NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 36 – January 2010

About this Bulletin:

It aims to draw attention to some of the key documents and reviews on clinical
effectiveness that have been published in the previous month.

Where possible, links to the full text documents are included. If the article is in a
journal, you can contact the Health Library for a copy.
Link to request form: http://www.keele.ac.uk/depts/li/hl/illjournal.htm
[Please note - a charge of £2 per request is payable for most copies]

If you need further assistance, please contact the Health Library or the NHS
Outreach Librarians, details below.

The bulletin can be e-mailed to colleagues who may also find it useful.

A list of websites that are checked in the production of this bulletin are listed on
the first page. Please suggest further useful sites.

Feedback is always welcomed to inform future issues of the bulletin.

Contact information
Contents in this issue
Cancer
Commissioning Bulletin produced by NHS Outreach Librarians
Guidance Tel: 07834 115958 [please leave a message]
Immunisation/Vaccination E-mail: jayne.hickton@northstaffs.nhs.uk
Infection Control
Long Term Conditions
Mental Health North Staffs Health Library
Musculoskeletal Tel: 01782 556565
Service Management Fax: 01782 556582
Workforce E-mail: health.library@keele.ac.uk

-1-
 NHS Library and Information Service North Staffordshire

Sources for Clinical Effectiveness Bulletin

Please suggest further sites that should be monitored in the production of this bulletin

Websites
Bandolier http://www.medicine.ox.ac.uk/bandolier/
Clinical Knowledge Summaries [NLH] http://cks.library.nhs.uk/
Cochrane Library http://www.library.nhs.uk/
CRD Centre for Reviews and Dissemination http://www.crd.york.ac.uk/crdweb/
- DARE – (Database of Abstracts of Reviews of Effects)
- NHS Economic Evaluation Database
Department of Health http://www.dh.gov.uk/en/index.htm
Health Technology Assessment (HTA) Database http://www.ncchta.org/
NICE http://www.nice.org.uk/
NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/
SIGN http://www.sign.ac.uk/new.html

Cancer
National Cancer Programme Bulletin
Department of Health
This bulletin aims to provide updated information about relevant policy and implementation news
for the National Cancer Programme which will be of specific interest to NHS staff involved in
cancer related projects.
http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/NationalCancerProgrammebulletin/DH
_110640

National Cancer Survivorship Initiative (NCSI) vision

Department of Health
This joint vision between the Department of Health and Macmillan Cancer Support commits to
taking steps by 2012 to ensure that cancer survivors receive the support and services to meet
their needs. The vision sets out that all cancer survivors should have: a personalised assessment
and care plan, support to self-manage their condition, information on the long-term effects of
living with and beyond cancer and access to specialist medical care for complications that occur
after cancer.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_111230

[back to topics]

Commissioning
Practice-based commissioning budget guidance for 2010/11
Department of Health
PCTs are responsible for ensuring that practices receive an indicative budget that reflects the
needs of their population as accurately as possible. The DH has updated the toolkit that can be
used to determine weighted capitation indicative budgets at practice level and has produced
accompanying guidance which sets out: details on the changes to the recommended
methodology for deriving practices' fair shares for 2010/11; and information on how to use the
new budget toolkit.

-2-
 NHS Library and Information Service North Staffordshire

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_111057

Promoting health and well-being: reducing inequalities

Royal Society for Public Health
This guide has been developed to assist commissioners to make the most of the best methods of
promoting health, using the latest understanding of how they can support people to make healthy
choices as individuals within the social and environmental contexts in which they live. The guide
will also be of value to providers in giving insight into the commissioning process.
http://www.rsph.org.uk/en/policy-and-projects/projects/commissioning-tool-for-health-
promotion.cfm

Schizophrenia commissioning guide

NICE
This commissioning guide provides support for the local implementation of NICE clinical
guidelines through commissioning, and is a resource to help health and social care professionals
in England to commission an effective service for the treatment and management of
schizophrenia in adults (18 years and over) with an established diagnosis of schizophrenia with
onset before age 60.
http://www.nice.org.uk/usingguidance/commissioningguides/schizophrenia/schizophrenia.jsp

[back to topics]

Guidance
NICE Clinical Guidelines

Venous thromboembolism: reducing the risk

Clinical Guideline: CG92
http://guidance.nice.org.uk/CG92

NICE Consultation Documents

Food allergy in children: clinical guideline scope consultation

Closing date for comments is 8 February 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=46988

Preventing obesity - a whole-system approach: public health guidance consultation on the

draft scope
Closing date for comments is 12 February 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=47042

Chronic heart failure (partial update): draft clinical guideline consultation

Closing date for comments is 10 March 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=47049

Stroke rehabilitation: scope consultation

28 January 2010 - 24 February 2010
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=47190

Clinical Knowledge Summaries updated in January 2010

• Colorectal screening (new)

• Halitosis (new)
• Hirsutism (new)

