Aspirin and cardiovascular disease

Full text extract from NHS Evidence:  Sept 2011

Overview: Aspirin is one of the most used medicines. It has long been a major analgesic and antipyretic, and now is widely used in lower doses as an antiplatelet agent helping to  reduce heart disease and strokes.

Research has shown aspirin to be effective in decreasing cardiovascular morbidity and mortality in patients with clinical evidence of cardiovascular disease (BMJ Clin Res ed. 2002 Jan 12;324(7329):71-86 and  Berger JS et al, Am J Med. 2008 Jan;121(1):43-9). However, there is ongoing debate about the role of aspirin in the prevention of cardiovascular disease for people without the condition. 

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Chemotherapy duration for advanced breast cancer

Cancer ribbon emblemExtract from NHS Evidence: Sept 2011

Overview: Breast cancer is the most common cancer affecting women in Englandand Wales, with about 40,500 new cases diagnosed and 10,900 deaths recorded in Englandand Wales each year.  In men breast cancer is rare, with about 260 cases diagnosed and 68 deaths in England and Wales each year.

Of these new cases in women and men, a small proportion are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, there are a significant number of women who have been previously treated with curative intent who subsequently develop either a local recurrence or metastases.

Current treatment: There is currently no cure for advanced breast cancer. However, treatment can slow tumour growth, relieve symptoms and improve quality of life.

NICE recommends endocrine therapy as first line treatment for the majority of patients with oestrogen receptor-positive advanced breast cancer. Chemotherapy is an option for patients who are not responding to hormone therapy or whose breast cancer is hormone receptor negative.

The NICE Pathway: breast cancer, brings together all related NICE guidance and associated products on the condition in a set of interactive topic-based diagrams.

New evidence: A systematic review and meta-analysis of randomised controlled trials (Gennari et al: Clin Oncol. 2011 Jun 1;29(16):2144-9) evaluated the effect of different first-line chemotherapy durations in patients with advanced breast cancer on overall survival and progression free survival.

The results of trials including 2,269 patients found that longer first-line chemotherapy duration significantly improved both overall and progression free survival.
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Non-invasive ventilation for acute pulmonary oedema

Extract in full from NHS Evidence: Sept 2011

Overview: Pulmonary oedema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli. It is frequently caused by disease affecting the heart’s left ventricle and may complicate the presentation of acute heart failure. The condition is a common medical emergency which requires urgent intensive treatment to reduce the risk of mortality.

Current treatment: Treatment of acute pulmonary oedema (ACPO) should be directed at reversing the specific cause, although this is not always possible.

Management is otherwise supportive and directed at improving oxygenation, perfusion and haemodynamics, and preventing further cardiac and/or renal damage.

Emergency treatment of acute heart failure includes morphine, nitrates, oxygen, diuretics and non-invasive ventilation (NIV), with urgent angiography if acute coronary syndrome is thought to be the cause. 
New evidence: A randomised controlled trial, carried out across 26 UK hospitals, set out to measure health utility and survival in patients with acute cardiogenic pulmonary oedema, identify predictors of outcome and determine the effect of initial treatment with NIV on outcomes (Goodacre, S et al. Emerg Med J 2011 28: 477-482).
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Global rise in diabetes

Extract from NHS Evidence: Issue 29 September 2011
Overview:  Diabetes is the most common endocrine disease affecting more than one million people in the UK and causing three million deaths globally each year. It  is defined by high blood glucose: fasting plasma glucose (FPG) below 5.6 millimoles per litre (mmol/L) is considered normal, above 7 mmol/L is diagnostic of diabetes and an FPG level between 5.6 and 7 is considered pre-diabetes.

Treating diabetes accounts for approximately 10% of NHS spend. This is largely due to its associated complications which include coronary, cerebrovascular, ophthalmological and renal disease.

New evidence: A global study into diabetes prevalence (Danaei, G et al, The Lancet, 378, (9785) 31-40) shows the number of cases has more than doubled over the past 3 decades, with an estimated 347 million people now living with the condition worldwide.

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Immunisation joins the newsfeed list

Keeping up-to-date with the latest publications and clinical developments can be time consuming.  Thankfully using newsfeeds and bulletins makes this task considerably easier.  The Immunisation newsfeed is the latest addition to be added to our website.  The list now includes:


If you want to learn more about subscribing to newsfeeds or setting up alerts, please contact us on 01625 66 1362.

Visiting the Centre? See what’s in the Library today!

