clinical effectiveness bulletin 47, december 2010

8/8/2019 Clinical Effectiveness Bulletin 47, December 2010

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NHS Library and Information Service North Staffordshire

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Clinical Effectiveness Bulletinfor PCTs in North Staffordshire

Issue No: 47 December 2010

About this Bulletin:

It aims to draw attention to some of the key documents and reviews on clinicaleffectiveness that have been published in the previous month.

Where possible, links to the full text documents are included. If the article is in ajournal, 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 NHSOutreach 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 onthe 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 LibrariansTel: 07834 115958 [please leave a message]

E-mail: [email protected]@northstaffs.nhs.uk

North Staffs Health Library

Tel: 01782 556565Fax: 01782 556582

E-mail:[email protected]


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Sources for Clinical Effectiveness Bulletin

Please suggest further sites that should be monitored in the production of this bulletin

Websites

Bandolierhttp://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 Healthhttp://www.dh.gov.uk/en/index.htmHealth Technology Assessment (HTA) Database http://www.ncchta.org/NICE http://www.nice.org.uk/NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/

SIGNhttp://www.sign.ac.uk/new.html

Contents in this issue

Alcohol Mental Health / LearningDisabilitiesCardiovascular Diseases MusculoskeletalCommissioning NeurologyDiabetes ObesityEnd of Life Oral HealthGeneral Practice PainGenetic Conditions Palliative CareGuidance PregnancyHIV Public HealthHospital Admissions Rehabilitation Medicine

Immunisations /Vaccinations

Renal Diseases

Infection Control Respiratory DiseasesInfluenza Service ManagementLiver Disease StrokeLong Term Conditions UrologyMedicines Workforce


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Alcohol

Opioid antagonists for alcohol dependenceCochrane Database of Systematic ReviewsRsner S., Hackl-Herrwerth A., Leucht S., Vecchi S., Srisurapanont M., Soyka M.Background: Alcohol dependence belongs to the globally leading health risk factors. Therapeuticsuccess of psychosocial programs for relapse prevention is moderate and could be increased byan adjuvant treatment with the opioid antagonists naltrexone and nalmefene. Objectives: Todetermine the effectiveness and tolerability of opioid antagonists in the treatment of alcoholdependence. Authors' conclusions: Naltrexone appears to be an effective and safe strategy inalcoholism treatment. Even though the sizes of treatment effects might appear moderate in theirmagnitudes, these should be valued against the background of the relapsing nature of alcoholismand the limited therapeutic options currently available for its treatment.http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001867/frame.html

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Cardiovascular Diseases

Prevention and management of venous thromboembolismSIGNThis guideline will be of particular interest to medical practitioners in a wide range of specialtiesincluding general practice, nurses, pharmacists and dentists. The guideline identifies adult patientgroups at risk of VTE and describes the available methods of prophylaxis. Important advances inthe diagnosis of DVT and PE are described, including the use of diagnostic algorithmsincorporating D-dimer assay. Finally, recommendations are made on treatment options forthrombosis in various anatomical regions, including choice of anticoagulant and duration of use,

taking account of evidence of risks and benefits of anticoagulant use.http://www.sign.ac.uk/guidelines/fulltext/122/index.html

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Commissioning

Commissioning ZoneNHS NetworksNHS Networks has launched the Commissioning Zone, an online information portal designed tomake it easier for commissioners to find the information they need and to connect them withcolleagues via the NHS Networks hub.http://www.networks.nhs.uk/commissioning

Local innovations in wheelchair and seating servicesDepartment of HealthThis document aims to support PCTs and local wheelchair service managers in theircommissioning and delivery of wheelchair and seating services by capturing current examples oflocal innovations that improve quality in wheelchair commissioning and delivery.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122492.pdf


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Provider economics impact assessment modelDepartment of HealthThe Department in partnership with the NHS Confederation have produced the Provider

economics commissioning impact assessment model, with associated guidance and summary,.to better understand provider economics. The purpose of the model is to enable commissionersand providers: to analyse the potential impact of commissioning decisions on service continuityand provider sustainability; and to understand how the financial system risks of decommissioningand reconfiguring services will materialise in differing economic scenarios and whether servicesprovide value for money.Accessible via:http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122570

Liberating the NHS: developing the healthcare workforceDepartment of HealthThe Commissioning for Quality and Innovation (CQUIN) payment framework enablescommissioners to reward excellence by linking a proportion of providers income to theachievement of local quality improvement goals. This Summary guide provides an overview ofkey publications and resources, and includes an updated set of Frequently Asked Questions(FAQs).Guidance on the national goals for 2011/12 supports use of the two national CQUIN goals foracute schemes, as set out in the NHS Operating Framework for 2011/12. The original guidance,published in 2008, introduced the CQUIN payment framework in context and remains the keypoint of reference. It describes the framework, setting out the timetable and scope, beforeexplaining the content that local schemes should cover, how the framework is funded, an outlineof how it might be used, and the support and assurance for local schemes.http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590

Items in the Mental Health, Public Health, Rehabilitation Medicine and ServiceManagement sections may also be of interest.

