Statins are the UK’s most commonly prescribed drugs and are among the most widely prescribed drugs globally. Though their use in people at high risk of stroke and heart disease is uncontroversial, recent recommendations to treat much larger numbers of people at low risk have caused a storm of controversy. Most hotly debated are the nature and frequency of side effects of statins and whether arguably small gains in life expectancy are worth the risk.
Endovascular therapy reduces disability from stroke, studies confirm
Healthcare scientists revolutionise stroke rehabilitation
Healthcare scientists and clinicians at the Royal Berkshire Hospital are using gaming technology to revolutionise the rehabilitation of stroke patients in Reading. A new NHS Confederation presentation exploring how commissioners can support innovation, published on Friday, explains how.
Working with Microsoft Kinect, the developers of the Xbox games console, healthcare scientists at the Royal Berkshire are writing programmes to address stoke patients specific needs and are seeing significant improvement in patients’ clinical outcomes.
Using the latest developments in medical physics, the initiative has also reported increased uptake and enthusiasm from patients and their families, reduced levels of depression and enabled patients to continue their rehabilitation at home without the need of NHS staff.
HRT increases risk of blood clots and stroke, finds new analysis
Hormone replacement therapy (HRT) offers women no protection against having or dying from a myocardial infarction while increasing the risk of blood clots and stroke, a new analysis published by the Cochrane Collaboration has shown.
But, complicating the message, a subgroup analysis of women who were given HRT below the age of 60 or within 10 years of the menopause did show a reduction in the risk of myocardial infarction and death from any cause while also showing an increased risk of blood clots and possibly stroke
News from Health Technology Assessments
NHS patients will benefit from £20 million investment into surgical research
Patients will benefit from £20 million funding into research on new cutting-edge surgical techniques, the President of the Royal College of Surgeons (RCS) has said. Ten of these projects have been funded by the NIHR HTA Programme. These include a project looking at total ankle replacement versus ankle arthrodesis and bypass versus angioplasty in severe ischaemia of the leg. [more…]
Intraoperative Radiation for Breast Cancer Study in The Lancet
The five year results of an NIHR HTA-funded study, on targeted intraoperative radiotherapy (TARGIT) for patients with breast cancer, have been published in The Lancet. [more…]
NIHR launches “Focus on Stroke” as ground-breaking stroke trial opens in the UK
EuroHYP-1, the largest worldwide clinical trial of a new revolutionary stroke treatment called Therapeutic Hypothermia, is due to open in the UK. The study is just one of those featured on “Focus on Stroke”, a new online resource from the NIHR aimed at raising public awareness of the exciting developments happening in stroke research. [more…]
BMJ Learning: Stroke – differential diagnosis
Take a look at this module available online from BMJ
You review a 53 year old woman because earlier in the day she had an episode where she experienced zigzag lines at the periphery of her vision. Her husband witnessed the event and reports that, at the time, she was “talking nonsense”. This lasted several minutes, and then she noticed pins and needles in her left arm. What is the most likely diagnosis? And what would you do? Not sure? — then complete the module below.
AQuA weekly news
HTA Bulletin: June 2013
Intermittent pneumatic compression reduces risk of deep vein thrombosis in stroke patients
Intermittent pneumatic compression is effective in reducing the risk of deep vein thrombosis in stroke patients, according to the findings of an HTA Programme study. [more…] Intermittent pneumatic compression is effective in reducing the risk of deep vein thrombosis in stroke patients, according to the findings of an HTA Programme study. [more…]
Use of magnesium sulphate for managing severe asthma
HTA funded research published in The Lancet has found that magnesium sulphate is not effective at treating patients with severe acute asthma needing hospital admission. [more…]
Surgery provides better relief from chronic reflux than drugs
After five years, surgery continues to provide better relief from the symptoms of gastro-oesophageal reflux disease than medication and is likely to be cost-effective, concludes research funded by the HTA Programme. [more…]
News update from NHS Networks
A survey commissioned by the all-party parliamentary group for continence care has vividly demonstrated a decline in the level of provision for continence care services in England.
Dementia is a major and growing challenge for both health and social care.
The Children and Young People’s Health Forum was asked by the secretary of state to help develop a new strategy for improving care for children and young people.
The NHS Confederation has published a briefing for non-executive directors (NEDs) interested in improving their understanding of their organisations’ data.
The Stroke Association is the UK’s leading charity for people affected by stroke and has recently taken over running a fortnightly email bulletin from the now defunct Stroke Improvement Programme.
