Smith I.E.; Johnson L.; Dowsett M.; R. Robertson J.F.; Robison L.E.; Kokan J.S. et al; Journal of Clinical Oncology

Trial of perioperative endocrine therapy: Individualizing care (POETIC) – conference abstract

Citation: Journal of Clinical Oncology, May 2011, vol./is. 29/15 SUPPL. 1, 0732-183X (20 May 2011)

Author(s): Smith I.E.; Johnson L.; Dowsett M.; R. Robertson J.F.; Robison L.E.; Kokan J.S. et al
Language: English

Abstract: Background: The neoadjuvant IMPACT trial suggested Ki67 levels after 2 weeks endocrine therapy predicts long-term outcome. Major changes in gene expression have also been seen in ER+ breast cancer after aromatase inhibitor (AI) treatment. POETIC evaluates whether changes in Ki67 level after 2 weeks treatment predicts for relapse-free survival (RFS) more effectively than the baseline value. It also tests whether gene expression profile at this timepoint provides more accurate prognostic and predictive information than the pre-treatment profile. Experimental evidence suggests peri-operative endocrine therapy may improve disease outcome. This hypothesis is also addressed in POETIC. (ISRCTN63882543 ) With a sample size of 4000, an improvement in 5 year relapse from 10% to 7% could be detected with 91% power (two sided alpha of 5%), as would a 1.3 fold difference in the ability of Ki67 to predict RFS (90% power, two sided 5% significance level). Target recruitment is 4000 patients from 100 UK hospitals over 3-4 years.

Methods: Patients are randomised in the ratio of 2:1 to perioperative AI (letrozole 2.5mg or anastrozole 1mg daily) starting 2 weeks before planned surgery until 2 weeks after surgery. FFPE and RNA-later samples are taken prior to trial entry (baseline) and at surgery. Eligible patients are postmenopausal with ER+ invasive breast cancer. Consent to take additional research tissue is sought from patients undergoing diagnostic biopsy. Consenting patients donate tumour tissue in RNA-later and/or a FFPE research sample and enter POETIC following diagnosis of ER+ breast cancer. Matching tumour tissue is taken at surgery. Where an RNA-later sample at baseline is unavailable, consenting patients may undergo a further biopsy for research tissue immediately before study entry. Where consent procedures at diagnosis present logistical challenges, sites may provide FFPE tissue left over from diagnosis only. The 1st patient was entered in September 2008, and by January 2011 102 UK hospitals open and 1200 patients were entered. 182 optional RNA-later samples at both time points are available. Current success is due to a flexible approach to tissue sample collection and overcoming local and national logistical challenges.

Conference Information: ASCO Annual Meeting 2011 Chicago, IL United States.

Conference Start: 20110603 Conference End: 20110607

Publisher: American Society of Clinical Oncology

Publication Type: Journal: Conference Abstract

Map of Medicine News

Local news spotlight:  North Mersey

North Mersey have localised over 80 care maps, carefully designed to tackle clinical or commissioning issues in their area as part of their QIPP scheme.

The North Mersey view covers all primary and secondary care Trusts within Liverpool, Sefton and Knowsley, and each area has its own view on the Map.
Dave Lawless, Project Manager for Map of Medicine in North Mersey, says: ‘In North Mersey we market Map of Medicine as the Yellow Pages for clinicians. All localised pathways contain specific information to add weight to the pathways, such as patient information leaflets and local clinic contact details. Pathways are accessed on all GPs’ PCs across the region and benefits are monitored by accessing Map of Medicine usage and referral rates.’

Athens users: can visit the Map here and select ‘International’ / ‘England’ or your local view.

Coming soon: Next month’s publication will include new care maps on Knee injuries and Perinatal mental health. In the meantime, 23-29 April is Orchid Male Cancer Awareness Week, so take a look at Prostate cancer and Testicular cancer care maps, both updated in February with the latest evidence.

