NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin for NHS Primary Care in North Staffordshire

Issue No: 58 November 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/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

NHS Library and Information Service North Staffordshire

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:
Cancer ...................................................................................................................................... 4 Carers ....................................................................................................................................... 5 Children and Young People ...................................................................................................... 5 Commissioning ......................................................................................................................... 6 Cystic Fibrosis .......................................................................................................................... 6 Dementia .................................................................................................................................. 7 Diabetes.................................................................................................................................... 7 Emergency Care ....................................................................................................................... 7 Epilepsy .................................................................................................................................... 8 General Practice ....................................................................................................................... 8 Guidance .................................................................................................................................. 9 Health Reforms ....................................................................................................................... 11 Health Visitors ......................................................................................................................... 12 HIV .......................................................................................................................................... 12 Infections and Infection Control .............................................................................................. 12 Influenza ................................................................................................................................. 13 Kidney Disease ....................................................................................................................... 13 Long Term Conditions............................................................................................................. 13 Midwifery................................................................................................................................. 14 Mental Health.......................................................................................................................... 14 Nursing ................................................................................................................................... 15 Offender Health ...................................................................................................................... 15 Older People ........................................................................................................................... 15 Palliative and End of Life Care ................................................................................................ 16 Patient Care and Safety .......................................................................................................... 16 Pharmacy and Prescribing ...................................................................................................... 17 Public Health ........................................................................................................................... 18 Research ................................................................................................................................ 19 Safeguarding Babies and Vulnerable Adults........................................................................... 19 Service Management .............................................................................................................. 20 Sexual and Reproductive Health ............................................................................................ 21 Stroke ..................................................................................................................................... 22 Substance Misuse .................................................................................................................. 23 Vaccination and Immunisation ................................................................................................ 23 Volunteering............................................................................................................................ 23 Womens Health ..................................................................................................................... 23 Workforce ............................................................................................................................... 24

NHS Library and Information Service North Staffordshire Cancer

Adjuvant Chemotherapy, with or without Taxanes, in Early or Operable Breast Cancer: A Meta-Analysis of 19 Randomized Trials with 30698 Patients Qin, YY et al. The authors concluded that adjuvant chemotherapy with taxanes could reduce the risk of cancer recurrence and death in patients with early or operable breast cancer, although the drug-related toxicities should be balanced. They also demonstrated that patients with high risk, node-negative breast cancer also benefited from taxanes therapy. PLoS ONE 6(11): e26946. doi:10.1371/journal.pone.0026946 Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and doseresponse meta-analysis of prospective studies Aune, D et al. The authors concluded that high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. BMJ 2011; 343 doi: 10.1136/bmj.d6617 (Published 10 November 2011) Improving outcomes and experiences for older women with breast cancer Breast Cancer Care This briefing is divided into three main areas: early diagnosis; treatment and assessment; and information and support. http://www.breastcancercare.org.uk/campaigning-volunteering/policy/breast-cancerinequalities/older-women-breast-cancer National Audit of Cancer Diagnosis in Primary Care RCGP This is the largest study to date of the primary care pathway to cancer diagnosis. It provides detailed insights into current clinical practice that can direct initiatives to reduce the time to diagnosis for cancer, as well as raising important questions for future research. Report: http://www.rcgp.org.uk/pdf/National_Audit_of_Cancer_Diagnosis_in_PrimaryCare.pdf Presentation slides: http://www.rcgp.org.uk/docs/RCGP%20presentation%20Nov%202011.ppt National Bowel Cancer Audit Report 2011 NHS Information Centre This audit concludes that achievement levels continue to rise against key care measures; such as the percentage of patients who survive following elective and scheduled surgery. However it notes that urgent and emergency surgery continues to carry a much greater risk of death compared to elective and scheduled procedures. http://www.ic.nhs.uk/bowelreports

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National Cancer Peer Review Programme report 2010-2011 Department of Health This report highlights the number of Trusts which are achieving high quality cancer care, and challenges to ensuring all cancer patients receive optimal care. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131433
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Carers
New Approaches to Supporting Carers Health and Well-being: Evidence from the National Carers Strategy Demonstrator Sites programme University of Leeds. Centre for International Research on Care, Labour and Equalities This report aims to map and assess the effectiveness of specific initiatives; examine their impact on carer health and well-being; outline the cost of initiatives and assess the level and nature of carer engagement in planning, delivery and evaluation of the programme. http://www.sociology.leeds.ac.uk/circle/circle-projects/national-carers-strategy-demonstratorsites.php How can the web support carers? Princess Royal Trust for Carers The report contains a detailed exploration of the advantages and challenges of providing carer support online, as well as the pros and cons for the main types of web services that are currently being offered. http://www.carers.org/get-online NHS Not Making the Break for Carers: a report on the implementation of the Carers Strategy by primary care trusts Crossroads Care This report investigates whether PCTs have published plans and budgets, and whether additional money has been used to increase services for carers or not, as outlined in the governments November 2010 Carers Strategy. http://www.carers.org.uk/_downloads/_associationnews/NHS_Not_Making_the_reak_for_Car ers.pdf
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Children and Young People

