Surveillance data from Australia suggests a reduced incidence of genital warts following the introduction of vaccination against human papillomavirus for girls and young women.
A meta-analysis shows that, compared with placebo, pramipexole, ropinirole, rotigotine, gabapentin enacarbil and pregabalin improve symptoms in people with long-term moderate to severe primary restless legs syndrome.
A longitudinal study finds that social isolation and loneliness in older people may be associated with increased all-cause mortality.
An observational study suggests that the risk of thromboembolism after in vitro fertilisation is low but persists into the first trimester of pregnancy.
A meta-analysis notes that COX-2 inhibitors and diclofenac are associated with increased incidence of major vascular events.
A randomised controlled trial suggests that acupuncture for seasonal allergic rhinitis may improve disease-specific quality of life and reduce use of antihistamines.
We highlight a new example from the QIPP collection demonstrating how NHS organisations have implemented new local practices that have both cut costs and improved quality.
“The Quality, Innovation, Productivity and Prevention (QIPP) collection is intended to be a resource for everyone in the NHS, public health and social care for making decisions about patient care or the use of resources.”
As part of NICE Evidence (National Institute for Clinical Excellence), this site is well worth exploring and encourages submissions from others. Here are some sample topics which give a flavour of the collection:
The rural geography of Cornwall means that many patients needed to travel for up to 1 hour to receive a dose of intravenous iron. This journey time increased during the summer because of the extra traffic caused by seasonal …
QIPP, 22 August 2013 – Publisher: Royal Cornwall Hospitals Trust – Publication type: Quality and productivity collection examples
ThinkGlucose is designed to improve the care of people with diabetes when they are admitted to hospital. Patients with a secondary diagnosis of diabetes who receive the right care for their diabetes are able to return home fitter, more safely and ….
QIPP, 20 June 2013 – Publisher: NHS Institute for Innovation and Improvement – Publication type: Quality and productivity collection examples
The QIPP Safe Care workstream launched its pilot, ‘Safety Express’, in January 2011. Over 1000 frontline staff in England worked collaboratively with a shared aim to deliver ‘harm-free’ care, defined as the absence of pressure ulcers, falls, …
QIPP, 20 June 2013 – Publisher: QIPP Safe Care Programme, Salford Royal NHS Foundation Trust and University of Central Lancashire – Publication type: Quality and productivity collection examples
Chronic peripheral joint pain (usually labelled osteoarthritis) is a major cause of suffering, physical disability, psychosocial distress, and direct and indirect healthcare and socioeconomic costs. Pain induced limitation of mobility and
QIPP, 09 April 2013 – Publisher: Sevenoaks District General Hospital – Publication type: Quality and productivity collection examples
Coordination and communication between hospital wards and team members has been a major issue locally and nationally. Standard pager and landline telephone systems are prone to delays. When pagers are answered, tasks must be interrupted to …
QIPP, 09 April 2013 – Publisher: Nottingham University Hospitals NHS Trust – Publication type: Quality and productivity collection examples
Latest news roundup from Eyes on Evidence
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:
NICE has recently published Evidence Updates on:
- Diabetic foot problems
- Hip fracture
- Caesarean section
This month’s topics in NHS Eyes on Evidence:
Analysis of data from a large randomised controlled trial suggests that intensive glucose control in critically ill patients is associated with moderate to severe hypoglycaemia, and a higher risk of death.
A large scale trial examines the benefits and effectiveness of telehealth and telecare services in helping patients avoid the need for emergency hospital care.
A cross-sectional study investigating a possible link between harsh physical punishment and mental health disorders reports that reducing physical punishment may help to reduce the prevalence of mental health disorders in the general population. It suggests giving parents information about alternative discipline strategies, such as positive reinforcement.
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 a new example:
Chair of the British HIV Association Guidelines Subcommittee, Martin Fisher, talks about the organisation’s experience of the NICE accreditation process.
At its January meeting the NICE Accreditation Advisory Committee accredited 2 guidance programmes.
NICE recently published Evidence Updates on:
- Strategies to prevent unintentional injuries among children and young people aged under 15
- Hyperglycaemia in acute coronary syndromes
- Common mental health disorders
Centre for Workforce Intelligence (CfWI)
This paper is an assessment of current workforce issues and potential opportunities for improvement for the allied health workforce. It considers how best to organise this workforce across care pathways, considering factors such as optimum skill mix, education and leadership, and the QIPP toolkit. It is designed to support those who commission services and education, including local education and training boards.
QIPP case study: Children and young people cancer survivorship initiative: Improving quality and the patient experience
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.
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.
Stroke pathway: delivering through improvement 2009
Although this information was published a couple of years ago, I include it here as an example of what is available on QIPP – which stands for Quality, Innovation, Productivity and Prevention
The NHS Institute supported Chief Executives and senior leadership to champion change and improvement across NHS organisations in all areas of the stroke pathway. Quality was improved by reducing mortality, time in A&E, and delay in CT. Read more at https://www.evidence.nhs.uk/qipp
Physical activity in Mental health
Promotion of physical activity, exercise and sport to improve the health of people with a mental health diagnosis.
My Shared pathway
My Shared pathway is part of the National Secure services Qipp Programme. It is developing a recovery approach to identifying and achieving outcomes and aims to streamilne the present pathway for service users in secure services.