King’s Fund: Palliative care articles

School for Social Care Research, London School of Economics and Political Science

End of life care: methods review
This review provides an overview of the range of research methods that have been commonly used in end of life care research and their relevance for social care. It provides a policy and service context for understanding end of life care research in social care and, using examples from relevant research, considers the advantages and disadvantages of different research methods and tools. The particular ethical challenges and practical issues that may arise are discussed along with some strategies and sources of support to address them.

Helen & Douglas House

A review of palliative care for children and young adults in the Thames Valley
Helen & Douglas House has commissioned and authored a collaborative review of palliative care need and provision in the region for patients up to the age of 40 years. The findings of the review are presented as a consultative report, with provisional recommendations at national, regional and organisational levels. It highlights a number of key findings, including that there is a lack of palliative care studies relating to young adults.

The King’s Fund: Inpatient Survey Results 2011

Inpatient survey 2011
This survey looked at the experiences of over 70,000 people who were admitted to NHS hospitals around England. The results of the survey will be used by NHS trusts to improve their performance and to understand their patients’ experiences, and the results will be used to support the CQC’s regulatory, compliance and monitoring activities.

East Cheshire’s results showed they remained ‘about the same’ compared to other Trusts.

Wellcome backs proposal – to share academic journals freely online

One of the world’s largest funders of science is to throw its weight behind a growing campaign to break the stranglehold of academic journals and allow all research papers to be shared online.

Nearly 9,000 researchers have already signed up to a boycott of journals that restrict free sharing as part of a campaign dubbed the “academic spring” by supporters due to its potential for revolutionising the spread of knowledge. But the intervention of the Wellcome Trust, the largest non-governmental funder of medical research after the Bill & Melinda Gates Foundation, is likely to galvanise the movement by forcing academics it funds to publish in open online journals. Continue reading

Risk of skin and soft tissue infections (including shingles) in patients exposed to anti-tumour necrosis factor therapy:

Risk of skin and soft tissue infections (including shingles) in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology …

JB Galloway, LK Mercer, A Moseley, WG Dixon… – Annals of the Rheumatic …, 2012
Hope Hospital, Salford (Dr Romela Benitha); King’s College Hospital, London, Macclesfield District General Hospital, Macclesfield (Dr Susan Knight)
Dr Knight was one of a number of consultants  acknowledged in this publication for their ‘enthusiastic collaboration’.

Back pain management: Occupational health practice in the NHS in England A national clinical audit–round 2

Back pain management: Occupational health practice in the NHS in England A national clinical audit–round 2

J Smedley, S Williams, P D’Arcy, M Roughton… – 2012
East Cheshire Trust was a participant in this audit.
Page 1. Back pain management: Occupational health practice in the NHS in England A national clinical audit – round 2 Supported by:
Page 2. Health and Work Development Unit Back pain management: Occupational health practice in the NHS in England

News from NHS Networks: Children with Diabetes

Every child and young person with diabetes in England can now expect an improvement in their level of care as a landmark funding agreement for paediatric diabetes services comes in to force.
The Health Education England transition team has launched its first bulletin to start providing regular updates on the development of the new organisation.

NICE: Update Infection Control guideline

Infection: prevention and control of healthcare-associated infections in primary and community care

Clinical guidelines, CG139 – Issued: March 2012

 This clinical guideline (published March 2012) updates and replaces NICE clinical guideline 2 (published June 2003). It offers evidence-based advice on the prevention and control of healthcare-associated infections in primary and community care. New and updated recommendations address areas in which clinical practice for preventing healthcare-associated infections in primary and community care has changed, where the risk of healthcare-associated infections is greatest, and where the evidence has changed.

New look coming to HDAS

From May 30th, the NHS Evidence Healthcare Database Service (HDAS) will have a new look.  

The new design addresses a number of priorities identified from user’s feedback.