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Diabetes

Glucose Self-Monitoring in Diabetes NHS Diabetes factsheet No. 32NHS DiabetesNHS Diabetes has published a new factsheet on the self-management of blood glucose (SMBG),including recommendations on self-monitoring for all people with Type 2 diabetesCurrently the first item in the list accessible via:http://www.diabetes.nhs.uk/publications_and_resources/factsheets_and_case_studies/factsheets

/

Altered dietary salt intake for preventing and treating diabetic kidney disease Cochrane Database of Systematic ReviewsSuckling R.J., He F.J., MacGregor G. A.Background: There is strong evidence that our current consumption of salt is a major factor forincreased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levelsare normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks andheart failure and slows the progression of diabetic kidney disease (DKD). Currently there is noconsensus in restricting salt intake in diabetic patients. Objectives: To evaluate the effect of


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altered salt intake on BP and markers of cardiovascular disease and DKD. Authors' conclusions:Although the studies are not extensive, this meta-analysis shows a large fall in BP with saltrestriction, similar to that of single drug therapy. All diabetics should consider reducing salt intake

at least to less than 5-6 g/day in keeping with current recommendations for the general populationand may consider lowering salt intake to lower levels, although further studies are needed.http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006763/frame.html

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End of Life

Deaths in Older Adults in EnglandNHS National End of Life Care Intelligence NetworkThis report, the fourth published by the National End of Life Care Intelligence Network, highlightsthe importance of understanding the differing needs of older adults at the end of life.

Third publication in the list:http://www.endoflifecare-intelligence.org.uk/resources/publications.aspx#neolcin

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General Practice

Healthy Working UK (HWUK) - website

Healthy Working UK / GP and Practice Team BulletinThis online resource for GPs and other primary care health professionals contains information,training and decision aids to support the management of health and work, including guidance onthe fit note. The site was developed by the Royal College of General Practitioners, the Faculty of

Occupational Medicine and Society of Occupational Medicine. Additional resources, including e-learning on health and work for primary care professionals and specific programmes on the fitnote and health and work in secondary care, are now being developed and will be available byMarch 2011.http://www.healthyworkinguk.co.uk/

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Genetic Conditions

2010 Annual Evidence Update on Familial hypercholesterolaemiaNHS Evidence Specialist Collections - Genetic conditions

This is the second Annual Evidence Update on Familial Hypercholesterolaemia. This updatewhich identifies the best clinical information since the first Annual Evidence Update from 2009.This update includes a list of relevant guidelines, systematic reviews, meta-analyses and selectedrandomised controlled trials published in the last year, together with a commentary written by arelevant expert.http://www.library.nhs.uk/geneticconditions/viewResource.aspx?resid=395178

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Guidance


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NICE Clinical Guidelines

Sedation in children and young people: Sedation for diagnostic and therapeuticprocedures in children and young peopleClinical guideline: (CG112)http://www.nice.org.uk/nicemedia/live/13296/52130/52130.pdf

NICE Technology Appraisals

Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascularevents (Review of TA90)Technology appraisal: (TA210)http://www.nice.org.uk/nicemedia/live/13285/52030/52030.pdf

Prucalopride for the treatment of chronic constipation in womenTechnology appraisal: (TA211)http://www.nice.org.uk/nicemedia/live/13284/52078/52078.pdf

Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid orcapecitabine for the treatment of metastatic colorectal cancerTechnology appraisal: (TA212)http://www.nice.org.uk/nicemedia/live/13291/52091/52091.pdf

NICE Consultation Documents

CG27 Referral for suspected cancer: review proposal consultationClosing date for comments: 3 January 2011Only registered stakeholders can comment register or contact the registered stakeholderorganisation that most closely represents your interests and pass your comments to them.http://www.nice.org.uk/guidance/index.jsp?action=folder&o=52087

MoorLDI2 Burns Imager a laser Doppler blood flow imager for the assessment of burnwounds: consultation documentClosing date for comments: 3 January 2011http://www.nice.org.uk/guidance/index.jsp?action=article&o=51949

Breast cancer - bevacizumab (in combination with a taxane): final appraisal determinationClosing date for comments: 4 January 2011http://guidance.nice.org.uk/TA/Wave21/7/FAD

Follicular non-Hodgkin's lymphoma - rituximab: appraisal consultation documentClosing date for comments: 7 January 2011http://guidance.nice.org.uk/TA/Wave19/59/Consultation/DraftGuidance

Thrombocytopenic purpura - romiplostim: appraisal consultation documentClosing date for comments: 11 January 2011http://guidance.nice.org.uk/TA/Wave17/16/Consultation/DraftGuidance


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Hip fracture: guideline consultation

Closing date for comments: 5pm, 12 January 2011Only registered stakeholders can comment register or contact the registered stakeholderorganisation that most closely represents your interests and pass your comments to them.http://www.nice.org.uk/guidance/index.jsp?action=folder&o=51531

Physical activity and the environment: review proposal consultationClosing date for comments: 5pm, 12 January 2011Only registered stakeholders can comment register or contact the registered stakeholderorganisation that most closely represents your interests and pass your comments to them.http://www.nice.org.uk/guidance/index.jsp?action=folder&o=52203

Type 2 diabetes - preventing pre-diabetes in adults: consultation on the draft guidanceClosing date for comments: 19 January 2011http://guidance.nice.org.uk/PHG/Wave19/6/Consultation/Latest

