NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin for NHS Primary Care in North Staffordshire

Issue No: 60 January 2012

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/healthlibrary/usingthehealthlibrary/interlibraryloans/#d.en.27437 [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 checked in the production of this bulletin is 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 679500 Fax: 01782 679582 E-mail: health.library@keele.ac.uk

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Sources for Clinical Effectiveness Bulletin Please suggest further sites that should be monitored in the production of this bulletin Websites Cochrane Library http://www.thecochranelibrary.com/ 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 Health Technology Assessment (HTA) Database http://www.hta.ac.uk Daily Health Bulletin http://www.sheffield.nhs.uk/healthbulletin/ Department of Health http://www.dh.gov.uk/en/index.htm Kings Fund http://www.kingsfund.org.uk/ NeLM (National Electronic Library for Medicines) news bulletin http://www.nelm.nhs.uk/en/ NICE http://www.nice.org.uk/ SIGN http://www.sign.ac.uk/new.html

NHS Library and Information Service North Staffordshire Contents in this issue:
Alcohol ...................................................................................................................................... 4 Breast implants ......................................................................................................................... 4 Cancer ...................................................................................................................................... 4 Cardiovascular Disease ............................................................................................................ 5 Commissioning ......................................................................................................................... 6 Children and Young People ...................................................................................................... 7 COPD ....................................................................................................................................... 7 Diabetes.................................................................................................................................... 7 General Practice ....................................................................................................................... 8 Genomics.................................................................................................................................. 8 Guidance .................................................................................................................................. 9 Health Reforms ....................................................................................................................... 11 Kidney Disease ....................................................................................................................... 12 Maternal and Infant Health...................................................................................................... 12 Mental Health.......................................................................................................................... 13 Multiple Sclerosis .................................................................................................................... 14 Nursing and Midwifery ............................................................................................................ 14 Nutrition .................................................................................................................................. 15 Obesity.................................................................................................................................... 15 Older People ........................................................................................................................... 15 Oral Health.............................................................................................................................. 15 Patient Care and Safety .......................................................................................................... 16 Pharmacy and Prescribing ...................................................................................................... 16 Public Health ........................................................................................................................... 17 Safeguarding Children and Vulnerable Adults ........................................................................ 19 Service Management .............................................................................................................. 19 Sexual Health ......................................................................................................................... 22 Telehealth ............................................................................................................................... 22 Tobacco .................................................................................................................................. 22 Urgent Care ............................................................................................................................ 22 Vaccination ............................................................................................................................. 23 Workforce ............................................................................................................................... 23

NHS Library and Information Service North Staffordshire Alcohol

Alcohol Guidelines House of Commons. Science and Technology Committee The report concludes that a thorough review of the evidence concerning alcohol and health risks is due. In the meantime, it says the evidence suggests that the public should be advised to take at least two alcohol-free days a week; and the sensible drinking limits should not be increased. http://www.publications.parliament.uk/pa/cm201012/cmselect/cmsctech/1536/153602.htm Alcohol-related deaths in the United Kingdom, 2010 Office for National Statistics http://www.ons.gov.uk/ons/rel/subnational-health4/alcohol-related-deaths-in-the-unitedkingdom/2010/index.html
Items in the Sexual Health section may also be of interest. [back to topics]

Breast implants
Poly Implant Prostheses (Pip) Breast Implants: Interim Report of the Expert Group Department of Health This report reviews the available data on the health risks from PIP implants and makes recommendations for treatment of women who have received these implants. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132110 Poly Implant Prothse (PIP) breast implants: Joint surgical statement on clinical guidance for patients, GPs and surgeons Association of Breast Surgery, British Association of Plastic and Reconstructive Aesthetic Surgeons, British Association of Aesthetic Plastic Surgeons, Federation of Surgical Speciality Associations and Royal College of Surgeons This guidance outlines appropriate treatment and referral pathways for women who have had PIP implants, and signs and symptoms to look out for when examining patients with the implants. http://www.rcseng.ac.uk/publications/docs/pip-statement/
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Cancer
Equity and Excellence for Bowel Cancer Beating Bowel Cancer This report sets out recommendations for how the reforms for health and social care can best be applied to improving outcomes from bowel cancer and how the risks posed by this transition can best be managed. http://www.beatingbowelcancer.org/equity-and-excellence-bowel-cancer 4

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Hospital-level briefings on applications to the Cancer Drugs Fund Rarer Cancers Foundation The briefings include information on the number of applications to the Fund between 1 September and 30 November 2011, as well as a breakdown of cancer treatments requested where data has been provided. University Hospital of North Staffordshire is included. http://www.rarercancers.org/index.php?option=com_content&view=article&id=238:cdfhospital-level-briefings-on-applications-to-the-cdf&catid=43:england-news&Itemid=5 More than a million: understanding the UKs carers of people with cancer Ipsos Mori for Macmillan Cancer Support This report contains the findings of research conducted among people in the UK who provide informal unpaid help and support for someone with cancer. It looks at what carers do, the impact on their lives of caring, and the support available to them. http://www.macmillan.org.uk/Documents/Cancerinfo/Ifsomeoneelsehascancer/More_than_a_ million.pdf
Items in the General Practice section may also be of interest. [back to topics]

