particularly for those working in Public Health and Health Improvement, Local Government, Social
Care, NHS and Employment. The checklist is evidence based and provides information on what
protects individual and community mental well-being, the wider determinants of mental well-being
and which populations face the greatest inequalities in mental well-being.
http://www.nmhdu.org.uk/our-work/promoting-wellbeing-and-public-mental-health/mental-
wellbeing-checklist/
18
Pharmacological interventions for people with depression and chronic physical health
problems: systematic review and meta-analyses of safety and efficacy
Taylor, D et al.
This review aimed to examine evidence related to efficacy, tolerability and safety of
antidepressants for people with depression and with chronic physical health problems. The
authors concluded that antidepressants are efficacious and safe in the treatment of depression
occurring in the context of chronic physical health problems. The SSRIs are probably the
antidepressants of first choice given their demonstrable effect on quality of life and their apparent
safety in cardiovascular disease.
The British Journal of Psychiatry (2011) 198: 179-188. doi: 10.1192/bjp.bp.110.077610
Public mental health and well-being – the local perspective
NHS Confederation
This report examines local leaders’ perceptions of public mental health and well-being, the
progress they have made, how they are acting on recent evidence, and the complementary
nature of addressing mental illness and improving mental well-being. It aims to describe the
current state of public mental health and well-being and to provide a sense of what would help to
take this work forward locally and nationally.
http://www.nhsconfed.org/Publications/reports/Pages/Public-mental-health-well-being-local-
perspective.aspx
Transitions Guides
4 new guides have been published to help improve the outcomes and process of Mental Health
Transition for Young People, that is young people who are receiving care and support from Child
and Adolescent Mental Health Services (CAMHS) but have reached an age where they will need
to move on to adult services. Young Minds, the National CAHMS Support Service (NCSS) and
the NMHDU have published information for Young People, for their parents and carers and for
Professionals.
http://www.nmhdu.org.uk/our-work/improving-mental-health-care-pathways/supporting-effective-
transitions-and-development-of-services-for-young-adults/transitions-guides/
Items in the Obesity and Children and Young People section may also be of interest.
[back to topics]
Nutrition
Nutrition screening survey in the UK and Republic of Ireland in 2010
British Association for Parenteral and Enteral Nutrition (BAPEN)
The report found that more than1 in 3 of all patients of all ages admitted into hospital are at risk of
malnutrition, an increase over previous seasonal surveys. Overall prevalence of malnutrition on
admission to the 185 participating hospitals was 34% up from 28% in the previous years’ surveys.
More than 1 in 5 of all admissions was recorded as being at high risk of malnutrition. More than 1
in 3 adults recently admitted to care homes and almost 1 in 5 adults admitted to Mental Health
Units were also recorded as being at risk of malnutrition (37% and 18% respectively). Less than
half of all hospitals stated that they always or usually included nutritional information in discharge
communications which potentially compromises the continuity of nutritional care as patients move
between care settings.
http://www.bapen.org.uk/pdfs/nsw/nsw10/nsw10-report.pdf
[back to topics]
Obesity
19
Data sources: environmental influences on physical activity and diet

National Obesity Observatory
This paper describes available sources of national and local data on aspects of the
neighbourhood environment that influence physical activity and diet. It also aims to help users
understand the challenges and limitations of using the data sources available, and to identify
gaps in the data and help users understand the options available at a local level to improve data
availability.
http://www.noo.org.uk/uploads/doc/vid_10418_Environmental%20%20data%20sources
%20FINAL_editedformatted_%20MG%20100311.pdf
Measuring diet and physical activity in weight management interventions

This paper is intended to be an accessible and practical guide to the measurement of physical
activity and diet and provides a shortlist of practical, validated tools to: support people conducting
evaluations of weight management interventions; help provide consistency and comparability
between evaluations of weight management interventions and to strengthen the evidence base;
and support the implementation of the Standard Evaluation Framework (SEF) for weight
management interventions.
http://www.noo.org.uk/uploads/doc/vid_10414_Assessment%20Tools%20160311%20FINAL
%20MG.pdf
A supplement (copies of questionnaires) is available at
http://www.noo.org.uk/uploads/doc/vid_10415_Supplement%20Assessment%20Questionnaires
%20%20Final%20Draft%20160311%20MG.pdf
Obesity and Mental Health