Me and My School: Findings from the National Evaluation of Targeted Mental Health in Schools 2008-2011 Department for Education This report looks at how different schools implement Targeted Mental Health in Schools (TaMHS), and what impact TaMHS and support material have on childrens mental health and wellbeing. https://www.education.gov.uk/publications/standard/publicationDetail/Page1/DFE-RR177
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NHS Library and Information Service North Staffordshire Commissioning

Choosing a predictive risk model: a guide for commissioners in England Nuffield Trust Following the Government's decision not to upgrade existing predictive risk models, this guide aims to help commissioners now tasked with choosing risk tools from an open market. http://www.nuffieldtrust.org.uk/publications/choosing-predictive-risk-model-guidecommissioners-england Commissioning for outcomes: A resource guide for commissioners of health and social care Liverpool PCT This guide aims to support the commissioner to commission for outcomes effectively, efficiently and competently. This pack will also help the commissioner to provide a comprehensive approach to commissioning from a strategic overview to the writing of detailed outcome statements. In addition, it helps to generate the detail required for service specifications and provides important links to areas such as service redesign, care pathways, quality standards, outcome frameworks and performance management etc. http://www.fadelibrary.org.uk/wp/2011/11/commissioning-for-outcomes-a-resource-guide-forcommissioners-of-health-and-social-care/ Commissioning Outcomes Framework: Engagement Document NHS Commissioning Board The Board is engaging with key stakeholders to develop emerging proposals for the Commissioning Outcomes Framework http://www.commissioningboard.nhs.uk/2011/11/29/cof/ NHS Confederation support for clinical commissioning groups NHS Confederation The Confederation provide a range of resources that will help CCGs to develop their local commissioning plans and structures, and to influence national health policy This leaflet provides some information about the Confederation and how CCGs can get involved. http://www.nhsconfed.org/Publications/Factsheets/Pages/support-for-CCGs.aspx
Items in the Emergency Care, Health Reforms and Pharmacy and Prescribing sections may also be of interest. [back to topics]

Cystic Fibrosis
Macrolide antibiotics for cystic fibrosis Southern, KW et al. The authors of this Cochrane review concluded that there is evidence of improved respiratory function after six months of azithromycin. Data beyond six months were less clear, although reduction in pulmonary exacerbation was sustained. Treatment appeared safe over a sixmonth period; however, emergence of macrolide resistance was a concern. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002203.pub3/abstract 6

NHS Library and Information Service North Staffordshire Dementia

Getting personal? Report about making personal budgets work for people with dementia Alzheimers Society This report presents evidence on the benefits and challenges of using personal budgets and direct payments, as described by people with dementia and carers. http://alzheimers.org.uk/site/scripts/download_info.php?fileID=1281
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Diabetes
Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials Hemmingsen, B et al. The authors concluded that intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes. Intensive glycaemic control increases the relative risk of severe hypoglycaemia by 30%. BMJ 2011; 343 doi: 10.1136/bmj.d6898 (Published 24 November 2011) Tailored Diabetes Commissioning: development of Local CQUIN & QOF Indicators for Diabetes Parliamentary & Stakeholder Diabetes Think Tank This document brings together a number of best practice examples, with key recommendations for new commissioners and managers taking these initiatives forward in their own local setting. http://youngdiabetologists.org/documents/tailored_diabetes.pdf
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Emergency Care
Breaking the mould without breaking the system: new ideas and resources for clinical commissioners on the journey towards integrated 24/7 urgent care Primary Care Foundation This guide makes a series of suggestions about how urgent care of the future could be more joined up, provide better value for money and offer better patient care. http://www.primarycarefoundation.co.uk/files/PrimaryCareFoundation/Downloading_Reports/ Reports_and_Articles/Urgent_Care_Commissioning/Breaking%20the%20Mould%20RELEAS E.pdf
Items in the Mental Health section may also be of interest [back to topics]

NHS Library and Information Service North Staffordshire Epilepsy

Eslicarbazepine acetate add-on for drug-resistant partial epilepsy Chang, XC et al. The authors of this Cochrane review concluded that eslicarbazepine acetate reduces seizure frequency when used as an add-on treatment for people with drug-resistant partial epilepsy. The trials included in this review were of short-term duration and focused on adults. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008907.pub2/abstract
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General Practice
2012/13 GMS Contract Negotiations Department of Health This letter sets out the outcome of negotiations between the BMA General Practitioners Committee (GPC) and NHS Employers on changes that will apply to GMS contractual arrangements in England from April 2012. http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/D H_130920 An evaluation of the Statement of Fitness for Work: qualitative research with General Practitioners Department for Work and Pensions This report forms part of a programme of evaluation gathering evidence on the use of the Statement of Fitness for Work (fit note). Based on interviews with GPs, it explores GPs views of the change in policy, how they prepared to use the fit note, and their views on their role in sickness certification. http://research.dwp.gov.uk/asd/asd5/report_abstracts/rr_abstracts/rra_780.asp QOF briefing 2012-13 changes NHS Primary Care Commissioning http://www.pcc-cic.org.uk/uploads/articles/briefings/qof_briefing_2012_13_changesv7.pdf Quality and Outcomes Framework exception reporting 2010/11 NHS Information Centre Exception reporting rates show the percentage of patients who are not included when determining Quality and Outcomes Framework achievement. The overall effective exception rate across all clinical domain indicators for England was 5.4 per cent, though there is variation between indicators. http://www.ic.nhs.uk/statistics-and-data-collections/audits-and-performance/the-quality-andoutcomes-framework/the-quality-and-outcomes-framework-exception-reporting-2010-11 A short guide to the benefit system for General Practitioners Department of Work and Pensions This guide provides a brief description of the main benefits GPs patients may be eligible for. http://www.dwp.gov.uk/docs/gp-benefit-guide.pdf
Items in the Cancer and Offender Health sections may be of interest.

