News from NICE

Help with identifying meningitis in children and young people
NICE?s latest quality standard on bacterial meningitis in children and young people can help GPs and other primary care professionals spot early signs and symptoms of the condition.
July 25, 2012
New treatment for blood clots approved by NICE
Patients with blood clots can be now be offered rivaroxaban as an alternative to warfarin for the treatment of blood clots following latest guidance from NICE.
July 25, 2012
First set of local government briefings launch
Tobacco, physical activity and workplace health are the topics covered in NICE?s first set of local government public health briefings.
July 25, 2012
NICE to assess high cost drugs for rare conditions
NICE will take on the role of assessing very high cost drugs for people who suffer with rare conditions, under the Health and Social Care Act 2012.
July 20, 2012
Healthy diet and exercise key to reducing the risk of type 2 diabetes
Simple lifestyle changes, such as increased physical activity or eating more healthily, can prevent or delay type 2 diabetes, says NICE.
July 12, 2012

Focus on National Health Executive (NHE)

Visiting the NHE website provides access to a wide variety of news media, resources and information.

Choose from interviews, featured articles, jobs, blogs, videos, news categories and health service focus.

Registration is free if you want to access all areas but you don’t need to do this in order to subscribe to a newsletter or individual news feeds.

An interesting and easy to navigate site.

NEWS system to provide a ‘step-change’ in patient safety

Extract courtesy of

The Royal College of Physicians (RCP) has launched a new National Early Warning Score (NEWS), to recognise very sick patients

A report on NEWS was produced by a multidisciplinary working group and clinical observation charts and e-learning materials have been provided by the NEWS educational programme, funded by the RCP, Royal College of Nurses (RCN), National Outreach Forum and NHS Training for Innovation.

On each acute hospital bed, a chart records patients’ pulse rate, blood pressure and temperature, but different NHS trusts use different types of chart, leading to a lack of consistency in the detection and response to acutely ill patients.

The NEWS system allocates a score to six physiological measurements; respiratory rate, oxygen saturations, temperature, systolic blood pressure, pulse rate and level of consciousness.

The more measurements vary from what would be expected, the higher the resultant score. These six scores are then aggregated into one overall score which, if high, will alert the medical or nursing team of the need to escalate a patient’s care.

RCP believes this provides the basis for a unified approach to assessment and continuous tracking of patients’ clinical care, standardised training of all staff and standardised data on regional variations in illness severity.

NEWS also provides detailed recommendations on actions for each score, and the e-learning materials aim to help trusts with implementation. NEWS has been evaluated against existing systems and proved to be as good as, or better, with greater sensitivity when triggering alerts.

A recent study of 1,000 adults dying in acute hospitals in England estimated that around one in 20 deaths in hospital, or 11,859, were preventable by improved clinical monitoring, fewer diagnostic errors and good drug or fluid management. Professor Bryan Williams, chair of the working party, estimated that around 50% of these deaths, 6,000, could have been prevented by using NEWS.

He said: “This new National Early Warning Score has the potential to transform patient safety in our hospitals and improve patient outcomes, it is hugely important.”

Professor Derek Bell, chair of the NEWS educational subgroup, said adopting NEWS would be “one of the most significant developments in health care in the next decade”.

And RCN director of nursing and service delivery, Janet Davies said: “There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care.

“I hope that every Trust will read this report and adopt this system as soon as possible, as countless lives could be saved in the future by adopting this simple process.”

Future app predicted to save NHS more than £3.6m

An application or “app” that has been developed after doctors joined forces with software developers in the first ever NHS “hack day” is set to bring a much needed technology boost to the “bits of paper” handover system currently used by most hospitals when doctors change shifts.

Colin Brown, the doctor on the team that took first prize at the hack day at the end of May, said that he had been pondering the idea for an electronic means of exchanging information at handover for a while. He was keen to take part in the day because getting together with experts in computer technology seemed like a logical step, he said.

