Aumeer, R: Obesity Reviews, May 2011

Audit on body mass index in pregnancy
Citation: Obesity Reviews, May 2011, vol./is. 12/(199), 1467-7881 (May 2011)
Author(s): Aumeer R.
Introduction and background: Obesity during pregnancy is a risk factor for many adverse outcomes such as stillbirth, macrosomia, and gestational diabetes, among others.
Objective: To assess the quality of care and management of obese pregnant women at Dudley Hospital, United Kingdom.
Design: A retrospective audit study.
Setting: Dudley Hospital, Birmingham, United Kingdom.
Standards and criteria: All pregnant women should have their body mass index (BMI) measured and recorded at their first prenatal visit. All pregnant women with BMI > 30 should have postprandial blood tests at 20 weeks and 26 weeks to screen for diabetes. All pregnant women should receive advice about sensible diet and exercise, which should be documented in their medical notes.
Methods: Medical records for all patients with delivery dates between December 2008 and January 2009 were audited post delivery.
Participants: Pregnant women (N = 91).
Results: BMI is recorded for 98% of patients. Over a quarter of women with BMI > 30 did not have postprandial blood tests at 20 and 26 weeks.
Conclusion: BMI is calculated and recorded for most patients, but uptake of postprandial blood tests is suboptimal in patients with BMI > 30.
Recommendations: To add a section on obesity in the maternity notes.
Institution: (Aumeer) East Cheshire NHS Trust, Macclesfield, United Kingdom

All-Party Parliamentary Group on Dementia (APPG)

Inquiry into how to improve dementia diagnosis rates in the UK
The APPG has launched its next inquiry which will focus on improving dementia diagnosis rates across the UK. An inquiry into this area will bring together more evidence and understanding about the current problems there are to improving diagnosis of dementia. It will also find good practice examples where services have been helpful to people with dementia getting an early diagnosis, and ensuring they have proper information and support afterwards, so that these examples can be shared. The APPG is seeking evidence from people with dementia and their carers, health and social care providers and practitioners, and key stakeholder organisations and professional bodies. The deadline for submission of evidence is 2nd March 2012.

MIND matters

  Extract from The King’s Fund

Managing and supporting mental health at work: disclosure tool for managers
The Chartered Institute of Personnel and Development carried out a survey of 2,000 people in employment in the UK which revealed that despite more than a quarter (26%) of employees having experienced a mental health problem while in employment, too few employers are taking positive steps to manage this increasingly business critical issue. This guidance, produced by Mind, will help employers ensure that how they manage people supports their mental wellbeing and resilience, and also encourage more employees to talk about any mental health issues they may be facing at an early stage.

eLearning alternative to ECDL

The ICT Department informs us that the ECDL course is no longer offered through the NHS and there is no replacement.

Alternatively, staff at work may access the website at: at to view recorded ‘virtual classroom’ sessions and How Do I Guides.

There is also the Microsoft Office Specialist course in Office 2003, 2007 or 2010.  Staff can register for their chosen course and receive access to all the workbooks, study materials and details on how to register for Microsoft E-learning.

Keys, GW et al: Bone Joint Surgery Br, Dec 2011

 Bone Joint Surg Br.2011 Dec;93(12):1610-6.

Examination of ten fractured Oxford unicompartmental knee bearings.


Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.


Since the Oxford knee was first used unicompartmentally in 1982, a small number of bearings have fractured. Of 14 retrieved bearings, we examined ten samples with known durations in situ (four Phase 1, four Phase 2 and two Phase 3). Evidence of impingement and associated abnormally high wear (> 0.05 mm per year) as well as oxidation was observed in all bearings. In four samples the fracture was associated with the posterior radio-opaque wire. Fracture surfaces indicated fatigue failure, and scanning electron microscopy suggested that the crack initiated in the thinnest region. The estimated incidence of fracture was 3.20% for Phase 1, 0.74% for Phase 2, 0.35% for Phase 3, and 0% for Phase 3 without the posterior marker wire. The important aetiological factors for bearing fracture are impingement leading to high wear, oxidation, and the posterior marker wire. With improved surgical technique, impingement and high wear should be prevented and modern polyethylene may reduce the oxidation risk. A posterior marker wire is no longer used in the polyethylene meniscus. Therefore, the rate of fracture, which is now very low, should be reduced to a negligible level.