Cardiovascular Disease
After the event: getting care right for patients after a heart attack Heart UK This report looks at regional variations in cardiac rehabilitation services, and makes recommendations for improvement, particularly to improve take-up of services. http://www.heartuk.org.uk/pressroom/index.php?/news/heart_uk_cardiac_rehabilitation_report Dabigatran Association With Higher Risk of Acute Coronary Events: Meta-analysis of Noninferiority Randomized Controlled Trials Uchino, K et al. The authors concluded that dabigatran is associated with an increased risk of MI or ACS in a broad spectrum of patients when tested against different controls. Clinicians should consider the potential of these serious harmful cardiovascular effects with use of dabigatran. Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.1666 Effect of Aspirin on Vascular and Nonvascular Outcomes: Meta-analysis of Randomized Controlled Trials Seshasai, S et al. The authors conclude that despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis. Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.628

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The effect of combination treatment with aliskiren and blockers of the reninangiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis Harel, Z et al. The authors conclude that use of aliskiren in combination with angiotensin converting enzyme inhibitors or angiotensin receptor blockers is associated with an increased risk for hyperkalaemia. Combined use of these agents warrants careful monitoring of serum potassium levels. BMJ 2012; 344:e42 doi: 10.1136/bmj.e42 (Published 9 January 2012) Guide for commissioning a quality heart failure service NHS Improvement This guide aims to demonstrate what good heart failure services looks like, to help improve and standardise care nationally, where service provision and resources vary. http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fHeart%20failure%20website%2fSLCSN_heart_failure_commissioni ng_guide.pdf
Items in the General Practice section may also be of interest. [back to topics]

Commissioning
Analytical tools to support commissioners NHS Primary Care Commissioning This updated summary of information sources and analytical tools to support planning and decision making briefly describes each resource and how it is used. Links are included. http://www.pcc.nhs.uk/uploads/tools_to_support_commissioners.pdf CCG case studies: patient and public engagement Department of Health These case studies share lessons learned from projects on increasing community involvement. Two focus on social media and technology and two look at citizens juries. http://healthandcare.dh.gov.uk/ppe_case_studies/ Specialists in Commissioning: Looking beyond current policy NHS Alliance This paper discusses GPs and specialists views on current policy on specialists in Clinical Commissioning Groups. It calls for policy to be more flexible to allow both groups to develop positive relationships to enable integrated care across primary-secondary care boundaries. http://www.nhsalliance.org/fileadmin/files/pdf/SPECIALISTSINCOMMISSIONINGJanuary2012 _kl3.pdf
Items in the Cardiovascular Diseases, Health Reforms, Mental Health, Service Management and Urgent Care sections may also be of interest. [back to topics]

NHS Library and Information Service North Staffordshire Children and Young People
Items in the Nutrition and Vaccination section may also be of interest. [back to topics]

COPD
National audit of supported discharge programmes for management of acute exacerbations of chronic obstructive pulmonary disease 2008 Kastelik, JA et al. This audit examined the use of supported discharge programmes (SDPs) in clinical practice against British Thoracic Society guidelines. The authors concluded that SDPs within the UK are safe and effective and reduce length of hospital stay without adverse effects on mortality. Thorax, 16 January 2011. doi:10.1136/thoraxjnl-2011-200884
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Diabetes
Care Planning and Diabetes NHS Diabetes This document includes a brief summary introduction, followed by a short collection of latest key policy papers, national body statements, clinical or care guidelines and the latest key research and evaluation papers. http://www.diabetes.nhs.uk/document.php?o=3188 Executive Summary: http://www.diabetes.nhs.uk/document.php?o=3189 DiabetesE Seventh National Report NHS Diabetes This Executive Summary provides a snapshot of the quality of diabetes services in England. It is based on data from the PCT and specialist diabetes provider questionnaires, captured on 17th December 2011. http://www.diabetes.nhs.uk/news_and_events/diabetese_seventh_national_report/ Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin Malanda, UL et al. The authors of this Cochrane Review concluded that when diabetes duration is over one year, the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months. Furthermore, based on a best-evidence synthesis, there is no evidence that SMBG affects patient satisfaction, general well-being or general health-related quality of life. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005060.pub3/abstract
Items in the Obesity section may also be of interest. [back to topics]

