Latest from BMJ Learning

Case Study:
An 84 year old woman is having trouble sleeping at night. This has been a recurring problem for some months. You know she has had a fall earlier this year. She wants some medication to help her sleep as she feels that this is affecting her ability to do things during the day. What would you advise? What if she didn’t want to follow your advice? If you would like to learn more about this topic, then click on the link to complete this module today.

Falls in older people: prevention and management

And here are our most popular modules in urology for you to complete.

Idiopathic constipation and nocturnal enuresis in childhood: a guide to management – in association with NICE

Lower urinary tract symptoms in men: a guide to management – in association with NICE

Erectile dysfunction: diagnosis and treatment

Managing patients at risk of prostate cancer: in association with the NHS prostate cancer management programme

Urinary tract infection in children: diagnosis, treatment, and long term management – in association with NICE

Changes to TIN’s Current Awareness Service

tin_logoThe Keeping up to Date element of The Improvement Network TIN) will be migrating to a new website. The existing TIN website will only continue until September 2013, as the Strategic Health Authority which hosted it no longer exists. TIN will not be maintained however.

The Current Awareness Service for Health is therefore creating a new site for health related alerting services, which will be based on the Keeping up to Date section of TIN. A copy of the site will be taken on 29 April after which no new content will be added until the new site is up and running. We will announce that as widely as possible, once the migration is completed, and redirects will be in place.

Grand Round: 1 May 2013

The next Grand Round will take place on Wednesday, 1st May, 2013 and will be a presentation given by Dr. M Silverdale, entitled ‘Headache’.

The lecture takes place at 1:00pm in the new lecture theatre, 1st Floor Macclesfield District General Hospital. It is preceded by a buffet from 12:15pm.

The next Grand Round will take place on Wednesday, 8th May, 2013 with a presentation by Dr. Marchetti, entitled ‘Post-Operative Cognitive Dysfunction and Delirium’.

Support for Stat&Mand elearning

keyboard handStatutory and Mandatory training via elearning is now being offered to staff across the Trust.  Whilst this is a flexible and often useful method of delivery, it is often difficult to work undisturbed in the workplace and concentrate on an elearning package.

The Staff Library has the perfect solution! We have 11 computers in a very pleasant space on the 2nd floor of New Alderley House, where people can work in peace and receive support from library staff, who can assist with getting started.  There is no need to book, so please just come along with your username and temporary password details (available from 01606544935).

 

 

Eyes on Evidence update: Issue 48 – April 2013

Changes at NICE

Since you last received Eyes on Evidence our name has changed to the National Institute for Health and Care Excellence, to reflect our new role and responsibilities. NICE’s role is to improve outcomes for people using the NHS and other public health and social care services.

Infectious diseases among homeless populations

The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, in homeless populations is significantly higher than in the general population. However, figures show much local variation raising questions about the need for a more locally-based response.

Risk of abuse in disabled children A systematic review of studies from across the world suggests that more than a quarter of children with disabilities will experience abuse within their lifetimes and that children with disabilities are 3 to 4 times more likely to be victims of abuse than their peers without disabilities.

Rheumatoid factor and risk of future rheumatoid arthritis A cohort study reports that raised levels of rheumatoid factor are associated with an increased risk of developing rheumatoid arthritis. Although treating pre-rheumatoid is currently of unproven value, this study suggests it might be possible in the future.

Heart failure: effects of aldosterone antagonists and renin-angiotensin antagonists on mortality An observational study in people admitted to hospital with heart failure (HF) with reduced ejection fraction finds that aldosterone antagonists reduce readmissions for HF but have no effect on mortality and increase the risk of admission with hyperkalaemia. Another observational study in people with HF with preserved ejection fraction finds that angiotensin converting enzyme inhibitors or angiotensin receptor blockers reduced all-cause mortality.

Grapefruit–drug interactions A review article details the evidence for a pharmacokinetic interaction between grapefruit and certain drugs, and the potential clinical consequences of this.

Case studies from the Quality Improvement Productivity and Prevention (QIPP) Collection

The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight 2 new examples:

Evidence Updates
NICE has recently published Evidence Updates on:

  • Diabetic foot problems
  • Hip fracture
  • Caesarean section
  • Anaphylaxis

 

Doctor know: a knowledge commons in health

National Endowment for Science, Technology and the Arts (Nesta)

Doctor know: a knowledge commons in health
This paper argues that society’s growing ability to mobilise knowledge from different fields and sources is beginning to show the potential of a ‘knowledge commons’ in healthcare: an open system of knowledge with researchers, practicing clinicians, patients, their families and communities all involved in capturing, refining and utilising a common body of knowledge in real time. It sets out what this might mean in practice, and steps that can be taken to get there.