This narrative was developed with service users, by National Voices and partners and shows what coordinated care would look like from the perspective of patients, service users, families and carers.
NHS England has published its latest bulletin for CCGs.
This letter invites local areas to express an interest in becoming ‘pioneers’, demonstrating the use of ambitious and innovative approaches to delivering integrated care.
New recommendations, published by the Royal College of General Practitioners, the Royal College of Radiologists and the Society and College of Radiographers, have outlined improvements for patients by ensuring that timely and appropriate medical imaging services such as scans are provided to them and their referring doctors.
This report looks at the nature of employee voice and the impact of social media.
This case study is part of a series designed to share good practice and lessons learned by local NHS organisations involved in major reviews of local health services.
The Dementia Challenge report describes achievements in the three main areas of the challenge: driving improvements in health and care, creating dementia friendly communities and better research.
Bob Ricketts, director of commissioning support, strategy and market development for NHS England, will outline the vision for service transformation.
Health sector regulator Monitor and NHS England are working together to reform the way NHS services are paid for.
The government has announced plans for a more joined up health and social care system by 2018.
A new guide by the BMA will help doctors tackle some of the dilemmas that they face on a daily basis.
The direct specialised commissioning function of NHS England is supported by a devolved clinical leadership model.
This report was commissioned as part of a review of HIV services in London and the aim was to gather data from patients to better understand patterns of service use and what they value in HIV services.
This update has been released in response to the government’s consultation on safeguarding power of entry between 11 July 2012 and 12 October 2012.
New chair-elect for the Royal College of General Practitioners (RCGP).
This briefing examines what the NHS mandate means for mental health services and the people who use them.
NHS England has published detailed data about the first four of the 14 hospitals involved in the review of mortality data.
Figures published by Public Health England (PHE) show that confirmed cases of whooping cough in England have continued to decrease in 2013 with 434 cases reported in March.
Report from NHS Change Day.
The Local Government Association and PHE have produced a guide for local councillors about the national child measurement programme (NCMP).
The National Institute for Health and Care Excellence (NICE) is seeking to recruit the following professional members to the NICE accreditation advisory committee.
Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures.
NHS England has written to NHS Trust medical directors and area team medical directors setting out interim arrangements for issuing healthcare professional alert notices.
This publication supports local authority health and wellbeing boards to develop and update pharmaceutical needs assessments (PNAs).
The Care Bill will modernise the law to put people’s wellbeing at the heart of the care and support system.
BMJ topics: 2 May
|Measles and stroke show why healthcare must innovate Trevor Jackson|
|Keeping hand hygiene high on the patient safety agenda Sheldon Stone, Graziella Kontowski, Rose Gallagher, Julie Storr, and Louise Teare|
|Measles in the UK: a test of public health competency in a crisis Felix Greaves and Liam Donaldson|
Understanding patterns in maternity care in the NHS and getting it right Lucy C Chappell, Catherine Calderwood, Sara Kenyon, Elizabeth S Draper, and Marian Knight
Orlistat: should we worry about liver inflammation? John Wilding
Recognising and responding to victims of human trafficking Sharon Doherty and Rachel Morley
News from NICE
NICE recommends blood pressure device that can help prevent strokes
A new device that allows GPs and practice nurses to detect pulse irregularities and pick up cases of atrial fibrillation whilst measuring blood pressure has been recommended by NICE. Atrial fibrillation (AF) causes the heart to beat with an irregular rhythm. It can be difficult to detect and subsequently diagnose as it is often asymptomatic and can be intermittent.
People with AF are at increased risk of developing blood clots and subsequent stroke, with 423,000 people aged 65 and over expected to have AF, of whom some will be will living with the condition yet are undiagnosed.
In its medical technology guidance on WatchBP Home A, NICE says the device reliably detects AF and may increase the rate of detection when used in primary care. This will consequently allow for preventative treatment to be given and to reduce the incidence of AF-related stroke.
|Statement of collaboration between NICE and Public Heath England
NICE and Public Health England agreed to collaborate on future work.
February 8, 2013
|Dementia, stroke and cancer among potential indicators for latest CCG Outcomes Indicator Set
Dementia, stroke, cancer, and end-of-life care are among 32 new indicators put forward for inclusion in the Clinical Commissioning Group Outcomes Indicator Set (CCG OIS).