“At the moment handover relies on lots of bits of paper on which doctors write notes or instructions about tasks and then juniors stuffing them in their back pockets. Then there are patient lists that juniors have to update in an Excel spreadsheet or in Word. There is no way to generate this electronically,” said Brown, currently an NHS fellow at the Health Protection Agency during a year out from his job as academic fellow in infectious diseases at St Thomas’ Hospital in London.

“The first part of our task on the hack day was to explain the current system to the software developers, and we had to keep re-explaining it because they were so incredulous at the systems used by most trusts.”

The app, which can be downloaded onto computers as well as mobile phones, uses a feed from the hospital’s electronic medical records to provide doctors with a list of all their patients and allows them to create task lists and update patients’ records.

Login to BMJ with your Athens account to read the full story at


NICE: Patient experience online training resources

Online training resources for patient experience themes

A range of online training resources covering various patient experience themes, such as dignity, pain management, communication and social inclusion and equality, have now been added to the support for commissioners’ tools for the guidelines on:

Coming soon … JuniorDr Magazine

JuniorDr is the UK’s only magazine dedicated to Medical Students, Foundation Year Doctors, Specialist Trainees, GP Trainees and Specialist Registrars. Copies are distributed free every quarter through the doctor’s mess, postgraduate centres, GP training scheme, libraries and medical schools throughout the UK. As an organisation run entirely by junior doctors we rely upon hospitals, training centres and libraries to help us get copies to junior doctors. We’re constantly looking for new sites to help us distribute each issue.”

25 copies have been ordered for the Staff Library, so look out for it next time you visit us.The readership and your feedback will determine whether this publication is stocked on a regular basis.

Click to see the JuniorDr website or to read the current issue online.


What healthcare professionals should know about hepatitis C

WORLD HEPATITIS DAY    –    28 July 2012

What healthcare professionals should know about hepatitis C

Jul 27, 2012 4:11 PM – Extract from The Guardian Show original item

Partnership between Addaction and the Hepatitis C Trust aims to ensure 2,000 at risk of contracting the virus are screened

World Hepatitis Day typically slips by without much fanfare, fitting for a disease which is rarely, if ever, spoken about.

That, in itself, is a real problem. The annual Health Protection Agency (HPA) report on hepatitis C, released this week, highlights how the hepatitis C burden continues to grow. Hepatitis C-related hospital admissions, liver cancer, deaths and registrations for liver transplants are all increasing.

Hepatitis C is much more infectious than HIV. In fact, despite being both preventable and treatable, it is the most prevalent blood-borne virus in the UK. It slowly destroys your liver and is the second most popular cause for a liver transplant after alcohol. And, as it’s an asymptomatic disease, without detection you won’t know you’ve got the virus until things have reached this stage and for many is too late.

If someone doesn’t know they have hepatitis C, they can unwittingly pass it onto someone else, something that happens most in marginalised groups such as intravenous drug users. If we leave that and similar situations unchecked, the picture is bleak. In fact, the HPA has predicted a 41% increase in the number of people with hepatitis C-related, “end stage” liver disease by 2015.

But the news is not all bad. If we improve upon the diagnosis and treatment we’re currently providing, it wouldn’t be an exaggeration to say we could effectively eradicate hepatitis C.

To do that, we need to raise awareness of the disease among the people we work with, and we as health professionals need to ensure that hepatitis C is firmly on our radar.

Addaction is one of the UK’s leading drug and alcohol treatment charities. Earlier this year, we joined forces with the Hepatitis C Trust to increase awareness and strengthen care pathways from diagnosis through to treatment.

The way this happens is simple. A staff member from the trust has been seconded to Addaction and, through our network of services across England and Scotland, they are delivering a nationwide training programme to more than 600 frontline staff. We estimate that at least 2,000 people at risk of the virus will be screened and those testing positive will be referred to specialist secondary care.