Al-Najjim M; Mustafa A; Fenton C; Morapudi S; Waseem M; 2013

Giant solitary synovial osteochondromatosis of the elbow causing ulnar nerve neuropathy: a case report and review of literature.
Citation: Journal of Brachial Plexus & Peripheral Nerve Injury, 2013, vol./is. 8/1(1), 1749-7221;1749-7221 (2013)

Abstract: Giant or solitary osteochondroma is part of a rare disorder known as synovial osteochondromatosis. It forms part of a spectrum of disease characterized by metaplastic changes within the joint synovium that are eventually extruded as loose bodies. It has been suggested that solitary synovial osteochondroma forms as progression of synovial osteochondromatosis through a process of either coalescence of multiple smaller bodies or the growth of a dominant synovial osteochondroma. Previous studies have shown that it occurs as a late phase of the disease. We report a rare case of giant synovial osteochondromatosis at the elbow causing ulnar nerve neuropathy and mechanical symptoms which has not been previously reported in the literature.

CASE REPORT: We report a case of a 56 year old Western European gentleman who presented with ulnar nerve neuropathy and swelling behind the elbow. The patient underwent MR imaging and subsequent biopsy that demonstrated synovial osteochondromatosis. Initially the patient declined surgery and opted for a watch and wait approach. Five years later he returned with worsening symptoms and underwent successful surgical resection of a giant solitary synovial osteochondroma.

CONCLUSION: The unique outcome in our patient despite the long interval between presentation and surgical treatment resulted in early full resolution of symptoms within a short period. It may suggest an improved prognosis as compared to multiple synovial osteochondromatosis in terms of mechanical and neurological outcomes.

Publication Type: Journal Article
Source: MEDLINE
Full Text: Available from BioMedCentral in Journal of Brachial Plexus and Peripheral Nerve Injury

Journal of Clinical Pharmacy and Therapeutics; Yates J.; Choudhry M.; Keys G; April 2013

A case report describing a suspected rivaroxaban hypersensitivity reaction in a surgical patient was published in April 2013, vol./is. 38/2(159-161), 0269-4727;1365-2710

Abstract:    Rivaroxaban is an oral anticoagulant, currently licensed for use as a venous thromboembolism (VTE) prophylaxis, and recommended by the National Institute for Clinical Excellence (NICE) for all patients undergoing elective hip and knee replacement surgery in the UK. We present the first case of a suspected hypersensitivity to rivaroxaban.

Case summary: A 57-year-old man with no previous allergies underwent an uncomplicated, elective partial knee replacement, after which he was prescribed a routine 2-week course of rivaroxaban 10 mg. He developed an allergic response requiring readmission for assessment and treatment 7 days post-operatively.

Conclusion: We believe this to be the first published case of hypersensitivity associated with rivaroxaban. More research is needed to determine this association. At the same time, given the growing range and increasing use of anticoagulants, particular vigilance is required regarding potential side effects so that these may be managed quickly and effectively in the early stages.

2012 Blackwell Publishing Ltd.
Publication Type: Journal: Article
Source: EMBASE

BMJ Case Reports; Jain Y.K.; Kokan J.S; 2013

An interesting case of screen-detected breast cancer encasing a ventriculoperitoneal shunt was published recently in BMJ Case Reports, 2013, 1757-790X (2013)

Abstract:  A 67-year-old woman was diagnosed with a breast cancer via screening encasing the ventriculoperitoneal shunt. Triple assessment including MRI scan of the breast confirmed the presence of a breast mass and the tubing of the ventriculoperitoneal shunt was running directly through the mass. She underwent wide local excision of the breast cancer as well as rerouting of VP shunt as a joint procedure with the neurosurgery team and recovered uneventfully. This is a very rare and an interesting case and required management involving a different specialty.

Source: Embase

Leadership course for frontline nurses and midwives

A new eight-day leadership course is helping front-line staff become better role models for their colleagues and provide excellent patient care across primary, community and secondary healthcare settings.