NHS Library and Information Service North Staffordshire General Practice

Choice of GP practice: guidance for PCTs Department of Health This guidance sets out the action PCT clusters need to take to ensure that patients who register with a GP practice away from home, as part of the forthcoming GP choice pilots, are able to receive home visits, and to access other urgent care and community health services. It also sets out the action needed to establish outer practice boundary areas for all GP practices, arrangements to simplify the system of open and closed lists; and best practice on providing information to support informed choice of GP practice. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132386 How GPs can prepare for Be Clear on Cancer Department of Health This short factsheet looks at how the campaign will affect GPs and how they can support the campaign. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132047 Top tips for GPs: Heart Failure NHS Improvement These postcards summarise key points. Diagnosis http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fHeart%20failure%20website%2fTop_Tip1.pdf Up-titration of drugs in heart failure http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fHeart%20failure%20website%2fTop_Tip2.pdf Managing heart failure patients http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fHeart%20failure%20website%2fTop_Tip3.pdf A crash course in heart failure with preservec ejection fraction http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fHeart%20failure%20website%2fTop_Tip4.pdf
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Genomics
Building on our inheritance: Genomic technology in healthcare Department of Health This report sets out a strategic vision for how the healthcare system in the UK and particularly in the NHS can benefit from the mainstream adoption of genomic technology. It also provides specific recommendations on the steps to be taken to realise this vision. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132369 8

NHS Library and Information Service North Staffordshire Guidance

NICE Clinical Guidelines The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care CG137 http://guidance.nice.org.uk/CG137 NICE Technology Appraisals Cetuximab (monotherapy or combination chemotherapy), bevacizumab (in combination with non-oxaliplatin chemotherapy) and panitumumab (monotherapy) for the treatment of metastatic colorectal cancer after first-line chemotherapy TA242 http://guidance.nice.org.uk/TA242 Dasatinib, high-dose imatinib and nilotinib for the treatment of imatinib-resistant chronic myeloid leukaemia (CML) and dasatinib and nilotinib for people with CML for whom treatment with imatinib has failed because of intolerance TA241 http://guidance.nice.org.uk/TA241 Rituximab for the first-line treatment of stage III-IV follicular lymphoma TA243 http://guidance.nice.org.uk/TA243 Roflumilast for the management of severe chronic obstructive pulmonary disease TA244 http://guidance.nice.org.uk/TA244
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NICE Consultation Documents Overweight and obese adults - lifestyle weight management: consultation on the draft scope To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 14 February 2012 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=57859 Overweight and obese children and young people - lifestyle weight management services: consultation on the draft scope To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 14 February 2012 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=57862

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BMI and waist circumference - black and minority ethnic groups: consultation on the draft scope To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 20 February 2012 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=57967 Consultation on Commissioning Outcomes Framework indicators Closing date for comments: 29 February 2012 http://www.nice.org.uk/aboutnice/cof/ConsultationOnCOFIndicators.jsp Prostate cancer (metastatic, castration resistant) - abiraterone (following cytoxic therapy): appraisal consultation Closing date for comments: 23 February 2012 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=58013 Gene expression profiling and expanded immunohistochemistry tests to guide selection of chemotherapy regimes in breast cancer management - MammaPrint, Oncotype DX, IHC4 and Mammostrat: diagnostics consultation Closing date for comments: 24 February 2012 http://guidance.nice.org.uk/DT/4/Consultation/DraftGuidance
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Other Health Technology Assessments The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation Pavey, T et al. This review found weak evidence to support the effectiveness and cost-effectiveness of exercise referral schemes in either people with a medical diagnosis or in those who are sedentary and without a medical diagnosis. Health Technol Assess 2012:15(44) A 1-year follow-on study from a randomised, head-to-head, multicentre, open-label study of two pandemic influenza vaccines in children De Whalley, P et al. The authors concluded that one year after immunisation, children receiving two doses of the routinely recommended, adjuvanted pandemic influenza vaccine had higher antibody levels than those receiving the alternative, egg-free vaccine; both groups produced a marked serological response to the H1N1 component of the 2010/11 seasonal influenza vaccine. Health Technol Assess 20120:15(45)
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NHS Library and Information Service North Staffordshire Health Reforms

Building the NHS Trust Development Authority Department of Health This document explains the purpose of the NTDA, its process, its people and its relationships with other parts of the NHS. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131776 Consultation on the regulations for Healthwatch England membership Department of Health This consultation asks about the number of members of HealthWatch England, suitability for membership; and the process for appointing members. Closing date for comments: 2 March http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132416 Design of the NHS Commissioning Board NHS Commissioning Board This paper presents recommendations for the organisational design of the NHS CB. It includes the context for the design process; details of how the Board will operate through a matrix working approach; and detailed recommendations on the design of each of the Boards directorates, including the Sectors and Local Offices. https://www.wp.dh.gov.uk/commissioningboard/files/2012/01/NHSCBA-02-2012-5Organisational-Design-Recommendations-Final.pdf Destabilising our healthcare: how private companies could threaten the ethics and efficiency of the NHS NHS Support Federation This report looks at the impact commercial providers might have on the NHS and its patients. http://www.nhscampaign.org/NHS-reforms/companies-run-hospitals.html Framework agreement for NHS Commissioning Board Authority Department of Health The agreement covers roles and responsibilities and lines of accountability, and describes how the Department and the Authority will work together. http://www.dh.gov.uk/health/2012/01/cb-framework/ JSNAs and joint health and wellbeing strategies: draft guidance Department of Health This guidance lays out a best practice framework, and the statutory duties underpinning the production of JSNAs and joint health and wellbeing strategies. It explains how JSNAs, joint health and wellbeing strategies and commissioning plans fit together in the new system, and sets out how they will make real improvements to the health and wellbeing of local people. Closing date for comments: 17 February http://healthandcare.dh.gov.uk/draft-guidance/