February 4, 2013
|Have your say on NICE’s social care work
The Department of Health has launched a 12 week consultation to gather views on the topics for NICE’s new quality standards and guidance for social care.
February 1, 2013
News from NHS Networks
NHS Networks requires free subscription before you can read any of the following articles in full.
Elearning: If you are looking for a less physically demanding alternative to gym membership in January, try our e-learning courses for practice managers looking to build a healthier, more robust business to meet the challenges of the new year. There is a free course on CQC compliance, plus several courses on finance, employment and HR issues and primary care medical contracts.
Children and young people’s health and wellbeing in changing times
The NHS Confederation has published a report on the impact of the health reforms on children and young people’s health and wellbeing. Read more »
NHS Improvement turns spotlight on stroke
NHS Improvement has published Spotlight on Stroke. Read more »
Health survey comes of age
The Health and Social Care Information Centre is running the annual health survey for England (HSE) for the twenty-first time. Read more »
Action plan for improving the use of medicines and reducing waste
A report commissioned by the Department of Health looks at how the NHS is working to improve the use of medicines and tackle avoidable medicines wastage. Read more »
Direct access to diagnostic imaging for cancer
NHS Improvement has produced a document to help diagnostic imaging for cancer. Read more »
The health and social care ratings review The Nuffield Trust has been commissioned by the secretary of state to review whether aggregate ratings of provider performance should be used in health and social care. Read more »
National continence survey
The all party parliamentary group (APPG) for continence care is pushing to make integrated services more widely available to all age groups, and also to help break the taboo which prevents individuals seeking and receiving medical attention. Read more »
Key performance indicators for improving access to psychological therapies
Latest figures from the NHS Information Centre. Read more »
Smoking campaign gets under way
The Department of Health has launched a new campaign to encourage smokers to quit in the new year. Read more »
Making integrated out of hospital care a reality
This report discusses the foundations for integrated care for adults, children and young people, with a focus on implementing out of hospital care, and connecting primary, community and social care. Read more »
Primary care IT services operating model published The NHS Commissioning Board has published a document setting out how the management of IT systems will be organised for primary care providers (dentists, pharmacists and optometrists) from April 2013. Read more »
New child abuse alert system for hospitals announced Hospitals will have a new system to help doctors and nurses spot children suffering from abuse and neglect, Health Minister Dr Dan Poulter has announced. Read more »
Lessons learned from the hospital pathways programme The hospital pathways programme aims to improve both processes of care and interactions between staff and patients through a collaborative programme involving five acute trusts, the King’s Fund and the Health Foundation to apply techniques, not widely used in the NHS. Read more »
Allied health professionals bulletin – December 2012
December edition of the Allied health professionals bulletin. Read more »
Cancer services coming of age report published The cancer services coming of age report has been published. Read more »
NHS funding transfer to local authorities
The Department of Health has written to the NHS Commissioning Board with provisional information on the transfer of £859m in 2013/14 to from the NHS to local authorities. Read more »
Transforming end of life care in acute hospitals
A short report reflecting the views from a focus group complements progress reports from acute trusts involved in the transform programme pilot.
Read more »
NHS Commissioning Assembly: next steps
The NHS Commissioning Board has published further information about the NHS Commissioning Assembly, the community of leaders for NHS commissioning. Read more »
Payment by results 2013/14 road test package The road test exercise provides an opportunity for the service to test out the new tariff and supports the planning process. Read more »
Advance care planning toolkit A team at the National End of Life Care Programme (NEoLCP) has developed an advance care planning toolkit to help care providers approach the planning process with confidence and knowledge. Read more »
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.
BMJ: Does routine oxygen supplementation in patients with acute stroke improve outcome?
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
Thousands risk stroke as mini-stroke signs ignored
Thousands of people are at risk of stroke because they fail to recognise the signs of a Transient Ischaemic Attack (TIA, also known as mini-stroke), according to the findings of a new poll(i) launched today on World Stroke Day (29 October 2012).
A Stroke Association survey of over 2,000 members of the public, conducted by ICM Research, revealed that:
- Over two thirds (68%) of people did not recognise the symptoms of a TIA, with over a quarter (26%) believing they were symptoms of a heart attack.
- Nearly nine out of ten people (87%) would be worried if they experienced the symptoms of a mini-stroke, yet almost three quarters (74%) wouldn’t take emergency action and go to hospital.
- Over two thirds of respondents (68%) had never heard of TIA and two in five (40%) were unaware that a TIA was a warning sign of a major stroke.