We’re committed to tackling hepatitis C, as in our experience it is a major barrier to the full recovery of people with a history of drug use. As an example, we’ve seen people who’ve beaten heroin addiction only to go on and develop severe problems with their liver later in life. That needs to change.

We’re certain the partnership we’re undertaking with the trust is incredibly important. It provides us with an enormous opportunity, to help thousands of people who really need it. It will lead to an evidence base that can be used by the whole of the healthcare sector and, most importantly of all, it could help us get rid of hepatitis C altogether.

David Badcock is head of research and development with Addaction

Improving communication between GPs and palliative care patients

The ACA training programme to improve communication between general practitioners and their palliative care patients: development and applicability

Source: BMC Palliative Care June 2012

Follow this link for the full text

Publication type: Web article

In a nutshell:  This article describes the development of a new training programme on GP-patient communication in palliative care, and the applicability to GPs and GP Trainees. This ‘ACA training programme’ focuses on Availability of the GP for the patient, Current issues that should be raised by the GP, and Anticipating various scenarios. Evaluation results indicate the ACA training programme to be applicable to GPs and GP Trainees. The ACA checklist was appreciated by GPs as useful both in practice and as a learning tool, whereas GP Trainees mainly appreciated the list for use in practice.

Length of publication: 16 pages

Map of Medicine News

Improving care in diabetes

Since 2005, there has been a 50% increase in the number of people diagnosed with diabetes. Prevalence in England is expected to rise….

Read more about this story ….
UK | 23 Jul 12

Leeds Clinical Commissioning groups launch MSK care maps

The three newly-formed clinical commissioning groups (CCGs) in Leeds have launched an ambitious project to improve the quality of referrals by adding local pathways….

Read more on Leeds….
UK | 23 Jul 12

Map of Medicine | Leeds Clinical Commissioning groups launch MSK care maps

Map of Medicine | Leeds Clinical Commissioning groups launch MSK care mapsThe three newly-formed clinical commissioning groups (CCGs) in Leeds have launched an ambitious project to improve the quality of referrals by adding local pathways to the Map of Medicine. Leeds West CCG, Leeds North CCG, and Leeds South and East CCG, with a combined patient population of over 810,000 spread over 113 GP practices, aim to ensure all GPs use the care maps when making musculoskeletal referrals.

Having agreed the pathways for six musculoskeletal topics locally, the Leeds project team used Map Transform, a package of care maps and services, to establish their pathways on the Leeds ‘view’. This package supports clinically-led service improvement, and enables cross-service communication via easy online access to the agreed local pathways for all stakeholders. The topics Leeds chose were:

  • Hip pain
  • Hand/wrist pain
  • Spinal pain
  • Knee pain
  • Foot and ankle pain
  • Shoulder pain

The care maps display referral criteria at specific points within the pathways, with information that guides the user to the appropriate local referral form. The overarching aim of these care maps is to standardise and improve the quality of referrals from primary care to community MSK and secondary services. While a triage service for all MSK referrals was in place, and effective at ensuring good conversion rates for surgery following onward referral to secondary care, it was felt that GPs could perform some of the functions of triage, with the patient pathway being streamlined. The care maps are intended to expand GPs’ knowledge of MSK conditions, and also promote patient self- management.

read more via Map of Medicine | Leeds Clinical Commissioning groups launch MSK care maps.

Prescription power for physios

Physiotherapists and podiatrists in England are to get the right to prescribe medicines by themselves.

Ministers agreed to the change in the law after carrying out a consultation, but it will be 2014 before it is fully rolled out.

When physios and podiatrists do start prescribing they will become the first in the world to be given such powers.