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Report of the commission on competition in the NHS Office of Health Economics This report recommends careful expansion of competition between providers of NHS-funded health care in England. http://news.ohe.org/2012/01/31/new-report-competition-can-help-the-nhs-%e2%80%93-butproceed-with-care/ Were massive reforms necessary to save the NHS? Inquiry into the NHS Health Reforms All Party Parliamentary Group on Primary Care & Public Health This report argues that finds there was no real need for a wholesale restructuring of the NHS in order to make the system more efficient. It makes a number of recommendations about the current health reforms, particularly related to CCGs, and engaging with patients. http://www.pagb.co.uk/appg/inquiry.html Why the RCN is opposing the Health and Social Care Bill RCN http://www.rcn.org.uk/__data/assets/pdf_file/0003/426909/Why_the_RCN_is_opposing_the_ Health_and_Social_Care_Bill.pdf
Items in the Commissioning, Public Health, Service Management and Workforce sections may also be of interest. [back to topics]

Kidney Disease
Chronic Kidney Disease Resource Pack NHS Kidney Care This Pack contains resources to support management of CKD in the community. http://www.kidneycare.nhs.uk/_Ourworkprogrammes-Prevention-Toolstohelpyou.aspx Parenteral versus oral iron therapy for adults and children with chronic kidney disease Albaramki, J et al. The authors of this Cochrane Review concluded that there is strong evidence for increased ferritin and transferrin saturation levels, together with a small increase in haemoglobin, in patients with CKD who were treated with IV iron compared with oral iron. From a limited body of evidence, they identified a significant reduction in ESA requirements in patients treated with IV iron, and found no significant difference in mortality. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007857.pub2/abstract
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Maternal and Infant Health

Interventions for helping to turn term breech babies to head first presentation when using external cephalic version (ECV) Cluver, C et al. The authors of this Cochrane Review concluded that betastimulants, to facilitate ECV, increased cephalic presentation in labour and birth, and reduced the caesarean section rate 12

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in both nulliparous and multiparous women, but there were insufficient data on adverse effects. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000184.pub3/abstract Preventing Babies Deaths: what needs to be done SANDS This report looks at the numbers of babies who are stillborn or who die shortly after birth in the UK, and makes recommendations for public health, patient care, staffing and research. http://www.uksands.org/fileadmin/content/Media/PREVENTING_BABIES_DEATHS_REPORT_2012LR02.p df
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Mental Health
Consultation on low secure services and psychiatric intensive care Department of Health This consultation is to invite stakeholders views on how new guidance will operate. Closing date for comments: 19 April. http://www.dh.gov.uk/health/2012/01/consultation-on-low-secure-services-and-psychiatricintensive-care/ Defining mental health services: promoting effective commissioning and supporting QIPP NHS Confederation In mental health there has not been a consistent set of definitions that describe what is meant by an inpatient bed. This has led to difficulty in benchmarking and understanding patterns of performance. This report seeks to address those variations of understanding by suggesting a range of definitions that can be used by commissioners and service providers. http://www.nhsconfed.org/Publications/reports/Pages/Defining-mental-health-servicesQIPP.aspx Estimating the Prevalence of Autism Spectrum Conditions in Adults: Extending the 2007 Adult Psychiatric Morbidity Survey NHS Information Centre This prevalence estimate was derived using data from the 2007 Adult Psychiatric Morbidity Survey (APMS 2007) in combination with data from a new study of the prevalence of autism among adults with learning disabilities, who could not take part in the APMS 2007. http://www.ic.nhs.uk/pubs/autism11 The Mental Health Strategy, system reforms and spending pressures: what do we know so far? Centre for Mental Health This paper examines how delivery of No Health without Mental Health is being influenced by pressures on public spending and the reforms in health and other public services. http://www.centreformentalhealth.org.uk/publications/summit_paper.aspx?ID=638

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Getting it together for mental health care: Payment by Results, personalisation and whole system working National Development Team for Inclusion This paper considers how the two policy initiatives of Payment by Results (PbR) and personalisation need to be developed in tandem with one another, and in the context of whole system commissioning, if the aims of both are to be achieved. It raises questions for discussion about whether personalisation and PbR can meet the challenge of a more radical whole system approach and what impact success or failure will have on mental health services and outcomes for individuals. It concludes with specific issues that need to be considered nationally and locally. http://www.ndti.org.uk/who-were-concerned-with/mental-health/payment-by-results-andpersonalisation-in-mental-health-services/
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Multiple Sclerosis
Interferon beta for secondary progressive multiple sclerosis (SPMS) La Mantia, L et al. The authors of this Cochrane Review concluded that recombinant interferon (IFN) beta does not prevent the development of permanent physical disability in SPMS. This treatment significantly reduces the risk of relapse and of short -term relapse-related disability. Overall, these results show that IFNs' anti-inflammatory effect is unable to retard progression, when established. The authors believe this review gives conclusive evidence on the clinical efficacy of IFNs versus placebo in SPMS. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005181.pub3/abstract
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Nursing and Midwifery