News round-up from National Health Executive
August News from National Health Executive
NHS receives over 3,000 complaints a week
Written complaints are on the rise in the NHS, new data shows. The Health and Social Care Information Centre (HSCIC) reported that over 3,000 written complaints a week were made against the NHS in 2011-12.
This resulted in just over 162,100 complaints for the year, an 8% rise on the previous year. However, the HSCIC cautioned that the comparison was affected by 23 FTs submitting data in 2011-12 but not for 2010-11.
Comparing the 501 NHS organisations who reported for both years, the rise was just over 1%, from 148,900 to 150,900.
The report present information from NHS hospitals and community health services, as well as from family health services by PCT area.
Grim NHS spending forecasts mean free services may have to go. Some free NHS services may need to become paid-for or the public will have to have their taxes hiked to pay for them, according to a detailed investigation into future health and social care spending.
The Institute for Fiscal Studies and Nuffield Trust plots future spending scenarios for the NHS inEnglandand examines their consequences for other public service spending and for taxation.
Report co-author Carl Emmerson, deputy director of the IFS, said: “The current spending plans that run to March 2015 are tighter for the NHS than any delivered in the last fifty years, and the outlook for spending on public services beyond this suggests that, if it grows at all, NHS spending is not likely to keep pace with the amount that it has been estimated it needs to keep pace with the costs of an ageing population.
Derbyshire Healthcare NHS Foundation Trust was the overall winner at the QIPP Awards and Conference in Manchester on June 28, chaired by Sir Muir Gray, for its ‘Better Together’ collaboration initiative. Here, Nick Hodson, head of service improvement and programme assurance at the trust, describes its work with the independent sector.
Sir Muir Gray absolutely pinpointed the reason why we have been so successful here at Derbyshire Healthcare NHS Foundation Trust in delivering efficiencies.
Delivering efficiencies sustainably requires an underpinning assurance process which embeds QIPP (Quality, Innovation, Productivity, Performance) as business as usual, and not some transient initiative that will eventually go away.
‘Better Together’, our trust’s offering, describes how we minimised risk and maximised opportunity through working with the independent sector.
RCN Stroke Care conference: 19 September
Stroke is one of the top three causes of death and the leading cause of adult disability in the UK; rising numbers of people who are morbidly obese with Type 2 diabetes brings additional risk of an increasing number of people who will have a stroke.
These events are aimed at all health care professionals who are involved in stroke management and rehabilitation.
Speakers will discuss their experiences and offer suggestions as to how you can help your patients regain skills, make adjustments to living with the long-term conditions of stoke and adapt to a different way of life.
More information from http://www.rcn.org.uk/newsevents/event_details/rcn_eventsms/rcn_stroke_care_-_birmingham_2012
Eyes on Evidence: August update
Risk of venous thromboembolism with non-oral hormonal contraception
Dehydration in hospital-admitted stroke patients
Long-term effects on renal function of tight glycaemic control in early type 1 diabetes
Atrial fibrillation (stroke prevention) – Rivaroxaban
Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation. (Full Guidance (PDF))
Technology appraisals, TA256 – Issued: May 2012
NICE recommends rivaroxaban as a possible treatment to prevent stroke and systemic embolism in some people with atrial fibrillation (see below).
Who can have rivaroxaban?
You should be able to have rivaroxaban if you have atrial fibrillation without underlying heart valve disease and at least one of the following applies:
- you have congestive heart failure (when the heart doesn’t pump blood as well as it should)
- you have high blood pressure
- you are 75 or older
- you have diabetes
- you have had a stroke or transient ischaemic attack (mini stroke) in the past.
Warfarin v Aspirin – new research published
“Aspirin could be as effective as more expensive drugs for heart failure patients with a normal heart rhythm, according to researchers.
Their study on more than 2,000 patients, published in the New England Journal of Medicine, said aspirin was as effective as the commonly prescribed drug warfarin. It said each drug had risks, but they had similar benefits overall.” (BBC News)
Read the full findings at http://www.nejm.org/doi/pdf/10.1056/NEJMe1202504
“The benefit of warfarin in reducing the rate of ischemic stroke was offset by an increase in the rate of major bleeding (1.78 events per 100 patient-years with warfarin vs. 0.87 events per 100 patient-years with aspirin, P<0.001; number needed to harm, 110), although there was no excess of intracerebral bleeding events (0.12 events per 100 patient-years with warfarin and 0.05 events per 100 patient-years with aspirin, P = 0.35).”