This paper provides an overview of current evidence on the relationship between obesity and
mental health in the UK and highlights the co-directional associations between common mental
health disorders and obesity. It also includes:
• issues around inequality
• the implications of psychological distress caused by weight related stigma and
discrimination
• specific issues relating to child and adolescent obesity
• current knowledge on the effectiveness of interventions
http://www.noo.org.uk/uploads/doc/vid_10266_Obesity%20and%20mental
%20health_FINAL_070311_MG.pdf
[back to topics]
Older People
An evaluation of the impact of community-based interventions on hospital use: a case
study of eight Partnership for Older People Projects (POPP)
Nuffield Trust
To improve the quality of care and at the same time reduce costs, efforts are being made across
the UK to deliver more health and social care in community settings. One recent initiative to
address this issue was the Partnership for Older People Projects (POPP) – a series of innovative
projects that received ring-fenced funding from the Department of Health over a two-year period.
The Nuffield Trust was commissioned by the Department of Health to evaluate a small but
carefully selected set of eight POPP interventions and examine whether these interventions were
successful at preventing unplanned hospital admissions.
http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=764
[back to topics]
20
Offender Health
Health protection in prisons report 2009-2010
For the past four years, Offender Health has commissioned the Health Protection Agency (HPA)
to develop and jointly deliver a programme to survey and prevent infectious diseases in prisons.
The work programme for 2009-2010 covered three key areas: improving infectious disease
surveillance, the hepatitis B vaccination monitoring programme, and information and
communication. This report outlines the progress made in meeting the objectives of the work
programme in these key areas.
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1296682988823
[back to topics]
Patient Care and Safety

HealthWatch Transition Plan
This document highlights key issues for Local Involvement Networks (LINks), their host
organisations and local authorities during 2011/12, prior to the establishment of HealthWatch.
H_125582
Learning report: Safer Patients Initiative

The Health Foundation
This report provides an overview of the Safer Patients Initiative and its evaluation, and highlights
the impact of the programme, key lessons and further issues for exploration. This report is
published alongside separate evaluations for Phase 1 and Phase 2 of the project.
http://www.health.org.uk/publications/?keywords=&refData_44=46&refData_53=&searchSubmit
State of Care 2009/10

This report looks at the quality of services during the final year of regulation under the Care
Standards Act 2000 and the Health and Social Care Act 2003. When producing the report, CQC
looked at outcomes for people using health care and social care services in 2009/10 to provide a
picture of their experiences. The report only covers the services that we regulated and assessed
under the previous legislation. These were:
• The NHS and independent healthcare services.
• Adult social care services such as care homes, nursing homes and home care agencies.
• Councils and primary care trusts (PCTs), which commission or provide the above
services for their communities.
CQC’s aim is that the evidence and conclusions in our report should inform and encourage
improvements in the quality of care through 2011 and beyond.
Full report, overview and video available at:
http://www.cqc.org.uk/stateofcare2009-10.cfm
An item in the Service Management section may also be of interest.
[back to topics]
Palliative Care
21
An item in the Learning Disabilities section may be of interest.
Physical Disabilities
Items in the Children and Young People, Learning Disabilities and Mental Health sections
may also be of interest.
[back to topics]
Prescribing
Controlled Drugs Record Card (CDRC)
National Prescribing Centre
The report of a detailed review by the NPC into the proposal for a national Controlled Drugs
Record Card (CDRC) as indicated by the Fourth Shipman Inquiry.
CDRC: Review of the implementation of the Controlled Drugs Record Card: Phase 1
The Phase One report covers the background to the CDRC, a review of the pilot sites and the
opinions of key stakeholders on how the CDRC could be implemented in a way that would
achieve its desired aim.
CDRC: Recommendations in response to the CDRC implementation review: Phase 2
The Phase Two report provides a series of recommendations that build on the current regulatory
infrastructure already in place. The recommendations are largely for local implementation.
http://www.npci.org.uk/cd/public/guidance.php
[back to topics]
Public Health
Cost-effectiveness of interventions to reduce dietary salt intake
Cobiac, LJ et al.
This study examined the cost-effectiveness of reducing salt in the diet through voluntary or
mandatory changes by the food industry or dietary advice for those at risk of cardiovascular
disease. The authors concluded that food manufacturer action was the preferred strategy to
improve health and reduce health spending in the long term, especially when mandatory. The
study was well carried out and the authors’ conclusions seem robust, but limited by the
uncertainty in some model inputs. (Centre for Reviews and Dissemination)
Heart 2010;96 p.1920-1925 doi:10.1136/hrt.2010.199240
Mobile phone base stations and health