Users can expect an improved more reliable performance which provides:

  • Extra navigation options
  • Collapsible/expandable search history
  • Context sensitive help and advice with task and function relevant HELP
  • Improved thesaurus and selection options
  • More flexible options for running previous searches
  • Applying limits to the search history display
  • Running count of the number of results a search will retrieve as searches are adjusted.

Pritchard E, Gidman J.; British Journal of Community Nursing, March 2012

Br J Community Nurs. 2012 Mar;17(3):119-2, 124.

Effective mentoring in the community setting
by Pritchard E, Gidman J.

Source: East Cheshire NHS Trust, Macclesfield, Cheshire


As nurses, we are expected to demonstrate the linking of theory to practice, undertake continuous assessment and to facilitate reflective practice. Literature suggests that the majority of mentors feel unprepared for the role and lack confidence in their ability to support students (Duffy, 2004). The main challenges facing mentors are understanding the needs of each individual and adapting and developing strategies in order to support them effectively. Whilst there is a major cognitive / intellectual component to mentorship both student and mentor often experience difficulties with these aspects of their roles (Moseley and Davies, 2008).  By recognizing the need to gain insight into the students individual needs mentors will be able to identify any concerns and develop action plans in order to alleviate them.

Available in fulltext at EBSCOhost 

Pope, H: Community Dental Health; March 2012

Community Dent Health. 2012 Mar;29(1):5-7.

This article ‘A description of a specialist led primary care based oral surgery service’, was written by Heather Pope.

Heather is Clinical Director for Dental Services, East Cheshire NHS Trust, Eagle Bridge Health and Wellbeing Centre, Dunwoody Way, Crewe, Cheshire,
CW1 3AW, UK.


To describe the establishment of a referral only oral surgery service in a primary care setting together with the challenges, benefits and successes of the service.


In 1994 waiting times for hospital for oral surgery and maxillofacial procedures were unacceptably long. A proposal to establish a primary care oral surgery service aimed to complement the hospital-based service, reduce treatment delays.


Referrals commenced immediately in response to a managed launch with local dentists recognising the service as a source of expedient and convenient treatment for their patients. The service now treats up to 1300 patients per year.

Continue reading

Gower, A, Nursing Standard Jan 2012

This article entitled ‘Healthy Ageing’ was recently published in the Nursing Standard, January 2012, vol./is. 26/18(59-60), 0029-6570;0029-6570 (2012 Jan 4-10)

Publication Type: Journal Article

Available in fulltext at EBSCOhost (NHS Evidence)
Available in fulltext at ProQuest

Available in print at Staff Library Service Macclesfield District General Hospital; Note: Imperfect

St Christopher’s Hospice – valuable end of life information

Vol 2 Issue 1 of The End of Life Journal is now available free online from St Christopher’s Hospice

Our thanks to Dr Trevor Rimmer for bringing this to our attention. You may have already signed up to it but if not registration is needed, but it is free.

Clinical review

Nursing case review

Clinical skills

Personal narrative

Legal discussions

National End of Life Care Programme update

See End of Life Care Information website at:

Information overload – or feeling left behind!! We can help

If you work in any of the areas listed below and are interested in staying up-t0-date as effortlessly as possible then we have a new service coming shortly.

For further information please contact or – marking your email Staying up-to-date.

  • Anaesthesia and Critical Care
  • Breast Feeding
  • Breast Surgery
  • Cancer
  • Cardiovascular
  • Children and Young People 
  • COPD 
  • Critical Care
  • Dermatology
  • Emergency Care
  • End of Life
  • Falls Prevention
  • Health Management
  • Immunisation
  • Infection Control
  • Musculoskeletal
  • Nursing
  • Orthopaedics
  • Patient Experience
  • Patient Safety
  • Rheumatology
  • Stroke

AQuA- advancing quality alliance webinars

The Trust is a member of AquA  who are providing a series of free web seminars starting from Friday 27 April. Please ensure you sign up first at the AQuA membership portal to access resources.