Breast cancer (metastatic hormone-receptor) - lapatinib and trastuzumab (with aromataseinhibitor): appraisal consultation documentClosing date for comments: 19 January 2011http://guidance.nice.org.uk/TA/Wave0/167/Consultation/DraftGuidance

Leukaemia (lymphocytic) - bendamustine: final appraisal determinationClosing date for comments: 5pm, 20 January 2011http://guidance.nice.org.uk/TA/Wave23/16/FAD

Colonoscopic surveillance for colorectal cancer in high-risk groups: inflammatory boweldisease and polyps: 2nd draft guideline consultationClosing date for comments: 21 January 2011http://www.nice.org.uk/guidance/index.jsp?action=folder&o=52046

Stent insertion for bleeding oesophageal varices - Consultation DocumentClosing date for comments: 21 January 2011http://www.nice.org.uk/guidance/index.jsp?action=article&o=52308

Endovascular repair of popliteal aneurysms - Consultation DocumentClosing date for comments: 21 January 2011http://www.nice.org.uk/guidance/index.jsp?action=article&o=52297

Carotid artery stent placement for asymptomatic extracranial carotid stenosis -Consultation DocumentClosing date for comments: 21 January 2011http://www.nice.org.uk/guidance/index.jsp?action=article&o=52277


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Colonoscopic surveillance for colorectal cancer in high-risk groups: inflammatory boweldisease and polyps: 2nd draft guideline consultation

Closing date for comments: 21 January 2011

http://www.nice.org.uk/guidance/index.jsp?action=folder&o=52046

Stable angina: guideline consultationClosing date for comments: 9 February 2011Only registered stakeholders can comment register or contact the registered stakeholderorganisation that most closely represents your interests and pass your comments to them.http://www.nice.org.uk/guidance/index.jsp?action=folder&o=52134

NICE Interventional Procedure Guidance

Cryotherapy for the treatment of liver metastases

Interventional procedure guidance: (IPG369)http://guidance.nice.org.uk/IPG369

Percutaneous closure of patent foramen ovale for recurrent migraineInterventional procedure guidance: (IPG370)http://guidance.nice.org.uk/IPG370

Percutaneous closure of patent foramen ovale for the secondary prevention of recurrentparadoxical embolism in diversInterventional procedure guidance: (IPG371)http://guidance.nice.org.uk/IPG371

Percutaneous radiofrequency ablation for primary and secondary lung cancersInterventional procedure guidance: (IPG372)http://guidance.nice.org.uk/IPG372

Selective dorsal rhizotomy for spasticity in cerebral palsy

Interventional procedure guidance: (IPG373)http://guidance.nice.org.uk/IPG373

Low intensity pulsed ultrasound to promote fracture healingInterventional procedure guidance: (IPG374)http://guidance.nice.org.uk/IPG374

Clinical Knowledge Summariesupdated in December 2010

Cervical cancer and HPV (new)

Diabetes - type 1 (new)

Diarrhoea - adults assessment (new)


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Insulin therapy in type 1 diabetes (new)

Pancreatitis - acute (new)

Pancreatitis - chronic (new)

Pityriasis rosea (new)

Whooping cough (new)

Other Guidance

Items in the Cardiovascular Diseases and Influenza sections may also be of interest.

Health Technology Assessments

Clinical effectiveness and cost-effectiveness of stem cell transplantation in themanagement of acute leukaemia: a systematic reviewHealth Technol Assess; 14.54

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HIV

Time to test for HIV: Expanded healthcare and community HIV testing in England; interimreport

Health Protection AgencyThe Department of Health funded eight demonstration projects to pilot the expansion of HIVtesting outside traditional settings. Three types of settings were assessed: hospitals, primary careand community outreach. The results of these projects will inform an evidence base forsuccessful strategies to increase HIV testing and reduce the proportion of individuals who areundiagnosed and present late. This interim report includes a summary of the projects andindividual results from each pilot. The projects have been assessed within the criteria of:feasibility, acceptability, effectiveness and cost effectiveness, and sustainability.http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287145497243

Increasing the uptake of HIV testing to reduce undiagnosed infection and preventtransmission among black African communities living in England: Barriers to HIV testing -

Final full report.NICEThe aim of this project was to systematically review qualitative literature that identifies the barriersand facilitators to the uptake of HIV testing among African communities in England. The reviewaddresses the following questions:- What factors help or hinder the uptake of HIV testing by black African communities living in

England and how can the barriers be overcome?- What interventions have successfully reduced the social, personal and cultural barriers

associated with testing among black African communities in the UK?- What (if any) are the adverse or unintended consequences (positive or negative) of the

interventions?- What environmental, social and cultural factors prevent or support the uptake of HIV testing?- How does HIV-related stigma affect the uptake of HIV testing?


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http://www.nice.org.uk/nicemedia/live/12064/50941/50941.pdf

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Hospital Admissions

Avoiding hospital admissions: What does the research evidence say?Kings FundEmergency admissions to hospital are costly to the NHS and also cause disruption to plannedhealth care. Considerable efforts have been made within the health service to reduce emergencyadmissions, but few primary care trusts have been successful, with some primary care trustsrecording an increase.This paper aims to address the following questions:What interventions work in reducing avoidable admissions?Who is at risk, and how do we identify them?

Which admissions are potentially avoidable?Which interventions work in:

primary care social care emergency care discharge from hospital.