And it will mean patients do not have to go back to GPs to get drugs such as anti-inflammatories and painkillers.

via BBC Health 23 July 2012, at

Hunter, John D; BMJ Online; June 2012

This article, “Ventilator associated pneumonia” by John D Hunter, Consultant in Anaesthetics and Intensive Care, was published in BMJ (Online), June 2012, vol./is. 344/7859, 1756-1833 (02 Jun 2012)
Institution: (Hunter) Department of Anaesthetics and Critical Care, Macclesfield District General Hospital, Macclesfield SK10 3BL, United Kingdom
Language: English
Country of Publication: United Kingdom

Summary points

  • Ventilator associated pneumonia is the most common healthcare associated infection in intensive care

  • The condition is associated with increased morbidity, mortality, length of stay, and costs

  • Lack of a “gold standard” definition leads to both under-diagnosis and overdiagnosis

  • A high clinical suspicion of pneumonia in a ventilated patient should prompt the immediate administration of an appropriate broad spectrum antibiotic(s)

  • Implement evidence based interventions that reduce the incidence of pneumonia in all patients receiving mechanical ventilation


The slimline paper journal collection

The Staff Library regrets it is only able to stock  the following paper journals due to space restrictions:

  • Archives of Disease in Childhood
  • Archives of Disease in Childhood Education and Practice edition
  • Archives of Disease in Childhood: Fetal and Neonatal edition
  • British Journal of Surgery
  • Clinics in Developmental Medicine
  • Health Service Journal
  • Journal of Analytical Toxicology
  • Journal of the Royal Society of Medicine
  • The Lancet
  • Medicine
  • MIDIRS Midwifery Digest
  • Nursing Standard
  • Nursing Times
  • Surgery

In the majority of instances, these journals are available online – make sure you quote your Athens details for full access.  If you haven’t already registered  then follow this link to Register for Athens

Something to celebrate

With less than a week to go before leaving his current placement in School Health, Tom Challinor has not one, but two things to celebrate. Firstly his move to Central Essex Community Care Trust to take up a new post as a Community Staff Nurse and secondly having his first article published in “Wound Essentials”.

Tom’s evidence based piece on “Uncovering the evidence on Larval Therapy” was written as part of his degree module on Tissue Viability, as recommended by Maureen Benbow, Senior Lecturer at the University of Chester.

“It took about 2 weeks to gather the evidence and write up and I really valued the 24/7 access to the library” said Tom.  Part of the brief was to ensure the article was of up-to-date evidence-based practice thus appealing to a wide audience – professionals, students and the general public.  It was also a learning experience for Tom as he gained an insight from reading other writing styles, which in turn, enabled him to write at a higher level.

Now he wants to do more writing and already has plans for another 2 articles.  Still focussing on wound care, Tom intends to research the efficacy of honey.  After that he will turn his attention to managing pain for patients with chronic wounds, drawing from the perspective of pharmacology and tissue viability.

Altogether this is not a bad start for our 3rd year student from University of Chester who is very much looking forward to the next stage in his career.  Amongst his future aims, Tom hopes one day to secure a place on the peer review panel of Wound Essentials, where it all began.

You can read the full-text (PDF) version of Tom’s article at:

New addition to Horizon Scanning

The list of topics available on the Horizon Scanning page has just grown to 20.  The latest one to be included is Learning Disabilities which sends the latest information direct to your inbox.  Why not sign up and give it a try – subscription is FREE. Click here.

Sample feed includes:

Behavioural family therapy used to support system around person with learning disabilities and mental health needs by John Northfield

Studies have suggested a higher incidence of mental health problems in people with learning disabilities, although there are some differences in estimates, which have varied in studies looking at people with learning disabilities who also have a co-morbid psychiatric disorder from 14 to 39%. There is also evidence of increased likelihood of family members and […]
People with learning disabilities have faced a range of barriers when attempting to negotiate the legal system. Public law is complicated but this new guide hopes to provide clear, accurate advice in a range of areas, The guide, called ‘Know Your Rights’ has been broken down into six main themes: Housing Social and Health Care

CQC finds half of learning disability services did not meet essential standards   by John Northfield

Last year, the BBC  screened its secret filming at the Winterbourne view home in Bristol which showed shocking scenes of abuse. The subsequent inquiry led to arrests and convictions, but there were concerns that this was not an isolated incident. The care services minister stated his determination to strengthen safeguards and the Care Standards Commission […]

EBSCOhost: Innovating for Life Awards.