Demand Management WebEx: Urgent and Emergency Care – Friday, 27 April 2012
Urgent and Emergency Care – the national policy context and A&E quality standards, the first year. The guest speaker is Dr Matthew Cooke, Department of Health National Clinical Director for Urgent and Emergency Care.

AQuA Improvement Methodologies (AIM)
Cohort 9 (May – July 2012)
Booking closes 25 May 2012
The AQuA Improvement Methodology programme is geared at front line staff/operational leaders in member organisations wanting to gain an introduction to the fundamentals and concepts of quality improvement. Suitable for staff with a basic knowledge of quality improvement tools or for experienced staff wanting to refresh their knowledge and skills.
Book online

Long Term Conditions Update
A monthly update, which covers the AQuA LTC programme.

Mental Health Update
Issue 2 – A monthly update, which covers the AQuA MH programme.

Dementia Improvement Weekly Planner

Risk Stratification Monthly Webex
Stratifying the whole population according to their risk of high intensity health and social care utilisation is a key driver to improve the quality of care for people living with Long Term Conditions.

Advancing Quality Heart Failure/CABG collaboratives
Advancing Quality is hosting two collaboratives on Monday 23rd April 2012 – one focusing on heart failure and one focusing on Coronary Artery Bypass Graph (CABG). Both events will include a number of presentations and networking opportunities where we hope to share best practice across theNorth West in heart failure and CABG care.

Advancing Quality Orthopaedic collaborative
We are inviting you and your AQ orthopaedic team to this Advancing Quality orthopaedic collaborative learning session seven on Tuesday 15 May 2012. The meeting will include a number of presentations and networking opportunities where we hope to share best practice across theNorth West in orthopaedic care.

Advancing Quality Stroke collaborative
We are inviting you and your AQ stroke team to this Advancing Quality stroke collaborative on Tuesday 29 May 2012.
The meeting will include a number of presentations and networking opportunities where we hope to share best practice across theNorth West in stroke care.

The Challenges of Making Care Safer: Leadership and System Transformation

Published in Healthcare Quarterly, 2012, GR Baker
  New programs, such as Releasing Time to Care: The Productive Ward, in Saskatchewan and Ontario offer systematic ways to examine and improve nursing care and patient unit environments, with the potential to improve efficiency, increase patient safety and quality, boost
Other articles included in this Canadian publication include:
  • The culture of patient safety
  • Teamwork and communication
  • Human factors in patient safety
  • Daignostic safety
  • Safety in the community and many more

Oxford Handbook series renewed and increased

The good news is that the NW wide online subscription was renewed last month plus an additional 12 titles.  To access them go to:  and enter your Athens details followed by the desired title in the search box.

See the sample list of titles below:

  • Emergencies in Critical Care
  • Emergencies in Obstetrics & Gynaecology
  • Emergencies in Psychiatry
  • Oxford Handbook of Medical Statistics
  • Oxford Handbook of Occupational Health
  • Oxford Handbook of Orthopaedic Trauma
  • Oxford Handbook of Sport & Exercise Medicine
  • Emergencies in Children’s Nursing
  • Oxford Handbook of Forensic Medicine
  • Oxford Handbook of Medical Dermatology
  • Oxford Handbook of Pain Management
  • Oxford Handbook of Orthopaedic and Trauma Nursing

In addition to the Oxford Textbook of Medicine there are the following textbooks –

  • Oxford Textbook of Palliative Medicine
  • Oxford Textbook of Orthopaedics and Trauma
  • Oxford Textbook of Public Health
  • Anaesthesia for Oral and Maxillofacial Surgery
  • Brain’s Diseases of the Nervous System
  • Oxford Textbook in Heart Failure
  • Oxford Textbook in Interventional Cardiology
  • Oxford Textbook of Community Mental Health
  • Oxford Textbook of Endocrinology and Diabetes
  • Oxford Textbook of Suicidology and Suicide Prevention
  • Oxford Textbook of Women and Mental Health
  • Oxford Textbooks in Public Health: Zoonoses
  • Marsden’s Book of Movement Disorders