This leaflet outlines some of the measures taken to address health concerns about mobile phone
service.
H_124897
Plan for Growth

HM Treasury
The Healthcare and Life Sciences section of the Plan for Growth highlights that health research
has a key role in the national economy as well as in improving health and care. A series of
announcements in the plan include:
• The Government will combine and streamline approvals of health research under a
regulatory agency, which will be established in the first instance as a Special Health
Authority, with the National Research Ethics Service as its core, during 2011.
22
• The new agency will aim to create a consistent national system of research governance
and consistent and professional local research management.
• The National Institute for Health Research will launch a UK Clinical Trials Gateway which,
by 2012, will make it easier for patients, their doctors and their families to find out
about trials that are relevant to them.
• The Government will bring forward plans for a research data service so that e-health
record data can create a unique position for the UK in health research.
The NIHR will work with partners to plan for the implementation of these policy developments.
http://cdn.hm-treasury.gov.uk/2011budget_growth.pdf
Public Health Responsibility Deal

What we eat, how much we drink and how active we are is heavily shaped by our environment.
Creating the right environment can encourage and empower people to take responsibility for their
health and make healthy choices. The Public Health Responsibility Deal has been established to
tap into the potential for businesses and other organisations to improve public health and tackle
health inequalities through their influence over food, alcohol, physical activity and health in the
workplace.
http://www.dh.gov.uk/en/Publichealth/Publichealthresponsibilitydeal/index.htm
Radon in homes in England and Wales: 2010 data

This report provides a summary of approximately 480,000 radon measurements made in English
and Welsh homes between 1980 and 2009. It updates a previous report issued in 2002 and
complements the radon atlas of England and Wales published in 2007. Results are shown for a
range of administrative areas, postcodes and NHS authorities and are accompanied by a short
descriptive text. For these administrative areas, the report presents estimates of the numbers of
homes at or above the Action Level of 200 becquerels per cubic metre of air. The total number of
homes above the Action Level is estimated to be between 100,000 and 200,000.
http://www.hpa.org.uk/Publications/Radiation/CRCEScientificAndTechnicalReportSeries/HPACR
CE015/
Items in the mental health section may also be of interest.
[back to topics]
Research
EU Clinical Trials Register
European Medicines Agency (EMA).
The online register gives public access to information on interventional clinical trials for medicines
authorised in the 27 EU Member States and Iceland, Liechtenstein and Norway, for the first time.
The database also allows the public to search for information on clinical trials authorised to be
carried out outside the EU if these trials are part of a paediatric investigation plan.
https://www.clinicaltrialsregister.eu/
[back to topics]
Safeguarding Vulnerable Adults