Around 1,200 nurses and midwives should complete the course, developed and delivered by the NHS Leadership Academy, by March 2014.

The programme focuses on the approach and behaviours of frontline nurses and midwives with leadership responsibilities, such as team leaders, ward sisters and supervisors, and the environment they create for their colleagues and patients.  It was developed with input from nursing and midwifery leaders from across the country.

In October 2012, the Government pledged £46m toward NHE leadership development in the name of better patient care.

Read the full article

WebWatch: Cancer Commons

Extract from website at: http://www.cancercommons.org/researchers-clinicians/

cancercommons_model

CANCER COMMONS “is an open science initiative linking patients, physicians and scientists in rapid learning communities. Our mission is to ensure that patients are treated in accord with the latest knowledge on targeted- and immunotherapies, and to continually update that knowledge based on each patient’s response.”

Model

Advisory boards, comprising leading physicians and scientists in each cancer, curate the molecular model that identifies the most relevant tests, treatments, and trials for each molecular sub type of that cancer, based on the best current knowledge.

Test and Treat

Patients and physicians access knowledge derived from the model, as soon as it’s deemed actionable, through alerts, notifications, news, and applications that inform testing and treatment decisions.

Report and Analyze

Physicians, researchers, and patients report clinical observations and outcomes and new data are analyzed in our Rapid Learning Communities by collaborative, interinstitutional teams to validate, refute, and amplify the current model’s knowledge and hypotheses.

Learn

The advisory boards review these results and update the framework in real time.

End of Life Journal – Spring Issue 2013

End of Life Journal is the free, online, peer-reviewed, quarterly journal that publishes articles on all aspects of nursing practice relating to end-of-life care.   It is primarily aimed at generalist nurses working in hospital, community and care home settings. However, many articles will also be of interest to the specialist palliative care nursing audience as well as members of the wider multidisciplinary team.   The journal focuses on care for patients with both malignant and non-malignant disease and their family and friends.

Articles include:endoflife_logo

CLINICAL REVIEW

CLINICAL SKILLS

CLINICAL PRACTICE DEVELOPMENT

ETHICAL/LEGAL DISCUSSIONS

NURSING CASE REVIEW

NATIONAL END OF LIFE CARE PROGRAMME UPDATE

NHS Athens re-branded as OpenAthens

nice_nhs_evidenceOpenAthens, formerly NHS Athens,  is an access management system provided by Eduserv, which enables eligible users to access the online content (see below).  Registration for OpenAthens is free by going online and completing a simple form at https://register.athensams.net/nhs/nhseng/  It is best to register from an NHS computer and you will need to quote your NHS email address.  Once this is done you will receive an activation email together with your username.

Your personal username and password will provide access to NICE Evidence Services (a suite of services that provide internet access to high quality authoritative evidence and best practice) formerly known as NHS Evidence.  The services cover health, social care and public health evidence.  Evidence Services aim to help professionals make better and quicker evidence based decisions. NICE Evidence Services consists of the following 6 resources

  • Evidence Search which provides free open access to a unique index of selected and authoritative health and social care evidence-based information.
  • Healthcare Database Advanced Search (HDAS), which provides access to an extensive set of journals and bibliographic databases. These are purchased by NICE on behalf of the NHS.
  • Clinical Knowledge Summaries (CKS) which provide primary care practitioners with access to evidence-based guidance on over 300 key conditions presenting in primary care.
  • BNF microsite which provides open access to BNF content across the UK.
  • UK DUETS, a database of Evidence Uncertainties which provides research funders and researchers access to the ‘known unknowns’ in the evidence base.
  • Bulletins, Alerts and Evidence Awareness service which helps busy professionals keep up to date with important new evidence.

If you need any assistance signing up for OpenAthens or using any of the NICE Evidence Services, please do not hesitate to contact any member of the Library staff.

01625661362 or email ecn-tr.stafflibrary@nhs.net

 

New resource available from the Centre for Nursing Innovation

FONSCentre for Nursing Innovation
http://www.fons.org/library/dissemination-series.aspx

Extract from newsletter

The links below enable you to freely download and share the latest Improvement Insights, part of the FoNS Dissemination Series Improvement Insights.

Each of these one-page summaries reports on the innovative ways in which nurse-led teams across the UK have been supported by FoNS to work with patients, relatives and staff in their drive to deliver excellent care.