Crotch-Harvey MA: Breast Cancer Research, November 2011: Conference abstract

Title: Occult breast carcinoma presenting with axillary lymphadenopathy
Citation: Breast Cancer Research, November 2011, vol./is. 13/(S11-S12), 1465-5411 (04 Nov 2011)  Author(s): Crotch-Harvey M.A.
Abstract: Introduction Occult breast carcinoma presenting with axillary lymphadenopathy is an uncommon but difficult clinical problem. The most appropriate diagnostic pathway, the prognosis and the best form of treatment may be uncertain. To answer these questions, we have examined the outcomes of women presenting in this way over a number of years. Methods Thirteen women were identified prospectively over a 12- year period, presenting with suspicious lymphadenopathy but no identifiable breast tumour on initial mammography or ultrasound. Biopsy of the abnormal nodes was consistent with a breast primary in all cases. All women had further imaging with breast MRI (11 cases), breast scintigraphy (one case) and CT scanning of the chest and abdomen. Second-look ultrasound was targeted to suspicious areas identified on second-line imaging. The type of treatment, presence of distant metastases and survival were recorded. Results Further imaging revealed a primary breast lesion in seven cases, six remained truly occult. Follow-up ranged from 3 to 144 months (mean 38 months). Three patients died, one is alive with distant metastases and nine remain disease free. Those with no identifiable primary were treated with chemotherapy usually in combination with radiotherapy. Conclusion The use of MRI and targeted ultrasound-guided biopsy revealed primary tumours in approximately half our cases presenting with lymphadenopathy and negative conventional imaging. Chemotherapy with radiotherapy appears to be an effective treatment for occult breast cancer. The initial staging tests are crucial and if clear the prognosis appears similar to patients with breast cancer and positive axillary nodes.
Publication Type: Journal: Conference Abstract
Source: EMBASE
Full Text:
Available in selected fulltext at BioMedCentral
Available in fulltext at National Library of Medicine

A timely look at staff appraisal

Extract from the second issue of Mastering Management in Healthcare: a practical resource

In this issue:


This article is all about developing you and your staff. The advice is kept as  practical as possible and include things that you can apply immediately. The intention is to try and provoke you to think differently about how you manage and encourage you to innovate and experiment.

Staff Appraisal – chore or golden opportunity?

A common challenge facing clinicians entering management roles is how to conduct appraisals for the staff now reporting to them. Quite apart from practical issues such as finding the time and an appropriate environment, the employer may also have a particular format to follow, and the whole process can end up looking like one big distraction from the main objective – providing care.

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HTA: New study into fluid in the middle ear

Health Technology Assessments

New study into fluid in the middle ear funded

A new study looking at the best treatment for children with fluid in the middle ear has been funded by the NIHR HTA programme.

Cleft lip and palate are among the most common inherited abnormalities effecting around one in 700 individuals and approximately 1000 children being born with cleft lip and palate each year. Historically, care for this group of children was delivered in a fragmented way across 57 centres in the UK.  [more…]


Nice news from NICE – the Lancet online

Some excellent news from NICE announced yesterday 20 December. 

National Institute for Health and Clinical Excellence (NICE) has signed a 3 year agreement to provide staff with access to The Lancet via NHS Evidence ( – the service provided by NICE.From 3 January 2012, every member of staff who is eligible for an NHS Athens password can access the latest online editions of The Lancet, as well as back copies from the last 4 years, removing the need for NHS library services  and  individual members of staff  to subscribe to access The Lancet online – a move which will save time and money and which will provide NHS-wide access to this valued resource.The agreement will also cover healthcare students from an NHS-commissioned education programme involving practice and placement within NHS services across England.

In addition, a free print copy of the Lancet will be sent to your NHS library every month for the next three years, starting with the first issue in January 2012. 

Please share this information with colleagues.  Thank you.

Thatchill J, Whitehead GA: Indian Journal of Pediatrics: Nov 2011

Clotting Screen Requests in Pediatrics


Coagulation parameters are routinely requested among all age-groups in pediatrics to identify abnormalities which may contribute to bleeding manifestations or thrombotic complications. These results are vital especially in the management of sick children although in some cases, they may be helpful in identifying those with inherited bleeding disorders and to confirm or exclude non-accidental injury. Despite the usefulness of these screening tests, it is important that the professionals who are responsible for the care of children interpret the results of these tests in the most accurate manner to avoid unnecessary further investigations and inappropriate management. 