The summary is accessible via:http://www.kingsfund.org.uk/publications/avoiding_hospital.html

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Immunisations / Vaccinations

Routine childhood immunisations from November 2010Department of HealthThe routine childhood immunisation schedule from November 2010, showing the immunisationsthat were previously given at two separate visits at 12 and 13 months of age now combined intoone visit between 12 and 13 months.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_122401.pdf

Rubella resourcesDepartment of HealthThe Department of Health has published the following 'Rubella resources'. These include posters

and leaflets for expectant mothers on protection against German measles (rubella).http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122409

Flu Vaccination for Pregnant WomenDepartment of HealthThis letter from the Director of Immunisation to the Royal College of Midwives, Royal College ofObstetricians and Gynaecologists and the BMA, is asking for their support to urge members toencourage all pregnant women, no matter what stage of pregnancy, to get their flu vaccine assoon as possible.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_122851.pdf


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Immunisation against infectious disease - 'The Green Book'

Department of HealthThis new edition (2006) presents latest information on vaccines and vaccination procedures for allthe vaccine preventable infectious diseases that may occur in the UK. In particular it deals withthose immunisations that comprise the routine immunisation programme for all children from birthto adolescence. All health professionals that give immunisations or provide information andadvice on them will find that this edition of the Green Book has been fully updated and gives acomprehensive and invaluable source of current information. All the new chapters are alsoavailable below to download in Portable Document Format (PDF)http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079917

Items in the Influenza section may also be of interest.

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Infection Control

The Health and Social Care Act 2008: Code of Practice on the prevention and control ofinfections and related guidanceDepartment of HealthThis Code of Practice comes into force on 1 April 2011 for existing registered providers andprimary dental care and independent sector ambulance providers, and 1 April 2012 for primarymedical care providers. It sets out the criteria against which a registered provider's compliancewith the requirements relating to cleanliness and infection control will be assessed by the Care

Quality Commission. It also provides guidance on how the provider can interpret and meet theregistration requirement and comply with the law. This document takes account of responses tothe consultation on the draft Code of Practice and related guidance that ran from 26 March to 15July 2010. The December 2009 version of the Code will remain in force until 1 April 2011.However, existing registered providers may wish to be aware that this new Code containsupdated references in the bibliography and takes account of the Equality Act 2010 in terms ofpre-employment health assessments. The code of practice and consultation document responsecan be accessed via:http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122604

Items in the Influenza section may also be of interest.

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Influenza

Treatment guidelines for patients with influenza 2010/2011Department of HealthProfessor David Salisbury wrote last week on the use of antivirals for individuals suspected tohave influenza, particularly in the context of primary care. The purpose of this letter is to providean update on appropriate guidelines for treatment in secondary care and other settings.Accessible via:


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http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_122682

2010/11 Seasonal Influenza: Prescription of AntiviralsNHS Central Alerting SystemThis letter contains information about the prescription of antivirals (oseltamivir and zanamivir) tomeet clinical circumstances arising during the current seasonal influenza outbreak.https://www.cas.dh.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=101515

Items in the Immunisations/Vaccinations section may also be of interest.

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Liver Disease

2010 Annual Evidence Update on Alcoholic Liver DiseaseNHS Evidence Specialist Collections Gastroenterology and liver diseasesThis is the second Annual Evidence Update on alcoholic liver disease. It highlights knowledgepublished since the 2009 Update on the diagnosis, treatment and management of alcoholic liverdisease. The information is provided along with additional expert commentary. The evidence hasbeen split into sections: epidemiology, treatment and adverse effects.http://www.library.nhs.uk/GASTROLIVER/ViewResource.aspx?resID=395097

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Long Term Conditions

The E's of self managementDepartment of HealthThe Long Term Conditions Quality, Innovation, Prevention and Productivity Team have producedthe E's of Self Management, which is aimed at professionals who are commissioning andproviding services for people with long term conditions and summarises support for professionalengagement in self management of long term conditions.Accessible via:http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_123018

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Medicines

Trading Medicines for Human Use: Shortages and Supply Chain Obligations

Department of HealthThis paper sets out the key legal and ethical obligations on manufacturers, wholesalers, NHSTrusts, registered pharmacies and dispensing doctors in relation to the supply and trading ofmedicines. Recent increases in the export of medicines are a major contributor to supplyproblems and risk jeopardising patient care.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122739.pdf


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Mental Health / Learning Disabilities

Mental health and the productivity challenge: improving quality and value for moneyKings FundThe Kings Fund and Centre for Mental Health, with the support of the Royal College ofPsychiatrists and the NHS Confederations Mental Health Network, have worked together toexplore how mental health services could be delivered in a different and more cost-effective wayThe consensus reached is that there is scope for mental health services not only to improve theirown productivity but also to support productivity improvements in other parts of the NHS. Thisreport focuses on: immediate priorities for improving productivity in existing mental healthservices, what mental health services can offer to improve productivity in the NHS as a whole, theeconomic benefits beyond the NHS of improved mental health care, and the longer-termchallenge of building a preventive and empowering mental health system. The report suggests

that there are real opportunities to change the way mental health services are delivered in orderto achieve more within existing budgets.http://www.kingsfund.org.uk/publications/mental_health_and.html

