Great value from Athens

It’s a good time to remind everyone who has registered for an Athens account, of all the electronic resources it provides access to via NHS Evidence.
Clicking on this link will take you to a complete list of nationally purchased databases and journals (correct as at Nov 2012).

If you haven’t registered for Athens yet, then follow this link – it only takes a couple of minutes and all you need is your NHS Mail address.  If you would like a refresher about getting the best from your Athens account, please call 01625 66 1362.


Our leaner meaner journal collection

DSCF0274As part of ongoing work to streamline our processes wherever possible, this month saw the successful update of our current paper journals and their details using the ‘link resolver’.  This is the ‘behind the scenes’ mechanism which seamlessly enables anyone searching the NHS Evidence databases or HDAS for a particular article, to see a list of possible suppliers ie: the paper and/or electronic holdings which we subscribe to or have as part of the NHS England core content deal.

Due to our move in March to much smaller accommodation, the reduction in our collection from over 160 journals down to just 14 vividly illustrates how much the library relocation has cost in terms of resources.

Our paper journals now comprise:

Rolling 12 months.  Donated

Rolling 12 months – Donated

Rolling 12 months. Donated

Rolling 12 months. Also available via NHS Athens

Held in bookstock

Rolling 12 months

Rolling 12 months. Also available via NHS Athens


LANCET (2012)
Rolling 12 months. Funded by NICE and also available via NHS Athens

Rolling 12 months

Rolling 12 months. Funded by University of Chester

Rolling 12 months. Funded by University of Chester and also available via NHS Athens

NURSING TIMES (2008 – to current)
Imperfect. Funded by University of Chester

SURGERY  (2012)
Rolling 12 months

Requests for articles and journals not covered in this list will still be available via the inter-library loan scheme.


Eyes on Evidence newsletter: Issue 45, January 2013

NHS Evidence produces Eyes on Evidence – you can sign up to receive regular emails.

A retrospective case record review shows the number of preventable deaths in English NHS hospitals is unacceptably high, but not as high as previously estimated.
An analysis of the impact of New York City policy to restrict the use of trans fat for human consumption shows a significant fall in the trans fat content of fast food purchases, without a commensurate rise in the level of saturated fat. 
A systematic review and meta-analysis show that the molecular detection of tumour cells in regional lymph nodes is associated with an increased risk of disease recurrence and poor survival in patients with node-negative colorectal cancer.
Results of a randomised controlled trial show that offering either additional free nicotine replacement therapy or higher intensity proactive telephone counselling to people who rang a national helpline for support to stop smoking, did not increase quit rates over and above those obtained using standard helpline support. 
A Cochrane review concludes that antihypertensive drugs have not been shown to reduce mortality or morbidity in adults with mild hypertension and no previous cardiovascular events. Significantly more people taking antihypertensive treatment discontinued treatment due to adverse effects, compared with placebo. However, the review has some significant limitations. 
The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices which have both cut costs and improved quality. 

Eyes on Evidence: August update

 Sleep apnoea may be an independent risk factor for deep vein thrombosis (DVT) but further research is required to confirm this.
Pharmacological thromboprophylaxis when used in addition to compression stockings does not reduce death rates, when compared with compression stockings alone. However, prophylaxis is still useful in reducing venous thromboembolism, unless there is a high risk of bleeding.

Risk of venous thromboembolism with non-oral hormonal contraception

An observational study suggests that women using the transdermal contraceptive patch or combined hormonal vaginal ring appear to have about twice the risk of venous thromboembolism compared with women using combined oral contraceptives containing levonorgestrel.

Dehydration in hospital-admitted stroke patients

Focusing on interventions to reduce the frequency and duration of dehydration have the potential to improve patient outcomes after stroke.

Long-term effects on renal function of tight glycaemic control in early type 1 diabetes

Long-term observational follow up of the Diabetes Control and Complications Trial shows that early tight control of blood glucose is associated with a lower risk of impaired renal function, but could not a detect a difference in the risk of severe renal impairment or end stage disease.
Evidence Updates

In the past month NICE has published online via NHS Evidence an Evidence Update on nocturnal enuresis.

NHS Evidence Updates – Cancer

The following updates are available from NHS Evidence


via Evidence Updates – NHS Evidence – Search Engine for Evidence in Health and Social Care.

Eyes on Evidence: Issue 38, June 2012

 People who are admitted to hospital with a psychotic disorder may have their illness misclassified. Diagnosis should be reassessed periodically to ensure that the most appropriate interventions are being used.

There may be differences in mortality risk between individual antipsychotic agents used to treat people with dementia. Patients should be monitored for adverse events in the acute treatment period, and periodic attempts to discontinue medication should be made.

Caution is urged over the long-term use of antiplatelets in people with chronic kidney disease. Treating 1000 patients with oral antiplatelet therapy for a year may prevent nine heart attacks, but this needs to be balanced against an increased risk of bleeding.
Pregnant women may experience some benefit from using relaxation techniques during labour, in relation to reduced pain, increased satisfaction and improved clinical outcomes. However, the available evidence is insufficient to make clinical recommendations.