Link to full text

J Thachil… – Indian Journal of Pediatrics, 2011
GA Whitehead Department of Child Health, Macclesfield General Hospital

Report of the national audit of dementia care in general hospitals 2011

Royal College of Psychiatrists

From The King’s Fund: 
This audit has identified a need for significant improvements in hospital ward environments, staff training and the overall approach to care delivery for patients with dementia. Although the majority of wards meet basic safety requirements, it shows that many had not addressed simple measures that could lessen the distress caused to dementia patients by an unfamiliar and confusing hospital environment. It also reveals deficiencies in staff training.

King’s Fund: All Party Parliamentary Group on Cancer

Tackling cancer inequalities – one year on
This report calls for the NHS Outcomes Framework to be broadened to include targets for every type of cancer, not just breast, lung and colorectal cancer. It also calls for data on the stage of cancer at diagnosis and the number of patients diagnosed as an emergency to be included in the Commissioning Outcomes Framework and for CCGs to be incentivised to make year-on year improvements against these.

QIPP: Change and improvement to the stroke pathway

Stroke pathway: delivering through improvement 2009

Although this information was published a couple of years ago, I include it here as an example of what is available on QIPP – which stands for Quality, Innovation, Productivity and Prevention

The NHS Institute supported Chief Executives and senior leadership to champion change and improvement across NHS organisations in all areas of the stroke pathway. Quality was improved by reducing mortality, time in A&E, and delay in CT.  Read more at

Public Health eNewsletter and resources at NHS Evidence

The latest e-newsletter from the National Library for Public Health is now available at   If you prefer you can subscribe to receive the newsletter every month by clicking here.

All the public health resources can be found at such as Public Health NICE Pathways – ‘bringing together all related NICE guidance and associated products in a set of interactive topic-based diagrams’. There are four Public Health pathways:

The contraceptive pill and ovarian cancer risk

Overview: Cancer of the ovary affects more than 6,500 women in the UK each year. It is the fifth most common cancer among women after breast cancer, bowel cancer, lung cancer and cancer of the uterus (womb). Ovarian cancer is most common in women who have had the menopause (usually over the age of 45), but it can affect women of any age. It is well established that the use of oral contraceptives reduces the risk of ovarian cancer, but the associations with other reproductive variables are less clear. See the NHS Evidence topic page on ovarian cancer for a general overview of the condition.

Current advice: Oral contraceptives have been found to increase the risk of some cancers, and lower the risk of others. NICE recommends that women should not be prescribed the oral contraceptive pill purely for prevention of cancer. Women aged over 35 years with a family history of breast cancer should be informed of an increased risk of breast cancer associated with taking the oral contraceptive pill, given that their absolute risk increases with age. There is accredited guidance on combined hormonal contraception from the Faculty of Sexual and Reproductive Healthcare.

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Perioperative management of patients with cardiac implantable electronic devices

British Journal of Anaesthesia:  Volume 107, Issue suppl 1 p116-126

Many anaesthesia practitioners caring for patients with a cardiac implantable electronic device (CIED) lack the knowledge, experience, and requisite programming devices to independently manage these patients perioperatively. A recently updated ASA task force Practice Advisory presents expert opinion regarding the perioperative management of patients with CIEDs, and the Heart Rhythm Society (HRS) recently published a consensus statement on this subject in collaboration with the ASA, American Heart Association (AHA), and Society of Thoracic Surgeons (STS).

The abstract is free and the full text article may be requested as an inter library loan.

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King’s Fund: The University of York

Estimating the costs of specialised care: updated analysis using data for 2009/10
This research shows that hospitals should receive additional funding in recognition of the higher costs associated with providing some types of specialised care. The researchers analyse the impact that specialised care has on costs for 12.9 million NHS patients treated in hospital during 2009/10. They found that many types of specialised care do not impose significant additional costs. But for some services, patients who received specialised care had higher costs than otherwise similar patients who do not.

King’s Fund: Cancer framework

Department of Health

An intelligence framework for cancer
This document sets out plans to tackle deficiencies of collection and analysis in cancer intelligence.

Improving outcomes: a strategy for cancer – first annual report 2011
This report aims to help the reformed NHS deliver cancer outcomes that are amongst the best in the world and provides information on progress in 2011.

CASPb: Crib Sheets for Critical Appraisal

The Critical Appraisal Skills Programme (CASP) was developed in Oxford in 1993 and has over the past ten years helped to develop an evidence based approach in health and social care, working with local, national and international partner organisations.

CASP’s workshops and resources aim to help participants put knowledge into practice by learning how to systematically formulate questions, find research evidence, appraise research evidence and act on research evidence.

One of the resources worth noting on their website – Crib Sheets

Cribsheets are core questions that aid you to critically appraise a research paper.

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