Volume 8 Numbers 1-10:

FoNS is committed to supporting the development of nursing and healthcare practice and one of the ways we achieve this is by providing freely accessible information. All the projects and initiatives reported on have been supported by one of FoNS’ practice based development and research programmes and have aimed to:

  • Respond to the needs of patients
  • Improve patients’ experience of care
  • Be evidence based (including practice knowledge and service users’ experience)
  • Make changes to practice
  • Share their learning

April news from Skills for Health

April edition of AQuA New

The April edition of AQuA News is now available via the attached link:

https://www.aquanw.nhs.uk/content_items/7389

In this edition:

  • AQuA Improvement Methodologies (AIM): Cohort 12
  • Deep Dive Into (formally AIM+)
  • EoL Care AIM: St Helens & Knowsley team case study
  • Call to Action! Improving Patient Safety within radiology departments
  • Advanced Team Training Programme: Cohort 4
  • Community SAFE – Programme update
  • Introduction to Lean: Cohort 3
  • Quality Improvement for Finance: Cohort 4
  • Launch of AQuA’s Lean Network
  • AQuA Observatory becomes AQuA Analytics
  • AQuA Analytics – Health Intelligence for Improvement event
  • Tweet all about it! Are you following AQuA on Twitter?
  • AQuA Member Survey 2012
  • Advancing Quality (AQ) takes to the international stage
  • AQ teams invited to register for upcoming collaboratives
  • Visit the Advancing Quality stand at this year’s NICE Conference
  • Advancing Quality clinical lead moves into new role
  • Secretary of State visits the North West and promotes good dementia care
  • The Mental Health State of the North West 2012/13
  • Don’t Just Screen – intervene project
  • Unlocking Diagnosis: Sharing good practice in the assessment of people with memory problems
  • Avoiding unnecessary admissions and A&E visits
  • Strategic Development Lead appointment for AQuA Academy and AQuA’s Integrated Care
  • Publication of AQuA Action report – Managing Elective Referrals: Review of Evidence and Case Studies
  • GPs ‘click’ with Shared Decision Making
  • ‘Ask 3 Questions’ listed for High Impact Innovations
  • AQuA starts its second Shared Decision Making collaborative
  • AQuA Partnerships: Seminar Event

Dementia care varies

Extract from BBC Health News

“The standard of care provided for people with dementia is “patchy”, the National Institute for Health and Care Excellence (NICE) has said.

Some people with the condition were not getting even basic levels of care, it added.  The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.”

NICE’s dementia guidance includes 10 standards it wants the care sector to follow.

One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.

Tatton Ward closure angers Knutsford residents

Extract from the Knutsford Guardian

“DISGRUNTLED Knutsfordians have blasted a decision by health bosses to permanently close an in-patient ward at the town’s community hospital.

In a meeting – attended by more than 50 residents – at St John’s Church hall last Thursday the East Cheshire NHS Trust board decided to close the 18-bed Tatton Ward.  However, it added outpatient and community services would not be affected by the decision. ”

For the full article – click here

NEW updates for OTs, Dietetics staff and Speech and Language Therapists

Picture1Carole Keeling one of our Outreach Librarians has put together a collection of articles of particular interest to Occupational Therapists.

Published in the form of an update, Carole is hoping to:

  • bring together a range of recently-published research reports, articles and electronic resources to help OTs keep up-to-date with developments.
  • remind readers of OT Update of the services available from the Staff Library Service – we can supply you with 1:1 or small group training in literature searching skills; obtain full-text articles for you; or provide services in literature searching to help you with your research tasks.
  • respond to your information needs – if you have any suggestions on the type of information sources you would find helpful in future editions of OT Update, then please let us know.

Carole also offers similar updates for Dietetics staff and Speech and Language Therapists.  If you haven’t received your ‘update’ via email already you can always request one by contacting Carole direct at c.keeling@nhs.net

Help with Athens

The Athens portal allows you to download the full text of articles, where the Trust has a subscription to the appropriate publisher. These are noted at the end of an abstract. You will need an Athens username and password to use the system, to register please log on to:  https://register.athensams.net/nhs/nhseng/

If you are new to Athens and would like help in registering and starting to use Athens, please contact Carole Keeling (Outreach Librarian) who can come to your workplace and help you get started.

Please email c.keeling@nhs.net, or phone ext. 1547 to make an appointment – a 30 minute slot will get you up and running!