Safeguarding adults: the role of health services
23
These documents remind health services of their duties to safeguard adults. They assist NHS
commissioners, health service managers and practitioners in preventing and responding to
neglect and abuse, focusing on patients in the most vulnerable situations. The documents include
good practice principles and examples. The self- assessment and assurance framework allows
providers and commissioners to benchmark their safeguarding adults arrangements against
related Care Quality Commission Essential Standards. The tool can help identify strengths or
gaps in provision and generates graphs and action plans for improvement.
H_124882
[back to topics]
Screening
Rapid testing versus karyotyping in Down's syndrome screening: cost-effectiveness and
detection of clinically significant chromosome abnormalities
Gekas, J et al.
This study examined the cost-effectiveness of six screening options for Down’s syndrome
(quadruple, combined, integrated, serum integrated, sequential, or contingent screening) followed
by one of three diagnostic tests (karyotyping, fluorescence in situ hybridisation, or quantitative
fluorescence polymerase chain reaction; QF-PCR). The authors concluded that QF-PCR after
contingent screening was the most cost-effective option for the detection of Down's syndrome.
The study was well carried out and the results were clearly presented. The authors’ conclusions
seem valid. (Centre for Reviews and Dissemination)
European Journal of Human Genetics (2011) 19. p. 3–9; doi:10.1038/ejhg.2010.138;published
online 15 September 2010
[back to topics]
Service Management
Consultation on Good Management Practice: guidance for all doctors
The GMC is consulting on draft guidance Good Management Practice: guidance for all doctors
and two pieces of supplementary guidance: Raising and acting on concerns about patient safety
and Writing references. The consultation is part of the review of the GMC's guidance from 2006,
Management for doctors and supplementary guidance Raising concerns about patient safety. The
revised draft, Good Management Practice, sets out doctors' wider responsibilities in relation to
employment issues including teaching and training, planning, using and managing resources,
raising and acting on concerns and participating in service improvement and development. The
guidance will apply to all doctors - regardless of whether they have a formal managerial role or
responsibility. There are two consultation questionnaires: the background and consultation
questionnaire (containing detailed questions on the drafting of the guidance); and the short
consultation questionnaire (targeted at individual doctors).
Consultation closing date: Friday 3 June 2011.
http://www.gmc-uk.org/guidance/news_consultation/8963.asp
Costing the heavens: chaplaincy services in English NHS provider Trusts 2009/10
National Secular Society
English NHS Trusts were asked how much they spent on hospital chaplaincy services using the
Freedom of Information Act. The proportion that trusts spent on chaplaincy was compared to how
well it performed on national quality ratings. The results showed huge variations in the
proportions that similar hospitals spend.
http://www.secularism.org.uk/study-shows-that-spending-on-hos.html
24
Equality Act 2010: Ending age discrimination in services, public functions and
associations - a consultation on proposed exceptions to the ban
The Equality Act 2010 includes provisions enabling a ban on age discrimination in the provision of
services and public functions. Implementing the age discrimination ban would require secondary
legislation to be made, setting out the circumstances in which it would remain lawful to use age
as a reason for treating people differently. This consultation sets out those areas where the
government believes that different treatment of people of various ages is justified; and proposes
how the legislation will be drafted to take account of these. The Government proposes no specific
exceptions to the ban on age discrimination for health or social care services. This means that
any age-based practices by the NHS and social care would need to be objectively justified, if
challenged.
Closing date for comments: 25th May 2011
http://www.equalities.gov.uk/equality_act_2010/age_consultation_2011.aspx
Integrating health and social care in Torbay: improving care for Mrs. Smith
King’s Fund
Integration of health and social care is a core policy aim of the new coalition government in
England. It has several benefits for patients, particularly older people and those with long-term
conditions. But how does integration work in practice? This paper sets out how one particular
area – Torbay – created an integrated care system that aimed to improve care for ‘Mrs Smith’, a
fictitious user of health and social care services. This case study sets out the background to the
development of integrated care, the setting up of a pilot team, the implementation of an integrated
management structure, the establishment of Torbay Care Trust (which is a fully integrated NHS
organisation responsible for commissioning and providing community health and social care
services) and assesses the impact of the integrated system on the performance of the Torbay
health and social care economy.
http://www.kingsfund.org.uk/publications/integrating_health_1.html
Making Quality Your Business: A guide to the right to provide

The right to provide is part of a bigger vision for the future of public services. This guide aims to
support people who are thinking about taking up the right to provide and has been built on the
experience of healthcare staff who have been through the right to request. This guide sets out a
process for people working in NHS Trusts who have the right to propose the development of a
staff-led enterprise. Department of Health also encourage staff working in social care who are
thinking about the right to provide, and people working in Foundation Trusts and Arm’s Length
Bodies who are interested in staff leadership to use this guide.
H_125578
Maintaining and improving quality during the transition: safety, effectiveness, experience
This report is the first in a two-phase review about maintaining and improving quality during the
transition and beyond. Building on the February 2010 Review of Early Warning Systems in the
NHS, it emphasises how quality must remain the guiding principle as organisations move to
implement NHS modernisation, and is clear that healthcare professionals are ultimately
responsible for the quality of care provided to patients. Focusing on 2011/12, it describes the key
roles and responsibilities for maintaining and improving quality; suggests practical steps to
safeguard quality during the transition; and emphasises the importance of the effective handover
of knowledge and intelligence on quality between old and new organisations.
H_125234
Mass casualties and Health Care following the release of toxic chemicals or radioactive
material: MASH EU Project 2007/209
25
It is prudent to plan for the response to a mass emergency involving toxic chemicals or
radioactive materials, although such events are rare. Nevertheless, such an eventuality may
develop at a rate and reach a magnitude sufficient to impose a major crisis on society. The EU
MASH (Mass casualties and healthcare following the release of toxic chemicals or radioactive
compounds) project has the objective of identifying ways to improve the overall capacity in
Member States to deal with casualties of such incidents. This report identifies a number of areas
for improvement and proposes six strategic aims for a programme of actions that would improve
the overall capacity of Member States to deal with a mass casualty event involving toxic chemical
or radioactive materials. This report also proposes a number of key objectives for EU coordinated
projects and initiatives over the next 3 years, 10 years and beyond which will enable these
strategic aims to be met.
http://www.hpa.org.uk/Publications/Radiation/MiscellaneousRadiationPublications/rad006miscpub
MASH/
NHS reforms in England: managing the transition