Commissioning Mental Wellbeing

National Mental Health Development UnitUsing a public health approach that identifies root causes of poor mental health, this brief offerscost-effective evidence based interventions and approaches to promote wellbeing. It will be ofinterest to all those working at senior level in the NHS, Local Government and the VoluntarySector and in or through the proposed Health and Wellbeing Boards, which will have the centraland leading role in improving population health and mental wellbeing at a local level. This briefprovides a summary and guide to action and includes:

- Making sense of Mental Wellbeing, Mental Health and Mental Illness- Action for wellbeing- Commissioning for mental health and wellbeing- The Case for Wellbeing Interventions- Commissioning cost effective interventionshttp://www.nmhdu.org.uk/silo/files/commissioning-for-wellbeing-and-population-mental-health.pdf

Valuing People Now: Summary Report March 2009 - September 2010

Department of HealthThis report includes findings from the Learning Disability Partnership Board Self-Assessments in2009-10. The report covers progress that has been made within the last 18 months underValuing People Now. It focuses on the key priorities of improving outcomes for people withlearning disabilities in health, housing, and employment, and shows where more work is neededto make the lives of people with learning disabilities better. Published with the report is additionalguidance containing good practice examples about different aspects of the Valuing People Nowprogramme.The report and good practice examples are accessible via:http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122385

Implementing Fulfilling and rewarding lives: Statutory guidance for local authorities andNHS organisations to support implementation of the autism strategyDepartment of Health


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The purpose of this guidance is to secure the implementation of 'Fulfilling and Rewarding Lives:The strategy for adults with autism in England' by giving guidance to local authorities, NHSbodies and NHS Foundation Trusts around training of staff, the diagnosis of autism and the

leadership and planning of services. This guidance will help these bodies to develop services thatsupport and meet the locally identified needs of people with autism and their families and carers.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/documents/digitalasset/dh_122908.pdf

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Musculoskeletal

2010 Annual Evidence Update on Complimentary and Alternative Medicine (CAM) for LowBack PainNHS Evidence Specialist Collections - Complementary and alternative medicine

This update aims to identify, organise and present the latest information on Complimentary andAlternative Medicine for lower back pain this topic. A large number of databases have beensearched for studies published or updated between September 2009 and September 2010. Theupdate includes a list of systematic reviews, meta-analyses and selected randomised controlledtrials, along with commentaries from experts.http://www.library.nhs.uk/CAM/ViewResource.aspx?resID=396560&tabID=289

Spinal diseasesAnnual Evidence UpdateNHS Evidence Specialist Collections - Trauma and orthopaedicsAs in previous years, the update includes guidelines and systematic reviews which have beenpublished within the last year. This Update includes reviews covering disc surgery and minimallyinvasive surgery along with various therapies and treatments. This topic should be of particular

interest to all health professionals working in this field.http://www.library.nhs.uk/TRAUMA_ORTHOPAEDICS/ViewResource.aspx?resID=396623&tabID=289&catID=1135

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Neurology

A guide to MS for GPs and primary care professionalsMultiple Sclerosis SocietySecond edition of the guide to MS for anyone working in primary care. It includes information ondiagnosis, symptoms, treatments and support.

http://www.mssociety.org.uk/downloads/A_guide_to_MS_for_GPs_and_primary_care_professionals_2009-1.c70914a7.pdf

Anti-inflammatory drugs and risk of Parkinson disease: a meta-analysisGagne J. J., Power M. C,Database of Abstracts of Reviews of Effects (DARE)This review concluded that non-aspirin non-steroidal anti-inflammatory drugs may provide aprotective effect against Parkinson disease. Overall, this was a well-conducted systematic reviewand the authors' conclusion is likely to be reliable.http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12010002640


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Item in the Pain section may also be of interest

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Obesity

Long-term cost-effectiveness of weight management in primary careNHS Economic Evaluation Database (NHS EED)Haynes S.M., Lyons G.F., McCombie E.L. et al.This study examined the long-term cost-effectiveness of an obesity-reduction programme within aprimary-care setting. The authors concluded that the Counterweight programme was a highlycost-effective intervention for obesity management, from the perspective of the health caresystem, compared with no intervention. The methods were valid and generally well describedand the authors conclusions appear to be valid and robust.http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22010000879

Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts Database of Abstracts of Reviews of Effects (DARE)Afshinnia F., Wilt T.J., Duval S., Esmaeili A., Ibrahim H.N.This review aimed to determine the effects of intentional weight loss on proteinuria and kidneyfunction and found that weight loss was associated with decreased proteinuria andmicroalbuminuria, which suggested a beneficial effect on surrogate outcomes of the decrease ofurinary protein excretion. Overall the review appeared well conducted and the conclusions arelikely to be reliable.http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12010002926

The National Obesity Observatory e-atlasesNational Obesity Observatory (NOO)The National Obesity Observatory has published new data from the National Child MeasurementProgramme (NCMP). The Child e-atlas now includes four years data from 2006/07 to 2009/10.The e-atlases are interactive mapping tools for the analysis of data on the prevalence of obesityand its determinants at Local Authority (LA) and Primary Care Trust (PCT) level in England. Thechild e-atlases enable users to view and compare data at PCT and LA level, for both single anddual maps.Child single map LA/PCT e-atlas:http://www.sepho.nhs.uk/noo/eatlas/childsingle/atlas.htmlChild dual map LA/PCT e-atlas:http://www.sepho.nhs.uk/noo/eatlas/childdouble/atlas.html?indicator=i9&date=2009/10&indicator2=i37&date2=2007