NHS Library and Information Service North Staffordshire Guidance

NICE Clinical Guidelines Colorectal cancer: the diagnosis and management of colorectal cancer CG131 http://guidance.nice.org.uk/CG131 Self-harm (longer term management) CG133 http://guidance.nice.org.uk/CG133 NICE Technology Appraisals Macular oedema (diabetic) - ranibizumab TA237 http://guidance.nice.org.uk/TA237 NICE Quality Standards End of life care for adults http://www.nice.org.uk/guidance/qualitystandards/endoflifecare/home.jsp NICE Consultation Documents Autism in adults: guideline consultation To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 27 January 2012 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=57391 Focal therapy using cryoablation for localised prostate cancer Closing date for comments: 20 December 2011 http://www.nice.org.uk/guidance/index.jsp?action=article&o=57250 Focal therapy using high-intensity focused ultrasound for localised prostate cancer Closing date for comments: 20 December 2011 http://www.nice.org.uk/guidance/index.jsp?action=article&o=57251 Opioids in palliative care: guideline consultation To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 6 January 2012 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=57393 Ovarian cancer To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 23 December 2011 http://www.nice.org.uk/guidance/qualitystandards/indevelopment/OvarianCancer.jsp 9

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Preventing type 2 diabetes - risk identification and interventions for individuals at high risk: draft guidance consultation To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 9 January 2012 http://guidance.nice.org.uk/PHG/Wave19/62/Consultation/Latest Prostate cancer update: scope consultation To comment, contact the registered stakeholder organisation that most closely represents your interests. Closing date for comments: 16 December 11 http://www.nice.org.uk/guidance/index.jsp?action=folder&o=57330
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Other Guidance The Care of Women Requesting Induced Abortion Royal College of Obstetricians and Gynaecologists Guidance: http://www.rcog.org.uk/files/rcog-corp/Abortion%20guideline_web_1.pdf Supporting documents: http://www.rcog.org.uk/news/rcog-release-revised-guidelines-women-seeking-inducedabortion-published-1 Guidelines for the management of norovirus outbreaks in acute and community health and social care settings Health Protection Agency http://www.hpa.org.uk/Publications/InfectiousDiseases/InfectionControl/1111noroguidance/ Sharps safety: guidance to support implementation of the EU Directive 2010/32/EU on the prevention of sharps injuries in the health care sector RCN http://www.rcn.org.uk/__data/assets/pdf_file/0008/418490/004135.pdf Use of Haemoglobin A1c (HbA1c) in the diagnosis of diabetes mellitus. The implementation of World Health Organisation (WHO) guidance 2011 NHS Diabetes http://www.diabetes.nhs.uk/news_and_events/use_of_haemoglobin_a1c_hba1c_in_the_diag nosis_of_diabetes_mellitus_the_implementation_of_world_health_organisation_who_guidanc e_2011/
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Other Health Technology Assessments Insulin sensitisers in the treatment of non-alcoholic fatty liver disease: a systematic review Shyangdan, D et al. This study found that the insulin-sensitiser pioglitazone, as a treatment for non-alcoholic fatty liver disease (NAFLD), shows some improvements in liver histology and other parameters but the newer agents, the glucagon-like peptide-1 analogues, may be more worthy of future trials. 10