Nuffield Trust
This Nuffield Trust policy response assesses the 2011/12 Operating Framework for the NHS
together with guidance on the operation of Payment by Results (PbR) in 2011/12. It sets out the
key challenges associated with managing the transition to a reformed NHS, as envisaged in the
White Paper: Equity and Excellence: Liberating the NHS, and proposes ways in which the risks
associated with transition might be mitigated. It calls for early development of clear guidance on
the governance and structural arrangements for emerging GP consortia, to ensure adequate local
and national accountability for quality, financial control and value for money. The authors stress
that the role of PCT clusters will be critical and extensive – if they are to retain staff and
effectiveness they will need support, more clarity as to their priorities, and assurance of a future
beyond 2013. They also call for more support for PCT clusters and shadow GP consortia.
http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=760
Productive places: continuing the focus on place-based improvement

Local Government Improvement and Development
This report showcases some of the interesting place-based work taking hold throughout the
country. It identifies the benefits that are starting to flow from this, and sets out some tips for
those places that want to take action. It also highlights lessons learnt about how to support places
to take new ideas on board and make change happen.
http://www.local.gov.uk/lgv2/core/page.do?pageId=1354073
Quality Accounts Mini Guides for Quality Accounts: a guide for Local Involvement
Networks (LINk) and Overview and Scrutiny Committees (OSCs)
Healthcare providers publishing Quality Accounts in June 2011 have a legal duty to send their
Quality Account to the LINk and OSC in the local authority area in which the provider has its
registered office, inviting comments on the report from the LINk and OSC prior to publication.
H_125165
Quality governance in the NHS: a guide for provider boards

This guide seeks to provide clarity and act as a route map to support provider boards as they
navigate the system and lead their organisation in delivering improved quality and outcomes. This
guide considers how to govern for quality, both in terms of driving continuous improvement
across the organisation and ensuring that the essential levels of quality and safety are met. It
recognises that processes and structures are vital in governing for quality, but also that values
and behaviours are essential to a culture that supports quality.
H_125238
26
Reconfiguring Hospital Services: Lessons from South East London

The King’s Fund
This report considers whether reconfiguration of hospital services is an appropriate response to
the need to drive up quality and drive down costs. Based on detailed analysis of proposed
reconfiguration in South East London, it draws out important lessons to inform the debate about
the merits of reconfiguration of hospital services elsewhere in England. The report concludes that
market forces alone are unlikely to result in improvements in quality of care for patients in many
hospitals, and could result in deterioration in some cases. It argues that the transfer of
commissioning to GP consortia increases the risks of deterioration in quality of care for some
patients and a widening of the quality gap between best and worst performers. Reconfiguration
that improves quality of care and reduces costs may require consolidation of services across
hospital sites. Decisions about reconfiguration will need to weigh the resulting improvements in
health care outcomes against the potential costs of reduced competition and choice.
http://www.kingsfund.org.uk/publications/reconfiguring.html
Social care funding and the NHS: an impending crisis?
The King’s Fund
This report examines trends in spending on social care, looking at three scenarios arising from
the 27 per cent real reduction in the central government grant to local authorities that between
2011/12 and 2014/15, social care spending will be fully cut, will receive some protection, or
receive no protection. This suggests that there could be a funding gap of £1 billion by 2014
unless councils can achieve unprecedented efficiency savings. This would have a knock-on effect
on the NHS, with cuts to frontline social care services leading to fewer people getting the help
they need, causing more emergency admissions, delayed discharges and longer waiting times.
This paper provides evidence on the inter-dependency of health and social care, includes case
studies of effective use of resources and recommends four areas for action to achieve better use
of health and social resources.
http://www.kingsfund.org.uk/publications/social_care_funding.html
Items in the Children and Young People, Commissioning, General Practice, Learning
Disabilities and Mental Health sections may also be of interest.
[back to topics]
Sexual Health
Population-based biomedical sexually transmitted infection control interventions for
reducing HIV infection
Ng, BE et al.
The authors failed to confirm the hypothesis that STI control is an effective HIV prevention
strategy. Improved STI treatment services were shown in one study to reduce HIV incidence in an
environment characterised by an emerging HIV epidemic (low and slowly rising prevalence),
where STI treatment services were poor and where STIs were highly prevalent. Incidence was
not reduced in two other settings. There is no evidence for substantial benefit from a presumptive
treatment intervention for all community members. There are, however, other compelling reasons
why STI treatment services should be strengthened, and the available evidence suggests that
when an intervention is accepted it can substantially improve quality of services provided.
Young people of Chinese origin in western countries: a systematic review of their sexual
attitudes and behaviour
Yu, J et al.
This paper reports on sexual attitudes and behaviour among ethnic Chinese young people
(mainly aged 13–25 years) living in western countries. Results show that ethnic Chinese youth
reported poorer sexual health knowledge than white young people in their host countries, while
they were found to be more likely to disapprove of uncommitted sex, be virgins, lose their virginity
27
at a later age and have fewer sexual partners. Factors associated with their sexual attitudes and
behaviour have also been identified. Countries like the United Kingdom, United States and
Canada have become multicultural societies with many diverse ethnic groups. Without doubt
educators and sexual health professionals need to provide sex education and services which
should be culturally appropriate to people from diverse ethnic backgrounds. An understanding of
their sexual values, sexual behaviour and associated factors is the first step towards achieving
this goal.
Health & Social Care in the Community 18(2) p.117-28. DOI: 10.1111/j.1365-2524.2009.00906.x
[back to topics]
Smoking
Cannabinoid type 1 receptor antagonists for smoking cessation
Cahill, K et al.
The authors concluded that from the trial reports available, rimonabant 20 mg may increase the
chances of quitting approximately 1½-fold. The evidence for rimonabant in maintaining
abstinence is inconclusive. Rimonabant 20 mg may moderate weight gain in the long term.
Taranabant 2-8 mg may moderate weight gain, at least in the short term. In 2008, development of
both rimonabant and taranabant was discontinued by the manufacturers.
Healthy Lives, Healthy People: a Tobacco Control Plan for England