Lone working survey 2011 RCN This survey of 766 RCN members looks at lone workers perceptions of safety and employer help and support with the challenges they face. It makes recommendations for improving lone nurses and midwives safety. http://www.rcn.org.uk/__data/assets/pdf_file/0007/424096/RCN_lone_working_survey_2011.p df Supervision, support and safety: quality assurance of the LSAs 2010-2011 NMC This report contains the analysis of the annual report received from local supervising authorities (LSA) in the UK. The LSA reports identified examples of good practice in supervision, with some key challenges. The key recommendations for the LSAs will be monitored during 2011-2012 through quarterly submissions to the NMC midwifery advisers. http://www.nmc-uk.org/Press-and-media/Latest-news/Supervision-support-and-safety-NMCquality-assurance-of-the-LSAs-2010-2011/
Items in the Patient Care and Safety section may also be if interest.

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NHS Library and Information Service North Staffordshire Nutrition

Claims about gluten in food Food Standards Agency This guidance aims to help industry and enforcement authorities understand the new rules and encourage the provision of information for coeliacs. It includes guidance for consumers and also for caterers. http://www.food.gov.uk/safereating/allergyintol/label/gluten/ Voluntary Food and Drink Guidelines for Early Years Settings in England: A Practical Guide School Food Trust This guide has been developed to help early years providers and practitioners meet the Early Years Foundation Stage (EYFS) welfare requirement for the provision of healthy, balanced and nutritious food and drink. http://www.schoolfoodtrust.org.uk/parents-carers/for-parents-carers/eat-better-startbetter/voluntary-food-and-drink-guidelines-for-early-years-settings-in-england-a-practicalguide

Obesity
Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials Vilsboll, T et al. The authors concluded that treatment with GLP-1R agonists leads to weight loss in overweight or obese patients with or without type 2 diabetes mellitus. BMJ 2012; 344:d771 doi: 10.1136/bmj.d7771 (Published 11 January 2012)
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Older People
Oral healthcare for Older People 2020 Vision: Check-up January 2012 British Dental Association This short report provides a check-up on 21 recommendations made by BDA in 2003, and updates demographic information and recommendations for how commissioners and social care services can ensure that the oral health needs of their patients are met. http://www.bda.org/dentists/policy-campaigns/research/patient-care/older-people.aspx

Oral Health
Items in the Older People section may be of interest.

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NHS Library and Information Service North Staffordshire Patient Care and Safety
The 'never events' list for 2012/13 Department of Health The list has been updated with minor amendments to two of the never event definitions. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132355 Putting quality into the Care Quality Commission RCN This report details the findings from a recent survey of more than 5,000 RCN members on the health care regulator, the Care Quality Commission (CQC). It found that although nurses support the CQC and welcome the improvements it has made, there is more work to do to fully understand issues such as staffing levels and skill mix when undertaking assessments. http://www.rcn.org.uk/__data/assets/pdf_file/0004/426478/004208.pdf Raising and acting on concerns about patient safety GMC The guidance gives advice on raising a concern that patients might be at risk of serious harm, and on the help and support available to doctors. It also explains doctors responsibilities when colleagues or others raise concerns with them and how to handle those concerns. http://www.gmc-uk.org/guidance/ethical_guidance/raisingconcerns.asp
Items in the Commissioning and Health Reforms section may also be of interest. [back to topics]

Pharmacy and Prescribing

Lithium toxicity profile: systematic review and meta-analysis McKnight, RF et al. The authors concluded that lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment. The Lancet, Early Online Publication, 20 January 2012. doi:10.1016/S0140-6736(11)61516-X Medicines Use Review Suggested Questions Pharmaceutical Services Negotiating Committee These questions aim to help shape pharmacists discussions with patients during MUR consultations. http://www.psnc.org.uk/data/files/PharmacyContract/Contract_changes_2011/Medicines_Use _Review_Exemplar_Interview_Schedule_Jan_2012.pdf