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The review also suggests that the non-alcoholic steatohepatitis stage of NAFLD is most in need of drug trials. Health Technol Assess 2011:15(38) The clinical effectiveness and costeffectiveness of management strategies for sciatica: systematic review and economic model Lewis, R et al. This study found non-opioid medication, epidural corticosteroid injections and disc surgery to be clinically effective for the treatment of sciatica. The evidence did not support the use of opioids and activity restriction. Health Technol Assess 2011:15(39)
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Health Reforms
Briefing for Commissioners Monitor This briefing aims to give commissioners of NHS services an overview of the role of Monitor and their approach to regulating NHS foundation trusts. It also sets out examples of when Monitor would expect commissioners to contact them. http://www.monitor-nhsft.gov.uk/home/news-events-and-publications/our-publications/browsecategory/about-monitor/briefing-commission Clinical Commissioning Groups: addressing outstanding size and configuration issues NHS Alliance This paper summarises the key issues associated with size and configuration of Clinical Commissioning Groups and makes proposals for how they might be addressed to maximise clinical leadership and engagement in commissioning. http://www.nhsalliance.org/press-releases/article/date/2011/11/clinical-commissioning-groupsaddressing-outstanding-size-and-configuration-issues/ Economic regulation in health care: What can we learn from other regulators? Kings Fund This paper describes the differences between the market in health care and the market in the utility sector, and briefly compares the proposals for the regulation of health care in England with economic regulation in The Netherlands and the United States. This paper concludes that the task faced by Monitor should not be underestimated because of the complexity of the product and the number and size of organisations in the market. http://www.kingsfund.org.uk/publications/economic_regulation.html Planning for contract transfer Department of Health Following a detailed assessment of contract transfer risk with a small sample of PCTs, the Department have developed a national framework and timescale for contract transfer and some supporting tools to assist PCT and SHA clusters to manage this process. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131039 11

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Public health human resources (HR) concordat Department of Health This document provides the principles and standards for managing the HR processes to support the transfer of PCT public health commissioning activity to Local authorities. It sets out the obligations of the NHS and local government employers and trade unions in managing the change. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131111 Transition Guidance National Information Governance Board for Health and Social Care The guidance is intended to support organisations in maintaining good information governance during the transition. Its purpose is to identify information governance issues and risks, understand their potential impact and provide guidance on how they can be addressed. http://www.nigb.nhs.uk/pubs/guidance/transguid
Items in the Public Health section may also be of interest. [back to topics]

Health Visitors
A Call to Action Health Visitor Implementation Plan Summary Progress Report Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_130856

HIV
HIV in the United Kingdom: 2011 report Health Protection Agency This report concludes that access to HIV care in the UK is excellent, and the standard of care is high. It makes a number of recommendations for all local areas and for specific vulnerable groups, and says further studies are needed to understand the reasons why some patients are not retained in HIV care. http://www.hpa.org.uk/Publications/InfectiousDiseases/HIVAndSTIs/1111HIVintheUK2011rep ort/
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Infections and Infection Control

Design Bugs Out: product evaluation report Department of Health This project aimed to bring designers and manufacturers together with clinical specialists, patients and frontline staff to help combat infections by making hospital furniture and equipment easier and quicker to clean. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131183 12

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European strategic action plan on antibiotic resistance 20112016 World Health Organisation. Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0011/148988/RC61_Pres_Rodier_antibiotic_re sistance.pdf Showcase hospitals local technology review reports Department of Health As part of the HCAI Technology Innovation Programme, Showcase Hospitals are undertaking local reviews of infection related products or technologies in which they have a specific interest. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_130912
Items in the Sexual and Reproductive Health and Substance Misuse section may also be of interest. [back to topics]

Influenza
The UK Influenza Preparedness Strategy 2011 Department of Health This strategy updates the clinical, health and scientific advice and information contained in 'Pandemic flu: a national framework for responding to an influenza pandemic 2007' and replaces that document. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_130903
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Kidney Disease
Items in the Palliative and End of Life Care section may be of interest.

Long Term Conditions

Self Management Support resource Centre Health Foundation This resource centre includes an overview of self management support, case studies of how self management support is already being implemented and information and practical resources to enable services to develop their own programmes. It also includes a wide range of national and international evidence, papers and practical resources. http://www.health.org.uk/resource-centre/new-sms
Items in the Pharmacy and Prescribing sections may also be of interest. [back to topics]

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NHS Library and Information Service North Staffordshire Midwifery

Perineal techniques during the second stage of labour for reducing perineal trauma Aasheim, V The authors of this Cochrane Review concluded that the use of warm compresses on the perineum is associated with a decreased occurrence of perineal trauma, and that the procedure has shown to be acceptable to women and midwives. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006672.pub2/abstract State of Maternity Services report 2011 RCM This report outlines increasing pressures on maternity services and makes recommendations for making the best use of scarce resources and meet future needs. http://www.rcm.org.uk/college/policy-practice/government-policy/state-of-maternity-services/
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Mental Health
Joining in the conversation - social media and mental health services NHS Confederation This Briefing looks at social media innovations underway in healthcare as a whole and highlights case studies from Mental Health Network member organisations. http://www.nhsconfed.org/Publications/briefings/Pages/Joining-the-conversation.aspx Music therapy for people with schizophrenia and schizophrenia-like disorders Mossler, K et al. The authors of this Cochrane review concluded that music therapy as an addition to standard care helps people with schizophrenia to improve their global state, mental state (including negative symptoms) and social functioning if a sufficient number of music therapy sessions are provided by qualified music therapists. They make recommendations for future research. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004025.pub3/abstract National Audit of Psychological Therapies for Anxiety and Depression National Report 2011 Healthcare Quality Improvement Partnership This audit finds that within an overall positive picture there is wide variation between services. The findings allow participants to benchmark their services, enabling clinicians, managers and commissioners to learn from good practice and plan positive change. http://www.rcpsych.ac.uk/quality/nationalclinicalaudits/psychologicaltherapies/psychologicalth erapies.aspx Systematic review of Solution Focused Brief Therapy (SFBT) with children and families Department for Education This review looks at the evidence for costs and benefits of SFBT, and considers the implications for its use, and implications for Local Safeguarding Children Boards. https://www.education.gov.uk/publications/standard/publicationDetail/Page1/DFE-RR179
Items in the Children and Young People sections may also be of interest.