Staff reminder:

If you are attending Statutory and Mandatory training or any courses in the Education and Training Centre, don’t forget to call in the Library and

  • see the latest new books on offer
  • check your emails
  • read the paper while you wait with a cup of coffee
  • browse the art exhibition
  • or choose something from the leisure reading collection 
  • sign up for Athens
  • join the library and get your FREE eco-friendly jute bag

The Staff Library is for all our staff and students – so come along and see what you have been missing!

Open Mon – Thurs: 8:30 – 5:00pm  and Friday 8:30 – 4:30pm


Reaping the rewards

Overdue congratulations go to  Angela Donnelly, Library Manager, for receiving one of the HR Service Staff Awards, in the category of Improvement through Innovation.

“I was very surprised and pleased to accept this award on behalf of the Staff Library Team who have all worked very hard to implement the changes in the way we deliver Library services to staff at East Cheshire” said Angela, seen above.  The award was given for the many improvements implemented since July 2010. These included:

  • the renaming and rebranding of the library;
  • redesigning the space and inviting staff to contribute to a display of art work
  • establishing the outreach service
  • developing a successful partnership with the public library, 
  • launching the ‘six book challenge’ 

” The changes have increased the usage of the library service, made cost savings and established the library as a real resource for all groups of staff,” said Jackie Knapman who was responsible for nominating Angela.


Chris Hughes: The making of Chapter 16

Back in 2004, as Chris Hughes began her preoperative assessment practitioner[1] (PSP) training at St Mary’s Hospital, London, she never imagined it would lead to her being asked to submit a chapter on consent, as part of a collaborative book.

Chris recollected that time, 7 years ago, when she was based at Macclesfield and being mentored by one of our surgeons, Mr Brough. Working in general/colorectal surgery and with a clinical background as a senior theatre sister proved to be excellent preparation for the PSP course which was both interesting and challenging. One module was devoted to the complex subject, consent.  This involved a number of training sessions at London’s famous Law Courts, including some time in the dock!  But all this paid off when she achieved her Level 4 masters module (Certificate of Advanced Study) and underlined for Chris, the importance of having a robust consent process here in Macclesfield.  Consent discussions are timed to occur well in advance of the patients’ appointed surgery date, allowing them plenty of time to ask questions and make fully informed decisions. Only after all the benefits and risks have been discussed does their planned procedure take place.

It was Chris’s course tutor who asked her if she would be interested in writing a chapter for the book “Preoperative Assessment and Perioperative Management” and set in motion what would become a well worn path to the Staff Library. Here Chris had access to the electronic resources she needed to complete her research and with the support from library staff, Chris was able to hone her literature search skills. Having achieved her target of 5,000 words plus additional case studies, quotes and court case examples, Chapter 16 was despatched on time to the publishers in 2008.

However, some 3 years later, the long awaited pleasure of holding the finished product is clearly evident from Chris’s smile – something she can take pride in sharing with her family and 3 grandchildren.

With its clear and open style, the book is suitable for all practitioners and staff, guiding them carefully through some complex topics by concentrating on three main aspects:

  • core clinical skills and knowledge used to assess patients prior to surgery
  • specialist areas of preoperative practice
  • service development and management of the perioperative systems.

Our thanks to the surgical business unit, who hope to purchase a copy and make it available on loan through the Staff Library service.  A fitting end for this chapter wouldn’t you agree?

Preoperative Assessment and Perioperative Management
Mark Radford, Alastair Williamson and Clare Evans
M&K Publishing

[1] Certificate of Advanced Study (CAS) Level 4 MA

NHS Kidney Care

Improving the standard of care of children with kidney disease through paediatric nephrology networks
This report focuses on the ‘patient experience’ in light of the health reforms taking place across England. It examines access to services, patient and carer involvement, quality indicators, audit and workforce planning. In particular, it draws out how paediatric nephrology networks will be setting out the core requirements for success and standards for commissioning and provision of services. It was created in collaboration with The Royal College of Paediatrics and Child Health and the British Association for Paediatric Nephrology.

Pancreatic Cancer UK

Extract as reported in The Kings Fund bulletin:
Study for survival 2011
This report finds that five year survival rates are amongst the worst in the world for UK pancreatic cancer patients. This is compared to patients living in other EU countries as well as the US, Australia and Canada. In some instances, like Canada and Australia, differences in reported survival rates are double those of the UK.

Verstappen S.M.M., McCoy M.J.,Knight S., et al: Journal of Rheumatology: March 2011

Published article – Disease activity, smoking, and reproductive-related predictors of poor prognosis in patients with very early inflammatory polyarthritis in the Journal of Rheumatology, March 2011, vol./is. 38/3(429-433), 0315-162X;1499-2752 (March 2011)

Abstract available – Athens required