NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 40 – May 2010

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

Contents in this issue Bulletin produced by NHS Outreach

Librarians
Cancer
Tel: 07834 115958 [please leave a message]
Commissioning
E-mail: jayne.hickton@northstaffs.nhs.uk
End of Life
Guidance
Mental Health
Musculoskeletal North Staffs Health Library
Oral Health Tel: 01782 556565
Respiratory Disease Fax: 01782 556582
Service Management 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
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

Cancer
Skin Cancer Annual Evidence Update
NHS Evidence
The update includes systematic reviews and guidance published since the last Annual Evidence
Update in May 2009.
http://www.library.nhs.uk/cancer/viewResource.aspx?resid=372272&code=506f6bfa45d58de9ea5
7f19f10b39c61

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Commissioning
Involving users in commissioning local services
Joseph Rowntree Foundation
This report is about service users’ experience and views of involvement in shaping services, and
the experiences and views of commissioners when involving users. The project reflected on
what's happening at the moment and how user involvement in commissioning could work in
practice. It found that: the involvement of service users in shaping local services is still in its
infancy; the definition of 'user involvement' varies from one-off consultations to equal
partnerships; and that there are more good practice examples of user involvement in Social Care
than in Health.
http://www.jrf.org.uk/publications/users-local-services

Commissioning for sustainable development

NHS Sustainable Development
The NHS Sustainable Development Unit has published two guides that are intended to help NHS
commissioners understand how and why they should integrate sustainable development into the
commissioning process:
- Commissioning for sustainable development - how to guide gives guidance on how to
commission sustainably
- Healthy Futures 9, Commissioning for Sustainable Development considers what sustainable
commissioning is and its role as an integral part of NHS core business.
http://www.sdu.nhs.uk/page.php?page_id=167

Quick guide for commissioners on non-medical prescribing

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National Prescribing Centre (NPC)

The National Prescribing Centre (NPC) has published a quick guide for commissioners on non-
medical prescribing by nurses, optometrists, pharmacists, physiotherapists, podiatrists and
radiographers. The guide aims to help commissioners understand the nature, role and benefits of
prescribing by these groups and provides practical information supported by case examples.
http://www.npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf

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End of Life
National End of Life Care Intelligence Network
NHS National End of Life Care Programme
NEoLCIN aims to improve the collection and analysis of information related to the quality, volume
and costs of care provided by the NHS, social services and the third sector, to people
approaching the end of life. This intelligence will help drive improvements in the quality and
productivity of services. The website includes the following sections: data and statistics on end of
life care, by Local Authority area in England and broken down by age, gender, place of death and
cause of death; resources (including research); a guide to key health, social care and related data
sources in the field; and where to go for advice and information for patients, carers and relatives.
http://www.endoflifecare-intelligence.org.uk/home.aspx

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Guidance
NICE Clinical Guidelines

The management of lower urinary tract symptoms in men

Clinical guideline: (CG97)
http://guidance.nice.org.uk/CG97

Recognition and treatment of neonatal jaundice

Clinical guideline: (CG98)
http://guidance.nice.org.uk/CG98

Diagnosis and management of idiopathic childhood constipation in primary and

secondary care
Clinical guideline: (CG99)
http://guidance.nice.org.uk/CG99

NICE Cancer Service Guidance

Improving outcomes for people with skin tumours including melanoma

Cancer service guidance:(CSGSTIM)
http://guidance.nice.org.uk/CSGSTIM

NICE Technology Appraisals

Use of tumour necrosis factor alpha (TNF a) inhibitors (adalimumab, and infliximab
[review]) for Crohn's disease (review of TA40)
Technology appraisal: (TA187)
http://guidance.nice.org.uk/TA187

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Human growth hormone (somatropin) for the treatment of growth failure in children
(review)
Technology appraisal: (TA188)
http://guidance.nice.org.uk/TA188

Hepatocellular carcinoma (advanced and metastatic) - sorafenib (first line)

Technology appraisal: (TA189)
http://guidance.nice.org.uk/TA189

NICE Interventional Procedure Guidance

Laparoscopic radical hysterectomy for early stage cervical cancer

Interventional procedure guidance:(IPG338)
http://guidance.nice.org.uk/IPG338

Limited macular translocation for wet age-related macular degeneration

Interventional procedure guidance:(IPG339)
http://guidance.nice.org.uk/IPG339

Macular translocation with 360° retinotomy for wet age related macular degeneration
Interventional procedure guidance:(IPG340)
http://guidance.nice.org.uk/IPG340