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NHS Library and Information Service North Staffordshire Nursing

Community nursing: transforming health care RCN This report, which includes a number of case studies, highlights the value of community nurses. It aims to inform and inspire and persuade people to identify how community nursing services can be both expanded and enhanced for the benefit of their local population. http://www.rcn.org.uk/__data/assets/pdf_file/0010/415918/004165.pdf Competences for nurses undertaking bimanual pelvic examinations RCN http://www.rcn.org.uk/__data/assets/pdf_file/0006/417489/004134.pdf Frontline First: November 2011 Update RCN This analysis of 41 trusts in England looks at the proportion of workforce cuts which are clinical and nursing posts. http://royalnursing.3cdn.net/1925bf57e25be07961_u1m6bjkpu.pdf Making the business case for ward sisters/team leaders to be supervisory to practice RCN The guidance aims to offer helpful and practical steps for senior nurses, assisting them to make an effective case for ensuring ward sisters and team leaders are supervisory to practice, allowing dedicated time for improving the quality of care. http://www.rcn.org.uk/__data/assets/pdf_file/0005/414536/004188.pdf
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Offender Health
Safer Prescribing in Prison Royal College of General Practitioners This guidance looks at a number of clinical areas and highlights issues such as medication misuse by patients and medications being traded between inmates. http://www.rcgp.org.uk/news/press_releases_and_statements/prison_prescribing_guidance.a spx

Older People
Comprehensive geriatric assessment for older adults admitted to hospital: metaanalysis of randomised controlled trials Ellis, G et al. Comprehensive geriatric assessment increases patients likelihood of being alive and in their own homes after an emergency admission to hospital. This seems to be especially true for trials of wards designated for comprehensive geriatric assessment and is associated with a potential cost reduction compared with general medical care. BMJ 2011; 343 doi: 10.1136/bmj.d6553 (Published 27 October 2011)
Items in the Cancer and Public Health section may be of interest.

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NHS Library and Information Service North Staffordshire Palliative and End of Life Care
Caring for Patients with Advanced Kidney Disease at the End of Life: Ten Top Tips NHS Kidney Care This guide aims to help GPs and primary care professionals provide high quality end of life care to patients with advanced kidney disease. http://www.endoflifecareforadults.nhs.uk/publications/caring-for-patients-with-advancedkidney-disease-at-the-end-of-life-ten-top-tips Palliative care funding pilots 2012-14 Department of Health These notes outline how to apply to be one of a number of pilots gathering information to inform decisions on the creation of a new funding system for palliative care, and to consider the proposals of the independent Palliative Care Funding Review Report. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131544
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Patient Care and Safety

NHS Breaches of Data Protection Law: How patient confidentiality was compromised five times every week Big Brother Watch This report is based on responses to a Freedom of Information query about members of staff accessing patient medical records inappropriately. http://www.bigbrotherwatch.org.uk/home/2011/10/nhs-data-protection.html NHS Continuing Healthcare: Frequently Asked Questions Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131084 Patient and Public Experience (PPE) NHS Improvement This website is designed to help people working with patients and carers, offering easy to access engagement resources, case studies and links to useful information. http://www.improvement.nhs.uk/ppe/default.asp A Process for rapid learning: sharing experience when things go wrong in out of hours services. Reflections one year on NHS Alliance Over the last year, ten out of hours providers have worked together to share experiences when things go wrong and developed ways of accelerating learning across organisations. This paper highlights some key issues and benefits so far, and potential future developments. http://www.nhsalliance.org/press-releases/article/date/2011/11/rapid-learning-driving-uppatients-safety-across-out-of-hours-services/ 16

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Using Happiness to Value Health Office for Health Economics This report considers the degree to which happiness data can overcome some of the problems with existing preference-based ways of valuing health. It presents new valuation data that show how the dimensions of health that matter most in happiness regressions are not the same as those that matter most when people are asked about their preferences. http://www.ohe.org/publications/recent-publications/list-by-date-20/detail/date////usinghappiness-to-value-health.html Registration required to access this document. Registration is free. Weve been listening, have you been learning? Patients Association This report details sixteen accounts of poor hospital care heard by the Patients Association Helpline in the last year. It focuses on four key fundamentals of care: communication, access to pain relief, assistance with toileting and help with eating and drinking. http://www.patients-association.com/default.aspx?tabid=80&Id=23
Items in the Workforce section may also be of interest. [back to topics]