This plan sets out how tobacco control will be delivered in the context of the new public health
system, focusing in particular on the action that the Government will take nationally over the next
five years to drive down the prevalence of smoking and to support comprehensive tobacco
control in local areas. It includes commitments to implement legislation to end tobacco displays in
shops; continue to defend tobacco legislation against legal challenges by the tobacco industry,
including legislation to stop tobacco sales from vending machines from October 2011; continue to
follow a policy of using tax to maintain the high price of tobacco products at levels that impact on
smoking prevalence; promote effective local enforcement of tobacco legislation; encourage more
smokers to quit by using the most effective forms of support, through local stop smoking services;
and publish a three-year marketing strategy for tobacco control.
H_124917
Impact of smokefree legislation: evidence review, March 2011

Legislation prohibiting smoking in workplaces and enclosed public places was introduced in
England in July 2007. This report outlines existing evidence of the impact of this legislation, and
places this research in an international context.
H_124961
A review of cost-effectiveness of varenicline and comparison of cost-effectiveness of

treatments for major smoking-related morbidities
Zimovetz, EA et al.
The authors concluded that varenicline appears to be cost-effective from the perspective of both
health care payers and employers, because of reduced health care consumption and costs. The
cost-effectiveness of varenicline also compares favourably to that of interventions recommended
for the treatment and prevention of smoking-related diseases.
28
Journal of Evaluation in Clinical Practice 17(2) p.288-97. DOI: 10.1111/j.1365-2753.2010.01439.x
Safety of nortriptyline at equivalent therapeutic doses for smoking cessation: a systematic

review and meta-analysis
Dhippayom, T et al.
This review aimed to examine the safety of nortriptyline at doses equivalent to those used in
aiding smoking cessation. Overall, no life-threatening events occurred in the included studies.
Orthostatic hypotension was significantly higher in nortriptyline users than in comparator groups.
Other adverse events significantly associated with nortriptyline were anticholinergic-related
effects including drowsiness, dizziness, gastrointestinal disturbance and dysgeusia. The authors
concluded that current evidence suggests that nortriptyline, at doses between 75 and 100 mg, is
not significantly associated with serious adverse events when administered in patients without
underlying cardiovascular disease.
Drug Safety, 1 March 2011. 34(3) p. 199-210(12)
Stop smoking service delivery and monitoring guidance 2011/12
This document provides best practice guidance relevant to the provision of all publically provided
stop smoking interventions and sets out fundamental quality principles for the commissioning and
delivery of services which can be used to inform the development of local commissioning and
provision arrangements. It also includes full details of the data requirements for local stop
smoking services.
H_125389
[back to topics]
Substance Abuse
ATLAS on Substance Use (2010): resources for the prevention and treatment of substance
use disorders
WHO
The ATLAS on Substance Use provides a structured description of available prevention and
treatment resources for substance use disorders in WHO regions, different income economies
and the world. The report is based on a survey instrument and has been accomplished through
collaboration with WHO regional and country offices, national focal points and a number of
leading experts in the field of psychoactive substance use.
http://www.who.int/substance_abuse/publications/treatment/en/index.html
Building recovery in communities: consultation