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Oral Health

NHS Dental Contract: Proposals for PilotsDepartment of HealthFrom April 2011 the government will be running a new series of pilots in 50 to 60 locations aroundthe country. Designed to test three different contract models, this exercise will help inform thedevelopment of a new national NHS dental contract. Based on registration, capitation and quality,the new contract will have three main objectives: improve the quality of patient care; increaseaccess to NHS dental services; and improve oral health, especially the oral health of children


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http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122789.pdf

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Pain

2010 Annual Evidence Update on HeadacheNHS Evidence Specialist Collection Neurological conditionsThis is the third Annual Evidence Update. NHS Evidence has carried out a systematic literaturesearch on headache to identify all high level evidence published since the date of the lastHeadache AEU in August 2009, including guidelines, systematic reviews, health technologyassessments and economic evaluations. Leading headache and migraine experts from aroundthe UK have read and appraised these for their validity and relevance to the busy clinician. Expertcommentaries are included.

http://www.library.nhs.uk/neurological/ViewResource.aspx?resID=389283

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Palliative CareThe Palliative Care Funding Review - interim reportPalliative Care Funding ReviewThis report makes recommendations for immediate improvements to the palliative care system,including investment to support 24/7 access to community services. It highlights the need todefine the core services that should be funded by the NHS as a statutory responsibility and howthese can be balanced with services that are supported by society.

http://www.palliativecarefunding.org.uk/InterimReport.pdf

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Pregnancy

Brief screening questionnaires to identify problem drinking during pregnancy: asystematic reviewDatabase of Abstracts of Reviews of Effects (DARE)Burns E., Gray R., Smith L.A.This review assessed performance of brief alcohol screening questionnaires in identifying riskdrinking in pregnant women. The authors concluded that T-ACE, TWEAK and AUDIT-C showedpromise for identifying risk drinking and AUDIT-C for identifying alcohol dependency or abuse;further evaluation was needed. These conclusions were appropriately cautious.http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12010003109

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Public Health

Healthy lives, healthy people White Paper: Our strategy for public health in EnglandDepartment of Health


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The White Paper sets out the Governments long-term vision for the future of public health inEngland. The aim is to create a wellness service (Public Health England) and to strengthen bothnational and local leadership.

White Paper and Impact Assessments available via:http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm

Healthy lives, healthy people: consultation on the funding and commissioning routes forpublic healthDepartment of HealthThis consultation explores the proposed funding and commissioning routes for public health,including the ring-fenced budget provided to local authorities. The consultation closes on 31March, after which a summary of responses received will be published.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_123114.pdf

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Rehabilitation Medicine

Medical rehabilitation in 2011 and beyond.

Royal College of PhysiciansThis working party report, examines the current state of rehabilitation medicine, and considershow it is likely to develop over the coming years. The report revises the definitions aroundrehabilitation medicine, in line with current practice. It also places rehabilitation in the broadercontext of acute illness management, arguing that commissioning - in the format newly proposedby the coalition government - should support interdisciplinary practice and clinical pathways whichreflect the widespread overlap with other areas of medicine. The report argues that, while shorter-

term programmes are functioning well, longer-term pathways need to integrate high-intensitytreatments, greater consideration of the individual's participation in life, vocational needs, familyrelationships, and the need to return to as normal a life as possible. This report is essentialreading, not just for rehabilitation medicine physicians, but also specialists in stroke, palliative,acute, geriatric medicine, and neurology. It also contains guidance for current commissioners,planners and providers of healthcare and social care, and for GPs for their clinical practice as wellas for their commissioning work in the near future.http://bookshop.rcplondon.ac.uk/contents/pub320-b2f017c5-09ef-42fa-a306-6f30956b9186.pdf

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Renal Diseases

2010 Annual Evidence Update on Post Transplant Lymphoproliferative Disorders in RenalTransplant patientsNHS Evidence Specialist Collections Kidney diseases and male urogenital disordersNHS Evidence has reviewed the literature for relevant systematic reviews, randomised controlledtrials and cohort studies, and assessed the impact of this new evidence published since theintroduction of the BSH/BTS guidelines for the diagnosis and management of PTLD which werepublished in June 2010.http://www.library.nhs.uk/KIDNEY/ViewResource.aspx?resID=394440

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Respiratory Diseases

Cost-effectiveness of school-based asthma screening in an urban setting

NHS Economic Evaluation Database (NHS EED)Gerald J.K., Grad R., Bailey W.C., Gerald L.B.The objective was to evaluate the cost-effectiveness of four school-based asthma screeningstrategies for elementary school children from urban, low income, ethnic minority populations.The authors concluded that these screening strategies were not cost-effective and more certaintyon the value of a day with symptoms was needed. The methods were good, but wereinsufficiently reported around the identification of the effectiveness data. Given the scope of theanalysis, the conclusions appear to be valid, but should be interpreted with cautionhttp://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22010000687