Pharmacy and Prescribing

Better joint working between the NHS and the pharmaceutical industry NHS Primary Care Commissioning These recommendations include the creation of a national database of case studies and improvement of the joint working toolkit published by the DH and the Association of the British Pharmaceutical Industry. http://www.pcc.nhs.uk/pharmacy-news/5654 Involvement, Shared Decision-Making and Medicines Royal Pharmaceutical Society This discussion paper explores the inherent complexities of increasing patient involvement in treatment decisions, and highlights the challenge of supporting healthcare professionals in exercising their professional judgement. http://www.rpharms.com/pressreleases/pr_show.asp?id=373 New Medicine Service Pharmaceutical Services Negotiating Committee Final Service Specification http://www.psnc.org.uk/data/files/PharmacyContractandServices/AdvancedServices/NMS_fin al_service_spec.pdf Guidance http://www.psnc.org.uk/data/files/PharmacyContractandServices/AdvancedServices/New_Me dicine_Service_guidance_2011.pdf Additional information about the New Medicine Service is available at http://www.psnc.org.uk/pages/nms.html

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Updated review of pharmacy contractual framework NHS Primary Care Commissioning This review looks at the policy background and service changes including the New Medicine Service (NMS). It also considers the challenges posed by the changes and the implications for clinical commissioning groups. http://www.pcc.nhs.uk/pharmacy-news/5618 QIPP e-learning resources National Prescribing Centre These resources aim to support organisations and prescribers in making best use of the NPCs document QIPP: Key therapeutic topics: medicines management options for local consideration. There are separate modules for the following topics: Alendronate; Antibiotics; Low dose antipsychotics in people with dementia; Clopidogrel; Hypnotics; High dose inhaled corticosteroids in asthma; Long-acting and intermediate-acting insulin analogues; Hypoglycaemics; Non-steroidal anti-inflammatory drugs; Orlistat; Proton pump inhibitors; Self monitoring of blood glucose in type 2 diabetes; Lipid-modifying drugs statins and ezetimibe http://www.npc.nhs.uk/qipp/key_therapeutics_topics.php
Items in the Infection Control and Offender Health sections may also be of interest. [back to topics]

Public Health
Cold Weather Plan for England Department of Health The Plan provides advice for individuals, communities and agencies on how to prepare for and respond to severe cold weather as part of wider winter planning and announces the Warm Homes, Healthy People fund. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_130564 Excess Winter Mortality in England and Wales, 2010/11 (Provisional) and 2009/10 (Final) Office for National Statistics http://www.ons.gov.uk/ons/rel/subnational-health2/excess-winter-mortality-in-england-andwales/2010-11--provisional--and-2009-10--final-/index.html From illness to wellness: achieving efficiencies and improving outcomes NHS Confederation This briefing is intended to share learning with commissioners and providers in the NHS, local government and health and wellbeing boards, to support integration of wellness approaches within existing programmes and services and scale-up system-wide change. http://www.nhsconfed.org/Publications/briefings/Pages/illness-to-wellness.aspx Public Health House of Commons Health Select Committee This report makes recommendations in several areas including: creating a duty for public health and local authorities to reduce health inequalities; the structure and role of Public 18

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Health England; funding and budgets for public health, commissioning and the role of Directors of Public Health, and the Responsibility Deal. http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1048/104802.htm WinterWatch Department of Health The online hub will provide regular updates about the increased demand on the NHS during the cold winter months and offer practical advice on keeping well when the weather is very cold. http://winterwatch.dh.gov.uk/
Items in the Cancer and Health Reforms section may also be of interest. [back to topics]

Research
Good Clinical Practice (GCP) discussion forum Medicines and Healthcare Products Regulatory Agency This forum has been created to help all those involved in the conduct of clinical trials implement quality procedures that can ensure compliance with clinical trials legislation and GCP requirements. It also provides the ideal opportunity for extended communication between researchers and allows users to put forward their comments and get 'real-life' examples. http://forums.mhra.gov.uk/forumdisplay.php?1-Good-Clinical-Practice-%28GCP%29
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Safeguarding Babies and Vulnerable Adults

Abuse of Vulnerable Adults in England, 2010-11 Provisional, Experimental Statistics NHS Information Centre These statistics present a variety of information on aspects of the safeguarding process, including type of alleged abuse, source of referral, location of alleged abuse, relationship between alleged victim and perpetrator and outcomes. http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-careinformation/abuse-of-vulnerable-adults-in-england-2010-11-provisional-experimental-statistics All babies count: prevention and protection for vulnerable babies NSPCC This report adds new dimensions to the case for early intervention. It highlights the disproportionate vulnerability of babies to abuse and neglect; and it provides the first estimates of the numbers of babies affected by parental problems of substance misuse, mental illness and domestic abuse. http://allbabiescount.nspcc.org.uk/latest-news
Items in the Mental Health section may also be of interest. [back to topics]

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NHS Library and Information Service North Staffordshire Service Management