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New Medicine Service (NMS) and Medicines Use Reviews (MURs) Pharmaceutical Services Negotiating Committee Guidance on the Medicines Use Review service This guidance is aimed at commissioners of community pharmacy, as well as pharmacy contractors and individual pharmacists who deliver the service. http://www.psnc.org.uk/data/files/PharmacyContract/Contract_changes_2011/Guidance_on_t he_Medicines_Use_Review_service_Jan_2012_final.pdf Working with hospital colleagues to support patients discharged from hospital: guidance for community pharmacists. http://www.psnc.org.uk/data/files/PharmacyContract/Contract_changes_2011/Postdischarge_guidance_for_community_pharmacists_January_2012.pdf Community pharmacy services: Guidance for hospitals http://www.psnc.org.uk/data/files/PharmacyContract/Contract_changes_2011/Community_ph armacy_services_-_guidance_for_hospitals_January_2012.pdf Related documents are available at http://www.psnc.org.uk/news.php/1218/guidance_on_post_discharge_nmsmur_published
[back to topics]

Public Health
Campaign Resource Centre Department of Health This website is a one-stop shop for all Department of Health public health campaigns. From keeping up to date with the latest campaign news, to the leaflets, posters, ads and toolkits available to support the campaigns, the CRC gives access to all the public health information and resources you need. http://campaigns.dh.gov.uk/category/home/ Health economic assessment tools (HEAT) for walking and for cycling. Methodology and user guide. Economic assessment of transport infrastructure and policies World Health Organisation. Regional Office for Europe. The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment. This booklet summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it. http://www.euro.who.int/en/what-we-publish/abstracts/health-economic-assessment-toolsheat-for-walking-and-for-cycling.-methodology-and-user-guide Healthy lives, healthy people: Improving outcomes and supporting transparency Department of Health This Public Health Outcomes Framework sets out the desired outcomes for public health and how these will be measured. Part 1 introduces the overarching vision for public health, the outcomes to be achieved and the indicators that will assist with understanding how well health is being improved and protected. Part 2 specifies the current technical details for each public

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health indicator and indicates where further work will be conducted to fully specify all indicators. Part 3 consists of the impact assessment and equalities impact assessment. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132358 Lifestyles Surveys: Consultation Review NHS Information Centre The Lifestyles Surveys are: Health Survey for England Health, Lifestyles and Social Care Smoking, Drinking and Drug Use Among Young People in England Infant Feeding Survey The findings provide an insight into the health and behaviour of people in England over time. This consultation aims to develop a more complete understanding of the use made of this data; ensure the surveys are relevant and meaningful to users needs; and to seek the views of users on the content and format of the publications. Closing date for comments: 23 March http://www.ic.nhs.uk/work-with-us/consultations/lifestyles-surveys-consultation-review Mortality in the United Kingdom, 2010 Office for National Statistics This summary provides an update of mortality within the UK and its constituent countries over the last 30 years. It describes current and past age-standardised mortality rates, along with the percentage distributions of all deaths by age in the UK. http://www.ons.gov.uk/ons/rel/mortality-ageing/mortality-in-the-united-kingdom/mortality-inthe-united-kingdom--2010/mortality-in-the-uk-2010.html New public health system Department of Health A series of factsheets on the new system is available, including a summary factsheet and more detailed information on Public Health in Local Government; Public Health Englands Operating Model; and Workforce and the new Public Health system. http://healthandcare.dh.gov.uk/public-health-system/ Public health transition planning support for primary care trusts and local authorities Department of Health This guide aims to help primary care trusts (PCTs) and local authorities as they develop transition plans for the transformation of the local public health system, including how transfer of accountability from the NHS to local government will be enacted during the transition year. It also aims to help SHAs and the NHS Commissioning Board. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132178 Public health workforce issues: Local government transition guidance Local Government Association http://www.dh.gov.uk/health/2012/01/public-health-workforce/

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Suicides in the United Kingdom, 2010 Office for National Statistics http://www.ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-unitedkingdom/2010/index.html
Items in the Cancer section may also be of interest. [back to topics]

Safeguarding Children and Vulnerable Adults

Childrens Safeguarding Performance Information Consultation Department for Education This consultation asks for views on the proposed children's safeguarding national performance information dataset, how the data is published and how the locally held information (published December 2011) is used. Closing date for comments: 16 April http://www.education.gov.uk/consultations/index.cfm?action=consultationDetails&consultation Id=1803&external=no&menu=1 Framework for the inspection of local authority arrangements for the protection of children Ofsted This document outlines the framework for the inspection of local authority arrangements to protect children, including the effectiveness of early identification and help for children, young people, their families and carers. Framework and related documents: http://www.ofsted.gov.uk/resources/framework-forinspection-of-local-authority-arrangements-for-protection-of-children Good practice resource - Non-executive scrutiny panel: Southend Safeguarding Children Board Ofsted This case study describes how the panel was set up and the impact it has had. http://www.ofsted.gov.uk/resources/good-practice-resource-non-executive-scrutiny-panelsouthend-safeguarding-children-board
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Service Management
Board governance assurance framework for aspirant foundation trusts: Development Modules Department of Health Modules are available on Financial governance, Organisational strategy and values, and Quality governance. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131547

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Can NHS hospitals do more with less? Nuffield Trust The report identifies the key determinants of technical efficiency in hospitals, which include: leadership, management and staff engagement; technology adoption; hospital operational processes; staff productivity; and the external policy environment. It also looks at the possible impact of Equity and excellence: liberating the NHS on the efficiency agenda. http://www.nuffieldtrust.org.uk/publications/can-nhs-hospitals-do-more-less Defining Risk Appetite and Managing Risk by Clinical Commissioning Groups and NHS Trusts Good Governance Institute This briefing includes a high-level outline of risk and risk appetite, and is accompanied by a matrix, by which boards can develop their own generic risk appetite and which can also be applied to specific risk. It also looks at how existing risk management systems including risk registers and Board Assurance Frameworks can be refreshed and made relevant to board agendas and decision taking. A case study scenario is also included. http://www.good-governance.org.uk/services/risk-appetite.htm Delivering sustainable cost improvement programmes Audit Commission This briefing summarises how successful organisations approach the delivery of cost improvement programmes. Supporting questions are included to enable organisations to review their own performance and identify areas for improvement. http://www.audit-commission.gov.uk/health/nationalstudies/financialmanagement/Pages/ACmonitor-CIPS-20120118.aspx Good governance handbook Good Governance Institute and Healthcare Quality Improvement Partnership This handbook identifies nine foundation principles of good governance, relevant to new and emerging organisations in healthcare, and to working through partnership and hosting arrangements. This report explains how to apply these within health and social care. http://ggi.multi3.sitekit.net/Product%20Menus/good-governance-guide.htm Integrated care for patients and populations: Improving outcomes by working together: A report to the Department of Health and the NHS Future Forum Kings Fund This report examines: the case for integrated care; what current barriers to integrated care need to be overcome and how; what the Department of Health can do to enable integrated care to flourish; and options for practical and technical support to those implementing integrated care. It asserts that developing integrated care should assume the same priority over the next decade as reducing waiting times had during the last. http://www.kingsfund.org.uk/publications/future_forum_report.html

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NHS Costing Manual Department of Health This Manual sets out mandatory and minimum principles and practices that must be applied to costing in the NHS. They are designed to support the calculation of reference costs, and through these, the national tariff, but can also be applied to other costing models. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132395 Related document: Reference costs guidance for 2011-12 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132390 The NHS Mobile Working Knowledge Centre NHS Connecting for Health The Department of Health Informatics Directorate (DHID) has developed an online resource to support mobile working programmes in the NHS. Primarily focused on community services, the Knowledge Centre presents good practice guidance, tools and case studies on the implementation of mobile working. www.connectingforhealth.nhs.uk/mobileworking Public Expenditure: thirteenth report of session House of Commons Health Select Committee This report examined the plans being made by NHS bodies to enable them to meet efficiency targets, and whether the NHS is succeeding in making efficiency gains rather than cuts. It also investigates the cost of the continuing reorganisation of NHS structures, progress on making efficiencies through the integration of health and social care services, and progress on changing the tariff structure. The role of local authorities, and the impact on the provision of adult social care of the 2010 Spending Review settlement, is also considered. http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1499/149902.htm Service-line management: can it improve quality and efficiency? Kings Fund This paper presents the findings from a series of interviews with staff at seven NHS trusts that are using Service Line Management or Service Line Reporting, showing how they are implementing this approach and identifying what helps and what hinders this way of working. http://www.kingsfund.org.uk/publications/slm_paper.html Standards for members of NHS boards and governing bodies in England: Draft for consultation Council for Healthcare Regulatory Excellence The Standards cover three domains: technical competence and ability to carry out the job; personal behaviours and accountability; and business practices including financial probity. Closing date for comments: 10 April 2012 http://www.chre.org.uk/satellite/413/
Items in the Mental Health and Workforce sections may also be of interest. [back to topics]

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NHS Library and Information Service North Staffordshire Sexual Health

Alcohol and sex: a cocktail for poor sexual health Royal College of Physicians. Alcohol and Sexual Health Working Party. This report highlights links between alcohol consumption and poor sexual health outcomes. It makes recommendations for population level initiatives, sexual health services, commissioning, training and research. http://www.bashh.org/documents/4075
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Telehealth
What can the NHS learn from experience at the US Veterans Health Administration? 2020health This paper explores lessons learnt at the world's largest user of telehealth services: the US Veterans Health Administration (VHA). The VHA aims to support patients with long term conditions through care at a distance and self-management skills. This has led to significant reduction in acute care facilities and the commensurate expansion of outpatient clinics. http://www.2020health.org/2020health/Publication/NHSit/Telehealth.html
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Tobacco
Local Tobacco Control Profiles for England London Health Observatory These profiles provide a snapshot of the extent of tobacco use, tobacco related harm, and measures being taken to reduce this harm at a local level. The indicators relating to quitting smoking have been revised to reflect quitting as a proportion of the smoking population, rather than the total population. Also new in the final version is data on: the cost per capita of smoking attributable hospital admissions in 2009/10, smoking prevalence overall (until March 2011) and smoking prevalence in the routine and manual group (until December 2011), successful quitters at 4 weeks and successful quitters (CO validated) at 4 weeks in 2010/11; and completeness of socioeconomic (NS-SEC) recording by Stop Smoking Services in 2010/11. http://www.lho.org.uk/lho_topics/analytic_tools/tobaccocontrolprofiles.aspx
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Urgent Care
NHS 111: getting lost in translation? NHS Alliance This paper draws on a survey of NHS Alliance members, which explored a general sense of concern expressed amongst new clinical commissioners about the national specification and 22