National Treatment Agency for Substance Misuse
The NTA is asking anyone with a personal or professional interest in drug treatment to be
involved in designing a new service framework that will support local areas in delivering the
government's new drug strategy. The framework is to provide better access to a complete range
of services to support people in sustaining their recovery. Among the key issues for discussion
are whether treatment for drug and alcohol dependence should be closely integrated, and how all
treatment inside prisons and out in the community can be better brought together in a seamless
service. The new framework should also reflect the importance of assessing and meeting the
wider physical, mental and social needs of substance misusers, and promote a new culture of
ambition that enables people to choose recovery.
Closing date: 4 May 2011
http://www.nta.nhs.uk/recovery-consultation.aspx
[back to topics]
Vaccination and Immunisation
29
Economic evaluation of infant and adolescent hepatitis B vaccination in the UK

Siddiqui MR
This study examined the cost-effectiveness of hepatitis B virus (HBV) vaccination programmes,
focusing on the threshold vaccine price that provided good value for money. At the vaccine price
at the time, a universal infant or adolescent vaccination programme, or a selective programme for
intermediate or high-risk infants, was not cost-effective from the perspective of the UK NHS. The
methods were robust and the authors’ conclusions appear to be valid, but more detail on the data
sources would have been useful.
Vaccine 29(3), 10 January 2011, p.466-475
JCVI advice on pneumococcal polysaccharide vaccination programme

The Joint Committee on Vaccination and Immunisation has advised that the pneumococcal
vaccination programme for those aged 65 years and older should stop. DH is asking professional
and patient groups for views before making a final decision on the programme. In the meantime,
clinicians should follow existing Green Book guidance.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
25195
Items in the Influenza section may also be of interest.
[back to topics]
Women’s Health
Call to end violence against women and girls: action plan
Home Office
This action plan provides an overview of the wide range of actions the government will be taking
forward with key partners to deliver its strategy to tackle violence against women and girls
(VAWG).
http://www.homeoffice.gov.uk/publications/crime/call-end-violence-women-girls/vawg-action-plan
[back to topics]
Workforce
2010 NHS staff survey
This is the eighth annual survey of NHS staff. The results help trusts to review and improve the
experiences of their staff, enabling them to provide better care to patients. 54% (of the 306,000
staff contacted) responded to the survey. Among these staff:
• 64% are happy with the standard of care provided by the trust (an increase from 62% in
2009)
• 41% have good opportunities to develop in their work (compared with 44% in 2009)
• 28% said that they will look for a new job in the next 12 months (compared with 22% in
2009)
• 8% overall reported experiencing physical violence from patients, relatives or other
members of the public, while 15% said they had been subjected to bullying, harassment
and abuse.
30
http://www.cqc.org.uk//newsandevents/newsstories.cfm?
cit_id=37204&FAArea1=customWidgets.content_view_1&usecache=false
ACAS support for NHS organisations undergoing change

ACAS
The Advisory, Conciliation and Arbitration Service (Acas) has developed a dedicated area on
their website to provide support for NHS HR directors and their teams when planning for
restructuring. (NHS Confederation)
http://www.acas.org.uk/index.aspx?articleid=3249
Factors influencing dental practitioner performance: a literature review

NPSA National Clinical Assessment Service
This review will contribute to the development of the NCAS dental service, as well as ensuring a
robust evidence-based foundation for concurrent research programmes. The specific questions
the review attempted to answer included the following:
• What are the factors that influence a dentist’s performance?
• Why do these factors arise?
• How do these factors impact upon performance?
• What interventions exist, and are they effective?
http://www.ncas.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=130106
Independent Public Service Pensions Commission: Final Report

Lord Hutton of Furness
This report sets out Lord Hutton’s recommendations to the Government on pension arrangements
that are sustainable and affordable in the long term, fair to both the public service workforce and
the taxpayer and consistent with the fiscal challenges ahead, while protecting accrued rights.
http://www.hm-treasury.gov.uk/indreview_johnhutton_pensions.htm
Maintaining patients’ trust: modern medical professionalism

Society for Cardiothoracic Surgeons in Great Britain and Ireland
This report includes submissions from a range of external organisations and opinion leaders. It
describes the Society’s work on outcomes and the role of professional societies in using clinical
outcomes; the importance of continuing professional development; measuring patient reported
outcomes; the role of multi-source feedback; managing poor performance; and the NHS Chief
Executive’s view
http://www.scts.org/documents/PDF/SCTS_Professionalism_FINAL.pdf
NHS Well-being at work

NHS Employers
This website brings together a comprehensive range of resources on health and well-being in the
workplace.
http://wellbeing.nhsemployers.org/
Report to the National Allied Health Professional Advisory Board on the outcomes of the
Modernising Allied Health Professional Careers Programme
Having a health and social care workforce that is flexible and able to respond to the different
needs that people have at different stages of their life is essential. It is important that the NHS
makes best use of its existing workforce as well as ensuring that the future workforce are able to
31
deliver the best quality care in the most efficient way possible ensuring improve outcomes for
patients. The National Allied Health Professions Patients’ Forum believe that this report will be
useful to help commissioners and service providers make the best decisions about patient care
and make the most of this under utilised part of the heath and social care workforce.
H_124801
Items in the Mental Health and Service Management sections may also be of interest.
[back to topics]
32

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Clinical Effectiveness Bulletin

About this Bulletin:

 Feedback is always welcomed to inform future issues of the bulletin.

Bulletin produced by NHS Outreach Librarians

North Staffs Health Library

Contents in this issue

Sources for Clinical Effectiveness Bulletin

Bowel (colorectal) cancer - UK incidence statistics

Cardiovascular Disease Profiles

Chest Pain - 2011 Evidence Update

Children and Young People

Child Health Profiles for Local Authorities in England

Complex Needs, Complex Challenges: a report on research into the experiences of

Long-term antibiotics for preventing recurrent urinary tract infection in children

NHS at home: children's community nursing services

Items in the Mental Health sections may also be of interest.

The functions of GP commissioning consortia: a working document

Including migrant populations in joint strategic needs assessment (JSNA)

NHS Outcomes Framework: Innovation in Outcomes competition

Practice-based commissioning: budget guidance for 2011/12 - Methodological changes

The European Dementia Research Agenda

Mapping the dementia gap

Patients' experiences of the First-tier Tribunal (Mental Health)

Comparative cardiovascular effects of thiazolidinediones: systematic review and meta-

Diabetes with Kidney Disease: Key Facts

DiabetesE Sixth National Report

Erectile Dysfunction: Factsheet

Eyes and Vision

Efficacy of Biological Therapies in Inflammatory Bowel Disease: Systematic Review and

Effect of laxatives and pharmacological therapies in chronic idiopathic constipation:

Improving the quality of care in general practice

Items in the Commissioning section may also be of interest.

Psychosis with coexisting substance misuse

NICE Technology Appraisals

NICE Consultation Documents

Clinical Knowledge Summaries updated in March 2010

• Antenatal care - uncomplicated pregnancy (new)

• Boils, carbuncles, and staphylococcal carriage

• Chest pain (new)

• Contraception - barrier methods and spermicides

• Contraception - combined hormonal methods

• Contraception - natural family planning

• Contraception - progestogen-only methods

• Knee pain - assessment (new)

• Melanoma and pigmented lesions (new)

• Meningitis (bacterial)/meningococcal septicaemia (new)

• Osteoporosis - prevention of fragility fractures (new)

• Otitis media with effusion

• Whitlow (staphylococcal and herpetic

Management of atopic eczema in primary care

Management of adult testicular germ cell tumours

Management of patients with stroke: rehabilitation, prevention and management of

Other Health Technology Assessments

NIHR Health Technology Assessment programme

Systematic review of the clinical effectiveness and cost-effectiveness of rapid point-of-

Pandemic Flu - National Planning Assumptions Assessments Tool

Review of the evidence base underpinning the UK influenza pandemic preparedness

UK influenza pandemic preparedness strategy 2011: strategy for consultation

The misdiagnosis of epilepsy in people with intellectual disabilities: A systematic review

Long Term Conditions

Gabapentin for chronic neuropathic pain and fibromyalgia in adults

Responding to a proposal for merger or reconfiguration of Maternity Services Provision in

An item in the Influenza section may also be of interest.