2010-11 reference costs publication Department of Health This document accompanies the national schedules of reference costs, the reference costs index, and source data, and describes how nearly 400 NHS organisations spent 53 billion delivering healthcare to patients in 2010-11. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131140 Case management: what it is and how it can best be implemented Kings Fund This report examines how case management can improve delivery of integrated care for people with long-term conditions. The authors explore the questions: What is case management? What are the core components of a case management programme? What are the benefits of case management when it is implemented effectively? What factors need to be in place for successful case management? http://www.kingsfund.org.uk/publications/case_management.html The financial cost of healthcare fraud: what data from around the world shows PKF and University of Portsmouth: Centre for counter fraud studies In January 2010, a Financial Cost of Healthcare Fraud Report collated the latest, accurate, statistically valid information from around the world about the real financial cost of fraud and error in healthcare. This Report renews and updates that research. http://www.pkf.co.uk/web/pkf.nsf/0/F459DDCCE5269C818025792D002A830E/$FILE/The%20 Financial%20Cost%20of%20Fraud_WEB.pdf Inside your hospital: Dr Foster hospital guide 20012011 Dr. Foster This guide compares hospitals across England on a variety of measures including mortality and patient safety. http://drfosterintelligence.co.uk/wp-content/uploads/2011/11/Hospital_Guide_2011.pdf Integrated Performance Measures Monitoring Department of Health Report on Primary Care Trust and NHS Trust performance against plans to address selected health priorities relating to the NHS Operating Framework. Areas covered include stroke, diabetes and NHS health checks. http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Inte gratedperfomancemeasuresmonitoring/index.htm The Operating Framework for the NHS in England 2012-13 Department of Health The Framework sets out the business and planning arrangements for the NHS. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131360 20

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Personal Health Budgets DVD Department of Health This DVD shares the experience of people in the personal health budgets pilot programme. The films also include the perspectives of family carers and health care professionals. They aim to illustrate the positive impact personal budgets can have on peoples health and lives. Ordering information is available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_131100 Perspectives on telehealth and telecare: Learning from the 12 Whole System Demonstrator Action Network sites Kings Fund This paper examines the experiences of 12 sites in implementing telehealth and telecare. It examines the challenges and barriers they faced, and the progress they made, in developing and adopting new technologies. http://www.kingsfund.org.uk/publications/articles/th_perspectives.html Sustainability in the NHS Building Research Establishment This portal aims to help Trusts and other healthcare organisations cut carbon emissions and energy use and to operate more efficiently. http://www.bre.co.uk/page.jsp?id=2622 Towards integrated care in Trafford Nuffield Trust This study of efforts in Trafford, Greater Manchester, to deliver integrated care provides valuable insights into the challenge of service reconfiguration at a time of financial constraint. http://www.nuffieldtrust.org.uk/publications/towards-integrated-care-trafford What makes a top hospital? Leadership CHKS This report is one of a series of five reports which aim simply to share examples of success in the NHS in hope that other organisations can take something from each of them. http://www.chks.co.uk/assets/files/Published%20articles/CHKS_2011_WMATH_3_FIN_lores.pdf
Items in the Health Reforms, Midwifery, Patient Care and Safety and Workforce sections may also be of interest. [back to topics]

Sexual and Reproductive Health

Sexually transmitted infections in men who have sex with men in the United Kingdom: 2011 report Health Protection Agency The recommendations of this report include that men who have sex with men (MSM) should have an HIV test and sexual health screen at every new attendance to ensure no MSM leave a clinic with undiagnosed HIV or any other STI. One-to-one behavioural interventions should 21

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be available in STI clinics for MSM to reinforce safer sex messages and reduce HIV and STI transmission. Further studies are needed to understand the role of the recent infection testing algorithm in prioritising and accelerating partner notification. http://www.hpa.org.uk/Publications/InfectiousDiseases/HIVAndSTIs/1111STIsinMSMintheUK 2011report/
Items in the Nursing section may also be of interest. [back to topics]

Stroke
Practical Principles for stroke care NHS Improvement: Stroke This series of 8 documents give practical principles: For improving psychological care after stroke http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles1%20for%20improving%20psychological%20care%20after%20stroke.pdf For developing an early supported discharge service http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles2%20for%20developing%20an%20early%20supported%20discharge%20service.pdf For improving access to CT scanning http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles3%20( 3)-%20for%20improving%20access%20to%20CT%20scanning.pdf For Transient Ischaemic Attack (TIA) http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles4%20( 3)-%20for%20Transient%20Ischaemic%20Attack%20(TIA).pdf How to establish joint care planning http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles5%20%20how%20to%20establish%20joint%20care%20planning.pdf To manage reviews for stroke survivors http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles6%20%20to%20manage%20reviews%20for%20stroke%20survivors.pdf Being the best in acute stroke http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles7%20( 4)%20-%20being%20the%20best%20in%20acute%20stroke.pdf For developing a community stroke service http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac% 2fNational%2fWebsite%2fStroke%2fPractical%20principles%2fPractical%20Principles8%20%20for%20developing%20a%20community%20stroke%20service.pdf

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Ways to enhance therapy provision in stroke rehabilitation NHS Improvement: Stroke This paper explores some of the different models adopted by therapy services to deliver more rehabilitation and provides further detail about process and outcomes. http://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Stroke%2f National%2fwebsite%2fMind%20the%20gap%2fMind_the_Gap.pdf
[back to topics]

Substance Misuse
Shooting Up Infections among people who inject drugs in the UK 2010: an update. Health Protection Agency This report is based on data to the end of 2010, and focuses on infections caused by bacteria. http://www.hpa.org.uk/Publications/InfectiousDiseases/BloodBorneInfections/1111Shootingup 2011/
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Vaccination and Immunisation

Immunisation against infectious disease - 'The Green Book' - 2006 updated edition Department of Health Chapter 19 on influenza has been updated. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_079917
[back to topics]

Volunteering
Opportunities for Volunteering: the legacy report: 30 years of funding volunteering in health and social care Department of Health The Opportunities for Volunteering scheme is designed to improve the profile and diversity of volunteers and develop the range and quality of volunteering opportunities in health, wellbeing and social care service provision. As OfV comes to an end, this report celebrates the achievements of volunteers across the life span of the scheme and looks to the future opportunities afforded by the new Volunteering Fund. http://www.dodsmonitoring.com/downloads/2011/Opportunities_for_volunteering.pdf

Womens Health
Conservative prevention and management of pelvic organ prolapse in women Hagen, S The authors of this Cochrane review concluded that there is some evidence available indicating a positive effect of pelvic floor muscle training (PFMT) for prolapse symptoms and severity. The largest most rigorous trial to date suggests that six months of supervised PFMT 23

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has benefits in terms of anatomical and symptom improvement (if symptomatic) immediately post-intervention. They also make recommendations for further research. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003882.pub4/abstract Hormone replacement for osteoporosis in women with primary biliary cirrhosis Rudic, JS The authors of this Cochrane review did not find evidence to support the use of hormone replacement for women with primary biliary cirrhosis. It seems that hormone replacement is connected with a significant increase in the occurrence of adverse events. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009146.pub2/abstract
Items in the Midwifery section may also be of interest.

Workforce
Assessing the patient safety competencies of healthcare professionals: a systematic review Okuyama, A The authors concluded that a reliable and valid toolbox for summative testing that covers all patient safety domains cannot yet be constructed. Many tools, however, are useful for formative feedback. BMJ Qual Saf 2011;20:991-1000 doi:10.1136/bmjqs-2011-000148 Enhancing employment practice to increase quality and safety NHS Employers This briefing looks at a number of issues being discussed that have a direct relationship to employment practices and poses some questions for consideration with board colleagues, following recent discussion in the healthcare and broader community. http://www.nhsemployers.org/Aboutus/Publications/Pages/Enhancing-practice.aspx A framework for technology enhanced learning Department of Health This framework provides guidance to help commissioners and providers of health and social care deliver high quality, cost effective education, training and continuous development to the workforce for the benefit of patients through the effective use of technology as part of a blended learning process. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc e/DH_130924 Generating savings by improving health and well-being: Experiences in NHS trusts NHS Employers This briefing features examples of good practice from across the NHS to help inform the planning of strategies to further reduce sickness absence and highlights the opportunities for financial savings that can be made through the introduction and implementation of new policies. http://www.nhsemployers.org/Aboutus/Publications/Pages/Generating-savings.aspx

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Good Medical Practice: consultation on the draft document GMC Good Medical Practice sets out the standards, principles and values expected of all doctors registered with the General Medical Council (GMC). The consultation is open to anyone who wishes to respond to the issues in the revised guidance. Closing date for comments: 10 February 2012 http://www.gmc-uk.org/guidance/10780.asp Managing industrial disputes: guidance for employers in the NHS NHS Employers This guidance will help employers in the NHS to manage the legal, practical and operational risks presented by the threat of industrial disputes. http://www.nhsemployers.org/Aboutus/Publications/Pages/industrial-disputes.aspx Medical revalidation: what employers need to know and do NHS Employers This Briefing provides a timeline of activity so far, a checklist of actions that organisations need to carry out if they are to be ready for the introduction of revalidation and a list of the key milestones ahead. It also provides an update on the following key areas: the role and training of responsible officers; appraisal and appraiser capacity; portfolios of supporting information and information management; working across organisational boundaries; changes in NHS organisations and structure; and handling and responding to concerns. http://www.nhsemployers.org/Aboutus/Publications/Pages/Medical-revalidationemployers.aspx P3M Resource Centre NHS Connecting for Health This website brings together support materials and tools to improve portfolio, programme and project management (P3M) practice and skills in the NHS. http://www.connectingforhealth.nhs.uk/systemsandservices/icd/informspec/p3m/resource Total reward in the NHS NHS Employers This Briefing recommends extending the annual benefits statement approach of illustrating employee benefits by adopting a total reward philosophy in NHS organisations. http://www.nhsemployers.org/Aboutus/Publications/Pages/Total-reward.aspx
Items in the Health Reforms, Midwifery and Service Management sections may also be of interest. [back to topics]

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