Antimuscarinic drugs for urinary incontinence in women 

There is no strong evidence of a clinically important difference in efficacy between antimuscarinic drugs. The choice of antimuscarinic drug for an individual woman is likely to depend on tolerability, patient preference, and cost.

Details of a new resource available via NHS Evidence search.

Cochrane quality and productivity topics

Potential disinvestment opportunities highlighted this month are:
  • Aminosalicylates for induction of remission or response in Crohn’s disease.
  • Oral budesonide for induction of remission in ulcerative colitis.

Evidence Updates

This month NHS Evidence has published three Evidence Updates.
  • Improving outcomes in head and neck cancers.
  • Familial breast cancer.
  • Sedation in children and young people.

Evidence updates: Cancer

‘Improving outcomes in head and neck cancers: Evidence Update May 2012’ focuses on a summary of selected new evidence relevant to NICE cancer services guidance ‘Improving outcomes in head and neck cancers’ (2004).

‘Familial breast cancer: Evidence Update May 2012’ ( focuses on a summary of selected new evidence relevant to NICE clinical guideline 41 ‘The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care’ (2006).

In producing the Evidence Updates almost 4,000 pieces of evidence were identified. An Evidence Update Advisory Group, comprised of subject experts, has reviewed the prioritised evidence and provided a commentary.

By producing Evidence Updates, NHS Evidence seeks to reduce the need for individuals, managers and commissioners to search for new evidence and to inform guidance developers of new evidence in their field.

Latest updates from NHS Evidence

The following new style Evidence Updates were published recently:

 Pregnancy and complex social factors: Evidence Update January 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 110, ‘A model for service provision for pregnant women with complex social factors’ (2010).

Bacterial meningitis and meningococcal septicaemia: Evidence Update January 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 102, ‘Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care’ (2010).

Chronic obstructive pulmonary disease: Evidence Update February 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 101, ‘Management of chronic obstructive pulmonary disease in adults in primary and secondary care’ (2010).

Venous thromboembolism: reducing the risk, Evidence Update February 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 92, ‘Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital’ (2010).

NHS Evidence Jan-Feb updates (Cardio-respiratory)

An NHS Athens account may be required in some cases:

Added in February

Added in January

NHS Evidence February updates (Cancer)

Added in February

Implementing the Equality Act 2010: interim guidance for the NHS

From NHS Employers

The Equality Act includes specific deadlines that all public bodies are legally required to meet. NHS Employers has published interim guidance to support NHS organisations with this. The guidance signposts the best advice and answers the most popular questions asked in relation to employer responsibilities.


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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Bespoke training opportunities

The Staff Library provides support and guidance to all staff and students in central and eastern Cheshire from its location in the Education and Training Centre, West Park and also through its comprehensive website.  

Utilising excellent IT facilities we specialise in providing 1:1 and small group training sessions
, tailored to the learner’s requirements. This enables us to offer a high quality training service, supporting clinical governance and evidence based healthcare.

Popular areas of interest include how to:

  • register for an Athens account
  • become familiar with some of the many resources in NHS Evidence
  • conduct effective literature searches using the Cochrane Library
  • search for full text journal articles using MEDLINE, CINAHL, BNI and others
  • maximise the benefit of online information using our website – setting alerts and subscribing to newsfeeds

Additional services from our Clinical and Community Outreach Librarians:

Carole Keeling, Clinical Outreach Librarian, offers staff and students at Macclesfield DGH, the following:

  • assistance with research and improving your information searching skills
  • literature searching service for individuals or departments, journal club, research groups
  • Manuscript publication assistance – help with proof-reading, references and advice on submitting your work to publishers.

Steve Collman, Community Outreach Librarian, works exclusively with community staff and students to:

  • discuss how to search more effectively and save time
  • support and guide your research and
  • discover ways in which our service can support yours!

Please contact Library Staff on 01625 66 1362 to discuss your training requirements

Focus on Guidelines – who writes them, what are they and where to find them?

What are clinical guidelines?

Clinical guidelines aim to help health professionals and patients make the best decisions about treatment or care for a particular condition or situation.  Authors review the research literature and take advice from experts to include the current  evidence on which to base their guidelines recomendations. Doctors, nurses and other health care professionals are encouraged to follow clinical guidelines where appropriate.

Where can I find guidelines:

NHS Evidence

Patient UK at

Who writes clinical guidelines for the UK?

Here are some of the main UK organisations involved in publishing guidelines:

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NHS Evidence resources: Bone Cancer Research Trust

NHS Evidence logoExtract from NHS Evidence: Sept 2011

Users of NHS Evidence can now gain access to patient information from the Bone Cancer Research Trust (BCRT), a national organisation which aims to improve outcomes for people with primary bone cancer through research, awareness, information and support. 

BCRT has produced information guides on two bone cancers, osteosarcoma and Ewing’s sarcoma. The comprehensive guides include overviews of the conditions, causes, symptoms, survival rates and diagnosis techniques.

All of BCRT’s information is reviewed annually to ensure it is still current and accurate. The organisation monitors scientific and medical literature and revises and amends information immediately if there are changes in national guidelines, treatments or other significant changes in evidence.

All patient information available through NHS Evidence has been accredited under the Department of Health’s Information Standard.