British Journal of Midwifery • May 2012 • Vol 20, No 5   AWARDS
2nd March 2012  Royal Society, London

Cow & Gate joined forces with journals, Infant and the British Journal of
Midwifery to present the Innovating for Life Awards, designed to encourage and reward initiatives that demonstrate innovation in infant and maternal care amongst the midwifery and neonatal professions and
recognise the critical role they play in giving babies the best start in life.

The winners were announced at a ceremony on 2nd March 2012 at the Royal Society, London. The judges drew up a shortlist of three midwifery entries and two neonatal entries, and the winners were announced by Dr. Janet Warren, Head of Medical Affairs at DANONE Baby Nutrition.

Project title: Improved parental education and IT website
Lead applicant: Alison Cooke, Parent Education Midwife, Parent Education Midwifery Team, East Cheshire NHS Trust.
A new Parent Education programme to optimise education in the class setting and increase postnatal education in the ward. The team’s goal is to provide enhanced customer service, improving choice and convenience for mothers and their families, which in turn will create a better and more positive maternity experience.

Dementia ‘not being diagnosed’

Fewer than half of people with dementia ever receive a formal diagnosis, according to a new parliamentary report.

Around 800,000 people in the country currently have dementia, with numbers expected to rise to more than a million by 2021.

However, a report published this week by the parliamentary group on dementia has found a “shocking” variation in the number of people with dementia who are diagnosed.

In England, just 41% of people receive a diagnosis, and in parts of Wales diagnostic rates are as low as 32%.



Benefits of cognitive stimulation for people with dementia

Overview: Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group, aimed at general enhancement of cognitive and social functioning. Family caregivers can be trained to provide cognitive stimulation on a one-to-one basis.

In 2011, the World Alzheimer’s Report recommended that cognitive stimulation should be routinely offered to people with early stage dementia. However, in recent years, increased interest in its use in dementia has provoked concern about its effectiveness and potential negative effects on wellbeing.
See the NHS Evidence topic page on dementia for a general overview of the condition.
Current advice: NICE recommends that people with mild-to-moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme. This should be commissioned and provided by a range of health and social care staff with appropriate training and supervision, and offered irrespective of any drug prescribed for the treatment of cognitive symptoms of dementia.
The guidance also raised a need for more research into both the clinical and cost effectiveness of cognitive stimulation, both compared to and in combination with acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine).
NICE has a pathway on dementia, which brings together all related NICE guidance and associated products on the condition in a set of interactive topic-based diagrams.
New evidence: A Cochrane review evaluated the effectiveness and impact of cognitive stimulation interventions aimed at improving cognition for people with dementia, including any negative effects (Woods et al. 2012).
The review included 15 randomised controlled trials involving 718 people with mild-to-moderate dementia, mainly in the form of Alzheimer’s disease or vascular dementia. Participants were treated in small groups and involved in different activities, including discussion of past and present events and topics of interest, word games, puzzles, music and practical activities like baking or indoor gardening. All activities were designed to stimulate thinking and memory. Improvements following cognitive stimulation were compared with those seen without treatment and with ‘standard treatments’, which could include medicine, day care or visits from community mental health workers, or in some cases alternative activities such as watching TV and physical therapy.
Results showed that those who received cognitive stimulation interventions scored significantly higher in cognitive function tests. These benefits were still observed 1 to 3 months after treatment. In addition, positive effects on social interaction, communication and quality of life or wellbeing were observed in a smaller number of the trials, based on self-reported or carer-reported measures.
Where family members were trained to deliver cognitive stimulation on a one-to-one basis, no additional strain or burden on care givers was reported.
Commentary: “The caveat to the findings of this Cochrane review is that many of the studies were low quality and with small sample size. Study populations varied and the protocols and content of therapy quite diverse. Cognitive stimulation therapy is not an easily defined intervention. Disappointingly, there is no evidence for an effect on function, mood or difficult behaviour.
Old man doing a crossword“Important questions remain: Is there a need for maintenance sessions to sustain benefit beyond 3 months? What ‘dose’ of stimulation is needed? What is the active ingredient(s)? How much therapist training is needed and are the benefits clinically meaningful? Is it cost effective?
“Despite the limitations there is evidence here to support the principle of ‘use it or lose it’. That one study achieved this by using family carers as therapists, without detriment to them could help carers with the question ‘What can I do?’ and to deal with their frustration of feeling powerless.
“For professional carers there is a message to develop a culture of stimulation for people with dementia in their care and keep people’s brains active if we want to do the best for them. There is more to supporting people with dementia than just administering care.” – David Anderson, Consultant in Old Age Psychiatry with Merseycare NHS Trust and Honorary Senior Lecturer at the University of Liverpool.