-3-
 NHS Library and Information Service North Staffordshire

• Lyme disease (new)

• Osgood-Schlatter's disease (new)
• Urinary tract infection (lower) - men

Health Technology Assessments

Multi-centre randomised controlled trial examining the cost-effectiveness of contrast-

enhanced high field magnetic resonance imaging in women scheduled for wide local
excision (COMICE) (Turnbull)
Health Technol Assess 2010; 14.1

Bevacizumab, sorafenib tosylate and sunitinib for renal cell carcinoma: a systematic
review and economic evaluation (Thompson-Coon)
Health Technol Assess 2010; 14.2

The clinical and cost effectiveness of testing for cytochrome P450 polymorphisms in
patients treated with antipsychotics: a systematic review and economic evaluation
(Fleeman)
Health Technol Assess 2010; 14.3

Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic

diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection
and follow-up of bladder cancer (Mowatt)
Health Technol Assess 2010; 14.4

Other Guidance

Diagnosis and pharmacological management of Parkinson's Disease

Scottish Intercollegiate Guidelines Network (SIGN)
The guidance includes comparisons of the accuracy of diagnoses carried out by different
healthcare professionals, and the value of different diagnostic tests for differentiating Parkinson's
Disease (PD) from other associated conditions. It also includes a comprehensive assessment of
pharmacological management of motor and non-motor symptoms associated with PD.
http://www.sign.ac.uk/guidelines/fulltext/113/index.html

Non-pharmaceutical management of depression

Scottish Intercollegiate Guidelines Network (SIGN)
This guideline provides an assessment of, and presents the evidence base for, the efficacy of
non-pharmaceutical therapies, encompassing psychological therapies, structured exercise and
lifestyle interventions, and a range of alternative and complementary treatments, many of which
are not routinely available within the NHS.
http://www.sign.ac.uk/guidelines/fulltext/114/index.html

[back to topics]

Immunisation/Vaccination
Changes to the childhood pneumococcal conjugate vaccine
Department of Health
A letter to immunisation leads and coordinators to inform them of a replacement vaccine that will
be introduced into the childhood routine immunisation programme in the spring.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
11299

[back to topics]

-4-
 NHS Library and Information Service North Staffordshire

Infection Control
MRSA and clostridium difficile data
Health Protection Agency
Surveillance data for healthcare associated infections (HCAIs).
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1244763936373

Geographical spread of MRSA

PLoS Medicine
Between September 2006 and February 2007, 357 laboratories serving 450 hospitals in 26
European countries collected almost 3,000 MRSA and MSSA isolates from patients with invasive
S. aureus infections. They found that MRSA occurs mainly in geographical clusters, which
suggests that MRSA is mainly spread by patients who are repeatedly admitted to different
hospitals. Control efforts aimed at interrupting this spread within and between health care
institutions may be feasible and ultimately successful the researchers commented, and should be
strongly encouraged.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000215

Infection prevention and control

RCN
The RCN considers infection prevention and control to be a core element of quality, patient safety
and governance systems and as such it is one of the RCN's key areas of activity. These web
pages bring together the latest news and guidance on infection prevention as well as resources
and downloads that will help you prevent and control infection.
http://www.rcn.org.uk/development/practice/infection_control

[back to topics]

Long Term Conditions

Improving the health and well-being of people with long term conditions. World class
services for people with long term conditions: information tool for commissioners
This information tool aims to share a common vision of what a good service for people with long-
term conditions is, and to provide some practical suggestions for commissioners to help them
achieve that vision.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_111122

Patient and carer involvement in chronic disease annual evidence update

NHS Evidence
This collects together the best current knowledge on self care in chronic disease management.
Key resources from a small sample of chronic conditions, together with the End of Life Care
setting are placed within the general theme of user involvement in health services.
http://www.library.nhs.uk/palliative/ViewResource.aspx?resID=338644&tabID=289

Kidney dialysis: developing costs to deliver an equitable and high quality service: final
report
Department of Health
The working group looking at Payment by Results for renal dialysis has produced a report of its
work. The report will feed into work being taken forward to develop a best practice tariff for kidney
dialysis services.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_111235

-5-
 NHS Library and Information Service North Staffordshire

[back to topics]

Mental Health
Improving dementia services in England - an interim report
National Audit Office (NAO)
The report states that although the Department of Health has developed an ambitious and
comprehensive strategy for dementia, there has not yet been a robust approach to
implementation. Despite the Department stating, since 2007, that dementia is now a national
priority, the NAO concludes that it has not been given the levers or urgency normally expected for
such a priority and there is a risk that value for money will remain poor unless these weaknesses
are addressed urgently.
http://www.nao.org.uk/publications/0910/improving_dementia_services.aspx

[back to topics]

Musculoskeletal
Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis
Hernandez-Molina G, Reichenbach S, Zhang B, Lavalley M, Felson DT
DARE
CRD Summary: This review assessed the efficacy of exercise for pain management in patients
with hip osteoarthritis.The authors concluded that therapeutic exercise, especially with an
element of strengthening, was an efficacious treatment for hip osteoarthritis. This appeared to be
a well-conducted study and the conclusions are likely to be reliable.
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009100046

Management of osteoporosis in a post-menopausal woman

National Prescribing Centre
This Bulletin describes the management of a postmenopausal woman with risk factors for
osteoporosis in a case-study format. It illustrates use of the two NICE technology appraisals on
drug treatments for primary and secondary prevention of osteoporotic fragility fractures in
postmenopausal women, and outlines some issues for healthcare professionals to consider.
http://www.npc.co.uk/ebt/merec/therap/osteo/merec_bulletin_vol20_no1.html

[back to topics]

Service Management
King’s Fund: Operating Framework 2010/11
The King’s Fund has produced a range of resources on the Operating Framework 2010/11, which
sets out the priorities for the NHS for the year ahead.
http://www.kingsfund.org.uk/research/topics/operating_framewor_2.html

NHS Institute: QIPP – quality, innovation, productivity and prevention

A website tool is being developed that will identify key products and services that the NHS
Institute for Innovation and Improvement has available to support the delivery of QIPP.
http://www.institute.nhs.uk/cost_and_quality/qipp/cost_and_quality_homepage.html

The standard NHS contracts for acute hospital, mental health, community and ambulance
services and supporting guidance
Department of Health
The contracts support the NHS Operating Framework for 20010-2011. The NHS standard
contracts cover agreements between PCTs and all types of provider delivering NHS funded

-6-
 NHS Library and Information Service North Staffordshire

services. The contract will apply to agreements from 2009-10 for, NHS trusts, NHS Foundation
Trusts, new agreements between PCTs and independent sector providers and new agreements
between PCTs and third sector providers.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_111203

Getting the measure of quality: opportunities and challenges

King's Fund
This report offers information about how quality is defined and how quality measures can be used
– and misused. It sets out the main debates and choices faced by those involved in measuring
and using data on quality and outlines some practical issues to be considered in choosing and
using quality measures. The paper emphasises that understanding how to produce good
indicators of quality is only the first step; what is critical is having systems in place to make use of
the information to improve patient care. It suggests that the scope of quality measurement is
widened to include measures of productivity, efficiency and inequality.
http://www.kingsfund.org.uk/research/publications/quality_measures.html

Funding and Performance of Healthcare Systems in the Four Countries of the UK Before
and After Devolution
Nuffield Trust
The researchers studied key performance indicators for the NHS in England, Scotland, Wales
and Northern Ireland at three time points – 1996/7, 2002/3 and 2006/7. The analysis confirmed
that, historically, Scotland, Wales and Northern Ireland have had higher levels of funding per
capita for NHS care than England. The research suggests the NHS in England spends less on
healthcare and has fewer doctors, nurses and managers per head of population than the health
services in the devolved countries, but that it is making better use of the resources it has in terms
of delivering higher levels of activity, crude productivity of its staff, and lower waiting times.
http://www.nuffieldtrust.org.uk/members/download.aspx?f=%2fecomm%2ffiles%2fFour_Countries
_Report.pdf&a=skip

PCT value for money profiles: interactive web tool

Audit Commission
The tool provides comparative information about a selected PCT's performance in managing
costs and delivering outputs (activities) and outcomes (health improvements for local people). It
also tracks performance over time to see whether improvements are being achieved in line with
priorities and how the trend in performance compares to others. The tool draws on the most
recently nationally available data. Auditors will use the tool in their assessments of PCT's use of
resources.
http://www.audit-commission.gov.uk/health/audit/uor/pctuseofresources/Pages/default.aspx

Engaging and responding to your community: a brief guide to Local Involvement Networks
Department of Health
Local Involvement Networks (LINks) exist in every local authority area of England to give people
more influence over how their local health and social care services are planned and delivered.
This guide is for health and social care managers and explains more about LINks. It outlines how,
through proactive engagement you can better understand the needs of your community and how
working with your LINk can be a key part of commissioning, running and reviewing health and
social care services.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_111457

Reforming general practice boundaries

BMA
This paper studies the implications of removing practice boundaries and the opportunities to
improve GP choice and access.
http://www.bma.org.uk/healthcare_policy/reformgpboundaries.jsp

-7-
 NHS Library and Information Service North Staffordshire

[back to topics]

Workforce
NICE guidance and the workplace
NICE
A list of NICE clinical guidelines and public health guidance related to employees and employers
or covering clinical conditions likely to be encountered by occupational health providers. They
serve as a reminder of the portfolio of guidance and all are pertinent to employees and employers
alike.
http://www.nice.org.uk/newsroom/nicenewslettersandalerts/intopractice-
newsletterforimplementers/niceguidanceandyourworkplace.jsp

[back to topics]

-8-