Prosthetic intervertebral disc replacement in the cervical spine

Interventional procedure guidance:(IPG341)
http://guidance.nice.org.uk/IPG341

Haemorrhoidal artery ligation

Interventional procedure guidance:(IPG342)
http://guidance.nice.org.uk/IPG342

Endoscopic saphenous vein harvest for coronary artery bypass grafting

Interventional procedure guidance:(IPG343)
http://guidance.nice.org.uk/IPG343

Epithelial radiofrequency ablation for Barrett's oesophagus

Interventional procedure guidance:(IPG344)
http://guidance.nice.org.uk/IPG344

Mini-incision surgery for total knee replacement

Interventional procedure guidance:(IPG345)
http://guidance.nice.org.uk/IPG345

Single incision laparoscopic cholecystectomy

Interventional procedure guidance:(IPG346)
http://guidance.nice.org.uk/IPG346

Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal

brain injury
Interventional procedure guidance:(IPG347)
http://guidance.nice.org.uk/IPG347

NICE Consultation Documents

Hepatitis C - peginterferon alfa and ribavirin: appraisal consultation

Closing date for comments 17 June 2010

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http://www.nice.org.uk/guidance/index.jsp?action=folder&o=48783

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of

non-ampullary duodenal lesions
Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=48823

Endoscopic submucosal dissection (ESD) of gastric lesions

Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=48820

Insertion of metal rib reinforcements to stabilise a flail chest wall

Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=48818

Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome

Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=48816

Minimally invasive total hip replacement

Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=48813

Contraceptive services for socially disadvantaged young people: draft guidance

consultation
Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=48774

Contraceptive services for socially disadvantaged young people: additional consultation

on the evidence
Closing date for comments 23 June 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=48769

Clinical Knowledge Summaries updated in May 2010

• Baker's cyst (new)

• Coeliac disease (new)
• Dupuytren's disease (new)
• Mastitis (new)
• Meibomian cyst (new)
• Psoriasis (new)
• Scarlet fever (new)
• Styes (hordeola) (new)
• Vitiligo (new)

Other Guidance

Management of sore throat and indications for tonsillectomy

SIGN
The Scottish Intercollegiate Guidelines Network (SIGN) has published a guideline on the
management of sore throat and indications for tonsillectomy.
http://www.sign.ac.uk/guidelines/fulltext/117/index.html

Health Technology Assessments

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Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs

(NSAIDs) for the reduction of morphine-related side effects after major surgery: a
systematic review (McDaid)
Health Technol Assess; 14.17

A systematic review of outcome measures used in forensic mental health research with
consensus panel opinion (Fitzpatrick)
Health Technol Assess; 14.18

The clinical effectiveness and cost-effectiveness of topotecan for small cell lung cancer: a
systematic review and economic evaluation (Loveman)
Health Technol Assess; 14.19

Antenatal screening for haemoglobinopathies in primary care: a cohort study and cluster
randomised trial to inform a simulation model. The Screening for Haemoglobinopathies in
First Trimester (SHIFT) trial (Dormandy)
Health Technol Assess; 14.20

Early referral strategies for management of people with markers of renal disease: a
systematic review of the evidence of clinical effectiveness, costeffectiveness and
economic analysis (Black)
Health Technol Assess; 14.21

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Mental Health
Implementing recovery: a methodology for organisational change
Sainsbury Centre for Mental Health
This paper helps mental health services to measure how well placed they are to support the
people who use them. It sets out the three stages a service needs to reach on ten key challenges
to become fully focused on recovery. It allows mental health services, their users and their
commissioners to judge how well they are doing in meeting each of the ten challenges.
http://www.scmh.org.uk/pdfs/Implementing_recovery_methodology.pdf

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Musculoskeletal
Combined chiropractic interventions for low-back pain
Walker BF, French SD, Grant W, Green S.
Cocrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD005427. DOI:
10.1002/14651858.CD005427.pub2
Authors' conclusions: Combined chiropractic interventions slightly improved pain and disability in
the short-term and pain in the medium-term for acute and subacute LBP. However, there is
currently no evidence that supports or refutes that these interventions provide a clinically
meaningful difference for pain or disability in people with LBP when compared to other
interventions. Future research is very likely to change the estimate of effect and our confidence in
the results.
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005427/frame.html

Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a

systematic review of clinical trials
Minns Lowe CJ, Barker KL, Dewey ME, Sackley CM
Database of Abstracts of Reviews of Effects (DARE)

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CRD Summary: This review concluded that there was insufficient evidence to established the
effectiveness of physiotherapy exercise following primary hip replacement for osteoarthritis. The
authors' cautious conclusions were supported by the results, but should be interpreted with some
caution due to questions relating to the analysis.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12009108571

Therapeutic aquatic exercise in the treatment of low back pain: a systematic review
Waller B, Lambeck J, Daly D
Database of Abstracts of Reviews of Effects (DARE)
CRD Summary: The authors concluded that there was evidence to suggest therapeutic aquatic
exercise had a potentially beneficial effect for patients who experienced chronic low-back pain
and pregnancy-related low-back pain. The reliability of the authors' cautious conclusion is
uncertain due to potential for language bias, poor-quality studies and a lack of reporting of review
methods.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12009102636

Economic evaluation of arthritis self management in primary care

Patel A, Buszewicz M, Beecham J, Griffin M, Rait G, Nazareth I, Atkinson A, Barlow J, Haines A
NHS Economic Evaluation Database (NHS EED)
CRD Summary: This study examined the cost-effectiveness of a self-management programme
and education booklet, for patients suffering from osteoarthritis of the hip, knee, or both. The
authors concluded that the arthritis programme was not cost-effective, using conventional criteria,
but it could be cost-effective when broader societal costs were considered. The methodology
was valid and the economic information was well presented. The authors’ conclusions appear to
be valid.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22009103066

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Oral Health
Oral Health Annual Evidence Update
NHS Evidence
The Update brings together the latest systematic reviews and evidence-based guidelines of
interest to oral health professionals. In addition John Stanfield, 2010 Dental Hygienist of the Year,
has written a commentary reflecting on the evidence from the perspective of a Dental Care
Professional.
http://www.library.nhs.uk/oralhealth/

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Respiratory Disease
Statins in COPD: a systematic review
Janda S, Park K, FitzGerald JM, Etminan M, Swiston J
Database of Abstracts of Reviews of Effects (DARE)
CRD Summary: The review concluded that statins may have a beneficial effect in the treatment of
COPD. This conclusion reflected the results of the review, but should be treated with caution due
to a limited number of studies and flawed methodology.
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009109058

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Service Management

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Value for money and the Quality and Outcomes Framework in primary care in the UK NHS
Walker et al
British Journal of General Practice, Volume 60, Number 574, May 2010 , pp. e213-e220(1)
Conclusions: For most indicators that can be assessed, QOF incentive payments are likely to be
a cost-effective use of resources for a high proportion of primary care practices, even if the QOF
achieves only modest improvements in care. However, only a small subset of the indicators has
been considered, and no account has been taken of the costs of administering the QOF scheme.
http://www.ncbi.nlm.nih.gov/sites/entrez
(Full text article available from the Health Library)

Changing cultures, relationships and performance in local health care economies

National Institute for Health Research
The findings of this research study on changing management cultures and organisational
performance in the NHS have now been published. The study was commissioned by the National
Institute for Health Research and involved the collection of data from all acute and PCTs in
England. The aims of the study were to understand the nature and dynamics of culture change in
the NHS, with a particular emphasis on how organisational culture links to health care
performance
http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1501-94

Medical chief executives in the NHS: facilitators and barriers to their career progress
HMSC
This study analyses the issues faced by medical chief executives and reports on the experiences
of 22 medical chief executives in England. The findings suggest that there should be a more
structured and systematic approach to developing medical leadership in the NHS.
http://www.hsmc.bham.ac.uk/news/pdfs/Medical-Chief-Executives-NHS.pdf

A high-performing NHS? A review of progress 1997-2010

King's Fund
Using official data, government reports and academic research, this report evaluates the NHS in
England from 1997 to 2010. It assesses how much progress the NHS has made in the following
eight areas: access; safety; health promotion and management of long-term conditions; clinical
effectiveness; patient experience; equity; efficiency; and accountability.
http://www.kingsfund.org.uk/publications/a_highperforming_nh.html

The Coalition: our programme for government

Cabinet Office
It includes sections setting out the Government's policy on the NHS and on Public Health.
http://www.cabinetoffice.gov.uk/media/409088/pfg_coalition.pdf

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