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Service Management

Measuring social value: How five social enterprises did itDepartment of HealthSocial enterprises have real potential to refresh and reinvigorate health and social care services.They provide more services than ever before, with more than 6,000 schemes estimated to bedelivering health and social care in the UK. Providing more choice and better quality, responsiveand innovative services, social enterprises also are distinctive features and a key part of whatsocial enterprises do, but it may not be easy to describe it in ways that make sense to businesspartners.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122354.pdf

Clinical and service integration: The route to improved outcomesKings FundOver the past decade a number of health policies have sought to put the patient first and toimprove health outcomes. Choice and competition have been key elements of these policies, butthe importance of integrated care was highlighted by Lord Darzi in the final report of the NHSNext Stage Review. Does integration of care act as a barrier to choice and competition? Thisreport describes integrated care and identifies the different forms it takes; explores the differentlevels within the system at which it operates and sets out the evidence for the different systems.Integration can take a variety of forms, involving either providers, or providers andcommissioners, who work together to deliver better outcomes at a number of levels within thesystem. This report summarises relevant evidence about high-profile integrated systems in theUnited States, such as Kaiser Permanente and Geisinger Health System and outlines examples

of integrated care in North America and Europe for particular groups, such as older people orpatients with long-term conditions for example, the integrated health and social care teams inTorbay. It also explores the range of approaches to improving co-ordination for individual patientsand carers for example, the Care Programme Approach in mental health. The report focuses onexamples that are most relevant to the NHS in England in the context of the coalitiongovernment's programme.http://www.kingsfund.org.uk/publications/clinical_and_service.html

Guidance on safe nurse staffing levels in the UK

Royal College of NursingStaffing levels have always been an issue. What is the optimal level and mix of nurses requiredto deliver quality care as cost-effectively as possible? is a perennial question. This report sets


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out the range of different factors that influence the total demand for staff and highlights the varietyof methods for planning or reviewing staffing levels.http://www.rcn.org.uk/__data/assets/pdf_file/0005/353714/003860.pdf

Transfer and transform: The challenges for community health services

NHS Confederation Primary Care Trust NetworkPlans are underway to transfer community service provision from primary care trusts (PCTs) byApril 2011. The presence of these services in the community and their close day-to-day workingrelationships with GPs means they are well placed to deliver the improvements that strike at theheart of the Governments planned NHS reforms.This Briefing sets out the key points from our discussions with members who have experience oftransferring services, including their learning about how best to transfer services, what exactlyshould be transferred, the cultural issues to consider and the necessary governancearrangements.http://www.nhsconfed.org/Publications/Documents/PCTN%20briefing_209_Nov2010.pdf

Liberating the NHS: Legislative framework and next stepsDepartment of HealthPublished in July 2010, the White Paper Equity and Excellence: Liberating the NHS outlines ourvision to make the NHS a truly world class healthcare service that puts patients at its heart andclinicians in the driving seat, focused on outcomes. Following three months of consultation on itsplans for the service, the Governments response published 14th December 2010 sets out furtherpolicy development based on substantial feedback and reaffirms the strong commitment to thereforms.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122707.pdf

Clinical responses to the downturn: Seven medical specialties address how they can helptackle the NHS financial challengeNHS ConfederationThis joint publication brings together practical recommendations from focus groups with sevenspecialty medical societies and royal colleges, each of which were asked to suggest ways thatclinicians in their own specialties can release NHS resources while maintaining or enhancingquality. Seven medical specialties address how they can help tackle the NHS financial challenge.This report examines how to release NHS resources across the seven specialties of:neurosurgery, geriatrics, vascular services, pathology, orthopaedics, neonatology, dermatology.The answers tackle issues with referrals, discharge, follow-up, procedures of low or questionablevalue, workforce profiles, commissioning, waste, and productivity, among others. Therecommendations will be of use to local commissioners and providers, clinical leaders, policymakers and anyone else seeking to address the most serious period of financial constraint in the

history of the NHS.http://www.nhsconfed.org/Publications/Documents/Clinical_responses_to_downturn_full_Dec2010.pdf

The Operating Framework for the NHS in England 2011/12Department of HealthThis years Operating Framework sets out what needs to happen over the transition year2011/12. All parts of the health service are required to work across organisational boundaries torespond positively to the reform set out in Equity and Excellence: Legislation for, whilst ensuringthat service quality and financial performance are maintained and improved at a time of change.http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122738


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NHS allocations

Department of HealthThe Department of Health allocates recurrent revenue funding to primary care trusts (PCTs) onthe basis of the relative needs of their populations and in line with pace of change policy.Available via:http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Allocations/index.htm

Implementing Fulfilling and Rewarding Lives: Summary and response to the findings fromthe consultationDepartment of HealthThis document is a summary of the responses received to the consultation on ImplementingFulfilling and Rewarding Lives, the draft statutory guidance for health and social care to supportthe implementation of the national autism strategy. It highlights the key themes from theconsultation and sets out the Government's response.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122907.pdf