This month in Eyes on Evidence

Data from the National Joint Registry for England and Wales indicates high failure rates for metal-on-metal hip replacements.
A Cochrane review shows cognitive stimulation therapies have beneficial effects on memory and thinking in people with dementia, as well as positive effects for wellbeing.
Developing more integrated support for people with mental and physical health problems could improve outcomes, by recognising the role of emotional and mental health problems in reducing people’s ability and motivation to manage their physical health.

Do renin-angiotensin system drugs reduce mortality in hypertension?

This systematic review provides good quality clinical evidence that  angiotensin-converting enzyme inhibitors reduce the risk of death in patients with hypertension. The benefits of angiotensin receptor blockers in reducing mortality are uncertain.
Angiotensin receptor blockers (ARBs) are no better than placebo or angiotensin-converting enzyme  inhibitors in reducing the risk of death, disability, or hospital admission for any reason. However, more patients stopped treatment early with ARBs than with placebo due to side effects.
An example from the Quality, Innovation, Productivity and Prevention collection on how the University Hospitals of Leicester NHS Trust has reduced delays, complications and costs around central venous access for patients.
Potential disinvestment opportunities highlighted this month are:
  • Biofeedback training for the management of faecal incontinence in children.
  • Non-pharmacological interventions for breathlessness.

Evidence Updates

This month NICE has published online via NHS Evidence an Evidence Update on constipation in children and young people.
How to get access, via NHS Athens on Apple and Android devices, to authoritative and practical information on the selection and clinical use of medicines from the British National Formulary.

AQuA Improvement Methodologies (AIM) in End of Life Care

AQuA Improvement Methodologies (AIM) in End of Life Care
Cohort 10 (July – Sept 2012)

The AQuA Improvement Methodology programme in End of Life Care is geared at front line staff/operational leaders in End of Life Care wanting to gain an introduction to the fundamentals and concepts of quality improvement. Delegates will work on their own End of Life Care improvement project and develop a project plan, aim and measures throughout the programme. Suitable for staff with a basic knowledge of quality improvement tools or for experienced staff wanting to refresh their knowledge and skills.
Book online at:

Booking closes 31 July 2012 (each individual in the team is required to book a place)

Apply for the ‘Nurse First’ cohort – FREE programme

Recruiting for the next free “Nurse First” cohort in Manchester in September 2012
Nurse First is the most intensive innovation and leadership programme in the UK for clinical staff. It is a free 21 – day residential programme that runs over a year and includes masterclasses, learning sets and coaching support, developed in partnership with the Queens Nursing Institute, Bucks New University, the Shaftesbury Partnership and Johnson & Johnson. It will support you to: create innovative ideas to clinical challenges, raise the funding needed to make these ideas happen and help you implement them in your organisation.
For more information visit: