Map of Medicine – how can it help your practice?

Respiratory viruses during winter can strain the NHS with an influx of patients, as well as more staff illness. In most cases, rest, increased fluid intake, and paracetamol are sufficient. However, winter can be much more serious for people with pre-existing conditions, such as COPD.  Total excess winter mortality is between 20,000 and 50,000 annually in England and Wales, principally from respiratory, cardiovascular or cerebrovascular diseases.  Older age, female gender and a history of respiratory disease confer greater vulnerability.
Optimising management of chronic conditions is a process, not an event, and clinicians can be supported in this by using the Map of Medicine.   The following care maps are accredited by the Royal College of Physicians (RCP) and offer evidence-based, practice-informed guidance for the on-going management of chronic conditions:

  • ‘Chronic obstructive pulmonary disease (COPD)’ – covers management in both primary and secondary care, and includes treatment of acute exacerbations of breathlessness, which can occur in response to viral infection
  • ‘Cardiovascular disease (CVD) risk management’ – gives information on primary and secondary prevention of cardiac disease
  • ‘Stroke and transient ischaemic attack (TIA)’ – includes information on the secondary prevention of cerebrovascular events

The Map and the RCP bring together evidence and practice to support clinical decisions at the point of care. The Map can be customised to reflect local needs by clinicians looking to support clinical decision-making. Over 150 organisations have ‘localised’ more than 1,300 care pathways. Local additions to the care maps for these chronic conditions range from signposting services, for example local telehealth initiatives and social care packages, to providing information on topics such as factors to consider when deciding where exacerbations of COPD should be managed, and which teams are responsible for delivering care.

Click here to see how the Map could help your organisation.

Summary of news from Health and Social Care News

Young people have hospital only mentality
Twenty five per cent admit they would call an ambulance when a trip to the doctor would suffice

NHS trusts to spend on new IT systems
50 per cent of trusts are looking to invest in either an electronic patient record or portal solution

Darlington care home fined for medication
A care provider that failed to comply with national standards has been fined £4,000 by the Care Quality Commission

Emergency ambulances ”use first-aiders”
Medical staff with basic first-aid training are being used instead of fully-trained paramedics

New SEN legislation ”needs improving”
Government must consult more with parents and young people on its new programme for children with special educational needs

A force for revolution 
Does the NHS Commissioning Board have what it takes to break down resistance to NHS reforms? Matthew D’Arcy reports from Public Service Events’ Digital by Default conference

Pilot projects focus on severe mental illness
The government wants to prioritise mental health ”like never before”, says Norman Lamb

”Give people surgeon performance data”
The public should get greater access to data on the performance of individual surgeons working in the NHS

NHS must be a seven days a week service
”We have got outpatient departments that are empty, operating theatres that lie fallow,” says Sir Bruce Keogh

£500m Tamiflu spend to be investigated
MPs asked Public Accounts Committee chair Margaret Hodge to look into if the NHS got it wrong

Burnham slams coalition’s record on NHS
We’re losing the NHS and that’s why we will keep stepping up the fight for it, says shadow health secretary

Cash for research – patients will be the real winners
Patients are set to benefit from more efficient delivery of highly effective new therapies tailored to their needs, writes Hilda Kalap, Technology Strategy Board communications manager

Dobson R.; Tweddle E.; Scott M.; Cubukcu; BMJ Case Report; 2012

left atriumThis case report on Large left atrial myxoma with an unusual origin was published in Sept 2012 by BMJ Case Reports.    Congratulations to the authors :

  • Rebecca Dobson – Endocrinology Dept, University of Liverpool
  • Emma Tweddle – Cardiology Dept, MDGH
  • Martha Scott – Cardiology Dept, MDGH
  • Arzu Cubukcu – Cardiology Dept, MDGH

BMJ Case Reports Published 24 September 2012; doi:10.1136/bcr-2012-006782

Primary Care Commissioning: News, events and elearning opportunities

primary care commissionExtract from the website of Primary Care Commissioning (PCC) … “provides trusted, practical support to commissioners and providers of health and care services including training, development and expert advice.

Our events, elearning and information services enable better value for the NHS, better business processes, better informed healthcare strategies and better outcomes.

We are a community interest company, a form of not-for-profit social enterprise.”

Happy New Year!


Wishing all staff and students across East Cheshire a happy and healthy New Year.  

If you struggled last year with references, research or simply something good to read, make sure you come and visit us in 2013 – we can help with all of the above and probably more besides!

Although we are closed on New Year’s Day, from 2 January we will be open as usual with complimentary tea and coffee, books, journals, computers and assistance with literature searches.  Whether you’re based in the community or onsite, we have someone who can help you. Why not call in and see what we can do for you?

Opening hours:
Monday to Thursday: 08.30 – 5:00pm  and Friday from 08:30 – 4.30pm


Cancer services coming of age

Learning from the improving cancer treatment assessment and support for older people project
This report summarises a series of pilots that tested whether appropriate assessment of older cancer patients would result in improved access to appropriate cancer treatment, based on need and not age. It also tested whether action, as a result of an age appropriate assessment, improved the scope for older people to benefit from treatment.



Cancer Statistics from The King’s Fund

New version of end of life care quality assessment tool launched


Extract from National End of Life Care Programme website

endoflifeThe National End of Life Care Intelligence Network (NEoLCIN) has released the new version of its End of Life Care Quality Assessment (ELCQuA) tool, which is now structured around the NICE quality standard for end of life care for adults.

ELCQuA is a free, online self-assessment tool designed to support local service improvement and the commissioning of end of life care services. It can be used by any organisation caring for people at the end of life, across the health, social care, voluntary and private sectors. This includes commissioners, local authorities, acute hospitals, primary care, community, palliative care and ambulance services.

Read more about it by following the link at the top of this post.

New modules from BMJ Learning

Some emergency medicine modules are now available for you to complete. They give an important update on a range of common dilemmas.



NICE News in December

    NICE local formularies guide will “reduce variation in prescribing”

    December 17, 2012

    NHS should offer early pregnancy services seven days a week

    December 12, 2012

    Greater awareness of hepatitis B and C needed

    December 12, 2012

    Recent press releases: Dec 18 2012

    AQuA News: Improving outcomes in Asthma – 1hr web training

    11 Jan 2013
    WebEx – Improving Outcomes in Asthma (part of Events and WebExs)
    Our Improving outcomes pack for asthma was launched 30th November 2012. Would you like to know more about the pack? A WebEx has been organised for Friday 11 January 2013 from 1 – 2pm.

    Latest Edition of AQuA News | Issue 24 December 2012 

    In this edition you will find: North West health improvement programme reduces mortality View AQuA’s newly enhanced external website Shared Decision Making ‘Train the Trainer’ resource launched Mersey Care bespoke work update Launch event ‘Don’t…

    Christmas opening hours

    The Staff Library team will be available as follows over the Christmas period:

    Monday 24 December   –  8:30 – 4:00pm

    Tuesday 25 – Friday 28 December – Closed

    Monday 31 December   –  9:00 – 4:00pm

    Tuesday 1 January         –  Closed

    Wednesday 2 January – Friday 4 January – Open (usual hours)

    Staff and students with 24/7 access will be able to enter the Library as usual.

    Don’t forget to renew your books if necessary for the holiday period.

    New book by Ben Goldacre: Bad Pharma

    A extract from The Economist: Q&A with Ben Goldacre whose previous book Bad Science is included in our library stock.
    “ALONG with lawyers, estate agents and journalists, the pharmaceutical industry occupies an unenviable position near the bottom of the public’s affections. Ask people why, though, and they may find the reasons for their disdain hard to pin down.

    Ben Goldacre, a British doctor and author, knows exactly what is wrong. “Medicine is broken,” he declares in his new book, “Bad Pharma”, before cataloguing the ways in which secrecy and laziness keep doctors ignorant about just what the drugs they prescribe are doing to their patients. Pharmaceutical firms routinely bury unflattering trial results and publish only the good ones. Those trials are run on unrepresentative patients, with dodgy statistical analysis, and then pushed on doctors with advertising budgets that are often bigger than those of the firms’ research-and-development arms.”

    Staff take the wellbeing prize

    The Trusts NEW Employee Well-being Strategy was recently launched at events  held at Macclesfield Hospital on 30 October 2012 and Eagle Bridge on
    5 November 2012. Both events were a great success with over 150 members of staff attending.  Numerous activities took place ranging from mini health checks to physiotherapy and nutritional advice. There were competitions including a diet and nutrition quiz, physiotherapy challenge and staff feedback competition.  Well done to the following winners!

    Staff Feedback & Suggestions

    1st Prize – Gill Mayer, Clinical Effectiveness
    2nd Prize – Joan Murray, Dental Team
    3rd Prize – Maria Davidson, District Nursing

    Diet & Nutrition Quiz

    1st Prize –       Cathy Hollinshead, District Nursing
    2nd Prize –      Sharon Oliver, District Nursing

    Physiotherapy Cycle Challenge 

    1st Prize –       Sophie Fryer, HR Graduate

    If you would like to become part of the Well-being Steering Group or have any ideas/suggestions, please contact:

    Eileen Platt, Well-being Group Chair.

    AQuA News: December

    The December edition of AQuA News includes these topics:

    • North West health improvement programme reduces mortality
    • View AQuA’s newly enhanced external website
    • Shared Decision Making ‘Train the Trainer’ resource launched
    • Mersey Care bespoke work update
    • Launch event ‘Don’t Just Screen – Intervene’
    • Armed Forces Community Directory
    • AQuA self-management support
    • Integrated Care Community launches
    • Quality of health care continues to rise in North West hospitals
    • Your opinion counts: Take part in the AQuA Member survey!
    • Nursing Times award winners

    AQuA Academy programmes – coming soon

    – AIM+: New quarter four dates launched

    – Quality improvement for finance: Cohort 3

    – AQuA Improvement Methodologies (AIM): Cohort 11 open for bookings

    • AQuA Patient Safety Ambassadors
    • AQuA: The Health Foundation Improving Safety Award

    Look for the next edition of AQuA News available in February 2013.

    Tatton Ward closure permanent at Knutsford Community Hospital

    TATTON Ward at Knutsford Community Hospital has been closed since 2010.

    Its operator – East Cheshire NHS Trust – has made it clear that it feels the ward is no longer able to meet the needs of patients.

    On its website it has listed the reasons behind the closure: it is old accommodation in need of modernisation; it has reduced access to therapy services; and it has limited access to medical care.

    The website adds: “We made the decision in September 2010 to temporarily close this facility due to these reasons. We are now proposing the permanent closure of this ward and the transfer of the service to the Langley Unit at Macclesfield District General Hospital.”

    Opioid prescribing for cancer pain

    Opioid prescribing for cancer pain during the last 3 months of life: associated factors and 9-year trends in a nationwide United Kingdom cohort study

    Posted: 10 Dec 2012 12:00 AM PST

    Source: Journal of Clinical Oncology

    Purpose: To determine time trends and characteristics associated with opioid analgesic prescribing to patients with cancer who are approaching the end of life.

    Patients and Methods: This population-based cohort study used data on 29,825 patients diagnosed with five common cancers – lung (34.2%), colorectal (19.9%), female breast (21.6%), prostate (19.1%) and head and neck (5.2%) – in the United Kingdom General Practice Research Database (GPRD) who died between 2000 and 2008.  Opioid prescription rates in the last 3 months of life were described.  Characteristics associated with opioid prescribing were investigated by using generalised estimation equation models. Results: In the last 3 months of life, 43.6% (95% CI, 43.0% to 44.2%) of patients received at least one prescription of opioids: morphine (33.4%; 95% CI, 32.8% to 33.9%), diamorphine (11.6%; 95% CI, 11.2% to 11.9%) and fentanyl family (10.2%; 95% CI, 9.8% to 10.5%).  Over time, prescription rates …

    Christmas opening hours

    The Staff Library team will be available as follows over the Christmas period:

    Monday 24 December   –  8:30 – 4:00pm

    Tuesday 25 – Friday 28 December – Closed

    Monday 31 December   –  9:00 – 4:00pm

    Tuesday 1 January         –  Closed

    Wednesday 2 January – Friday 4 January – Open (usual hours)


    Staff and students with 24/7 access will be able to enter the Library as usual.

    Don’t forget to renew your books if necessary for the holiday period.

    AQuA News: 4 December

    In 2008/09 there were 49,054 emergency adult admissions for asthma at a cost of £61 million to the NHS, however it is currently estimated that three quarters of these are preventable

    Boards on Board November 2012
    Presentations and resources from the two day residential event delivered by AQuA, NWLA and IHI.

    This week’s news:

    Your opinion counts – take part now in the AQuA 2012 Member survey!
    29 November 2012

    Congratulations to the Winners of the HSJ Awards 
    29 November 2012

    Sir Stephen Moss and Gill Harris confirmed faculty for AQuA Patient Safety Ambassadors programme Jan ’13 
    03 December 2012

    05 Dec 2012
    Leadership for Integration 3 AQuA led Pre-Programme preparation day (part of Integration)
    Introducing a Framework for Integration, Preparing your Integration projects for Success

    06 Dec 2012

    AQ Programme Leads (part of Reducing avoidable mortality)
    The next Advancing Quality (AQ) Programme Leads meeting will be taking place on 06 December 2012. To ensure you are fully up-to-date with the latest AQ developments, we highly recommend programme leads from every trust attend as these meetings are yo…

    06 Dec 2012

    The shape of the acute care sector post – NHS reform: implications for commissioners and providers (part of Partnerships)
    Long-term and immediate pressures on acute sector, why the reforms will lead to a ‘new world’ for the hospital’s role in healthcare, opportunities for new models of provision and the whole-system responses needed to make these happen.

    13 Dec 2012

    Action Learning Set 1 (part of Integration)
    First Action learning Set for the Integrated Care Community 2

    14 Dec 2012

    Dementia improvement Community – Holding the gains, maintaining Improvement (part of Quality of life for people with long term conditions)
    The focus of this Dementia Improvement Community event will be to demonstrate improvement in a range of aspects of dementia care, with participating organisations sharing and learning from national best practice.

    20 Dec 2012

    AQuA Integrated Care – Project Manager Learning set (part of Integration)

    09 Jan 2013 — 25 Mar 2013

    Cohort 3 of the Patient Safety Ambassadors programme
    Third cohort of the Patient Safety Ambassadors (PSA) programme. See modules for more information.

    14 Jan 2013 — 14 Jan 2013

    Fundamentals for Improvement of the AQuA Improvement Methodology Plus programme

    14 Jan 2013

    Action Learning Set 2 (part of Integration)
    Second Action learning set for the Integrated Care Community 2

    25 Jan 2013 — 12 Mar 2013

    Cohort 3 of the Quality Improvement for Finance programme

    08 Feb 2013

    Children & Young Peoples
    (part of Quality of life for people with long term conditions)
    Further details to follow

    BMJ: Does routine oxygen supplementation in patients with acute stroke improve outcome?


    BMJ 2012; (Published 30 November 2012)   Cite this as: BMJ 2012; 345:e6976

    Stroke is the third most common cause of death and the leading cause of long term disability in developed countries.  Specialist care in stroke units is well established as being effective in preventing death and disability after stroke.1 However, which aspects of stroke care are crucial for improving outcome remains unclear. Patients in a stroke unit are more likely than those on a non-specialised general ward to receive oxygen.2  Bravata and colleagues found that treating all episodes of hypoxia with supplemental oxygen was one of three key processes associated with better outcome in acute stroke care.3 Mild hypoxia is common in patients with stroke and may have substantial adverse effects on an ischaemic brain after stroke. Whereas healthy adults with normal cerebral circulation can compensate for mild hypoxia by an increase in cerebral blood flow, this is not possible in patients whose brain is already ischaemic after stroke.4 Hypoxaemia in the first few hours after hospital admission is associated with an increased risk of death.5

    Read the full text – requires Athens account details


    Continue reading

    Syam PK Morapudi, William J Marlow, Daniel Withers, Peter Ralte, Ayman Gabr, Mohammad Waseem; Journal of Orthopaedic Surgery; Nov 23 2012

    Total wrist arthroplasty using the Universal 2 prosthesis

    Syam PK Morapudi, William J Marlow, Daniel Withers, Peter Ralte, Ayman Gabr, Mohammad Waseem, Macclesfield District General Hospital, Macclesfield, Cheshire

    Abstract: Purpose. To report outcomes of 21 total wrist arthroplasties  (TWA) using the Universal 2 prosthesis.

    Methods:  Five men and 14 women aged 44 to 82 (mean, 62) years underwent 21 total wrist arthroplasties for rheumatoid arthritis (n=19) and post-traumatic
    arthritis (n=2) by a single surgeon using the Universal 2 prosthesis. Pre- and post-operative pain and function were assessed by a single surgeon using the
    Disabilities of the Arm, Shoulder and Hand (DASH) score and the patient-rated wrist evaluation (PRWE) score. Range of motion, stability, dislocation rate, and
    neurovascular status were also assessed. Radiographs were evaluated for implant alignment and fit, screw positioning, and implant loosening.

    Mathioudakis A.G.; Chatzimavridou-Grigoriadou V.; Evangelopoulou E.; Mathioudakis; European Respiratory Journal, November 2012

    Chronic bronchitis: An objective diagnosis of exclusion

    Citation: European Respiratory Journal, November 2012, vol./is. 40/5(1305), 0903-1936;1399-3003 (01 Nov 2012)

    Author(s): Mathioudakis A.G.; Chatzimavridou-Grigoriadou V.; Evangelopoulou E.; Mathioudakis G.A.

    Institution: (Mathioudakis) Medical Department, Macclesfield District General Hospital, National Health Service, Victoria Road, Macclesfield, SK10 3BL, United Kingdom; (Chatzimavridou-Grigoriadou, Evangelopoulou, Mathioudakis) Respiratory Dept, General Hospital of Nikaia St. Panteleimon, Piraeus, Greece

    Country of Publication: Switzerland

    Publisher: European Respiratory Society (4 Ave Sainte-Luce, Lausanne CH-1003, Switzerland)

    Publication Type: Journal: Letter

    Athens required: Full text not available


    Meacock R.; Harrison M.; Shelmerdine J.; Value in Health; November 2012

    Exploratory mapping of the lupusqol to the SF-6D

    Citation: Value in Health, November 2012, vol./is. 15/7(A477), 1098-3015 (November 2012)

    Author(s): Meacock R.; Harrison M.; Mcelhone K.; Isenberg D.; Ferenkeh-Koroma A.; Ahmad Y.; Bruce I.N.; Shelmerdine J.; Gordon C.; Griffiths B.; Maddison P.; Akil M.; Abbott J.; Teh L.S.

    OBJECTIVES: To derive a mapping algorithm to estimate scores (utility values) for the preference-based SF-6D measures from the non-preference-based diseasespecific

    Athens account required. Not full text