Implementing Fulfilling and rewarding lives: Statutory guidance for local authorities andNHS organisations to support implementation of the autism strategyDepartment of HealthThe purpose of this guidance is to secure the implementation of 'Fulfilling and Rewarding Lives:The strategy for adults with autism in England' by giving guidance to local authorities, NHSbodies and NHS Foundation Trusts around training of staff, the diagnosis of autism and theleadership and planning of services. This guidance will help these bodies to develop services thatsupport and meet the locally identified needs of people with autism and their families and carers.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/documents/digita

lasset/dh_122908.pdf

Payment by Results 2011-12 road test packageDepartment of HealthThe road test exercise provides an opportunity for the service to test out the new tariff, andsupports the planning process. The main focus of the road test is to gather comments on the draft2011-12 PbR guidance and PbR Code of Conduct.The covering letter from David Flory, NHS Deputy Chief Executive, details the changes made tothe proposed 2011-12 tariff arrangements since his letter of 30 September 2010.Road test documents, feedback form, draft guidance and covering letter are all accessible via:http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_123073.pdf

Healthy Lives, Healthy People: transparency in outcomes, proposals for a public healthoutcomes frameworkDepartment of HealthThis consultation explores the proposed public health outcomes framework. The consultationcloses on 31 March, after which a summary of consultation responses received will be published.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_123113.pdf

Joined-up care delivering seamless care: A practical guide tomaking change happen


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NHS Institute for Innovation and ImprovementThis guide is a practical guide to making change happen, which succinctly outlines the principlesand methods needed to enable you to successfully develop patient centred Joined-up care.

http://www.institute.nhs.uk/images/documents/Joined_Up_Care/NHSI%20JOINED%20UP%20CARE%20DOCUMENT.pdfRelated case studies, literature review, measuring improvement documents and links areaccessible via:http://www.institute.nhs.uk/qipp/joined_up_care/joined_up_care_homepage.html

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Stroke

Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trialsDatabase of Abstracts of Reviews of Effects (DARE)

Schurks M., Glynn R.J., Rist P.M., Tzourio C., Kurth T.This review evaluated the effect of vitamin E supplementation on the incidence of total, ischaemicand haemorrhagic stroke. The authors concluded that vitamin E increased the risk forhaemorrhagic stroke by 22% and reduced the risk for ischaemic stroke by 10%. The authors'conclusions and recommendations for research and practice seem likely to be reliable.http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12010007595

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Urology

Cost effectiveness of management strategies for urinary tract infections: results from

randomised controlled trialNHS Economic Evaluation Database (NHS EED)Turner D., Little P., Raftery J., Turner S., Smith H., Rumsby K., Mullee M., UTIS TeamThis study assessed the cost-effectiveness of five management strategies for suspected urinarytract infections. The authors concluded that dipstick testing followed by targeted antibiotics waslikely to be the most cost-effective strategy, if the value of a day without moderate symptoms wasat least 10 UK pounds sterling. There were a few limitations to the study, but the methods andresults were generally well reported and the authors' conclusions reflect the evidence available.http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22010000335

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Workforce

Support workforce new webpagesNHS EmployersNHS Employers have brought all their support workforce resources into one place. The new webpages discuss the need to invest in the development of support workers, utilising the assistantpractitioner and apprenticeship models and education and training options, as well as providinglinks to tools and resources to assist in implementation.http://www.nhsemployers.org/PlanningYourWorkforce/SupportWorkforce/Pages/SupportWorkforce.aspx


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Maternity issues for doctors in trainingNHS EmployersThis factsheet provides guidance for doctors in training who need to plan maternity leave. The

factsheet includes information on timelines for telling your employer you are pregnant, when totake maternity leave, maternity pay and advice for doctors in training who may be movingbetween employers.http://www.nhsemployers.org/Aboutus/Publications/Documents/Maternity%20issues%20for%20doctors%20in%20training.pdf

The Back on Track Framework for Further Training: Restoring practitioners to safeand valued practiceNHS National Clinical Assessment ServiceThe National Clinical Assessment Service (NCAS) has published a new good practice guideaimed at helping doctors, dentists and pharmacists return to safe and valued practice. The Backon Track Framework is a completely new edition of the guide published in 2006. The guild buildson NCASs ten years of experience in tackling concerns about professional practice.http://www.ncas.npsa.nhs.uk/resources/good-practice-guides/back-on-track/

Human Rights and Human Rights Legislation (in recognition of Human Rights Day 10December 2010)NHS EmployersIn recognition of Human Rights Day on 10 December 2010, NHS Employers have publishedinformation for employers about what human rights and human rights legislation mean for theNHS workforce. Our web page includes information on articles of the Human Rights Act (1998)that can be applied directly to the workplace, as well as advice for employers, and case studiesfrom NHS organisations that have embedded human rights into their service delivery.http://www.nhsemployers.org/EmploymentPolicyAndPractice/EqualityAndDiversity/Diversity-calendar/Pages/HumanRightsDay10December2010.aspx

Simplified KSFNHS EmployersIn response to requests from employers, a Word version of the NHS Staff Council's Appraisalsand KSF made simple - a practical guide is now available on our KSF pages for trusts to tailor totheir local needs. All the appraisal templates are available as individual Word documents on ourappraisal tools and tips page.http://www.nhsemployers.org/PayAndContracts/AgendaForChange/KSF/Simplified-KSF/Pages/SimplifiedKSF.aspx

Liberating the NHS: developing the healthcare workforce

Department of HealthThis consultation document sets out proposals to establish a new framework for developing thehealthcare workforce and seeks views on the systems and processes that will be needed tosupport it. The final date for responses is 31st March 2011, but earlier expressions of view wouldbe helpful.http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590

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