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roll out of the NHS 111 programme and, in particular, the lack of engagement with Clinical Commissioning Groups (CCGs). http://www.nhsalliance.org/fileadmin/files/pdf/NHS111-gettinglostintranslationFINAL.pdf
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Vaccination
Statement on the use of meningococcal C vaccines in the routine childhood immunisation programme Joint Committee on Vaccination and Immunisation http://www.dh.gov.uk/ab/JCVI/DH_094744
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Workforce
The benefits of consultantdelivered care Academy of Medical Royal Colleges This report examines the evidence for medical care being delivered by consultants. The context for this project is a climate in which it is increasingly asserted that the NHS cannot afford to have the number of consultants that current training numbers will deliver. The focus of the report is on the quality, outcomes and productivity of consultant- delivered care. http://aomrc.org.uk/component/docman/doc_download/9450-the-benefits-of-consultantdelivered-care.html Guidance on meeting the specific duty: publishing information to demonstrate compliance NHS Employers This guidance includes examples of the types of evidence that can be used to demonstrate compliance with the public sector equality duty and the need to eliminate harassment, advance equal opportunities and foster good relations between people with different protected characteristics. http://www.nhsemployers.org/EmploymentPolicyAndPractice/EqualityAndDiversity/atest-eand-d-news/Pages/Publishingequalityinformation-newguidance.aspx Guidance on the equality duty Equality and Human Rights Commission These guides have been updated to reflect the final version of the specific duty regulations. They provide an overview of the equality duty, including the general equality duty, the specific duties and who they apply to. They cover what public authorities should do to meet the duty. This includes steps that are legally required, as well as recommended actions. http://www.equalityhumanrights.com/advice-and-guidance/public-sector-equalityduty/guidance-on-the-equality-duty/ Implementing the Equality Act 2010: interim guidance for the NHS NHS Employers This guidance signposts the best advice and answers the three most popular questions that NHS Employers have been asked in relation to employer responsibilities: 23

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What does my organisation need to do in order to meet the requirements of the public sector Equality Duty of the Equality Act 2010? What does my organisation need to do by 31 January 2012? What does my organisation need to do by 6 April 2012? http://www.nhsemployers.org/SiteCollectionDocuments/Equality%20Act%202010%20interim %20guidance.pdf Leadership and management for all doctors GMC This guidance covers responsibilities relating to employment issues; teaching and training; planning, using and managing resources; raising and acting on concerns; and helping to develop and improve services. http://www.gmc-uk.org/guidance/ethical_guidance/11758.asp Liberating the NHS: Developing the Healthcare workforce - From Design to Delivery Department of Health This document sets out the policy framework for a new approach to workforce planning and the education and training of the health and public health workforce. It builds on the responses to earlier public consultation and the advice of the NHS Future Forum. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132076 The Management Code of Conduct The Institute of Healthcare Management The code aims to build and sustain workplaces with a positive work culture assured by a high quality of management in health and social care. https://www.ihm.org.uk/About_Us/code_of_conduct/ NHS Pension Scheme increased contributions calculator for 2012-13 employee contributions Department of Health The employee contributions calculator enables NHS Pension Scheme members to calculate how much their contributions will increase, if at all, on a monthly basis on both a gross and net of tax relief basis. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_132287 Recognising and Approving Trainers: a consultation GMC The consultation is on proposed new arrangements for recognition and approval of trainers. Closing date for comments: 30 March https://gmc.e-consultation.net/econsult/consultation_Dtl.aspx?consult_Id=230&status=2 Review of NHS Pension scheme Department of Health These slides cover the Government case for reform; changes to the NHS Pension Scheme; existing benefits; considering opting out; pension choice exercise; and useful links. http://www.dh.gov.uk/health/2011/12/slide-nhs-pension/ 24

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A strategic review of the future healthcare workforce: informing medical and dental student intakes Centre for Workforce Intelligence This report provides a starting point to consider factors that may influence the requirements, numbers and proportions of the future medical workforce. It is based on interviews with 30 experts, complemented by secondary research, who were asked to consider the possible technological, economic, environmental, political, social and ethical influences of the following question: thinking up to the year 2040, what factors will influence requirements of the future medical workforce, and future medical workforce numbers and proportions? http://www.cfwi.org.uk/resources/horizon-scanning-report-informing-medical-and-dentalstudent-intakes
Items in the Nursing and Midwifery and Public Health sections may also be of interest. [back to topics]

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