Allied health professionals (AHP) QIPP toolkits
The Department of Health has identified potential savings and the opportunity to provide better care by involving more AHPs in patient care. This series of online tools aims to help the NHS identify how therapists can intervene at different stages of a patient’s condition to improve patient care whilst saving on costs. This first set of toolkits covers how AHPs can help to improve care for stroke; oral nutritional support; musculoskeletal care; cancer; and diabetes.
New drug for stroke prevention approved by NICE
|Patients with atrial fibrillation can now be offered dabigatran (Pradaxa) in order to reduce the risk of developing blood clots and subsequent stroke, following final guidance from NICE. Dabigatran should only be offered after a discussion over its risks and benefits in comparison with warfarin.|
Aqua news update
AQUA news and events
The trust is a member of the Advancing Quality Alliance (AQuA,) a membership health improvement organisation in theNorth West. Its mission is to mission is to stimulate innovation, spread best practice and support local improvement in health and in the quality and productivity of health services.
To help it achieve its mission AQuA provides a range of free webinars, workshop and training materials to stimulate innovation and improvements in clinical practices.
N.B Access to resources is free but staff members must sign up to the free AQuA membership portal. Each of the links below will prompt you to sign up before progressing to the resources or register for the free training sessions.
Demand Management WebEx: Urgent and Emergency Care – Friday, 27 April 2012.
Urgent and Emergency Care – the national policy context and A&E quality standards, the first year.Guest Speaker: Dr Matthew Cooke, Department of Health National Clinical Director for Urgent and Emergency Care.
Improving quality outcomes
AQuA is pleased to announce an update to its COPD Improving Outcomes Packs (IOPs). Improving the quality of services for patients who have been diagnosed with, or are at risk of developing COPD should be high on every commissioner’s agenda. Follow the link above to access contemporary resource.
AQuA Improvement Methodologies (AIM)
Cohort 9 (May – July 2012)
The AQuA Improvement Methodology programme is geared at front line staff/operational leaders in member organisations wanting to gain an introduction to the fundamentals and concepts of quality improvement. Suitable for staff with a basic knowledge of quality improvement tools or for experienced staff wanting to refresh their knowledge and skills.
Long Term Conditions Update
A Monthly update, which covers the AQuA LTC programme.
Mental Health Update
Issue 2 – A Monthly update, which covers the AQuA MH programme.
Long Term Conditions Diagnostic tool
The AQuA LTC diagnostic tool, based onThe King’s Fund’s Ten Priorities for Commisisoners, aims to provide a cross sectional view of outcomes across the ten priorities benchmarked against regional and national data.
Advancing Quality Heart Failure/CABG collaboratives
Advancing Quality is hosting two collaboratives on Monday 23rd April 2012 – one focusing on heart failure and one focusing on Coronary Artery Bypass Graph (CABG).Both events will include a number of presentations and networking opportunities where we hope to share best practice across theNorth West in heart failure and CABG care.
Advancing Quality Stroke collaborative
We are inviting you and your AQ stroke team to this Advancing Quality stroke collaborative on Tuesday 29th May 2012.
The meeting will include a number of presentations and networking opportunities where we hope to share best practice across theNorth West in stroke care.
NHS Evidence Jan-Feb updates (Cardio-respiratory)
An NHS Athens account may be required in some cases:
Added in February
- Dehydration in hospital-admitted stroke patients: detection, frequency and association, Stroke, December 2011
- Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation, European Heart Journal, December 2011
- Interventions for treating anxiety after stroke, Cochrane Database of Systematic Reviews, December 2011
- Is tongxinluo more effective than isosorbide dinitrate in treating angina pectoris? A systematic review and meta-analysis of randomized controlled trials, Journal of Alternative and Complementary Medicine, December 2011
- Low-molecular-weight heparin and mortality in acutely ill medical patients, New England Journal of Medicine, December 2011
- Patient education in the management of coronary heart disease, Cochrane Database of Systematic Reviews, December 2011
- Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction, Heart, December 2011
- Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data, Lancet, January 2012
Added in January
- Does higher quality primary health care reduce stroke admissions? a national cross-sectional study, British Journal of General Practice, December 2011
TRIP Database: Antibiotic therapy for preventing infections in patients with acute stroke
QIPP: Change and improvement to the stroke pathway
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